Direct Entry Midwifery Programs...

Selke · Sep 17, 2006

Hi...I am in a Master's Entry Program in the midwest, but I am thinking of transfering out of the area for my specialty coursework. I will get my RN in May, and I am considering starting a different program next summer or fall. I am wondering if anyone has any thoughts on the midwifery programs at UCSF, Penn and/or Yale (or others!)? I would like to attend a great school with supportive faculty/mentors, and one that embraces the philosophy of midwifery. I am also interested in a program that offers students out of hospital birthing experiences. If you have any ideas about midwifery programs, please let me know! thanks!!

Why are you thinking of transferring? Are you at UIC? They have a great program (if I had any sense I would have accepted their admissions offer a year ago ....) What does your program not have that you want in a program?

Yale's midwifery program isn't supportive of nurses at all, and the GEPNs are very cliquey if you did not go through the program from the first. They are a dedicated GEPN program, with their financial aid going primarily to GEPNs, not RNs. They did have a homebirth clinical elective, but this was cancelled last year, amidst much student protest. They do place a few students in birth centers for integration.

Penn does have a few clinicals in birthing centers. Some of the other schools I spoke with have connections with various birth centers, midwives serving the Amish community, &c. I suggest you start calling schools and speak with the program directors about it.

You can usually arrange to have a clinical experience at least in a birthing center, if not in a homebirth practice, no matter which school you go to -- but I think each school has different insurance issues which may prohibit, say, students at homebirth (this is sort of what happened at Yale -- I think the higher-ups didn't want their endowment vulnerable to a malpractice lawsuit. Talk about deep pockets). Some schools, like Frontier, have relationships with birth centers and homebirth practices all over the country, many run by alum, and they are more likely to take FNS students (Frontier has probably the best networking system of any school I've heard of.)

In fact the entire midwifery philosophy of FNS emphasizes out of hospital birth. For one example, to graduate, we have to write a business plan and community and needs assessment to start our own birth center practice. Because of this, FNS grads have a solid real world foundation in understanding and negotiating contracts, third party payors, state laws, fair reimbursement for midwifery services rendered, &c -- most CNM programs do not adequately cover this. Out of hospital birth isn't just all woo-woo crunchy granola -- if you do this for a living you will not be an employee of a healthcare corporation but are likely be the proprietor of the business, or the associate of the proprietor, and ypu better well be able to understand how the business works from the inside out.

You can also schmooze and network on midwifery listservs (there are several) -- introduce yourself, put out your request -- to find the out of hospital practices that take students, either informally (say, during your summer break), or formally for credit. (This is how to find a job after graduation, too. CNMs post their open positions on these listsevs ... forget the ACNM job board ....) If you are able to relocate and pay your expenses this may be an option. I got several offers for not only birth center and homebirth clinical experiences, but for integration when I put the word out earlier this year on a couple of listservs -- the midwives who contacted me said I was the kind of student they'd love to have. For example, recently a CNM with a homebirth practice advertised that she wanted to find a dedicated SNM who wanted to do integration with her and even become a practice partner. They're out there, but you have to do detective work, then hope your school will approve the arrangements. (Again, much easier with a distance program.)

There are a couple of birth centers in El Paso that take students, who pay a fee for however many weeks or months they want to stay. They take students year-round.

Good luck with your search. I think more and more midwifery students do want out of hospital experiences -- schools will have to accomodate this eventually, I hope!

LAW79 · Sep 17, 2006

Thanks, Anon, for the great reply! Yes, I am at UIC, and while it does have a very good reputation, I have learned that it might not be the right fit for me. It seems to be very medicalized, partly due to the AMA which is headquartered in Illinois. Free-standing birth centers are not allowed in Illinois, nor can homebirth midwives get malpractice here. There are some midwives who go bare and deliver anyway, but my school doesn't offer clinical placements outside of the hospital. I have talked to them about it, and they say I can leave the state to do it but it will have to be an additional semester, rather than part of the program. The more time I spend in the hospital, the more I realize it is a less than ideal place to give birth. I started to wonder how not having those outside experiences will shape me as a midwife, and I think that they will. My master's portion will be 3 years because they require me to work FT as a L&D nurse (which is not thrilling to me), and I can only imagine how frustrating those three years could be. I am not from Chicago, and I do not plan to stay here and practice, so I thought now would be an ideal time to think about making a switch. I am just in the research stage, so I may find that other schools are about the same as UIC, but I want to make sure I am making the best decision.

