xt7xks6j2j6k https://exploreuk.uky.edu/dips/xt7xks6j2j6k/data/mets.xml The Frontier Nursing Service, Inc. 1979 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service Quarterly Bulletin, Vol. 55, No. 2, Autumn 1979 text Frontier Nursing Service Quarterly Bulletin, Vol. 55, No. 2, Autumn 1979 1979 2014 true xt7xks6j2j6k section xt7xks6j2j6k VOLUME 55 AUTUMN 1979 NUMBER 2
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Nativity play at Wendover
i 0
US ISSN 00162116 . ,
Published at the end of each quarter by the Frontier Nursing Service, Inc. } i;
Wendover, Kentucky 41775
Subscription Price $2.00 a Year l
Edit0r’s Office, Wendover, Kentucky 41775
Second-class postage paid at Wendover, Ky. 41775 and at additional mailing offices `
Send Form 3579 to Frontier Nursing Service, Wendover, Ky. 41775
Copyright 1980, Frontier Nursing Service, Inc.

l An Announcement Kate Ireland 2
  An Oral History Event Dale Deaton 35
  Beyond the Mountains 52
 il Dentistry at FNS Mark Addison 37
 l _ Dr. Gascoigne Leaving FNS June Lehue Rand 13
*4 Field Notes 45
·_ Friends of FNS Cookbook 3
in From the Medical Director S. D. Palmer, M.D. 17
= Immunization Drive in G. B. Gascoigne, M.D. 41
I Leslie County
I In Memoriam 32
  Mary Dow Novotney Patti Rogers 44
  Memorial Gifts 32
I Midwifery Delivery- Sue Palmer 27
. Family Centered Care
A Nurse Practitioners: An Max Michael, M.D. 17
E Innovation of Proven Quality
g Old Courier News 25
i Old Staff News 30
  Staff Opportunities Inside Back
{ Cover
K The Community Health Center Ron Hart 16
  The Quilting Party Molly Lee 39
4 Tomorrow’s Child Eunice K. M. Ernst 4
  Urgent Needs 29
White Elephant 55
  Women in Kentucky A Book Review 54

Many of our friends will have heard by now that Frontier Nursing
Service must recruit its fourth Director as the five year commitment to the
Board of Governors of the present Director ends in May, 1980.  
Much has been accomplished in the FNS in recent years: the local _2·
Advisory Committee, whose chairman automatically serves as an ex  2
officio member of the Board of Governors, was organized and has become  
a vital part of the FNS; outpost nursing centers have been relocated,  
centralizing patient loads and expanding into new territories; the family i P
nurse practitioner has been interpreted to physicians throughout the
country, and testimony before legislative committees in Frankfort and I,
Washington has helped with the enactment of new legislation recogniz— W, `
ing and utilizing nurse practitioners in rural clinics; an FNS—sponsored l
symposium on primary care in 1976 was the beginning of the Kentucky  
Primary Care Association. *§·
A Task Force of the Board of Governors has worked for some months
to reaffirm the mission and major goals of FNS, as a guide for the new
Director, and a Search Committee of the Board has been appointed to ,
receive applications from candidates for the position. This announce- 5
ment has been authorized by the Board in the hope that it will aid our  
recruiting efforts. If any of you are interested in submitting a name, I s,
shall be delighted to receive it, addressed to me, as Chairman of the  
Search Committee, at Wendover, Kentucky 41775. [1
The Frontier Nursing Service offers family-centered primary health E
care through an interdependent complex of hospital, home health i
agency, outpost nursing centers, and a School of Midwifery and Family ‘_
Nursing. It is a collaborative effort of nursing and medicine, of patients, i
staff and thousands of friends who support the organization in and  
outside of Kentucky. Our Board feels that the fourth Director, like the first i"
three, should have been a provider of health care, as service to patients is  
our most important goal. The Director must also be an individual with _
strong leadership qualities and proven administrative ability.
It may not be easy to find just the right person but we feel that the
position of Director of Frontier Nursing Service offers a challenge and an
excitement today that is equal to the excitement and challenge faced by
Mary Breckinridge in 1925.
We seek your help in finding that person.  
—Kate Ireland, Chairman
Frontier Nursing Service _
Board of Governors V;

