Birth in Eastern Kentucky

Like in most places in the United States prior to the 1900s, if you were living in southeastern Kentucky and were expecting a child, you were planning to have that baby at home.  Your birth would either be attended by a “granny” woman (lay midwife), or if you were living too far from others or if you chose, you would have your baby unattended or amongst other experienced mothers.  In very rural areas throughout the United States the outcomes were dismal as compared to today’s standards. “For every 100,000 live births, over 800 resulted in maternal death (vs. 7.7 per 100,000 in the US today), and 100 out of 1000 children died before their first birthday (vs. 7.2 per 1000 in the US today)”(CDC, 1999 – Achievements in public health, 1900-1999: healthier mothers and babies. Morbidity and Mortality Weekly Report, 48 (38); 849-858).  The reason for this cannot be blamed solely on the lack of professional training of the “granny” midwives.  These women were trained through experience and apprenticeship to care for birthing women and ailments throughout the communities.  Mothers trusted their “granny” midwives at a time when seeing a physician was not possible and often was not preferred as outcomes for doctors were not better nor were doctors cleaner in their procedures.

During the post Civil War period industry came to the mountains, and along with it poverty like eastern Kentuckians had never known before.  Our way of life was interrupted and changed.  No longer did we depend completely on our own hands to provide us with food, but we came to rely more and more on money for our livelihood.  We were no stranger to hard work as prior to coal mining we were mostly subsistence farmers.  However, as our hills were logged for trees, our families sold the mineral rights of the land, and our men began to work in the coal mines, we saw less food coming in from our family farms.  In the early days of coal, men risked their lives just to “owe my soul to the company store” as the lyrics of the popular song states.  The resulting poverty escalated and is still an issue here today, though media has a way of exploiting it.

With this poverty women saw harder lives.  Their work around the home was increased just to make ends meet.  Strenuous chores that were often a husband’s duty, especially during the time of childbearing, were dependent on the women to be done as men moved to work outside the home and off their own land.  In many cases, there were other children to be tended to, as we had some of the largest families in the United States at that time.  Food became less and less, so women were entering pregnancy malnourished.  The combination of these things made pregnancy a risky state of being for women during this period.

Currently, the WHO (World Health Organization) believes that 85-95% pregnancies can be expected to go perfectly (“Care in normal birth:Report of a technical work group.” 1999, Geneva: WHO).  With that in mind, it would be plausible to think that the majority of the pregnancies/births that “granny” midwives attended also should have been expected to go normally and their training of experience sufficient to handle the majority of complications that they would see.  However, when the many factors listed above made the mothers no longer low risk, and without advanced medical training for the “granny”women to address situations that result from high risk pregnancies, the maternal/infant mortality rates were not what they could have been under better conditions.

Fortunately, some brave women saw this issue and devoted a portion of their lives if not their entire lives to helping the families of mountain communities.  Their efforts changed the environment for childbirth in the mountains in wonderfully positive ways.  One such woman was Mary Breckinridge, the founder of the Frontier School of Midwifery and Family Nursing.  Breckinridge was inspired by the loss of her two children and husband to help others who might experience the same devastating grief.  She saw that the best prenatal care being received at the time was through the nurse midwifery model which she saw in practice in Great Britain.  Breckinridge and a team of dedicated teachers, volunteers, and nurse midwives came into the mountains to assess and improve upon the situation with great results.  Breckinridge believed in meeting the people where they were instead of making them conform to requirements of receiving healthcare in outside clinics and hospitals.  She and the nurse midwives that worked with her continued to deliver babies safely in women’s homes through medical understanding.  They worked with “granny” midwives, who were willing, to encourage them to let go of invasive techniques that they might have been using to speed labor along, and advised nurse midwifery training.

The following is a video about FNS, it’s history and current activities.

