Louise has a long conversation with her mother about what brought her mother to Rass Island and why she is comfortable there, and her mother tries to convince her to leave.
Louise goes to the University of Maryland. This is the late l940s and a time when there aren't many places in medical schools for women so she transfers to a nurse-midwife school. When she graduates she goes to a mountain village. Louise marriesd, and her first son arrives just after her father dies. She doesn't go home for the funeral. At the end of the chapter (and of the book) she delivers another pair of twins. “In the end, Jacob Have I Loved is about love; Louise discovers the frustrated love behind her grandmother's hatred for Captain Wallace and behind her own hatred for Caroline and Rass Island. Over the course of the book Louise learns that negative feelings often have the power to obscure positive ones and realizes that many of her relationships have reflected her grandmother's influence. During adolescence, for example, she belittles Call, undervaluing her companion's friendship until he gains Caroline's attention and marries her. Only with the Captain's help does Louise finally recognize that she is slipping into behavior that threatens to endanger her relationships with others. Like most of Paterson's works, this novel shows that love provides the freedom to be obligated to others.”