How Many Hours to Become a Homebirth Midwife?

I came to my midwifery journey in a round about basis. I can't say that I always knew I would be a midwife but my life experiences have definitely helped bring me to this place. I looked into becoming a Certified Nurse Midwife briefly while on I was on the nursing track. After the birth of my second in 2005 I looked at different distance education options including Midwifery College of Utah and National College of Midwifery. My midwife for my second offered to be my preceptor if I went with a school she was familiar with. I also looked into finishing my nursing degree and then doing my CNM through Frontier School of Midwifery which would be relatively easy since I already had a Bachelors of Science Degree. In the end we moved away and I resolved myself not to do midwifery or other birth work. We moved to an area that had no CNM's or licensed midwives that did home births. I was very grossly misinformed regarding the education it took to become a traditional midwife and thought I would never want to train with any of the midwives locally.

I took a little over a year off. Few people even knew I had ever been involved with birth work and it was a much needed break. After the difficult birth of my third I knew that in order to be sure that quality midwifery care was offered in the area I would need to help by providing it myself so my midwifery journey began. I attended a few births of mutual friends with a local midwife I had been friends with for a few years. We hit it off and before I knew it I had transitioned from assistant to apprentice.

I still struggled about whether or not I needed a more traditional school. In the end it came down to a few things. 1- I had already done the traditional college route and done it well graduating with and A- average and learned and retained very little compared to the amount of time spent. 2- Money. We already have so much student loan debt for my husbands law degree that the thought of spending more money on my school for a career that wasn't a huge money maker just wasn't possible for my family. 3- I wanted to be able to tailor what I learned and avoid the busy work. I eventually developed my own curriculum and study system and passed the NARM exam on the first time with flying colors.

It took me a little over 3 1/2 years to complete all of the things needed to sit for the NARM (I had more than enough numbers and experience a year earlier but I had some documentation problems) and then an additional 6 months of waiting for the next exam. For those years of my life I spent time studying individually, studying and discussing with my preceptor, teaching childbirth classes, attending doula births, attending prenatals, births, and postpartum visits, doing skills classes, attending workshops, and forming and attending a local and several online study groups. 

In the end the time spent in my apprenticeship ended up looking something like this:

Time spent studying individually, reading, writing protocols etc.
8 hrs a week x 208 weeks =1664 hours

Time spent doing prenatals and postpartum visits
6 hrs a week x 208 = 1248 hours

Time spent in skills class (suturing practice, exams, etc.)
5 hrs a month x 48 months = 240 hours

Discussion, review and study with my preceptor
2 hrs a week x 208 = 416 hours

Birth attendance
2 births a month at an average of 8 hours per birth x 48 months = 768 hours

Additional workshops
24 hours total

Study Groups
2 hours a week x 52 weeks x 48 months = 416 hours

Childbirth classes and doula births
3 series a year at 18 hours per series plus another 20 hours a year doing doula births x 4 years =296

Total: 5072 hours of study and instruction

Approximate cost for books, workshops, gas, food, childcare and supplies $12,000

NARM the national midwifery association that provides the test for your Certified Professional Midwife required a minimum of 1350 hours.

Community School of Midwifery

Midwifery School

I went through quite the ordeal in order for me to sit for the national NARM exam and finally receive my Certified Professional Midwife credential. I did self study and had much hands on support from my preceptors but little help with book learning. I vowed to do everything I could to make it easier for all my midwifery sisters who came after me. I was asked to join this amazing midwifery school and assist them as the Academic Dean. I am both humbled and excited by the opportunity. The school provided weekly in person education for midwifery students at several Utah locations. 

Please visit http://www.thecommunitymidwife.com/ for more details.

