Get Started: Suggestions for Aspiring Midwives
“Until one is committed, there is hesitancy, chance to draw back, always ineffectiveness. Concerning all acts of initiative (and creation) there is one elementary truth, the ignorance of which kills countless ideas and and splendid plans: that the moment one definitely commits oneself, then Providence moves too. All sorts of things occur to help one that would have never otherwise occurred. A whole stream of events issues from the decision, raising in one’s favor all manner of unforeseen incidents and meetings and material assistance, which no [wo]man could have dreamed would come [her] way. I have learned a deep respect for one of Goethe’s couplets:
Whatever you can do,
or dream you can, begin it.
Boldness has genius,
power and magic in it.”
– W.H. Murray, The Scottish Himalayan Expedition
©Shawna Wentz Photography Sacred Womb Artistry
GETTING STARTED: TIPS FOR ASPIRING MIDWIVES
Getting An Education and Connecting with Midwifery Networks
First, Choose the type of Midwife you want to be: Certified Nurse-Midwife or Direct-Entry Midwife (Certified Professional Midwife/Licensed Midwife). For more information, read our articles on the types of midwives, “Two Roads Into Midwifery”.
Consider the Pros and Cons of each type of midwife (PDF). Choose carefully which path suits your lifestyle and future plans before embarking. becoming a midwife takes diligence, dedication, resilience, determination and persistence and considerable investment of time and money. It can be a long and ardous road. Many midwives have commented that had they known what they know now, they might have chosen the alternate path. So consider carefully before you begin your journey.
Seek out local midwifery study groups or join your state midwifery organization. Connect with your local chapter of a national midwifery organization. If you want to be a Certified Professional Midwife (CPM), contact Midwives Alliance of North America for midwives organizations in your state and region. If you live in California, that’s California Association of Midwives. If you want to be a Certified Nurse Midwife, contact American College of Nurse Midwives for state chapters. or if you’re in California, it’s California Nurse-Midwives Association
CHOOSE YOUR PATHWAY: Nurse-Midwifery or Direct-Entry Midwifery (Certified Professional Midwife/Licensed Midwife)
GETTING A NURSE-MIDWIFERY EDUCATION
Nurse-Midwives are trained in both disciplines of nursing and midwifery. Nurse Midwives work in hospitals, birth centers and homebirth settings, are licensed and legal in all 50 states. Accreditation standards are set by The American College of Nurse-Midwives (ACNM), who offers the certification examination for nurse-midwives leading to the Certified Nurse Midwife (CNM) credential. (In addition, ACNM offers a Certfied Midwife (CM) credential, which does not requre a degree in nursing, but is only legal in two states, and only one CM program at a university in NY exists).
Become a Nurse. All Nurse-Midwifery Training Programs require that you become a Registered Nurse. If you are already a Licensed Vocational Nurse (LVN) there are bridge programs to allow you to either become a ADN/RN, BSN/RN, MSN/RN within one program which are usually 2-3 years in length, depending upon whether you’ve completed the science pre-requisites before entering the program. Some programs require that they be completed before you begin. Others allow an extra year within their program to complete pre-nursing curriculum before entering the nursing portion.
Obtain a Bachelors of Science in Nursing (BSN). There are bridge programs (called Accelerated BSN Programs) which allow persons with a BA or BS in a non-nursing degree to obtain a second bachelor’s degree in nursing (BSN) and an RN License. These are 2-3 year programs and require pre-requisites in sciences: chemistry, physiology, anatomy and microbiology as well as general education requirements in Lifespan Developmental Psychology, Sociology, English Critical Thinking, Political Science, etc. If you have a BA or BS already, your course work may be transferable. However science courses must be completed within the past 5 years of your application. After obtaining your BSN, you can enter a Masters in Nursing Program (MSN) with an emphasis in Nurse-Midwifery/Women’s Health Care, which is usually 2 years in length. Masters programs require the Graduate Records Examination (GRE) and a Statistics course.