Out of Ideas for Meals?
Tired of That Same Old Thing?
  Need A Unique Gift —
I  Christmas?
  R Special Occasion?
  Now On Sale Is The First Edition Of The
1; Recipes have been contributed by friends in the community, staff,
  faculty, students, couriers, volunteers and visitors.
{ ordered by sending your name and address and $4.50
` Director of Nursing
Frontier Nursing Service
Hyden, Kentucky 41749
Personal Pickup
1 at the Mary Breckinridge Hospital — $3.50
All proceeds will go to
E the Frontier Nursing Service

by Eunice K. M. Ernst, CNM, MPH  A
Presented as the keynote address at the American College of Nurse-
Midwives 24th Annual Meeting, Miami Beach, Florida, April 30, 1979.
Kitty Ernst served as the 4th President of the American College of `·
Nurse-Midwives, 196l-1963. Currently, she is a Consultant for Maternity .
Center Association of New York, a member ofthe Board ofGovernors of  .
the Frontier Nursing Service, and a graduate of the Frontier Graduate _
School of Midwifery. This abstract of her address is reprinted, with 9
permission, from the Journal of Nurse-Midwifery, Vol 24, No. 5, _
September/October 1979, Copyright 1979 by the American College of D
Nurse-Midwives, and with the permission of the author. ,
This paper reviews the life of Mary Breckinridge, her commitment to i
mothers and children, and her contributions to nurse-midwifery. An F
optimistic outlook for tomorrow’s child is envisioned with humanism in ,
childbirth superseding technology as the first priority. {
. . . And gently lead those who are with young . . . I
Isaiah 40:11 _
Four years ago, on the occasion of the 20th anniversary of the I
American College of NurseMidwives, the keynote address paid f
tribute to the pioneers that had lent their special talents to the  
development of nurse—midwifery in the United States. As we .
celebrate this International Year of the Child, I would like to take
you further in Search of roots where we will find our germination `
in the great heart of an unabashed lover of children. Nurse-
Midwifery was introduced to the United States in one of the most {
daring demonstrations of health care ever conceived. It was born g
from the soul of a woman who had experienced the joys of birthing  
two children and the despair of losing them both in infancy and V
Who was Mary Breckinridge? ...
Everyone knows that she established the Frontier Nursing 1
Service in 1925 to improve the health and welfare of mothers and Q
babies in a remotely rural region of southeastern Kentucky.  
Most of you know: l
1. That the Frontier Nursing Service successfully demon-  ,
strated a decentralized regional plan for the delivery of `
midwifery care and health services through a network of I

district nursing centers connected to a medically directed
3 clinic and hospital that connected to medical teaching and
 F specialty centers outside the mountains.
2. That it demonstrated an effective and efficient utilization of
manpower by a team approach to care, guided by establish-
‘~ ed protocols, procedures and medical directives (sometimes
i referred to as the recipe book).
 T 3. That it demonstrated, through the courier service, the use
‘ and value of young volunteers with minimal training, for
· support services that ranged from grooming horses to
  ' caring for post—op tonsilectomy patients.
  4. That it established a program of education for nurse
L midwives and more recently for family nurse practitioners.
_ 5. That it documented the services provided by ongoing
{ research which demonstrated, with a high level of
. significance, the impact of the care on the health and
welfare of mothers and babies.
i 6. That it has been supported locally and nationally by
· voluntary effort in the committees organized to raise money
E to meet the needs for development and operation.
Q 7. That it has been studied by thousands of visitors from all
over the world and has trained hundreds of nurse-midwives
· for work here and in dozens of underdeveloped countries.
8. But most of all it has demonstrated a concern for children
{ that focused on care of the mother, tenderly cared for during
; pregnancy; lovingly supported in birth and religiously
  followed daily for ten days, weekly for one month, monthly
” for one year, biannually until school and annually in school
until that child became a woman and mother and the cycle
began again.
{ T It is important to recognize today that the splendid home birth
, record of the Frontier Nursing Service (and of Maternity Center
i Association) was achieved by that kind of care. And that kind of
 Y care is nurse—midwifery care. The hub, or center of the FNS was
·. the hospital, staffed by doctors, nurses and nurse-rnidwives. But
= the heart or life of the service was in the district centers where the
 , nurse-midwife served families within the context of their in-
‘ dividual life styles.
. Who was Mary Breckinridge? How did she arrive at the

