The first woman doctor, U.S. division

As the first woman doctor in the United States, Elizabeth Blackwell had the dubious honor of showing the way for women to qualify for and enter a profession in which, at the time, they were pointedly unwelcome.

Blackwell endured repeated rejections on her way into medical school, where she was shunned by the male students and shut out of clinical opportunities by the teachers. After she finished medical school, when no one would hire her, she founded her own hospital and made her own opportunities.

Elizabeth Blackwell

Elizabeth Blackwell

Blackwell was born in England; her father was a wealthy Quaker and sugar refiner whose business eventually fell on hard times. The large family moved to the United States when Elizabeth was 11 and settled in Cincinnati, Ohio.

Blackwell''s father died when she was a teenager and the family opened a small private school, where Elizabeth began teaching.

When she decided she wanted to be a doctor, she was turned away from 29 medical schools before being accepted by the Geneva Medical School in Geneva, N.Y. In spite of the hostility she encountered there, she graduated at the top of her class in 1849, with plans to become a surgeon.

Blackwell traveled to Paris to take a course in midwifery, where she contracted an infection that cost her the sight in one eye. That put an end to her hopes of becoming a surgeon. Back in the United States, Blackwell found she couldn't get work in a hospital, so she went into private practice.

In 1853, along with her sister Emily, and Marie Zakrzewska, two other early female doctors, Blackwell founded the New York Infirmary for Women and Children, now New York Downtown Hospital. During the Civil War, Blackwell trained nurses to treat soldiers injured on the battlefield.

The Blackwell sisters also founded the Women's Medical College of New York in 1869, but within a few years, Elizabeth went back to England. She was a professor of gynecology at the London School of Medicine for Women for the rest of her working life. Blackwell died at the age of 89, in 1910.

The Frontier Nursing Service

Mary Breckinridge, a daughter of a prominent Kentucky family that included John C. Breckinridge, James Buchanan’s vice president, suffered the loss of both her children before they reached the age of 5. Instead of allowing these tragedies to ruin her life, she channeled her energy into a passionate campaign to improve the health of the children of Appalachia.

Mary Breckinridge

Mary Breckinridge at work

To Breckinridge, a healthy child required a safe birth, a living mother and a healthy family. Making childbirth safe was a primary goal when, in 1925, she founded the Frontier Nursing Service in Leslie County, Ky. The previous year, Breckinridge, 43 and already a nurse, had traveled to England to learn midwifery because she could find no adequate course in the United States. She continued to send FNS nurses to England until the outbreak of World War II.

The FNS deployed the first nurse-midwives to practice in the United States. Breckinridge had encountered nurse-midwives in Europe, and thought that the model was well suited not only for delivering babies but also for providing prenatal care and for assessing and helping to plan for the health needs of the whole family and, indeed, the whole community.

FNS nurses traveled by horseback to attend home births; high-risk patients went to the FNS hospital in Hyden, Ky. Clinics in the community served an average of 250 families. The FNS maternal mortality rate for its first 30 years was about one quarter of the rate for the United States as a whole.

Breckinridge died in 1965. The Frontier Nursing Service, based in Wendover, Ky., is still active, as its midwifery school, which was added in 1939.

A Midwife’s Tale

Only one American midwife of the Revolutionary War era left a diary that has been recovered, Martha Ballard of Hallowell, Maine. It is a fairly basic document. Some entries are just a few words. Still, between 1785 and 1812, a time of incredible change in New England, Martha tended her diary regularly.

A Midwife's Tale

A Midwife's Tale

In 1990, the historian Laurel Thatcher Ulrich used her own considerable knowledge of the period to connect the dots in Ballard's diary. The result was A Midwife's Tale, which won the Pulitzer Prize and other awards. It is a terrific book, and it was made into a film for PBS's "American Experience."

One of the best things about A Midwife's Tale is the fact that Ulrich has given us a fully fleshed-out picture of Martha Ballard, and has at the same time retained her distinctive voice. Ballard was a religious, hard-working wife and mother who trained her daughters and other young women to assist her, understood the medicinal uses of the plants she grew in her kitchen garden, and in her prime delivered two-thirds of the children in Hallowell.

The town had more than one doctor, but in 816 births over the course of 27 years, Martha called a doctor in to help her with a birth just twice. In all those years, Martha saw 19 babies and five mothers die just before, during or just after birth.

While childbirth rested on a community of women when Ballard began her career, one of the tensions of the book comes out of the inroads male doctors were already making into midwifery by the time Martha died in 1812.