Our midwifery study and training program consists of a three part formula incorporating antepartum, intrapartum, postpartum, newborn and reproductive health care, plus beginning, intermediate, and advanced practica.
1) Heart & Hands Course Work
Completion of thirteen modules (beginning and advanced levels) requires approximately 810 hours of study;
2) Study Group Course Work
Completion of fifty-two modules requires approximately 1080 hours of study; and
3) Preceptor-Supervised Apprenticeship
Completion of clinical experience meeting the requirements of North American Registry of Midwives’ Certified Professional Midwife (NARM CPM) credential and California Midwifery Practice Act.
Part 1: Heart & Hands Course Work
Heart & Hands Midwifery Intensives have long been the starting point of instruction for aspiring midwives in the San Francisco Bay Area. As students in other areas began to express interest in the class, Heart & Hands was adapted to a modular course work format so that students could have access to this material regardless of their location.
Heart & Hands Course Work provides an integrated overview of core knowledge and skills for midwifery practice and thus lays the foundation for the rest of the NMI program. Thirteen modules (ten beginning and three advanced; see below for details) incorporate didactic material and many activities for hands-on learning. Course materials are designed to accommodate students at various levels of sophistication. Beginners are always welcome!
Heart & Hands Course Content includes:
"Personally, I loved the essay questions because they challenged me to express my own ideas and opinions on case studies. This practice in critical thinking really helped prepare me for real life midwifery situations."
~ a Heart & Hands student
History and Politics of Midwifery
Prenatal Care and Complications
Counseling and Communication Skills
Sexuality in the Childbearing Cycle
The Role of Intuition in Caregiving
Facilitating Labor and Assisting Delivery
Labor Complications and Transport
Perineal Assessment and Repair
Newborn Complications and Neonatal Testing
Postpartum Care, Breastfeeding, and Maternal Adjustment
Reproductive Health Care Throughout the Lifecycle
Case Histories: Prenatal, Intrapartum, Postpartum
Collaborative Care and Informed Choice
Venipuncture and Lab Work
Homeopathy and Herbs in Pregnancy and Birth
Heart & Hands Course Work is available to students prior to (and regardless of) enrollment in NMI, in keeping with our belief that detailed information on birth, lifelong reproductive health care and midwifery should be available to anyone interested in exploring these areas.
Click below to view a sample Course Work module:
More About Heart & Hands Course Work
Heart & Hands Midwifery Intensives were originally founded by Elizabeth Davis in 1982. The class was developed at the request of a group of birth assistants seeking to acquire practical midwifery skills. Over the years and by demand, the class evolved to include basic introductory information and emphasis on the intuitive, interpersonal skills essential to effective midwifery care.
While Heart & Hands Course Work is part of the curriculum of National Midwifery Institute, Inc., Heart & Hands Midwifery Intensives class remains freestanding and avocational. Intensives students wishing to enroll in NMI should consult with the instructor regarding any additional requirements for Heart & Hands Course Work completion. To learn more about Heart & Hands Intensives, visit the website at elizabethdavis.com.
"I loved Heart and Hands. It’s why I chose NMI as a school. I learned a lot from Elizabeth Davis and thought it was a very good midwifery primer. What an excellent teacher. There were some moments in that class that I’ll never forget." ~ an NMI student
Part 2: Study Group Course Work
As a follow-up to Heart & Hands Course Work, Study Group Course Work is intended to help students integrate didactic learning with clinical experiences in apprenticeship.
Study Group Course Work is comprised of fifty-two modules, each module demanding focus on a particular topic and its context.
Completion of modules requires approximately 1080 hours of study. When Study Group Course Work is completed during apprenticeship, many students spread their work over twelve or more months. With a focus on integration of clinical and didactic knowledge, students set their own pace while meeting NMI's minimum academic progress requirements. At your initiation into NMI Study Group Coursework, you will be asked to complete a set of ten foundational modules to set a ground work for your transition into apprenticeship and more advanced modules.
After you have completed your foundational modules, the remaining modules can be completed in any order but we recommend you ask your preceptor or the Study Group Instructor for advice on the next best module to complete. Simply select the next module you want to work on, and proceed. Modules are designed to be stand-alone topics that together complete a comprehensive picture of midwifery care. Allowing the bulk of module submission in any order is meant to enhance relevance of student learning, and have students complete modules as needed throughout their clinical education.
