The Service maintains six rural healthcare clinics in eastern Kentucky, the Mary Breckinridge Hospital (now part of Appalachian Regional Healthcare[2]), the Mary Breckinridge Home Health Agency, the Frontier Nursing University and the Bed and Breakfast Inn at Wendover, Kentucky.
[3] In choosing that site, she traveled through Leslie, Knott, and Owsley counties to determine what childbearing women and families needed most in those areas.
[4] Breckinridge, who graduated from St. Luke's Hospital of Nursing in New York in 1910, chose that area of Kentucky as a site for the school for several reasons: it was a remote region that was difficult to access, suggesting that success there would equate to success anywhere; there were no licensed physicians in Leslie county; Breckinridge was from a well-known family in Kentucky, resulting in a built-in network for monetary support from other parts of the state.
[8] During this time period, debates among physicians, health officials, and social reformers about the causes of high maternal and infant mortality were frequent and resulted in disagreements about who was best to oversee childbirth: general practitioners, obstetricians, or midwives.
She did send interested American women abroad tor education, paying for all of their expenses, provided they agreed to work for the Frontier Nursing Service for two years.
[14] The women who worked for the service traveled to remote locations, many without running water or electricity, providing care to people who were considered wild or even "foreign" to Americans in more populated areas.
[15] Upon the outbreak of World War II Breckinridge no longer could send American nurses to Britain where they had been going for midwifery training.
The 6-month course was based on the curriculum of the Central Midwives Board of England and Scotland, and every student was required to participate in 20 midwifery cases.
[16] Reva Rubin who was one of the first specialists in maternity nursing worked here[citation needed].FNS trained students and for other agencies.
During this time period, the Community-based Nurse-midwifery Education Program (CNEP) began as a pilot project funded by the PEW Foundation.
The development of the CNEP was originally a cooperative effort of the Maternity Center Association (MCA), the National Association of Childbearing Centers (NACC), Frances Payne Bolton School of Nursing, Case Western Reserve University (FPBSON/CWRU) and the Frontier Nursing Service (FNS).
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[28] In addition to moving all FNU operations to metro Versailles, Kentucky, FNU attempted to remove a stained glass window belonging to the St. Christopher's Chapel in Hyden, Kentucky to be installed at their new campus in Central Kentucky leading to Congressman Hal Rogers to make this statement, "Quite frankly, the action taken by this board to quietly remove the stained-glass window, as well as the educational operations from Leslie County, does not align with Mary Breckinridge’s legendary heart of service and courageous action for the Appalachian people.
In 2019, the General Assembly of the Commonwealth of Kentucky passed Senate Bill 84 to provide certification and regulation for midwives, as well as creating a new public council to implement new licensure requirements.
The advisory council is set up under the Board of Nursing, which will promulgate regulations to establish standards for training programs, licensing, transfer of care from a midwife to a hospital, disciplinary actions, and more, as well as define a list of conditions that require the collaboration, consultation or referral of a client to a physician or other appropriate healthcare provider.