Obtain a Masters of Science in Nursing (MSN). There are Entry Level Masters in Nursing Programs (EL-MSN) or Masters Entry Programs in Nursing (MEPN)–also called direct-entry nursing programs, not to be confused with direct-entry midwifery. These are programs which allow a person with a BS or BA in a non-nursing subject to obtain an RN license (preparing them to take the National Council Licensure examination-NCLEX-RN) within the first year, and obtain a MSN in years two and three. Some programs, but not all, have a specialization emphasis in Nurse-Midwifery. One such program in California is University of California of San Francisco (UCSF). The other two programs in California offering MSN degrees in Nurse-Midwifery/Women’s health are California State University Fullerton and University of Southern California San Diego, but neither have a specialty emphasis in Nurse-Midwifery for the Entry Level Masters in Nursing Programs. Candidates are required to be RNs before admission to their Nurse-Midwifery program.
There are people who have opted to do an EL-MSN/MEPN program obtain the RN in the first year and then after graduating with a MSN, enter a Nurse-Midwifery Program (2 years) for a post-master’s certificate or second Masters Degree. The problem with a EL-MSN/MEPN program which does not provide an option of specialization in nurse-midwifery/women’s health is that while graduates of these programs will obtain a Masters Degree in Nursing (MSN), they may not obtain any work experience in midwifery, maternity care or Labor and Delivery during their program, other than brief clinical rotations. The graduate will still need to learn midwifery, so they will still require post-masters coursework and clinical training in Nurse-Midwifery.
There are distance learning/hybrid classroom programs for Nurse-Midwifery. Some programs require a BSN/RN, other programs allow a ADN/RN to enter the program. Students do coursework the first year and then arrange for clinical training with a CNM-Preceptor in their own community. Coursework in statistics and the GRE is required prior to admission. Such programs are Philadelphia University and the Community Based Nurse-Midwifery Program (CNEP) of Frontier School of Nursing in Hyden, Ky, among others.
Start completing your pre-requisite science courses. All nursing and midwifery programs whether ADN, BSN or MSN require course work in Anatomy (5 units + lab) Physiology (5 units + lab), Microbiology (5 units + lab), and for some programs Chemistry (5 units + lab) is also required. Science courses must be completed within the past 5 years (with passing grade of at least a C or higher depending upon the program). Nursing programs at any level also require Lifespan Developmental Psychology, Sociology, Psychology, English (critical thinking), Speech, and other general education requirements (i.e., History, Political Science, etc.). If you already have a Associates Degree or Bachelors degree in a non-nursing subject, your pre-requisites may be transferable if your grades were C or higher. Unfortunately, if you have already obtained a Masters Degree in a non-nursing subject before entering a 2nd undergraduate program in nursing, your coursework may not be transferable to the lower degree.
GETTING A DIRECT-ENTRY MIDWIFERY EDUCATION: Certified Professional Midwife and/or Licensed Midwife
Direct-Entry Midwives (LMs or CPMs) enter the profession directly–without becoming a nurse first. They work in out-of-hospital settings: homebirths, clinics and birth centers. Certified Professional Midwives (CPMs) meet criteria establshed by the North American Registry of Midwives (NARM) and may take the examination to become a CPM. Licensed Midwives (LMs) must take their state examination to become licensed. However, non-nurse midwives are not legal in all 50 states. In California, midwives have had the ability to become licensed since 1994.
