BACKGROUND:
Midwives attended most US births during the colonial era into the mid-20th century. However, midwives currently attend 12% of births in the US. The careers of Mary Breckinridge and Margaret Charles Smith highlight the differences in social status, race, and financial means, and how those differences impacted communities served and contributed to the decline of the midwifery profession.

OBJECTIVES:
The purpose of this study was to examine historical factors influencing the professionalization of midwifery in the United States. Systemic and cultural inequities that influenced the careers of two prominent midwives in the early twentieth century provide insight into the decline of midwifery in the United States and the subsequent evolution of midwifery to nurse-midwifery.

METHODS:
Traditional historical methods were used to examine the evolution of midwifery in the United States in the 20th century. A social history framework provided insight into the impacts of gender, race, and political influences on the profession.

RESULTS:
Mary Breckinridge was a white woman of high society in rural Kentucky. Margaret Charles Smith was an African American woman of limited means in rural Alabama. These pioneering midwives came from very different backgrounds, but both created enduring legacies in their communities. Support from patrons allowed Breckinridge to expand her services and elevate the profession through the Frontier Nursing Service. Race, social status, and financial resources were barriers to Smith’s midwifery practice and limited her practice.

CONCLUSIONS:
The stories of Breckinridge and Smith’s careers demonstrate how cultural and systemic inequities affect the work of midwives, which leads to disparities in the care they are able to provide to their patients and their communities.

KEY MESSAGE:
As midwives work to provide care for women globally, lessons from history provide context for understanding the profession today and help guide efforts to make access to midwifery a right for all women. Poster session 4 (Group B)