During the 1910s-1920s physicians became better organized and had more uniform training.  Upper class women began to seek physician care for childbirth, and people began to look at homebirth and midwifery as something only for the backward and lower classes.  In eastern Kentucky however, the people did not have access to doctors and hospitals.  The care that nurse midwives were providing mountain women was exceptional, and the mortality rates improved for both mothers and infants despite births not being attended by physicians or taking place in hospitals.

In the mountains of eastern Kentucky, birth remained something that took place in the home for most women well into the 1960s.  Nurse midwives continued to serve mountain women.  Strong women like Peggy Kemner remained in the mountains loving the women she served in their most transitional moments.  These women met the needs of the community on horseback or in rugged terrain vehicles as roads were more like paths in those days.

The following video is a short bit on Peggy Kemner and her work on Stinking Creek.

As the country moved toward the hospital as a place of birth, we began seeing an increase in childbed fever.  Physicians began using procedures and instruments that caused harm to mother and baby.  A national study done in 1925 (around the time Breckinridge came to the mountains) concluded that “untrained midwives approach and trained midwives surpass the record  of physicians in normal deliveries.” (The Official Lamaze Guide: Giving Birth with Confidence, 2005)

Even the “untrained”, “granny” midwives were having nearly equal results in homebirths that physicians were having in hospital births when advanced medical procedures were not required for delivery.  Despite this male doctors became the preferred birth attendants, and birth nationwide moved out of the home and into the hospital (The Official Lamaze Guide, 2005). In the 1970s with the construction of new hospitals, roads, and clinics in the mountains, we also experienced the shift.  Mountain women no longer wanted to be seen as having backward ways, or being too poor to afford modern medical care, and they began to seek physician healthcare instead of healthcare meeting them through the nurse midwives.

Please visit again soon for the continuation of this three part series.  I will be writing about the current state of birth in eastern Kentucky.

Many happy days to you and yours,

Kelli

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About Kelli

I am Kelli B. Haywood, LCCE, a childbirth educator certified through Lamaze, a birth doula, and prenatal yoga instructor. My two little girls light my life. I am the wife of artist, musician, and teacher - John Haywood.
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14 Responses to Birth in Eastern Kentucky

  1. Desiree says:

    Thank you for this. My great great grandmother was a midwife in Confluence (Leslie county) until she died in 1930. It’s wonderful to hear the stories. She was a lay midwife and her husband an herb doctor. She had 14 children of her own and going back 200 years of records on my family, never had a single childbirth death until the 30’s and that was at a hospital with a complicated twin delivery. I wish I could go back and talk to them and see how they did it!

    • eastkentuckygal says:

      Oh, that’s so neat! It’s awesome to correlate history references with our own stories. There is so much to fill in. It sounds like she was a good midwife. 🙂

  2. Lora says:

    Thank you kelli for another great post! I just happened to win a book on Mary B at a raffle last weekend and can’t wait to read it!

  3. Angie D says:

    Hi, this is all great. In our family, everyone of us was born at home. Tony was born on Holly Bush in Knott County (weighing in at a grand 11.5 pounds!!!) I was born in Toot Holler, in the western NC Smoky Mtns, (weighing 11 pounds) and our boy Jubal was born right here in this house on the Clinch Mtn (another 11 pounder!) all births went very well and we lived to tell the tales that our mothers shared with us about the events. I wouldn’t have traded the grand experience of birthing here for nuttin! It was awesome and fun and trippy and amazing! there’re so many c-sections now. I heard on NPR this week that doctors feel it is less risky (aka liable!) and can be better planned (of course!)

  4. eastkentuckygal says:

    Thanks Lora and Angie! Angie you are one powerful birthing woman, an inspiration to all of us “big” baby growing mamas. 🙂

  5. Annita Lawson says:

    Kelli, I know this is an older post, but I wanted to say my husband knows Peggy Kemner well (he actually stayed at the Center she ran for awhile as a child) and I have always lived on Stinking Creek. I had not saw this video, but it was very interesting. It is amazing what Peggy has done for our area, I was pleased to see a story about her featured here!