Choose a Midwifery School. Most direct-entry midwifery schools are 2-3 years of academic study and 1-3 years of supervised clinical training which may or may not be concurrent with academic study. Most direct-entry midwifery (non-nurse) schools do not have a classroom; students learn from their own community via fax and modem or study group with other students in their physical or virtual community. Most direct-entry midwifery schools do not have a facility to provide clinical training. Students must obtain clinical experiences on their own, though schools maintain a list of approved preceptors and clinical training sites. Most academic and clinical requirements for direct-entry midwifery study are based on the Core Competencies for Professional Midwives developed by Midwives Alliance of North America and prepare students to become Certified Professional midwives (CPMs). Licensure is unavailable in all 50 states. In states where it is available, you may have to take an examination to be come licensed to practice in that state. In most cases, the license obtained in one state is not legal in another state. You must obtain licensure in every state where you practice (however, Florida, Washington and California licenses are reciprocal). This is the case in California. After becoming a CPM, you can enter the California Midwifery Challenge Process, and take the state licensing exam to become a California Licensed Midwife. Check the California Medical Board Division of Midwifery Licensing for the list of approved schools who administer the California Midwifery Licensing Challenge Process.
Consider self-directed study. Some aspiring midwives who cannot relocate to attend midwifery school learn their academics through self-directed study (reading midwifery textbooks, attending study groups, taking community college courses) and then to obtain clinical experience, attend a short term intensive birth center or hospital training program. There are programs in TX, NM and overseas. For more information on such programs visit the Midwifery Education Accredidation Council website at http://www.meacschools.com.
What About the Apprenticeship Option?
California does not allow for apprenticeship. All student midwives in California must be currently enrolled in a California Medical Board approved school with a school-approved preceptor, who is a Licensed Midwife in the state of California. Once the clinical training portion of the student’s education has begun, the student must be under the supervision of the LM Instructor. (This means the direct physical presence at all times when care is being conducted by the student) The student’s status must be disclosed to the client, and the midwife instructor must have a license which is free and clear of all restriction. The law prohibits an individual midwife from providing supervised clinical training to a student or students who are not officially enrolled in an approved midwifery training program. There is no legal provision in California for an individual student to be “enrolled” in a “program” of supervised clinical training with an individual midwife. The student must be officially enrolled in an approved midwifery school.
Obtain clinical skills. State licensing and national certification programs require skills in neonatal resuscitation, venipuncture (phlebotomy), suturing, and IV administration. You can take these courses through continuing education programs for EMTs and/or nurses at your local hospital or vocational training center or by attending midwifery conferences or workshops. Our Midwife Assistant Training teaches basic midwifery-assisting skills such as vaginal exams, auscultating fetal heart tones and palpation. The Farm Midwifery Center in Summertown, TN offer skills in the basics of midwifery assisting as well. Midwives Alliance of North America and American College of Nurse-Midwives have national conferences yearly. Midwifery Today hosts several conferences throughout the year. Many state midwifery associations hold conferences. California Association of Midwives holds an annual conference each October.
Other Ways to Prepare to Enter the Midwifery Profession
Become a Doula or Breastfeeding Counselor. Providing hospital labor support or postpartum care is a great starting point for an aspiring midwife. This is a good way to see how you manage your life while having to be on call 24/7. By providing professional labor support or postpartum doula care or breastfeeding support, you’ll have an opportunity to work with a variety of women and see the many ways births unfold and interface with medical and nursing personnel. If your clients are having homebirths, you will have the opportunity to meet local midwives, who may be looking for a new assistant.
Become a Certified Nursing Assistant or Emergency Medical Technician. CNA and EMT programs are available through many community colleges or vocational schools. Nursing Assistants work as a clinical assistant in a prenatal, family planning clinic, birth center or doctor’s office, or do home health care nursing or may assist midwives. The basic medical skills learned in an EMT program can be a door opener for a midwife seeking to take on a new student.
Start or attend a childbirth/midwifery study group. Attend existing study groups or start your own! You can invite nurses and midwives to teach skills such as history taking, pap smears, IV Infusion and suturing, as well as the spiritual and ethical aspects of midwifery.
