Something has gone wrong with the way that we handle birth in this county. After nearly a century of progress, deliveries are now getting more dangerous rather than less so. The number of women who go into shock during childbirth has more than doubled in the past decade, and those who suffer kidney failure rose 97%. Globally, we are tied with Belarus in maternal mortality.

As we look for solutions, we'd be well served to examine a remarkable 1920s success story that has almost been forgotten. The key was taking a more personal approach, with a focus on prenatal care, in the style of British midwives. While Americans treated birth as a medical event performed on the mother, British midwives learned that birth was a physical event, performed by the mother.

In 1923, Mary Breckinridge started the Frontier Nursing Service in rural Appalachia. At that time, nine women died for every 1,000 births in the U.S.—a rate 100 times higher than we see today. And in these deep hollows, where people were cut off from medical care, the risk for pregnant women was even greater. Breckinridge changed all that when her horseback midwives began riding out into mountain snowstorms to deliver babies by candlelight.

Within a decade, the astonishing impact of that care was apparent. (Breckinridge recruited Louis Dublin, vice president and statistician at the Metropolitan Life Insurance Com pany, to do the numbers; the results were published in 1932.) The women the Frontier Nursing Service cared for, who were desperately poor and usually gave birth at home, were 10 times less likely to die in childbirth than the average American at the time. The nation as a whole wouldn't catch up until the 1950s, after the widespread acceptance of antiseptic and the discovery of antibiotics.

There was nothing mystical about this improvement. The midwives simply understood that, instead of focusing narrowly on the birth, they needed healthy families to produce healthy babies. They treated snakebites, fevers and men shot in feuds. They made frequent house calls—18 prenatal visits and 12 postpartum checkups were standard for an uncomplicated pregnancy.