16 minute read
A Lasting Impact
Kitty Ernst Retires from FNU
Kitty Ernst’s history with Frontier began in 1951 when she attended the Frontier Graduate School of Midwifery, which was part of the Frontier Nursing Service. Her official retirement in May 2021 marks 70 years of dedicated service to Frontier Nursing University. Passionate about ensuring that all families receive the best possible care during pregnancy and birth, Kitty is a dynamic and committed pioneer in midwifery education and practice. Even as a young nurse, she knew that she wanted to work in a place where she could make a difference in the lives of women and families.
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After graduating from the Waltham Hospital School of Nursing in Massachusetts in 1951, Kitty made the decision to attend the Frontier Graduate School of Midwifery of the Frontier Nursing Service (FNS), in Hyden, Kentucky. During her time as a midwifery student at FNS, Kitty realized the important relationship of midwifery care to the health of women and families. Throughout her life, Kitty often told the story of how awestruck she was when she first witnessed the power of a woman birthing in her own mountain home. Those first births Kitty witnessed as a midwifery student set her on a lifelong course of promoting and supporting normal birth, in a safe and comfortable setting, and educating midwifery students in these principles. Following her time at FNS, Kitty went on to earn a bachelor’s degree in education from Hunter College in 1957 and a master’s degree in public health from Columbia University in 1959. From 1954-58, Kitty also served as a nurse-midwife for the Maternity Center Association (MCA) in New York City. After practicing as a nurse-midwife, Kitty turned her attention to advocating for nurse-midwives to play an important field consultant for MCA, she developed the family-centered maternity care model which was demonstrated by an obstetrician and nurse-midwife team at the Salvation Army Booth Maternity Center in Philadelphia. Generations of midwives have learned from Kitty that birth centers are crucial to providing midwives with a place to practice true midwifery; as a safe, cost-effective, and satisfying place for families to grow; and as a part of the healthcare system. Kitty co-founded the National Association of Childbearing Centers (NACC) in 1983. As Director of the National Association of Childbearing Centers, she continued to be a leader in the effort to bring birth centers and midwives into the mainstream of health care delivery and helped to institute the Commission for Accreditation of Freestanding Birth Centers in 1985.
In the 1980s, Kitty became particularly concerned about two issues: the small number of nurse-midwives being educated each year, and the fact that the majority of nurse-midwives were being educated in large tertiary care centers and had a lack of out-of-hospital experience. To address these issues, she led the design and implementation of the first distance education program for nurse-midwives, which was adopted by the Frontier School of Midwifery and Family Nursing, now known as Frontier Nursing University (FNU). Starting with the inception of the distance program in 1989, Kitty graciously shared her personal story, her passion, and her vision with every single class of incoming FNU students.
and respected role in our society’s health care system. During this time, Kitty began working as a parent educator, teaching some of the first childbirth education groups of the International Childbirth Education Association. As a
Kitty, who often quotes one of the key beliefs of FNS that “all health care begins with the care and education of the mother,” has always maintained strong ties with FNU. She served on FNU’s Board of Directors and was awarded an honorary doctorate from FNU in 2011.
Kitty is revered not only by FNU but by other institutions as well. She served as the president of the American College of Nurse-Midwives (ACNM) from
1961-63 and again from 2007-2008. Beginning in 1998, ACNM annually presents the Kitty Ernst Award to “an exceptional, relatively new CNM/CM who is an ACNM member, has been certified for less than ten years and has demonstrated innovative, creative endeavors in midwifery and/or women’s health clinical practice, education, administration, or research.”
The criteria for the ACNM Kitty Ernst Award is befitting of Kitty’s contributions to the profession. She was a leader in
education and administration, conducting the first wave of accreditation for nursemidwifery education programs and developed the first “What is a NurseMidwife” brochure. Over the course of her career, she published valuable information defining the role of a nursemidwife and even played a crucial role in the first accreditation of nurse-midwife programs in the U.S. As the Director of the pilot Community-based NurseMidwifery Education Program (CNEP), she developed a model for meeting the overwhelming need for increased numbers of nurse-midwives who all understood the birth center model of care and were committed to providing innovative family-centered maternity care. She brought this model to a new arena as the chair of the ACNM National Commission on Nurse-Midwifery Education in 1992. Kitty’s impact spreads far and wide. She traveled across the U.S. and abroad to Germany, Hungary, Belgium, Russia, and Haiti to provide consultation and workshops on the midwifery model of care in birth centers.
Kitty Ernst (left) with Dr. Susan Stone Kitty’s many accolades included the Martha Mae Elliot Award for Exceptional Health Service to Mothers and Children from the American Public Health Association. ACNM presented Kitty with the Hattie Hemschemeyer Award, which honors an exceptional certified nurse-midwife or certified midwife who is an ACNM member, has been certified for at least ten years, and has provided either continuous outstanding contributions or distinguished service to midwifery and/or maternal child health (MCH), or contributions of historical significance to the development and advancement of midwifery, ACNM, or MCH. She received the Childbirth Connection Medal for Distinguished Service and was awarded the Maternity Center Association’s Carola Warburg Rothschild Award, which recognizes outstanding contributions to the health and well-being of women and their families.