Form a Birth Collective and Educate the Community on Childbirth Alternatives. The truth of the matter is that only 7% of births in the U.S. are attended by midwives, and of that 7% only 1% or less are homebirths (the rest are hospital midwife attended births). The reality is that very few communities have birth centers, and in urban areas, there are several midwives competing for a very small clientele. In sparsely populated areas, there are may only be one midwife, but homebirth clients are few and far between, and oftentimes the local hospital is hostile towards midwives. Also, in rural areas, the population may be low income on Medi-Caid and cannot afford midwifery care. Few states Medi-Caid plans cover midwifery care in out of hospital settings. If you want to have clients when you complete your training, you must work now to educate and inform the public and public policy makers about midwifery care and out of hospital birth. Along with other midwifery enthusiasts, you can do some community education, form a network or a legislative taskforce. The Big Push for Midwives is a national campaign to legalize the CPM in all 50 states. Get involved.
Train as a Prenatal Massage Therapist, Hypnobirthing Instructor, Prenatal Yoga or Prenatal Exercise Instructor. This is a good way to meet clients who will invite you to be their labor companion
Become A Certified Childbirth Educator. A good starting point for a person wanting to become a midwife is to become a Childbirth Educator. Childbirth Educators assist pregnant women and their partners in making informed decisions about their care and developing the confidence they need for birthing. Through training as a childbirth educator, you will learn basic information about pregnancy and childbirth, become informed about risks and benefits of obstetrical interventions, relay this important information to your students and gain satisfaction in assisting couples in making congruent choices about their baby’s birth. You will also develop the ability to educate the public about midwifery. Also, your students may invite you to attend their births as a labor companion.
RESOURCES FOR ASPIRING MIDWIVES
Organizations
Childbirth Assistant and Childbirth Educator Training
Birthing From Within
81 David Love Pl, #207
Goleta, CA 93117
Email: contact@birthingfromwithin.com
International Birth and Wellness Project-IWBP/The Organization of Labor Assistants for Birthing Options and Resources-TO-LABOR formerly the Association of labor Assistants and Childbirth Educators
International Childbirth Education Association (ICEA)
PO Box 20048
Minneapolis, MN 55420-0048
612-854-8660
email: info@icea.org
The Bradley Method
American Academy of Husband – Coached Childbirth (AAHCI)
PO Box 5224
Sherman Oaks, CA 91413
818-788-6662
email: info@aahcc.com
ASPO-Lamaze
2025 M Street, NW, Suite 800
Washington, DC 20036
800-368-4404
BirthWorks
P.O. Box 2045
Medford, NJ 08055
888-TO-BIRTH (862-4784)
email: info@birthworks.org
Doulas of North America (DONA)
P.O. Box 626
Jasper, Indiana 47547
(888) 788-DONA (3662)
email: info@dona.org
Periodicals
Midwifery Today
PO Box 2672
Eugene, OR 97402
e-mail: admin@midwiferytoday.com
Mothering Magazine
Mothering Magazine
PO Box 1690
Santa Fe, NM 87504
Phone: 505-984-8116
email: circulation@mothering.com
Journal of Nurse-Midwifery
Elsevier North Holland
Vanderbilt Ave.
New York, NY 10017
Aspiring Midwives Reading List
Midwifery
by Helen Varney
Maternity and Women’s Health Care
by Lowdermilk, Perry and Bobak
Human Labor and Birth
by Oxorne & Foote
A Textbook for Midwives
by Margaret Myles
A Guide to Physical Examination
by Barbara Bates
Becoming A Midwife
by Caroline Steiger
Paths to Midwifery: Getting an Education
Published by Midwifery Today Magazine
Holistic Midwifery
by Ann Frye
Heart and Hands
by Elizabeth Davis
Understanding Diagnostic Tests in the Childbearing Year
by Ann Frye
Spiritual Midwifery
by Ina May Gaskin & The Farm Midwives
Helping Hands: The Apprentice’s Workbook
by Carla Hartley
available through Ancient Art Midwifery Institute
Associations
International Center for Traditional Childbearing (Black Midwives Association)
The Farm Midwifery Workshops
Contact: Pamela Hunt
42 The Farm
Summertown, TN 38483
931-964-2472
