The history of maternity nursing in many ways echoes that of other types of nursing, although it is arguable that improvements in the quality of nursing care have had an even greater impact that improvements in other arenas of health-care. This paper examines one of the nurses who was instrumental in improving maternal health care through changes and improvements in maternity nursing, Mary Breckenridge, a nurse-midwife who helped to established a neonatal health-care that dramatically reduced the mortality rates of both mothers and infants.
Humans have nursed each other since the beginning of the species - indeed attempts to care for other individuals to help reduce their pain and increase their overall health are seen in a wide range of primates: Nursing is arguably something that is encoded in our very genes. However, modern nursing can realistically trace its roots only to the 19th century, which is where this paper begins.
Breckinridge came from a relatively privileged background. She grew up alternatively in Washington, D.C., where her father served in the Congress as a representative from Arkansas, and in St. Petersburg, Russia, where he held the position of ambassador to Russia. She was educated at elite private schools in Switzerland as well as the United States, returning to her family home in Arkansas after she had finished her secondary education in 1899. She married in 1904 but was widowed in 1906; after her husband's death she entered the New York St. Luke's Hospital School of Nursing, graduating in 1910 with her R.N. In 1912 she married Richard Ryan Thompson, who was the president of an Arkansas women's school. Breckinridge taught French and hygiene at the school, but her life was soon touched by tragedy even greater than the loss of her first husband: A newborn daughter died in 1916 and her four-year-old son died in 1918. She then made the decision to commemorate their lives by dedicating her own life to improving the lives of other children.
In the last months of World War I and its aftermath, she worked first as a public health nurse in Boston and Washington D.C., before being posted to France where she worked with the American Committee for Devastated France. Her work there convinced her that American children's lives would be improved by the care of trained midwives.
She divorced her husband in 1920, in large measure because he did not support her work and her growing independence. She studied public health nursing at Columbia University and midwifery at in Britain. In 1925 she moved to rural Kentucky to found the Frontier Nursing Service, using an inheritance form her mother to establish the clinic. Her introduction of nurse-midwives to provide care to the children and women of the region reduced both maternal and neonatal death rates to far below the national average. Her work in Kentucky led to the 1929 foundation of the American Association of Nurse-Midwives, for which she served as a fundraiser and spokesperson until her death in 1965.
In seeking to use the profession of nursing to improve the lives of women and their children, Breckinridge was following in a path established by Florence Nightingale. Nightingale helped to revolutionize the practice - and profession - of nursing in the middle of the 19th century when she established a series of training schools for nurses that instructed nurses in a range of skills, including basic hygiene, as Dossey (1999) describes. While many of the problems in 19th century hospitals certainly were based in the limited medical technology and knowledge that were available at the time, many of the problems resulted from sloppy practices.
Nightingale trained her nurses in the latest medical knowledge, but she also trained them in organization so that the hospitals in which they worked might take advantage not only of scientific advances but also of fundamental managerial principles.
These were especially important as applied to childbirth, for women often died as the result of infections after giving birth and the Nightingale-era reforms helped provide a safe arena for women in labor, although the changes that were brought during the era of the rise of maternity nursing were not always entirely beneficial to women.
Maternity nursing, as distinct from midwifery, is an outgrowth both of the widespread reforms and changes that occurred in nursing overall as a profession as well as an increasing commitment to public-health nursing which extended health-care beyond hospitals into the community and into homes, where most children in the 19th century were born. Breckinridge sought to combine the best practices of both maternity nursing and midwifery.
Public health nursing in the United States began in the late 1800's through the efforts of a few wealthy women in New York, Boston, Philadelphia, and Buffalo, who hired trained nurses to care for the poor in their homes. These nurses worked six days a week, eight to ten hours a day, and were able to visit eight to twelve patients each day.
New York City established a Division of Child Hygiene in 1880 in the New York Health Department. This Division demonstrated that public health nurses could reduce infant mortality through home visiting and teaching. In 1898, Los Angeles became the first city to officially employ a nurse to care for the sick in their homes. By 1910, many of the urban visiting nurses had initiated preventive programs for school children, infants, mothers, and patients with tuberculosis.
Among the specific improvements in maternal health that Breckinridge's improvements in nursing practice brought about was the idea of prenatal care in which nurses helped women understand that their own overall health affected that of their babies. Nurses also helped to instill far better hygienic practices in childbirth, which helped to decrease maternal death rates from postpartum infections and fevers.
Breckinridge sought to professionalize the work of midwives and to ensure that pregnant women had access to trained nurse-midwives when they gave birth.
Up until the 1930s, an American woman was more likely to die in childbirth than from any other disease, except tuberculosis. The mortality rate was particularly high for pregnant women in rural areas where hospitals and qualified medical care were scarce. Breckinridge recognized this concern and succeeded in one of the pioneering attempts to bring professionalized health care to rural-America.
After the dissolution of her second marriage, and after her two children had died as infants, Breckinridge traveled to France to volunteer for the American Committee for Devastated France following the end of World War I. While in Europe she became acquainted with the nurse-midwives in France and Great Britain and thought that with their training, she could perhaps met the problem of medical care for mothers and children in rural America.
Breckinridge was one of the first to understand the need for educating women themselves about pregnancy and labor, transforming them into educated medical consumers. This has been an increasingly important function of maternity nurses over the past several decades as women have struggled to free themselves from patriarchal medical models of childbirth.
The beginning of the era of professional maternity nursing may be seen as a part of the process during the 19th century by which male, formal medical knowledge replaced female, practical knowledge about birth. In some cases, doctors were better able to help women in labor, in other cases midwives were: The hospitalization of birth is a reflection of shifts in society that stripped from women their traditional spheres of power and influence. It is no coincidence that women began to be stripped of their standing as midwives at precisely the same historical moment that they were trying to win the suffrage.
However, in more recent decades, maternity nurses have begun to resume more of the tasks that midwives once undertook, providing emotional support and knowledge about the birth process that allows women to help reclaim the act of giving birth. For, ironically, many of the improvements that Breckinridge brought to nursing would turn out to be mixed blessings.
Over the past century and a half, the maternity nurses who are the heirs to Breckinridge's reforms have been part of the process of defining birth in scientific terms. While this has certainly been advantageous in some ways, the view of birth as a dangerous medical condition has its own risks. Birth has been redefined as the province of women and women's knowledge and given over to the province of male doctors. Maternity nurses have helped to provide the kind of emotional support that was once so essential to midwifery.
This support of the emotional needs of laboring women by nurses has not only made the process of labor more rewarding for women but has also made it safer:
In the twentieth century hospitalization of birth, it seems we have forgotten that for most of our race's history women in labor have been attended throughout by other women. In 1989, Marshall Klaus, M.D., cited a study of 127 non- industrialized cultures. Of those, 126 cultures featured childbirth practices where the mother is attended continously…