FNU has awarded Kitty the 2021 Lifetime Achievement Award, upon which the inscription aptly reads “In recognition of your Innovation, Leadership, and Guidance to all at Frontier Nursing University and your unwavering support for Mothers, Babies, and Families.”
“No one could be more deserving of the Lifetime Achievement Award than Kitty Ernst,” FNU President Dr. Susan Stone said. “Kitty has truly dedicated her entire life to the care of women and families and to the education and preparation of those who provide that care. For 70 years she has been an innovator, educator, and leader. Through her legendary accomplishments, she has shown us all the incredible impact one person can make. She is an inspiration, a friend, and a most deserving recipient of this award.” Kitty Ernst is a legend and pioneer in every sense of the words. When she led the establishment of the Communitybased Nurse-midwifery Education Program (CNEP), she charted the course for the future of Frontier Nursing University. Simply put, FNU would not be what it is today without the innovation, leadership, and simple presence of Kitty. There are no words to accurately describe the influence that she has had not only on nurse-midwifery and FNU but also on me personally. Kitty’s impact is significant and everlasting upon every person she has ever met and every organization she has served. She is a dear friend, loyal supporter, inspirational leader, and is kind and gracious to all. We are thankful for her countless contributions to FNU and to midwifery. Even in retirement, she will always be part of the Frontier Nursing University community. Thank you, Kitty, for paving the way for so many of us, for your friendship, counsel, and inspiration. We are forever grateful and indebted. Sincerely,
A Message from Dr. Susan Stone
Susan Stone, CNM, DNSc, FAAN, Susan Stone, CNM, DNSc., FACNM, FAAN FACNM
Following is a transcript of a video message Kitty Ernst recorded announcing her retirement from FNU:
Dear Frontier Students, Graduates, Faculty, Staff, and Board,
I am proud of each of you and the promise of what you will accomplish. I am proud of the people who joined me in starting CNEP and helped it grow into Frontier Nursing University, despite great odds and challenges. I am proud of reminding the powers-that-be of the needs
of the students and of the mothers and the babies. I am proud to see YOU surpass all those whose shoulders you stand upon.
To everything, there is a season and it is time for me to retire from Frontier Nursing University. I have tried to retire several times over the last 20 years – and each time have been called back into service in some form or another. I have answered the call to serve whenever asked.
As I am finally, actually retiring, at almost 95 years of age, I want to be very clear with you. I wish you all well. And please do not ask me to serve again, because you know I am not good at turning you away.
I want to also express appreciation for my family who always chipped in whenever I asked them to help with any project for nurses or midwives. Just like the colleagues who joined CNEP as the first faculty members, mostly from the birth centers. As some of you know, we are a strange lot who take pride in making something out of nothing, questioning the status quo, and building a more inclusive community. I am proud that YOU are challenging, expanding, and making that better. YOU are taking it further than we could. YOU are doing what YOU can do with YOUR gifts and YOUR perspectives. And we all hope that those you nurture, who come after you, will take it further still.
Despite many personal challenges, I am asking myself what’s next? I am reminded of my training in the Cadet Nurse Corps, in World War II a program that only lasted five years but it reinvigorated the whole American health care system in a time of crisis by creating opportunities for people to serve. Without that government-funded program to swiftly increase the number of nurses, it is unlikely I would have gone to nursing school. In the Cadet Nurse Corps,
I found myself vulnerable in the teetering post-war health care system. That vulnerability showed me opportunities to ask questions, as well as wonder how could it be different and better? I looked at the past 14 months and see the numbers of nurses who died in service in their communities, and who report being burned out, and who plan to quit nursing. And I wonder if it is time for a modern Cadet Nurse Corps? Will YOU be part of shaping the future with YOUR wonderings? Your bold ideas? Your energetic vision and spirit?
Lastly, in regalia familiar to you, I want you to know: I believe in YOU. You are my hope for our future. Don’t be afraid to sing and dance and have fun while you’re doing your heart’s hard work. It will feed your soul.
I’ve done all I can. I had fun along the way – and I hope you do too. The future is in your hands.
FNU Board of Directors photographed on the newly purchased Versailles campus in 2017. Front Row (L-R): May Wykle, Kitty Ernst, Susan Stone, Phyllis Leppert, Wallace Campbell. Back Row: Peter Schwartz, Kerri Schuiling, Michael Carter, Jean Johnson, Robert Montague.
