From Prairie losses to Delta deliveries: what Laura Ingalls Wilder didn’t know and what Leland women now do

When Laura Ingalls Wilder wrote about life on the American frontier, she described snowstorms, schoolhouse brawls, and butter churns, but not the stillbirth she experienced or the miscarriage that followed. In 19th-century America, maternal loss was so common, it often went unspoken.

Then: Prairie motherhood was a gamble

On the frontier, pregnancy was a quiet act of courage. There were no prenatal checkups, no Rhogam shots and no fetal monitoring. A woman could carry a child to term, go into labor surrounded by her sisters and a midwife, and just never recover; or, she might deliver a baby who never drew breath.

Wilder’s mother, Caroline Ingalls, gave birth to five children, including a son, Freddie, who died before his first birthday. No cause of death was recorded. Wilder herself had one surviving child, despite multiple pregnancies.

Some historians and obstetricians have speculated that Rh incompatibility may have played a role. The condition occurs when a mother with Rh-negative blood carries an Rh-positive fetus. It can cause hemolytic disease in subsequent pregnancies. Without Rhogam (developed in the late 1960s), many women had no defense against immune complications that were not yet understood.

In those days, a child’s death was met with quiet mourning and few answers.

More than a century later, women in rural Mississippi towns like Leland still give birth far from major medical centers. But, unlike the Ingalls women, they now have access to prenatal vitamins, blood testing, ultrasounds and physicians trained to spot complications before they become tragedies.

That difference plays out quietly each day in a small clinic on Broad Street.

Now: Maternal health closer to home

Today, Leland mothers no longer walk miles through snow or ride wagons to reach care. The Leland Medical Clinic, part of Delta Health Center, offers full prenatal services in town. From gestational diabetes screenings to early ultrasounds, expectant mothers can access the kind of care Wilder never imagined.

Nurse practitioners Heather Lloyd and Lacie Brackeen provide prenatal counseling, order labs, track vital signs, and coordinate high-risk referrals. Ultrasounds and OB-GYN consultations are available in Greenville, less than 15 miles away.

Blood type screening, including Rh factor, is now a routine part of early pregnancy care. When needed, Rhogam is administered before a mother’s immune system can attack fetal red blood cells.

But some risks haven’t gone away — they’ve changed

For all that modern medicine offers, it has introduced new dangers. While frontier women died from lack of intervention, today’s mothers may suffer from its overuse.

Mississippi has the highest rate of cesarean births for first-time, low-risk mothers in the country. In 2020, nearly one in three women classified as low-risk, meaning they carried one baby, head-down, past 37 weeks still gave birth by C-section.

Some Delta hospitals exceed that average. At South Sunflower County Hospital in neighboring Indianola, 46.7% of low-risk first-time mothers underwent cesarean surgery between 2014 and 2022.

Markedia Perryman of Indianola said she had labored for just four hours before being told surgery was necessary. Her records cited “nonreassuring fetal heart tones” and “arrest of labor,” yet showed no documentation of fetal monitoring.

After the C-section, Perryman developed an infection and was hospitalized for a month. She was transferred to the University of Mississippi Medical Center for higher-level care and still faces surgery this year to repair a hernia caused by the initial operation.

“I was really mad, depressed,” she said. “When I got home, me being away from my daughter for so long — when I tried to hold her, she didn’t do nothing but cry. That hurt me a lot.”

Across Mississippi, Black women like Perryman are far more likely to experience cesarean birth, even when controlling for health conditions, insurance, and access to care. Researchers say provider bias, outdated algorithms, and hospital culture play a significant role.

Dr. Neel Shah, an OB-GYN and professor at Harvard Medical School, says the most important factor in whether a woman has a C-section is not her risk level or preference, but which hospital door she walks through.

“We’ve designed the system backwards,” Shah said. “Everybody gets a surgeon. Not everybody gets support.”

But now, that could be changing Sunflower County and Leland women stand to benefit from the new Maternity Care Center, which opened in June 2025 at South Sunflower County Hospital. With Certified Nurse Midwives (CNMs) now integrated into the care team, the hospital is shifting toward a more personalized, supportive approach. Early indicators suggest that surgical births may decline over time as the team adopts best practices proven to reduce unnecessary interventions (Healthier Mississippi, 2025).

The facility features new rooms where labor, delivery, recovery, and postpartum care all happen in one room, along with telehealth capabilities, prenatal education and a focus on continuity of care. A team-based model like this one has been linked to increased vaginal birth rates and fewer birth-related complications.

Leaders behind the center, including Blue Cross & Blue Shield of Mississippi and the Delta Health Alliance, say the goal is simple: “healthier moms and babies.”

Hopefully, stories like Perryman’s will soon become the exception rather than the norm. While high C-section rates in the region may stem from provider caution and chronic conditions such as diabetes and hypertension, the new maternity center aims to reduce avoidable surgeries by focusing on early intervention, education, and relationship-centered care.

For the most complex births or emergencies, mothers are transferred to the University of Mississippi Medical Center in Jackson with the state’s only Level IV neonatal intensive care unit (NICU), a two-hour drive from Indianola. Reducing preventable surgical births locally may also reduce the number of transfers needed.

Still: The strength of rural mothers remains

On the prairie, childbirth was always a looming danger, and half the battle was knowing what to expect. Today, there is an opportunity to help educate Leland and Delta mothers to ask the right questions, seek prenatal care and advocate for themselves to reduce unnecessary cesarean deliveries.

Caroline Ingalls and Laura Ingalls Wilder never found out why they lost their children. But, today, women in Leland have the tools their foremothers never had: prenatal screening, antibiotics, Rhogam, blood pressure monitoring, a new maternity care center nearby and, perhaps most importantly, answers.

What hasn’t changed is the strength it takes to carry life while navigating hardship. The way small-town women show up for one another remains the same, and so does the quiet courage of every mother who walks into a clinic with hope in her belly and questions in her heart.