Where are you studying? Thanks for your thoughts on Yale. I originally applied there but I turned down their offer of admission because it was more than I could afford, but I liked the program. It is good to know that I might not be incorporated in the mainstream, because I am looking for a supportive group to spend the next couple of years with. I saw that Penn offered some alternative birthing opportunities, and I am just wondering if there are any students that have personal thoughts on it. What do you think of Frontier? At first I was a bit turned off by the whole distance thing, but it sounds like a wonderful program that could be tailored to my interests. I have this idealistic idea that spending the next couple of years with the right group who shares the same philosophy of midwifery will help me to go further in my career.

Thanks for all your great advice, I will be sure to look into some of those alternative birthing opportunities!

Selke · Sep 18, 2006

I'm not surprised in the least at what you said about the clinical placements at UIC ... it's true birth centers are illegal in IL, sadly, although there are homebirth practices. Last spring I met a UIC student who worked for one and did homebirths for them, but it was NOT a part of the clinicals and she could not count those births towards graduation requirements. I've wondered how medically oriented UIC is. When I worked in Chicago I never met a midwife who did things, for example, like labor support, hypnobirthing, optimal fetal positioning, the kinds of things I've experienced since leaving the state. Intermittent fetal monitoring just was never permitted. Granted, to be fair, I worked in highly medicalized teaching hospitals which might have influenced the few CNMs they did employ to be "medwives" .... so my experience, from over 10 years ago, hopefully does not reflect the range of midwifery practised there now. I have no idea how "midwifey" the UIC faculty are or what they teach students.

I suggest you find all the advanced UIC students you can and poll them about their clinical experiences. Chicago is a big place with lots of CNMs now and I'd think you could find CNMs who can teach you what you want to learn, albeit in a hospital environment. You don't want to work FT as an L&D RN while finishing school, but perhaps they have that requirement to try to compensate for some of the weaknesses DE students can have (and which are debated ad nauseum here, so I'm not going there).

I know medicalized hospital birth can be a real drag, and you want to offer women something more glorious and memorable, but bear in mind that there are many skills to learn there which will be indispensible if you do out of hospital births. For example, as much as I still hate EFM after all these years (and I just got ANCC certified in reading the damn things), you need to see hundreds of strips, listen to hundreds of FHR patterns, experience many many types of labors, how women respond to labor, how their mental state hinders labor or lets the baby out, in order to put the picture together. That way, when you are using a doppler out of hospital, and palpating a belly, you will know EXACTLY what you are listening for and will instinctively react. You will be able to instinctively put together the Whole Picture of labor and get over initial panic at being in situations that go bad fast, or just happen fast. You'll know how to get an IV in stat, how to recognize things like PIH, PTL, &c &c &c, and how to intervene. You will also start to realize that there are situations where interventions are necessary, and will thank the goddess that they are there to save a baby and mom's life. BUT you will also start to discern when they are unneccessary ... this is a very important difference. You'll "get" epidurals, why some women really do need them, the different players in the health care system -- face it, even with out of hospital births you will transfer some ladies in and it's good to be able to schmooze well with potentially hostile caregivers. Sadly, you'll see how so many American women do want epidurals, inductions, c-sections -- how would you care for them as a CNM who doesn't want to intervene? It's frustrating ....