threshold of the door to nurse—midwifery in the United States? The
answer lies in forty years of accumulated experiences and a
distinct calling to a work for children.
Her roots were deep in the aristocracy of the post Civil War
reconstruction south. An aristocracy whose life-style had been I
catapulted into turmoil. Her mother’s family had been plantation .
owners in Louisiana and Mississippi. While the men ofthe family ·
worked to rebuild a life on the plantation in Mississippi — the  
women `were moved to a safer and easier life in Memphis,  
Tennessee. There, in her grandmother’s home, Mary Breckinridge j‘
was born in 1881. Although her birth was apparently normal, her ve
mother had childbed fever and was unable to breastfeed. Mary  
was wet-nursed by a young black mother who came morning and §
evening. In between she was nourished by the milk of a nanny *,~
goat. Her family ascribes her intense interest in breast feeding to  
this experience .... ,
In 1906, at age 25 and widowed, Mary Breckinridge was faced
with the realization that her life had not really "f1tted her to be of h
service to anyone". The long and sporadic preparation for the ¤
service that was to become her life began with nurses training at ,-
St. Luke’s Hospital in New York. A vignette of her love for
children appeared there when she attempted to adopt and care for Q,
an abandoned baby girl with spina bifida. In spite of the fact that
she was denied the adoption and the loving care she so desired to g
give, she attended the baby girl until death and arranged for  
private burial rather than leaving her to rest in a pauper’s grave.  
Upon the completion of her nurse’s training, she went to spend ?
a year with her family that was to stretch into eight years, a  
second marriage, the birth and death of two children and finally
divorce. The journal she kept of her life with her son, Breckie, is a
chronicle of all the joys of infancy and early childhood tempered
by the tragedy of the premature birth and death of her girl baby, %~
Polly, about which she wrote . . . ,  
. . . "For you who share with me a memory like this, I have a message.  
Keep your baby alive in your heart . . . But in loving it, do not seek to 4,.
hold it. You must learn the nature of spiritual motherhood, as indeed one
should learn in caring for (all) children. The more we seek to hold our =
children to ourselves, the less they are ours. All of the love we give them =
has as its goal to set them free from us, to train them to bethemselves."** I
In 1917, while she carried Polly in her womb, Mary ‘
Breckinridge Thompson published in The Southern W0man’s