There are three final modules about the set-up and practicalities of midwifery practice. These are to be completed just before graduation from the program.
"The modules encourage problem solving and differential diagnosis. After completing the course work I felt confident and well prepared for the NARM exam."
~ an NMI graduate
The modules are designed to stimulate the self-motivation and passion for learning that are the hallmarks of the midwifery profession.
While Study Group modules are well suited to independent study, students have the unique opportunity to organize facilitated discussions in their own communities or join the online study group facilitated by NMI. Following the experience of Study Group in the San Francisco Bay Area, practical written guidelines are provided for organizing local Study Group sessions with midwife facilitation. These student-driven meetings may be reminiscent of a one-room schoolhouse with students representing diverse levels of experience and expertise. Additional support is always available by phone, text, and email.
Sample Study Group Module Topics
Physical, Sexual and Other Abuse
OP, Brow & Face Presentations
Newborn Apnea, Hypoxia, Respiratory Distress
Renal and Urinary Tract Infection
Nutrition and Digestion
Stillbirth and Miscarriage
Post Dates & Post Maturity
Lab Work & Other Clinical Assessment
Postpartum Mood Disorders
Substance Use and Abuse
Pelvic Health Birth Lacerations and Suturing
Consult, Transport & Transfer of Care
Cesarean and VBAC
Charting & Practice Guidelines
Anti-Racism in Midwifery
Liver and Jaundice
Gender and Sexuality
Fertility and Conception
Fetal Heart Rate Patterns
Embryology & Fetal Development
Grief and Self Care
Genetic & Prenatal Screening
Pharmacology for Midwives
Click below to view sample Study Group Course Work modules, updated edition*:
Sample SG Module 1: Third Stage
Virtual Online Group
Once a week, students have the opportunity to join and instructor and other students for a 1.5 hour online meeting. All students are welcome no matter where they are in the program or apprenticeship. During the meeting with discuss a midwifery topic, share resources, discuss apprenticeship and other student issues. This meeting is not mandatory but it is a great way to stay connected to the student community.
More About Study Group Course Work
Study Group was initiated by Shannon Anton in 1994, in response to apprentice midwives in the San Francisco Bay Area who expressed a need for a midwife-facilitated group learning process.
Students who attended the first eighteen months of Study Group virtually defined the curriculum. Focus remained on the context of experiential learning, which moved the group from topic to topic. Study Group Course Work modules were created using the living outline that this evolving group made manifest.
Part Three: Preceptor-Supervised Apprenticeship
Knowledge and skills gained in the didactic/course work portion of the program prepare students for active participation at the onset of the apprenticeship experience. Students are responsible for selecting and securing their preceptorship. They may interview with potential preceptors at any time, and may choose to work with any midwife meeting the criteria for precepting faculty. While NMI preceptors do not need to apply or register as NARM Precepting Faculty, they must complete the NMI Preceptor application process and must meet the following minimum qualifications:
Must be credentialed as a Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), Certified Midwife (CM), or Obstetrician/Gynecologist (OB/GYN).
Must be a licensed practitioner legally recognized by a state/jurisdiction to provide maternity care.
Must have an additional three years of experience after credentialing or fifty primary/co-primary births beyond entry-level CPM requirements.
Must have ten continuity of care births beyond entry-level CPM requirements.
Must have attended a minimum of ten out-of-hospital births in the last three years.
As precepting midwives observe and document increasing skill in their apprentices, they are expected to respond by making additional responsibilities and practice opportunities available. Through a joint process of preceptor and self-evaluation, students document their accomplishments and progress at their own pace towards meeting NMI program objectives and mastering MANA core competencies.
“This course was one of birthing myself as a midwife... I remind myself that I am in the early stages of labor, and I must be patient and sensitive to tune in to the pace at which this birthing wants to happen.”
~ an NMI Student
The Apprenticeship Experience
Apprenticeships are generally based in homebirth or birth center practices. Students can also expect to attend hospital births in the event of transport, which gives them opportunity to learn about and observe obstetrical standards of practice. Students are required to attend a minimum of 2 planned hospital births, either as an observer, student assistant under preceptor supervision, or student primary midwife under preceptor supervision. These planned hospital births are not transports, but may follow a prenatal transfer of care. Additionally, during the course of training within a preceptor’s practice, students will likely have opportunity to consult with other health care providers if complications develop in caregiving or questions arise concerning a client's health status. Students may also have opportunity to accompany their precepting midwife to peer review sessions, and so may confer with other midwives in the community on practical and professional issues.
