Kentucky once sent midwives on horseback to reach mothers where they lived. A century later, the state ranks near the bottom on nearly every measure of maternal and infant health, labor and delivery units are closing, and Medicaid cuts loom. Still- midwives, doctors, and a group of determined moms are trying to build something new.

A century ago, if you were about to give birth in the mountains of Eastern Kentucky, help might have come on horseback.

In 1925, Mary Breckinridge founded the Frontier Nursing Service in Leslie County. Qualified nurse-midwives were so scarce in the United States that the service had to either send American nurses to Great Britain for training or recruit British midwives outright. Those women rode from home to home through hollers and creek beds no car could manage, their saddlebags packed with everything they needed for a birth. Local children were told the babies arrived in those saddlebags, a story still passed down in Leslie County today.

When World War II pulled the British nurses home, the service opened its own graduate school of midwifery, enrolling its first class in November 1939. Today it's Frontier Nursing University in Versailles.

"The birthplace of nurse-midwifery is very much credited to being here in Kentucky," said Mary Kathryn DeLodder, who leads the Kentucky Birth Coalition.

The idea behind those horseback rides was simple: bring care to mothers, wherever they are.

So where does a pregnant woman in Kentucky stand today?

Dr. Jay Miller says our choices- as women in the Commonwealth- have never been more limited. His one-of-a-kind birth center in rural Kentucky was closed with 30 days' notice earlier this year. Now, he's one of several people trying to protect what few options expecting mothers have left.

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