Jennifer Foster has pushed the frontiers of nurse midwifery for almost 30 years, and has practiced in underserved areas of Guatemala, Hawaii, Mississippi, Maryland and Massachusetts.
In honor of her lasting contributions to the field, Foster was inducted into the 2011 Fellowship class of the American College of Nurse-Midwives in May. Only 200 fellows have been named since induction was started in 1994.
“Midwifes deliver about 10 [percent] to 15 percent of births in the U.S., but the percentage is much higher around the world, where they are a large part of the health care structure,” said Foster, CNM, MPH, Ph.D., FACNM, an associate professor and maternal and newborn health researcher at Emory University’s Nell Hodgson School of Nursing. “What an impact we could have by implementing a better model of practice that could be used around the world.”
After graduating from nursing school in 1976 and spending a year in a hospital medical/surgical unit, a two-year enlistment in the Peace Corps set the direction of Foster’s nursing career.
“I went to the remote western highlands of Guatemala as a public health nurse, where I was exposed to so many mother/baby health issues,” Foster said. “Traditional native midwives would attend the births, but when there were complications, the women would come to me. That’s when I decided to become a nurse midwife.”
Foster, who earned nurse midwifery certification from the University of Mississippi in 1982, practiced in eastern Maryland before establishing the first nurse midwifery practice on Moloka‘i, the most remote of the Hawaiian Islands.
“I had met and married my husband, who while working at the University of Hawaii had visited Moloka‘i. It was his dream to work there,” Foster said.
When her husband landed a job with the Moloka‘i Economics Justice Council, Foster thought she’d have to return to public health nursing. To her surprise, a nurse midwife was exactly what Moloka‘i — home to mostly native Hawaiians, Japanese and Filipino residents and served by a 24-bed hospital — needed.
“There was a spike in obstetrician malpractice insurance in 1985, and the family practice on the island decided that they would no longer offer obstetrical practice,” she said.
That meant the local hospital would lose revenue and mothers would have to take a 20-minute flight to Honolulu to give birth.
“Native Hawaiians are culturally tied to the land and the soil where they are born. They didn’t want to travel to Honolulu, be separated from their families, or have the additional expense of hotel bills while waiting for birth,” she said. “No one was happy.”
Islanders skeptical
Nor were they happy with a hospital plan to employ a nurse midwife to handle normal births and consult with Honolulu physicians when there were complications.
“The population wasn’t aware of nurse midwifery training and the word on the street was that they were getting second-rate care. That’s the environment I entered,” Foster said.
Handling maternal care, deliveries, infections, post-partum visits and breastfeeding education, Foster was never off duty. It soon became obvious that a second midwife was needed.
Foster said that the outcomes were good, and that her working relationship with the physicians in Honolulu was positive.
“There were no high-tech expectations on the island, and women knew that the nearest NICU (neonatal intensive care unit) was in Honolulu,” Foster said.
Living on an island could bring surprises. Once, Foster delivered a mother who was well-past her due date. The plan was to transfer her to Honolulu but a terrible thunderstorm shut down the airport.
“She went into labor and the power went off. Our generator didn’t work very well, so we lit some candles. I remember thinking it was this woman, me and God — that’s all we’ve got,” Foster said. “It turned out to be a lovely birth. She didn’t even need stitches, even though the baby weighed 11 pounds.”
In 1988, the Fosters left Moloka‘i to raise their son near his grandparents in Massachusetts. Attracting and keeping nurse midwives on remote Moloka‘i was a challenge, but a plan to bring back family-physician deliveries met with resistance on the island.
“I heard from co-workers at the hospital that mothers said they wanted the best care, and that meant nurse midwives. I felt like we’d come full circle,” she said.
For 18 years, Foster worked at a midwifery practice in Massachusetts that treated a large number of Puerto Rican women. She completed a doctorate degree in cultural anthropology at the University of Massachusetts Amherst in 2003 and joined the nursing faculty there.
“We had been working to reduce infant-mortality rate, which we did, and to reduce teen pregnancy, which was increasing, even though we all spoke Spanish and gave out free birth control,” Foster said. “I felt like cultural issues were affecting those outcomes, and felt compelled to ask the kinds of questions that anthropologists ask in my research.”
Recruited to work at Emory in 2007, Foster, academic program coordinator of international health at the Lillian Carter Center for International Nursing and a fellow at the Center for Research on Maternal and Newborn Survival, recently completed a three-year National Institutes of Health study in the Dominican Republic.
She and some Emory nursing students trained local nurses and community leaders as researchers. The aim was to hear and interpret community perceptions about the quality of maternity health services in order to improve practices.
“The most satisfying part of my job is to connect deeply with individual women and foster the kind of connection with other health care workers that can bring about better models of care,” Foster said.
About the Author
