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Midwifery and the Development of Nursing Capacity in the Dominican Republic: Caring, Clinical Competence, and Case Management


  • Jennifer Foster CNM, PhD,

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    • Jennifer Foster, CNM, PhD, is Visiting Scholar at the Nell Woodruff School of Nursing, Emory University, Atlanta, GA.

  • Annemarie Heath CNM, MSN

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    • Annemarie Heath, CNM, MSN, is Assistant Clinical Professor at the University of Massachusetts Amherst. She is also the founder and executive director of Project ADAMES.

Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Suite 428, Atlanta, GA 30322. E-mail:


The contribution of midwifery care to positive health outcomes has been acknowledged both nationally and internationally, yet currently there are insufficient numbers of midwives and nurses to meet the maternal-infant health needs around the globe. Project ADAMES, (ADelante, Asegurando Madres E Infantes Sanos; in English: Onward! Assuring Healthy Mothers and Babies), is a non-profit nongovernmental organization created as a collaborative, community-based partnership between the maternity nurses in a hospital in the Dominican Republic and a group of certified nurse-midwives from the United States. After attending a series of educational conferences in midwifery over the course of 3 years, a subset of motivated Dominican nurses and auxiliaries (the Comité) have trained hospital volunteers to be doulas, to provide the caring and supportive role to laboring women they do not have the time to provide themselves. The Comité also proposed to initiate a postpartum assessment flow sheet and precept nursing student volunteers from Project ADAMES to demonstrate the performance of routine assessments among postpartum women. The Comité desires to train nurses in other neighboring hospitals. As the nurses and midwives implement improvements in quality of care, they strive to develop a sustainable, transferable program that could be available to other sites where nurses similarly manage vaginal deliveries.