Magazine a ma-rvelous series of articles on childbirth and child
. rearing entitled — "Motherhood — A Career".? Ironically, her own
career as a mother was halted by a swift illness which took the life
of her beloved 4-year old son, Breckie. The final entry of the
` journal which enclosed the precious moments of those four years
was the declaration of commitment to children upon which the
. Frontier Nursing Service was built. She wrote:
I "What of the children? What of childhood? From the desolated shores of
  Armenia to the Balkan mountains, from the plains of Poland to the
- Belgian and French coast and over at last to the streets ofour great cities
,g and the farms of our remotest hills — travels that cry of childhood
», which throughout the ages has been the cry of martyrdom. This my
  reason cannot accept — this tortures the devout in my soul. . .There is a
I work beside which all other strikes me as puerile —— the work which seeks
J? to raise the status of childhood everywhere, so that finally from pole to
t pole of this planet all of the little ones come into that health and
;l happiness which is their due. If everyone who had ever loved a child
would but do his part this might come to pass. What if we do not
understand? What if we cannot be held responsible for the way God has
- ordered his world? There is, nevertheless, deep in the heart ofevery child
lover, a feeling of responsibility which will not let him put the thing
‘ aside. If God cherishes His little ones only in my breast, says the child
lover, He cherishes them there, and I fight for them — fight until that
ancient saying has come true, ‘until He shall gather the lambs in His
bosom, and gently lead those that are with young.’ And when the
,_ crooked paths are made straight and the waste places smooth, it will be
_· time for me to understand."*‘
  . . . After nursing victims of the 1918 influenza epidemic in
Washington and a short but intensive course in public health
l nursing in Boston, she sailed for France as a member of the
  American Committee for Devastated France. There she imported
{ goats, crated them over the Pyrennes into the villages to supply
milk for the starving mothers and babies. She fought epidemics of
scarlet fever, diphtheria and dysentery and created the first Child
Hygiene and Visiting Nurse Service in France. Her demonstra-
  tion of the impact that public health nursing could have on the
g   health of children caused nursing leaders to plead that she stay
E and develop the nursing schools needed to expand such services
, "F throughout France. But Mary Breckinridge was beginning to hear
; the beat of another drummer. To her mother she wrote, "A
 J decision has come to me and not of myself. Call it what you will, I
{ feel it definitely and will follow it with the assurance that I am
doing what is right. A reform in the Paris hospitals and through
them in all France is not my job . . . I am to work directly for little

 8 momiun Nunsmo ssavics
children now and always . . . Some very special thing is waiting
for me on the other side of the ocean (although I don’t know what it
is)."“’ Ofiher work in France she wrote:
"Nothing better prepared me for(the Frontier Nursing Service) than my ,
years in France. I learned then that it is wise to begin small, take root =
and then grow. I also formed a habit, indispensable in new under-
takings, oflearning all I could about native customs so that new things
could be grafted to old. Finally, I gained a respect for facts — old and
new — with the knowledge that change is not brought about by
Heeding the call to work with children, Mary Breckinridge  
entered the final stages of her preparation. She attended "”
Teacher’s College of Columbia University as a non-matriculated V
student (her three years of formal education and nurse’s training i_
did not meet the requirements for admission even then). She if
selected the courses in public health, psychology, education,  
biology and statistics that she felt she needed; a program not  i
unlike the master’s degree program for nursemidwives today. . . . I
The first contact that Mary Breckinridge had with midwives p-
was at the birth of her brother in Russia when she was 14.  g
Although two doctors stood by in case they were needed, she was
impressed with the fact that the midwife attended the birth. In
France she had worked with midwives who were not nurses. In
America she had worked with nurses who were not midwives. Her ,
association with British nurse-midwives led her to the conclusion
that the combined expertise she found in them best suited her I
belief that the most important care of children is concentrated in i
the care of the mother before birth and ofthe child up to age six. In _
the fall of 1923 she began a four—month midwifery program at
British Hospital for Mothers and Babies in Woolrich, England. To
her formal midwifery training she added district midwifery _
experience in London slums, a short course for Teachers of (
Midwifery and a thorough investigation ofthe organization ofthe `°
Highlands and Islands Medical and Nursing Services in the  ‘
Hebrides of Scotland; a service that formed the prototype for what K
would become the Frontier Nursing Service.  i`
At age 44 she returned to Kentucky to organize the people who ,
would "back—up" her work. The judge who opened the first —
meeting of the Kentucky Committee for Mothers and Babies
perhaps expressed the sentiments of that prestigious group of
ministers, physicians, politicians, lawyers and educators when he