Maybe you could look up the American Association of Birth Centers and see if they have a listing of their members. Find out which ones take students. Connecticut had many BCs and they took FNS students as well as Yale. Do google searches for what you want. Contact ACNM chapters with your questions. There are hospitals out there that are very "midwifey" if you know where they are. Some posters here at allnurses.com work at them -- like one of the moderators seems to work at such a place. Call midwifery programs and talk to their directors about types of clinical placements. Find midwives who serve groups such as the Amish and ask if they take students.

Which state are you from? Have you investigated resources there?

Seems like SNMs have to be very proactive these days about getting what they want out of school. It takes lots of investigative work, phone calls, and emails. Makes me tireder thinking about it.

I apologize for this being so long. Just don't think hospital experience will be a waste or simply teach you bad things ... there's plenty of positives in it to take with you when you do OOH births. Face it, hospital birth isn't going to go away .... pretend you're an anthropologist doing participant observation while working in one and learn what you can about this alternate universe ....

cherrymary · Sep 18, 2006

Hello LAW79, have you looked at the U of Washington at all? I visited there and it was definitely my first choice for midwifery - they have incredible clinicals in just about every type of practice you can imagine all over the state and the region - rural, urban, private practice, migrant farmworker clinics, etc. The Northwest is just naturally a very midwife-friendly place, and the UW Medical Center has the same high standards of teaching that you could hope to find anywhere. The nursing school was ranked number 1 by US News and World Report, and they receive one of the highest amounts of research funding from the NIH. They have a small midwifery faculty, but the students I talked to loved being able to practice so many styles of midwifery in clinicals.

I know I sound as if I work for them, but I was just very impressed by the program!! I'm applying to Yale first, but if I don't get in I'm definitely trying there next year.

LAW79 · Sep 20, 2006

Many thanks, Anon Nurse, for your great suggestions. I think that getting a great education in midwifery can take a lot of investigation! Thankfully most people in the field have been super supportive and have helped me develop some direction. I like your thoughts on working in the hospital, and I think that working in a family-friendly hospital might be the perfect compromise. I need to do some more investigation to find those places. So are you at Frontier? How do you like it?

Cherrymary, thanks for your suggestions abour UW. I have heard lots of good things about the state (generally I find the west is more progressive and midwife-friendly). I like the idea of a diverse range of clinical experience...and it is good to know that students are really enjoying their experiences. I will look into it, thanks! What made you decide to apply to Yale first?

Selke · Sep 20, 2006

cherrymary is right about UW and west coast schools. They are the best and midwifery is at its best on the west coast, but its difficult to get into those schools. I had called UW once and was told they only admit 8 students, and reserve most of those spots for Washington state residents, so I didn't even bother applying.

A poster in one of these threads (can't remember who) who is attending Frontier said she is doing her clinicals at the same places UW students are doing theirs and loves it.

So there are ways to get what you want; you may have to go through the back door, so to speak, and work harder to get it.

cherrymary · Sep 23, 2006

Well, it's a silly reason, but essentially because Yale has fewer prerequisites! If I were to apply to UW, I would have to spend a whole extra year taking science classes at a community college, because you have to have taken most of them by the time you apply (the deadline is in October).

I really like Yale, though - the international programs look amazing, I know quite a few midwives who have gone there and loved it, it's closer to home, etc.

But if I don't make it, UW (and OHSU in Portland) are next!!!

All the best of luck,

cherry

lovingpecola · Sep 26, 2006

I am in the Yale midwifery program, and I just wanted to say ask a few more people before you make your decision. It definitely isn't for everybody, but it did turn out to be right for me. And, I would say that it is right for far more people than it is wrong.

You should visit the school, talk to RN-entry students one on one, sit in on a class, talk to faculty, etc. You should also do this for any other program you are strongly considering. You pay waaay to much in *any* program to not like it!

LAW79 · Oct 5, 2006

many thanks to all for providing such useful info! midwives are the best :) i have managed to find some out of hospital birthing experiences here, which i think will help feed my soul while i remain in a medicalized institution for midwifery training :) so i am going to stay put and get as much experience as i can for the next few years...thanks again!