While apprenticeship can be completed in two years, three to four years is more common. As an apprentice, students are usually on call 24/7 and expected to attend all exams and births for every client in their preceptor's practice. Students occasionally do apprentice in practices with multiple preceptors and apprentices that allow on- and off-call hours, but this is less common.
Minimum Timeline Requirements
While students are not required to enter the program having already secured an apprenticeship, NMI maintains a minimum timeline for clinical experience requirements:
Within 36 months of initial enrollment: student must secure an apprenticeship.
Within 42 months of initial enrollment: student must begin filing documentation of non-primary experience.
Within 60 months of initial enrollment: student must begin filing documentation of student-primary care under preceptor supervision.
Clinical Requirements for Graduation
Current clinical requirements for graduation from National Midwifery Institute’s Certificate Program are published in the NMI Handbook.
Functioning in any role (observer, doula, family member, friend, beginning apprentice):
10 Observe Births
Functioning in the role of student-assistant midwife under preceptor-supervision:
20 Assist Births
22 Assist Prenatal exams
3 Assist Initial exams
20 Assist Newborn exams
10 Assist Postpartum exams
Functioning in the role of student-primary midwife under preceptor-supervision:
25 Births attended
75 Prenatal exams
20 Initial exams
20 Newborn exams
40 Postpartum exams within the first five days of birth
40 Postpartum exams/family planning/gyn visits
Of the 25 required Student-Primary under Preceptor-Supervision births, 10 must be with clients for whom the apprentice provided Continuity of Care, with at least:
1 prenatal exam in a student-primary or student-assisting role; and birth.
Of the 25 required Student-Primary under Preceptor-Supervision births, an additional 5 must be with clients for whom the apprentice provided Full Continuity of Care, with at least:
5 prenatal visits spanning two trimesters;
1 newborn exam performed within 12 hours of the birth, and;
2 postpartum exams occurring between 24 hours and 6 weeks following the birth.
Other Experience Details:
All Student-Assist prenatal exams, newborn exams, and postpartum exams must be completed before beginning the same categories of clinicals as student-primary midwife under preceptor supervision.
18 Student-Assist births must be completed before beginning Student-Primary under Preceptor-Supervision births, or more at the discretion of the supervising preceptor.
A minimum of 5 home births must be attended in any role.
A minimum of 2 planned hospital births must be attended in any role.
Transports to the hospital from an out-of-hospital setting are limited to 3 out of the 25 Student-Primary under Preceptor-Supervision births: the first 20 Student-Primary under Preceptor-Supervision births may include 2 transports, and the remaining 5 Student-Primary under Preceptor-Supervision births may include 1 transport.
10 out-of-hospital Student-Primary under Preceptor-Supervision births must occur within the last 3 years.
All required minimum clinical experience must occur within the last 10 years.
A minimum of 10 of the 25 Student-Primary Under Preceptor-Supervision births must be attended in the US or Canada and must occur in out-of-hospital settings.
NARM requires that the clinical component of a student’s midwifery education must be at least two years in duration. California Midwifery Practice Act requires for licensure: a program that is 84 semester units in length, with half of the program consisting of clinical practice (84 semester units equates to 3780 total contact hours, with half being 1890 clinical contact hours.) NMI requires a minimum student enrollment period of twelve months, provided that the student meets the NARM two-year clinical timeframe stated above.
These clinical experiences are sufficient to meet NARM certification standards for entry-level midwifery practice, California licensing requirements as well as the licensing requirements of many states.
At this time, NMI is not accepting new out-of-country clinical placements (with exceptions - see below). United States residents interested in obtaining clinical training abroad may choose to do so, but the clinical experiences that they attend while abroad will not count toward NMI's clinical experience requirements for student-assistant under preceptor supervision or student-primary under preceptor supervision phases of clinical training. Students applying with advanced placement or transfer students with clinical experience obtained prior to enrollment who do not meet the exceptions below may be able to count out-of-country clinical experiences that they obtained with qualified preceptors prior to January 1, 2015.
Clinical experiences obtained in Canada and/or the United Kingdom may be able to be counted toward NMI's clinical experience requirements for graduation.
