Let's imagine, for the sake of argument, that you've been blessed with a privileged Memphis birth in 1881 to a well-to-do Kentucky family, the granddaughter of a US Vice President and the daughter of a Russian ambassador. As a girl, you are educated at the best Switzerland and Connecticut boarding schools. At age 23, you meet the man of your dreams and promptly marry him. He dies of appendicitis three years later. You grieve, but your loss ignites a desire to care for others. You move to New York for nursing school. You meet someone else. You marry again, start teaching in Arkansas, and have a baby boy and then a girl. Both babies die. It's 1919.

It was a life that, until that point, was equal parts affluence and tragedy. It was a life that provided the necessary conditions for what would become Mary Breckenridge's awe-inspiring accomplishments in the field of nursing, midwifery, and public health. Breckenridge, renowned for her drive and vision, was a woman engaged in a single-focused mission to improve healthcare in one of the most rural, neglected patches on an American map.

Mary Breckenridge took careful note, while she was working in France during World War I, of the British nurse-midwives with whom she worked. She thought about the state of health for women and children in her native Kentucky, and felt strongly that the model of care practiced by these midwives could be the answer to the staggering and inexcusable rates of maternal and infant mortality she witnessed in her home state. Breckenridge took the steps necessary to put her plan into action. She got a Public Health degree from Columbia University and then became a certified nurse-midwife in London. At the time, "granny midwives", poorly educated farm women, delivered Kentucky babies as well as they could in rural areas lacking hospitals and skilled birth attendants.

Breckenridge would base her system of decentralized community care upon the system of midwifery care she'd observed in Scotland. In 1925, at age 44, she established the Frontier Nursing Service in southeastern Kentucky. She staffed it with British nurse-midwives and funded it through her family's financial connections and her own speaking campaign. Care was delivered to women and families by midwives on foot and horseback.

At the start of World War II many of Mary's midwife colleagues wanted to return to England. This presented a new challenge for her. But, true to form, she found a quick solution. She would start a graduate program for American nurses in nurse-midwifery at her own school in Hyden, Kentucky. The first class began their studies in 1939. With this expansion, Mary Breckenridge became the mother of modern day American midwifery.

In later years, Breckenridge's Frontier Nursing School grew to include classes of family nurse practitioners. It now offers a distance-learning education model that allows practitioners to stay in their own underserved communities while obtaining advanced degrees. Like Mary Breckenridge herself, it is ahead of its time in providing user-friendly, comprehensive care for those least able to access it.

Eventually Mary Breckenridge fell from her horse, rendering her unable to make house calls, but she stayed active as the leader of the Frontier Nursing Service until the end of her life in 1965. Immortalized in a 77 cent US stamp, Mary Breckenridge continues to serve as an ongoing inspiration of commitment, diligence, insight, and humility, a real nurse's nurse.

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