 QUARTERLY autumn 9
stated that he was impressed by the "sublime audacity" of the
program. 1* The same remark could be made of a number of nurse
midwives and the programs they have created today . . .
. By 1930 the hospital and six outpost centers were in place. An
’ overwhelming accomplishment with all supplies 25 miles by mule
sled from the nearest railroad. Staff were recruited mainly from
Great Britain.
In 1928, 50 years ago, in order to "foster, encourage, and
maintain a high standard of midwifery," The American Associa-
  tion of Midwives was formed. Prominent obstetricians, brought to
il the annual meetings in the mountains to address the problems
Q encountered in rural practice, represent a who’s who in American
{_ obstetrics.
ii` Metropolitan Life Insurance Company provided on going
  evaluation research of the work. In 1932, a report of the first 1,000
 i births stated:
i "The study shows conclusively what has in fact been demonstrated
_ before, that the types of service rendered by the Frontier Nursing
= Service safeguards the life ofthe mother and baby. Ifsuch service were
‘ available to the women of the country generally, there would be a
saving of 10,000 mother’s lives each year in the United States, there
would be 30,000 less stillbirths, and 30,000 more children alive at the
end of the first month of life" . . . "
_ Who was Mary Breckinridge?
She was a woman who put aside a life of comfort and pleasure
. to follow a calling to work for children.
~ She was a nurse-midvvife who, when put to the test, made a
total commitment of her wealth and her life to insure that
I yesterday’s child would live to become today’s mother.
But what of today’s nurse-midwife and tomorrow’s child? As I
reviewed the life of Mary Breckinridge I truly thought I might
  gain specific insight into the problems we face today. But Irealize
‘-' now that that was a bit naive. Three mile island, fetal scalp
- electrodes, and the great middle man of third party reimburse
 I ment were not even part of the language of that day.
 L At times I have the feeling that tomorrow’s child is a
, commodity, the welfare of which will be measured in computer
· printouts, numbers of beds, occupancy rates and cost stabiliza-
tion. It would not surprise me to one day hear the Dow Jones
averages report — Birth enterprises up 2 points, Birth technics up
one half, Level II’s down one, Birth environments up 6. On the

other hand, at times I have the feeling that we are on the brink of a
major breakthrough into an era of the most profound understan-
ding of human birth ever known. In the paradoxes that we face
today lie both the dilemma and the solutions.
The mother of tomorrow’s child is under your care today. What
will childbirth be like for her two or three decades from now?
It has been said that "Prediction is a risky, difficult and unrewar-
ding activity in any time . . . To engage in such endeavor in a world of
unprecedented complexity during changes of unparalleled rapidity is
as absurd as it is necessary"."’
Such an absurd necessity was engaged in recently by Norma _
Swenson, a long time parent advocate. For an article in Omni Q.
Magazine,2° she envisioned childbirth in the year 2000 A. D. It 1}
went something like this: A woman in rural Vermont wanted to `
deliver her baby vaginally at home with a midwife. Toward the `
end of pregnancy while relaxing at home with her husband a
helicopter swoops down and lands in her backyard. A physician “
and policeman produce a court order to take the unborn baby into
protective custody to prevent child abuse. They take the scream- I
ing woman to a hospital where she is admitted to a birthing suite .
complete with curtains and potted plants. She sits in her rocking ‘
chair, stunned, aware that at her only visit to her gynecologist he
registered her pregnancy with the Perinatal Center and im- _
planted in her vagina a tiny receiver for electronic fetal monitor- _
ing along with a device used to track down migratory animals. P
Her pregnancy had been followed for months by a computer at the
Perinatal Center. She is induced, fetal distress develops, she is _
rushed to the operating room, anesthetized and a caesarean  ·
section is performed. The baby is transported to intensive care :
while the mother, still dazed, is wheeled back to the homey _
birthing suite (to rest for a few hours before discharge).  _,
Absurd? Perhaps. But the technology for it exists today. The . i
acceptance of this scenario is close at hand. Home birth has been  ,
declared a form of child abuse and home birth couples have been ,_
so charged in three states. One was reported to have been forcibly
transported from her home to the hospital while in labor.
A national registration of pregnancies has been proposed by a
leading perinatologist. "Active Management" is a term used to
routinely employ interventive technology. i
But I have a different view of the birth of tomorrow’s child. In

