This paper examines the history of midwifery in Appalachia. Throughout history, women in labor have been supported by other women. Midwives learned as apprentices, gaining skills and knowledge from older women. Eventually, formalized training for midwives was developed in Europe, but no professional training existed in the United States until 1939. In 1923 Mary Breckinridge organized the Frontier Nursing Service in Wendover, Kentucky, to meet the health needs of rural women and children. Breckinridge had become acquainted with nurse-midwives in France and Great Britain during World War I and later attended classes in London. She brought trained midwives from England, who made prenatal home visits on foot or horse. In 1939 the Frontier Nursing Service started the Frontier School of Midwifery and Family Nursing, which still exists today. It is estimated that a quarter of all certified American nurse-midwives graduated from the Frontier School. In 1989 the school began offering a national distance-learning program to make it easier for nurses in small towns and rural areas to become nurse-midwives. This paper includes anecdotes about Appalachian lay-midwives and "granny women" and traditional birth customs. Definitions of the different types of midwives and birth attendants and their training are provided. (Contains 18 references.) (SV)