Kitty Ernst
By Phyllis Leppert, CNM, MD, PhD Professor Emerita, Department of Obstetrics and Gynecology, Duke University and President, The Campion Fund
I met Kitty in 1963. She was then Kitty MacDonald and a member of the faculty at Columbia University, College of Physicians and Surgeons, Department of Nursing’s Nurse-Midwifery Program and I had just enrolled. Kitty was a breath of fresh air in a very traditional school. The fact that nursing was a department in a medical school in those days tells you a great deal about the way things were. It was a difficult place for nurse-midwifery. Mothers in labor in Presbyterian Hospital in the City of New York were admitted into a screening room. Then if they were in active labor, they were moved into a laboring room and for birth rushed into a delivery room down a hall and around the corner. The delivery rooms were very much like an operating room and most women had caudal anesthesia, an early form of epidural. All nurse-midwifery students had their first birth experiences there and there was a great deal of resistance to our management approach from the obstetric and gynecology residents. For our summer session we rotated to King’s County Hospital and to their established nurse-midwifery service. At that hospital we were able to truly manage the experience of mothers and babies as midwives. Kitty had prepared us well and we knew that our work was to facilitate each mother’s birth. “Mother the mother” throughout her whole childbearing time was her rallying cry. Her lectures where she shared with us her work in eastern Kentucky at the Frontier Nursing Service were very influential to me, not only as a nurse-midwife but as a physician and physician-scientist. She presented us students with a different and important way of looking at each woman’s pregnancy and birth experience, one that emphasized that it was her birth and that she should be treated with dignity and love. I will never forget her pictures of all the families in the Kentucky mountains that she had cared for and her description
of the Frontier Nursing Service. The spirit of the love of each mother shown through all her teaching. Kitty also taught us that we needed to be certain that we always considered the physical safety of the mother as well. She told us about her experiences in remote places as a public health nurse caring for childbearing women and that if she had known then what she learned at the Frontier Nursing Service she would have done many things differently. That resonated with me. I had been a public health nurse in New York City serving Central Harlem and had made the decision to apply for nursemidwifery education because I realized that I needed further knowledge and skills to truly help childbearing women and their babies.
Upon graduation I kept up a relationship with Kitty. She was one of the very few nurse-midwives who did not shun me when I made my decision to apply for admission to medical school. She stood up for me when many of my colleagues stopped speaking to me. She told them that I would be in a position someday to support midwifery. As a first -year medical student at Duke, I went to an ACMN annual meeting and while most of my fellow nurse-midwives were less than cordial, Kitty was very welcoming and in fact motherly. I will never forget her support. Our relationship continued over the years and when she started CNEP I was enthusiastic about the program. I followed the program carefully over the years and was pleased when CNEP and distance learning was incorporated into Frontier Nursing University. Over the years as a physician, I was happy to have CNEP students in our hospital and university programs and I was proud to encourage the establishment of a free- standing birth center in upstate New York. During my professional career I moved to many new faculty positions, always supporting midwifery and trying to be true to what Kitty had taught me in the early 1960s. When I was in a junior faculty at Columbia’s College of Physicians and Surgeons, I supported what Kitty and others were doing. Support for Childbirth Centers for me was a given, even though in the early days there were colleagues of mine in obstetrics and gynecology as well as pediatrics who were saying that they were unsafe. I helped as a consultant on the first study of outcomes of births in free standing birth centers published in the New England Journal of Medicine.
I was very proud of that paper. Kitty was the force behind the paper. She understood two important things. The first was that it was necessary to educate many nurse-midwives if we were to have any impact on childbearing in the United States as she understood that schools graduating small numbers each year would not be enough to ever make a difference in care of mothers and families. The second important thing she understood was that we needed to study all the outcomes of nurse-midwifery care and to document and publish the data. Over the years I personally have been concerned that midwives in the United States were so unable to be as flexible as necessary in the education of midwives and that direct entry for motivated students, those who were not nurses first was important. The “My colleague said to me: ‘it was not a delivery it was a birth.’ I knew then that the message that Kitty began years ago was on fertile ground. Her ideas have influenced the care of many.”
divisions within midwifery circles upset me and I was very glad that Kitty kept her eye on the ball of the educational expansion of the profession. The ball we were to keep our eyes on was women and their families.
Many things have changed in obstetrics and gynecology since the 1960s. Midwives have had a real impact. When one of my colleagues at Duke School of Medicine described a difficult labor that she managed that ended in a necessary C-Section she told me how the mother was awake, and that the baby’s father was there and that she gave the baby to the mother to hold immediately. The mother held her baby just after birth and while the surgery was being completed. My colleague said to me: “it was not a delivery it was a birth.” I knew then that the message that Kitty began years ago was on fertile ground. Her ideas have influenced the care of many. Mothers birth babies she taught. Kitty called me to say that she had proposed me as a member of the Board of Directors of Frontier Nursing University a number of years ago. I was nominated and appointed and was very pleased to serve in that capacity. It meant seeing more of Kitty and to know that she was true to her vision. Take care of the mothers, she said. That is her great and very important legacy.
