HYDEN — In her 1952 autobiography, Wide Neighborhoods, Mary Breckinridge told how she started Frontier Nursing Service here in 1925 to show how nurses also trained as midwives could make a big difference in rural health care.
Breckinridge, who died in 1965 at age 84, could not have imagined just how wide her old neighborhood would become.
The nurse-midwives she sent out on horseback to remote cabins in the mountains of Leslie and Clay counties were trained in England until World War II made travel there impossible. So, in 1939, Breckinridge started a small school for midwives, who deliver babies.
That school is now Frontier Nursing University, which is celebrating its 75th year as the nation's oldest and largest school for nurse-midwives. Its graduates work in all 50 states and seven foreign countries.
Frontier also is marking 25 years as a distance-learning institution. It pioneered many of the online methods now beginning to revolutionize all higher education.
Many students, faculty, alumni and supporters were in Kentucky over the weekend for anniversary festivities. Events included a gala in Lexington, where Frontier has its administrative offices, and tours of the campus in Hyden, which coincided with the town's annual Mary Breckinridge Festival.
The celebration not only marked an illustrious past, but also a promising future.
Mary Breckinridge would seem an unlikely pioneer of health care for the rural poor. She was a society lady, born into one of Kentucky's most distinguished families. Her father was a congressman and ambassador to Russia; her grandfather was Vice President John C. Breckinridge, whose statue stands in Lexington's Cheapside Park.
But Breckinridge was living in rural Arkansas when her two children died young, and she blamed inadequate medical services. Already trained as a nurse, she volunteered in France after World War I and saw the difference nurse-midwives made there.
Breckinridge went to England for midwife training, then dedicated the rest of her life to improving public health in Eastern Kentucky by focusing on young children and their mothers.
Because there were few good roads here then, Frontier Nursing Service's uniformed nurse-midwives rode horses to places such as Confluence, Cutshin and Hell-for-Certain. They carried medical equipment in their saddle bags, delivered babies and staffed community clinics. For serious cases, there was a doctor at the small hospital Breckinridge helped build on Thousandsticks Mountain overlooking Hyden.
After World War II, Eastern Kentucky's population declined as the region modernized. Jeeps replaced the last Frontier horses in the 1960s. After the area hosted clinical trails for the birth-control pill, the birth rate plummeted.
By the 1980s, Frontier nurses mostly provided home health care to elderly people and staffed Mary Breckinridge Hospital, which was sold to Appalachian Regional Healthcare in 2011. The school for midwives struggled until it ventured into distance learning in 1989.
Susan Stone was a student in that first distance-learning class for midwives. She became a faculty member in 1993, remembering how she was told to buy a bigger mailbox because distance learning then meant a lot of packages and postage.
Stone has been president of Frontier Nursing University since 2001, and she has led dramatic growth made possible by the Internet, an expansion of degree programs and an increased demand for graduates.
Frontier had about 4,000 graduates in the first 75 years. Now it has 1,500 students enrolled in several master's and doctoral nursing programs in addition to midwifery. Annual admissions have had to be capped at 700.
The average Frontier student is a 35-year-old registered nurse. More than 90 percent are women, and 70 percent live in rural areas. They come to the Hyden campus only two or three times: for a few days of orientation, a few days of clinical simulations and, if they wish, for their graduation ceremony.
"Our target is nurses who live in rural areas and want to stay and serve in those areas but want a graduate degree," Stone said.
Students study online with 96 faculty members scattered across the country and do clinical work in their own communities. "We've been able to recruit a high-quality faculty because we don't make them move," Stone said.
Stone thinks the demand for nurse-practitioners and nurse-midwives will continue to increase because of trends in the health care industry. She sees Frontier continuing to change to meet needs.
"One of the things we teach our students is entrepreneurship," she said. "Sometimes what is needed is just not there and you have to create it."
For example, one of Stone's future goals is to offer training for psychiatric nurses, who are in big demand but short supply in rural America.
"Mary Breckinridge's whole idea was that this would be a pilot project and there would be replications," Stone said. "It's just amazing when you look at what our graduates are doing. They really are going to change the face of health care."