    • eastkentuckygal says:

      Thanks Anita! It’s good to hear from you! I learned from her actually for the first time through her memoirs. You should read them if you haven’t already. Interesting. 🙂 This piece was fun to write!

      • Annita Lawson says:

        I haven’t read them, that does sound interesting. I love what you are doing with this blog by the way, it is much needed information.

      • eastkentuckygal says:

        Thanks again Anita! I think you would enjoy the memoirs. They are really interesting. I hope to read Mary Breckinridge’s next. She is such an inspiration to women in general I believe. I’m glad you like this blog. That means alot coming from another writer, and one such as yourself. 🙂

  6. Hello, I just ran across your site and I’m amazed to find someone else in my neck of the woods (Laurel Co. transplant from Harlan Co.). Reading through your three part series, it makes me really wish we had more options for our births. Rural areas shouldn’t have to just accept “what you can get”. Thanks for writing!

    • eastkentuckygal says:

      Thanks so much for visiting! I love finding folks from my neck of the woods too! I feel the same as you do. What Mary Breckinridge did with establishing the Frontier School is just so inspiring to me, but now things have changed so very much. She interviewed and helped lay midwives in our area, and brought in others from outside of our region, but the point being women were cared for in a holistic, safe and up to date way. At that time period care like those midwives provided was only accessible to the very rich if even them. Choice is so important in pregnancy and childbirth. First and foremost, pregnancy isn’t an illness, especially if one is low risk, so essentially we are hiring a doctor or midwife. Freedom to find a provider you feel comfortable with is so important. This is a big part of achieving a healthy birth. I also support homebirth for women who feel it is right for them, and I believe women should have access to that option with a certified care provider who is also recognized as such by any hospital he/she would transfer a patient to in an emergency or other situation. Having trained with Lamaze, they support homebirth as a safe place to birth as well. However, most women in our region don’t have access to that option at this time. I think if nationwide we’d become more accepting of that it would really help rural areas like ours. Not only would it employee more people, but it would provide several scenarios of choice. Also, adding true birthing centers in our state would do a tremendous service to women who are low risk, but not comfortable with birthing at home. But, I definitely agree with you. We deserve to have options, and we also deserve to be educated of our options. Thanks for visiting this blog!

  7. Pingback: Supporting Homebirth and Birth Center Midwifery Care for Rural Kentucky Women | Birth True Blog

  8. Bonnie Martin says:

    Hello! I am thrilled to find info on KY home births. My ggrandmother, Nancy Ann Bentley Bradley b1860 d1940, was a midwife in Greenup, KY area or maybe Portsmouth, OH. She delivered my mother in 1923 and a cousin in 1933 (I have birth certificates signed my NA as attending. My mother said NA rode a horse, smoked a stone pipe, received a certificate (citation) from OH or KY for delivering over 500 live births. I do not think she was involved in the Breckenridge school or has anything to do with the Bradley Method (however I’d love to knowe IF she was). Her father is Solomon C. Bentley and mother is Susannah Higgins and husband is Green Bradley. I have such a desire to find information about NA. If possible would you point me to places I can research. I’ve been looking a long time and it is like she is invisible! Please reply to my email address in case I loose this site information. Thank you!

    • Kelli says:

      It sounds like you know quite a bit about Nancy. Dr. Bradley founded The Bradley Method of Husband Coached Childbirth much later you Nancy’s time. However, I’m sure Nancy was very skilled and her certificate proves that. She likely had her own methods, techniques, tricks, etc… There were many many lay midwives serving mountain women during that time. They were an essential part of the healthcare of the holler communities. They attended to other needs as well as those pertaining to pregnancy and birth. Many were also well versed in herbals. For a history of childbirth take a look at http://www.mothersadvocate.org and Videos for a Better Birth. There is some interesting info there. I also have some videos here that would give you an idea of what life would have been like for her.

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