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. The modules may be approached in any order the student finds appropriate, and may reflect current issues in apprenticeship.
"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. 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 available by phone, text, and email.
Sample Study Group Module Topics
- Life Science
- Postpartum Care
- Physical and Sexual Abuse
- OP, Brow & Face Presentations
- Newborn Apnea, Hypoxia, Respiratory Distress
- Urinary Tract Infection
- Ruptured Membranes
- Stillbirth and Miscarriage
- Post Dates & Post Maturity
- Prenatal Lab Work & Assessment
- Postpartum Depression
- Preterm Labor
- Renal System
- Second Stage
- Shoulder Dystocia
- Substance Abuse
- Third Stage
- Breech and Twins
- Cesarean and VBAC
- Charting & Practice Guidelines
- Diversity Awareness
- Ectopic Pregnancy
- Female Sexuality
- Fertility and Conception
- Fetal Heart Rate Patterns
- Embryology & Fetal Development
- Fetal/Newborn Circulation
- First Stage
- Gestational Diabetes
- Genetic & Prenatal Screening
- Pharmacology for Midwives
- Homeopathic Remedies
- Physical Assessment
Click below to view sample Study Group Course Work modules, 2009 edition*:
Click below to view sample Study Group Course Work modules, updated edition*:
*NOTE: NMI is currently completing a major Study Group Course Work revision project, but all revised modules have not yet been completed and posted. Until all 52 newly revised modules are posted, students may continue to complete and submit older versions of NMI Study Group modules if the new version of the particular module is not yet available. However, if the new version is available students must complete and submit the revised module.
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.
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