Susanna Cox was born around 1785 into a poor Pennsylvania German family in Berks County, Pennsylvania. Due to limited resources, she received little to no formal education and was illiterate. At a young age, she began working as a domestic servant for the family of Jacob Geehr in Oley Township, where she was employed for approximately eleven years. Described as a simple and uneducated woman, Susanna spoke a German dialect common among the Pennsylvania Dutch community.​

On the morning of February 17, 1809, the body of a newborn infant was discovered in a rubbish bin behind the Geehr property. Upon questioning, Susanna admitted that the child was hers but claimed the baby was stillborn. A medical examination revealed that the infant had a broken jaw and fabric stuffed down its throat, suggesting foul play. Susanna was arrested on February 20, 1809, and charged with infanticide.​

Her trial commenced on April 7, 1809. Due to her illiteracy and language barrier, coupled with an inadequate defense, Susanna was unable to effectively advocate for herself. The court-appointed lawyers did little to defend her, and no witnesses were called on her behalf. After a brief trial, she was found guilty of murdering her illegitimate child.​

Following her conviction, Susanna was held in the local sheriff's home until her execution. On June 10, 1809, she was hanged in Reading, Pennsylvania, marking the last public execution of a woman in the commonwealth. Her case garnered significant public sympathy, leading to the creation of a ballad that recounted her tragic story. This ballad was widely circulated in both German and English throughout the nineteenth and twentieth centuries and is still recited at the annual Kutztown Folk Festival.​