Applicants who are native or naturalized citizens of countries not listed here, and who secure preceptorships with midwives who are also native or naturalized citizens and are credentialed and legally practicing, may be able to document clinical experiences that will count toward NMI's clinical experience requirements for graduation.
Contact NMI to discuss your unique situation.
Included are samples of NMI's clinical experience documentation forms and evaluation forms, for both student-assistant under preceptor supervision and student-primary under preceptor supervision phases of apprenticeship training. Enrolled students have access to current forms in the Student Portal.
Experience Documentation Forms
Sample Student Assistant Under Supervision Individual Client form - One for each client; filed during each quarter of active apprenticeship
Sample Student Primary Under Supervision Individual Client form - One for each client; filed during each quarter of active apprenticeship
Sample Assistant Under Supervision Preceptor Evaluation of Student form - Completed after every 3 months of student-assistant under preceptor supervision training
Sample Student Self-Assessment for Assist Births form - Completed after every 3 months of student-assistant under preceptor supervision training
Sample Student Evaluation of Preceptor form - During student-assistant training, completed after every 3 months of student-assistant under preceptor supervision training; during student-primary training, completed after every 5 births as student-primary under preceptor supervision
Sample Form 52: Assessment of Student's Midwifery Skills - Completed after every 5 births as student-primary midwife under preceptor supervision
Academic Honesty Policy
Honesty is a core value within National Midwifery Institute. The members of its community both require and expect one another to act with civility, personal integrity, and respect for one another’s dignity, rights, and intellectual property. This requires participation from all members of the NMI community to help create and maintain an environment in which all can succeed through the fruits of their own efforts. An environment of academic integrity is requisite to respect for self and others. NMI requires that each member of the NMI community adhere to the following principles and rules and pursue academic work in a truthful and straightforward manner, free from deception or fraud.
In order to complete their enrollment at NMI, students sign an Academic Integrity Agreement. [internal note: As of August 31, 2018, the Academic Integrity Agreement will have been distributed to all current NMI students: Current students are required to return their completed version to NMI no later than December 31, 2018. As of August 31, 2018, all applicants are required to sign the Academic Integrity Agreement in order to complete enrollment in our program. The Academic Integrity Agreement includes a commitment not to engage in or tolerate acts of falsification, misrepresentation, or deception. Below is a list of specific actions that NMI considers academic dishonesty, as well as our procedure for addressing violations.
Definitions of Academic Dishonesty
Cheating: Cheating is defined as fraud, deceit, or dishonesty in an academic assignment, or using or attempting to use materials, or assisting others in using materials that are prohibited or inappropriate in the context of the academic assignment in question, such as:
Copying or attempting to copy from others during an exam or on an assignment.
Communicating answers with another person during an exam.
Preprogramming a calculator, cell phone, pager, PDA or other electronic device to contain answers or other unauthorized information for exams.
Using unauthorized materials, prepared answers, written notes, or concealed information during an exam.
Allowing others to do an assignment or portion of an assignment, including the use of a commercial term-paper service.
Submission of the same assignment for more than one course without prior approval of all Instructors involved.
Collaborating on an exam or assignment with any other person without prior approval from the instructor.
Taking an exam for another person or having someone take an exam for them.
Using resources on an exercise that was intended by the Instructor to be completed without resources.
Plagiarism: Plagiarism is defined as use of intellectual material produced by another person without acknowledging its source, for example:
Wholesale copying of passages from works of others into modular course work without acknowledgement.
Use of the views, opinions, or insights of another without acknowledgment (i.e using sources without citation or attribution).
Working with another individual on an assignment, sharing information and files, and then turning in separate identical copies of that assignment as one’s own individual work.
False Information and Representation, Fabrication or Alteration of Information:
Furnishing false information/representation in the context of an academic assignment.
Fabricating or altering information or data (such as clinical experiences) and presenting it as legitimate.
Providing false or misleading information to an Instructor or any other NMI official or staff person.
Academic Misconduct: Other academically dishonest acts, including but not limited to:
Allowing another student to use their work and claim it as their own.
Tampering with the work of another student.
Facilitating other students’ acts of academic dishonesty.
Attempting to falsify an excuse in order to receive an extension on a deadline.
It is the responsibility of all students, faculty, and staff to report any violations of NMI’s Academic Integrity Policy to a Course Work Instructor or to one of the the Program’s Educational Directors.