2000 A. D. I envision a mother whose preparation for birth began
when she was born into her mothers arms and held close to her
bosom until she herself created distance — this secure loving
experience was reinforced when she attended her brother’s birth.
On her first visit to her obstetrician and midwife (childbirth is
presented as normal until proven otherwise.) Multiple options for
pregnancy and birth are available. Her prenatal care will begin
with education for self-care. She will learn prenatal screening
techniques, nutritional assessment, physical examination,
)_ procedures for monitoring the progress of her own pregnancy and
  fetal growth, techniques for coping with labor, newborn assess-
j ment, breast feeding, principles of early attachment and begin-
  ning parenting skills.
H  Her care will be supported and managed by a well coordinated
— doctor/ nurse/ midwife team. The place of birth will be an environ-
ment that meets her individual and medical needs and will
~ include home birth center or hospital. Emergency transport
(without a policeman) will be available to take her swiftly and
~ safely to more sophisticated levels of care and to less sophisticated
· levels of care when indicated.
l Family members and friends will be invited to share in the
birth celebration. Prepaid, extended care will be available in the
home (or in a homelike facility) by a mother substitute.
` The technology for this care also exists today. The acceptabili-
 » ty of this scenario is also at hand. Parents, in ever increasing
numbers, are seeking to obtain more control of the planning of
maternity care services.
 _ The questions that are raised by these two views of the future
I Throughout the recorded history of the human race, woman has
* given birth and women have controlled the giving of birth. Today
`·' that age-old biological and spiritual responsibility is being
  challenged. A young mother attending an obstetrical task force
` meeting of the local HSA in Philadelphia expressed it well when
i' she said, "I wanted the best that money could buy so I went to the
biggest hospital in town to have my baby. But I’ll tell you, I might
have a home birth next time. Why, I might as well not have been
there . . . I had the feeling they would do it all without me if they
1 could".
The major issue for nurse—midwives today, as I see it, the one

that over-shadows all others is — "wi1l we help parents to regain F
the control that is rightfully theirs"? Will we continue the medical
model of prenatal care that focused on a search for pathology,
important as that is, or will we step forward toward more
productive prenatal care provided by a team effort, that prepares I
parents to become real partners in health? 5
Will we battle with one another, obstetricians, midwives,
parents, about the merits of one place of birth over another, or will L
we share our talents and support one another in our different ;
callings to serve?
Will we allow ourselves to become blinded with organizational  
details and se1f—serving ministrations, or will we keep our vision
clear, our goals simple, our actions close to those we serve?
I am confident, that in the same spirit of commitment shown *1
by Mary Breckinridge we will respond to the cry of parents heard  
with increasing clarity throughout the land. That we will survive in
these difficult times of torment. That we will gently lead those who ,
are with young until the crooked paths are made straight and the  ·
waste places smooth. »
For in so doing we will realize the great privilege of being a  i
nurse-midwife.  ~
"Mary Breckinridge, Wide Neighborhoods: A Story of The Frontier Nursing  .
Service, Harper, New York, 1952, p.66 j
iMary Breckinridge Thompson, R.N., "Motherhood —- A Career," Southern y
Woman 's Magazine (Nashville, TN), November, 1916-June, 1917.
*Mary Breckinridge Thompson, Breckie: His Four Years, 1914-1918, New York, Q
1918. .
'"Mary Breckinridge, Wide Neighborhoods, p. 100. ~
"lbid, p. 109. "
‘·‘Ibid, p.159.  
"Metropolitan Life Insurance Company, “Report on The First Thousand Con- -·
finements of the Frontier Nursing Service, Inc.," Frontier Nursing Service L
Quarterly Bulletin, Vol. VIII, Summer, 1932, p. 9.
"’Bemis, W. and Staly, Philip, The Temporary Society, Harper Rowe, New York, g
1964, p. 1. i
*""Childbirth, 2000 A.1).," Omni Magazine, January 1978. I,

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