Erik Erikson’s Stages of Development and Dy’s Midwifery Stages of Development

This is a re-post of an old midwifery student blog I used to write for. Not that I have progressed through a few of these stages I thought I would share it again for all of my midwifery students and interested clients.   So this wild road we call midwifery education has gotten me thinking a lot about my more traditional education. I studied psychology for my undergraduate degree and I must say that it transfers very nicely into midwifery. One memory that kept coming to mind was Erikson’s Stages of Personal Development and I couldn’t help but see how similar they were to my personal midwifery journey. For those who are not familiar with Erickson here is a quick run down thanks to about.com and copy and paste so I don’t have to write it all out in my own words.  One of the main elements of Erikson’s psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experience and information we acquire in our daily interactions with others. In addition to ego identity, Erikson also believed that a sense of competence also motivates behaviors and actions. Each stage in Erikson’s theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which he sometimes referred to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a sense of inadequacy. In each stage, Erikson believed people experience a conflict that serves as a turning point in development. In Erikson’s view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.
Erickson’s Psychosocial Stages of Development	Dy’s Midwifery Stages of Development
Psychosocial Stage 1 – Trust vs. Mistrust The first stage of Erikson’s theory of psychosocial development occurs between birth and one year of age and is the most fundamental stage in life. Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child’s caregivers. If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable.	Midwifery Stage- Birth Normal vs. Not normal ·         The first stage of midwifery (for most) is giving birth themselves. These are formative times helping establish what we believe to be true about birth. ·         An expectant woman is dependant upon her resources and those whose influential sphere she is under. ·         If a woman successfully develops a belief in normal birth she will feel secure that our bodies perform the way they were intended and require little outside intervention. ·        Failure to develop a belief in normal birth leaves a woman feeling untrusting of her natural instincts both as a woman and as a mother.
Psychosocial Stage 2 – Autonomy vs. Shame and Doubt The second stage of Erikson's theory of psychosocial development takes place during early childhood and is focused on children developing a greater sense of personal control. Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was quite different then that of Freud's. Erikson believe that learning to control one’s body functions leads to a feeling of control and a sense of independence. Other important events include gaining more control over food choices, toy preferences, and clothing selection. Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt.	Midwifery Stage 2- Activist vs. Conformer ·         The second stage takes place shortly after the woman has a positive or negative birth experience and is focused on assimilating the information she has learned into action. ·         She learns to share what she has learned with others in a positive way that is well received. She may become a doula or childbirth educator. ·         She will likely struggle with the poor birth outcomes she sees around her and get pickier about what she feels is ok and acceptable. ·         Midwives who successfully complete this stage are left determined to improve the maternity situation around them. ·         Those who do not successfully complete this stage conform to what is considered normal for birth in the mainstream while being irritated at it at the same time.
Psychosocial Stage 3 – Initiative vs. Guilt During the preschool years, children begin to assert their power and control over the world through directing play and other social interaction. Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of initiative.3	Midwifery Stage 3- Student Midwife vs. Birth Observer ·         During this stage young midwives begin to get their feet wet. They often find a preceptor to work with and start attending births. ·         Those who are successful with this stage combine reading and researching with the births they are attending to start developing a knowledge base of midwifery. ·         Those who are not successful may choose a different lifestyle or choose to remain on the sidelines as a birth observer and activist.
Psychosocial Stage 4 – Industry vs. Inferiority This stage covers the early school years from approximately age 5 to 11. Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities. Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their ability to be successful.	Midwifery Stage 4-  Active Participant vs. Midwifes Grunt ·         The woman starts to begin feeling “itchy to get her hands dirty.” ·         She starts to interact with the primary midwife in a different way. Intuitively or habitually knowing what needs to be done next. Her abilities increase. ·         Those who succeed often have been encouraged and commended by couples and preceptors to develop feelings of competence and belief in their skills. They are actively urged to keep learning and working. ·         Those who don’t succeed receive little or no encouragement and may continually be lead to believe they will always be lesser and never know enough.
Psychosocial Stage 5 – Identity vs. Confusion During adolescence, children are exploring their independence and developing a sense of self. Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will be insecure and confused about themselves and the future.	Midwifery Stage 5-   Primary Under Supervision Midwife vs. Eternal Midwifery Student ·         This stage is the “teenage phase” of midwifery. ·         The student knows just enough to be potentially dangerous but too much just to sit on the sidelines. ·         Her sense of accomplishment has major mountains and valleys as you strive to develop her own midwife personality while still practicing under her preceptor. ·         The student’s relationship with her preceptor is of utmost importance at this point to ensure that she has been given adequate instruction combined with enough freedom to learn and develop a sense of independence. ·         Those who remain unsure and unsupported will be insecure and confused about them selves and their future and are often afraid to take the plunge into being a primary midwife..
Psychosocial Stage 6 – Intimacy vs. Isolation This stage covers the period of early adulthood when people are exploring personal relationships. Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will develop relationships that are committed and secure. Remember that each step builds on skills learned in previous steps. Erikson believed that a strong sense of personal identity was important to developing intimate relationships. Studies have demonstrated that those with a poor sense of self tend to have less committed relationships and are more likely to suffer emotional isolation, loneliness, and depression.	Midwifery Stage 6-  Primary midwife vs. Midwifery Wanna Be ·         This stage is when a Midwife flies or falls. The number of new midwives that are practicing after 3 years is dramatically reduced. ·         It is important for a Midwife to develop relationships that support and uphold her. Positive relationships with her midwifery peers and other birth professionals can help her sink or swim. ·         Developing appropriate boundaries and relationships with clients can keep a midwife from burning out. ·         Midwifes who are overly confident of their abilities, untrained, insecure, and without sufficient support may find themselves in poor situations often leaning to midwifery getting a bad rap and the midwife not being in business for long.
Psychosocial Stage 7 – Generativity vs. Stagnation During adulthood, we continue to build our lives, focusing on our career and family. Those who are successful during this phase will feel that they are contributing to the world by being active in their home and community. Those who fail to attain this skill will feel unproductive and uninvolved in the world.	Midwifery Stage 7- Preceptor vs. Secret Holder ·         A Midwife’s decision to share her gifts and knowledge with other sisters in birth is one of true selflessness. ·         Many midwives fear that by training young midwives that they will overpopulate their community affecting their business. They worry their secrets will be shared with those they don’t trust. ·         Those who are successful during this stage eagerly take young midwives to be under their instruction and help them develop and mature ready to help support normal birth around them. ·         Those who are unsuccessful hoard their knowledge worrying only about themselves and the bottom line denying themselves the gift of growth and learning they would encounter while helping train another.
Psychosocial Stage 8 –  Integrity vs. Despair This phase occurs during old age and is focused on reflecting back on life. Those who are unsuccessful during this phase will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair. Those who feel proud of their accomplishments will feel a sense of integrity. Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death.	Midwifery Stage 8-  Granny Midwife vs. Bitter Birth Professional ·         Many “Granny Midwives” are wise women until the day the pass on whether they are still attending births or not. ·         Those who are successful see their life for the good they helped bring out in others and the positive changes that were made. All the while still being humble and remembering that there is always more to learn. ·         Those who are unsuccessful are bitter about what they gave up to work in midwifery and are left feeling unfulfilled and unsupported at the end.