This research examines the origins, development, and practice of the Frontier School of Midwifery & Family Nursing. The research will set forth the background and context in which the Frontier School came about and then discuss its governing principles as well as its institutional position in the larger scheme of nursing training and practice in the US.
The evolution of public health care in the US is inextricably tied to what turned out to be the establishment of institutional-based medical-care delivery on one hand, and medical-care delivery controlled and administered by professionals licensed for the purpose and under the state-sanctioned authority of physicians and institutions. This has historically made the position of nurses and the function of nursing problematic from both theoretical and practical perspectives. Throughout the literature of nursing is reflected a presumption that nurses should perform with friendliness, expertise, and compassion according to the expectations of patients and family (Grossman, 1996)--even when those expectations fly in the face of institutional hierarchical arrangements and even though nurses as a group bear much responsibility and little authority (Shindul-Rothschild, Berry, & Long-Middleton, 1996; Cullen, 1995).
Now all of these considerations are or have been at issue in the modern period. Still more were they in the background of the emergence of the Frontier Nursing Service (FNS), which began in 1925 and which was and remains based in the state of Kentucky (Frontier, 2000). But the development of the FNS must be viewed in an even wider historical perspective. As O'Mara points out (1999), it was not until the 1920s that the majority of middle class women were routinely giving birth in hospitals, attended by physicians. Indeed, until 1914, when so-called Twilight Sleep for the mother was introduced into the childbirth process, midwives attended most American childbirths in private homes...