How do US midwives qualifications compare to the UK and other countries?

Xenia · #1 (**permalink**) 13-Aug-2008, 13:58

Hi all,

I'm a newbie from the USA and I was wondering about how our midwifery paths compare to yours.

What are the different ways of becoming a midwife? How "medical" are they? Are you in a seperate field from nursing?

Here in the US we have both midwives associated with the nursing/medical community (CNMs) and midwives who are not (DEMS- direct entry).

I'm studying to be the latter. Lately theres been a whole lot of to-do about the DEMs. Basically, they're being attacked, along with homebirth, and freestanding birth center birth, by the American Medical Association (which has lots of Drs. and money behind it).

There is a lady named Amy Teuter that has a blog at http://homebirthdebate.blogspot.com/ . Supposedly, she's an obstetrician, but is not practicing and no one can seem to find many credentials. She is brutal and goes around to all of the articles on homebirth, etc and posts damamging comments. A lot of us think she's a hired hack for the AMA.

Anyways, our local paper posted a story on homebirth. You can see it (along with a beautiful video) at http://www.sun-sentinel.com/news/loc...,2487303.story .

This "Dr" Amy is posting on the comments and has made the assertion that our licensed midwives in the US don't have the neccesary qualifications to do what they are doing. She said that the qualifications in Europe are much more for midwives.

I don't know if this is true or not, and I certaintly believe that licensed midwives (DEMs) have what they need to handle births... otherwise, I wouldn't be doing this.

Can anyone assist me by telling me what paths there are to becoming a midwife in the UK or any other countries you're in? What do you need to "qualify" as a midwife? Any links would be appreciated, too!

Thanks!

smwife · #2 (**permalink**) 13-Aug-2008, 14:07

Hey Xenia, I've replied to your other thread. We hear that alot, America is certainly a hostile place for normality in childbirth and thus for midwives too!

There are two routes in the uk now to becoming a midwife. The first and most popular with the most places is the direct entry route of three years which gives a BSc (Bachelor of Science) The other was the diploma route, this is now obsolete almost everywhere (i think!)

The other route is the post-grad route for qualified nurses. This is 18 months, though some uni's are increasing it to two years, some are scrapping it completely.

There are many variances to the course structure over here, as I guess there is there too? hth?

Midhusband · #3 (**permalink**) 13-Aug-2008, 18:50

Greetings Xenia, SMWife and StudentMidwifeForums,

I joined this list some time ago, but this is my first post here. As for introductions, my name is Russ Fawcett and I am the Legislative Chair for the North Carolina Friends of Midwives. North Carolina (NC) is one of the 10 states in the US in which non-nurse midwives are considered as practicing midwifery without a license (a class III misdemeanor). Our objective is to pass legislation to license Certified Professional Midwives (CPM) in NC. In NC, there are 15 CPMs serving women who birth at home. There are 3 Certified Nurse Midwives (CNMs) who attend women who birth at home and we have one obstetrician who attends home births. The primary caregiver to home birthing families is the CPM and the current situation has many problems associated with it (continuity of care, transfer of care, etc…). For women who choose to birth at home, maternity care in NC is broken, and the leadership of the North Carolina Medical Society is perfectly happy with that.

On the subject of training, I think it would be great to have a gap analysis to really get a handle on this. At first glance, the two nurse midwifery programs appear similar (undergraduate degree in nursing and graduate training in midwifery). I would be interested in understanding how much OOH experience is available/required for UK midwives. There are several routes of training for the CPM, the most popular is the Portfolio Evaluation Process in which the training is largely in a clinical setting and the training is provided by a preceptor. The other fundamental route is through an accredited MEAC school. In this route, the didactic components are either classroom or online and I believe the clinical skills are also generally acquired through working with a preceptor. I am less familiar with the MEAC path, but they both end up with the same credential that is confirmed with the same examinations and skills requirements.

We recently had a comparative evaluation performed by Becky Bagley, CNM (the Director of the CNM program at East Carolina University) comparing the requirements to obtain the CPM, the CNM and the CM (the CM being the ACNM version of the Direct Entry Midwife). The general conclusion is that the CNM has a broader training associated with a broader scope of practice and that the CPM training requirements are comparable for care during the childbearing year (in some areas the CPM requirements are higher). The thing that gives midwifery adversaries heartburn and ammunition is that the CPM requirements are restricted to skills and training required for entry level midwifery (i.e. university training is not required). A key issue in the US is that the CNM program does not produce home birth midwives (only 1% of CNMs serve women who choose to birth at home). The vast majority of CPMs serve women who choose to birth at home (~100 home birth CNMs versus ~1400 CPMs). Again, I would very much like to see a gap analysis between the US CPM and the UK DEM. I doubt there is any perfect program and I think we in the US would benefit from a good understanding of how other midwifery-centric models view training.

My feeling is that the adversaries will always resist OOH birth and autonomous midwives. They will do anything they can to discredit them including misinformation and disdainful language. Amy is their champion and has been campaigning for several years now all over the internet. She is actually doing us (the Good Guys) a favor with her inflammatory remarks. So don’t be discouraged.

Russ

midwifemissy · #4 (**permalink**) 13-Aug-2008, 19:32

Hi Midhusband,

Glad you have finally jumped in and posted here. That was very informative, it is good to see how midwifery training in other countires compares to our own here in the UK.

It seems a shame that the training in North Carolina meets with such opposition and problems.

Thanks for sharing that with us.

Xenia · #5 (**permalink**) 14-Aug-2008, 04:24

Hostile, indeed. In fact, my state, Florida, has something called "Sunset Review" for the health professions. Licensed midwives are up for review next year, and they could basically close the legislation fo us, meaning, no miore LMs, new homebirth practices, or DEM birth centers. Anyone in school at the time, like me, would get grandfathered in, but its not a very nice prospect to think about.

Our routes sound pretty similar. I'll post our guidelines sometime tomorrow, because right now it is 12:23 a.m., I just got home from class and am t-i-r-e-d.

We definitely have quite a bit of variance, as someone else already posted!

'til later...

Originally Posted by smwife

Hey Xenia, I've replied to your other thread. We hear that alot, America is certainly a hostile place for normality in childbirth and thus for midwives too!

There are two routes in the uk now to becoming a midwife. The first and most popular with the most places is the direct entry route of three years which gives a BSc (Bachelor of Science) The other was the diploma route, this is now obsolete almost everywhere (i think!)

The other route is the post-grad route for qualified nurses. This is 18 months, though some uni's are increasing it to two years, some are scrapping it completely.

There are many variances to the course structure over here, as I guess there is there too? hth?

Xenia · #6 (**permalink**) 14-Aug-2008, 04:33

Hi Russ,

Thanks for posting. I absolutely agree about the gap analysis. What we need to do is find a nice public health student looking for a Masters thesis topic:

Also thanks for clarifying between the CM and CNM. I came across this in the ACNM's response to that putrid AMA resolution and was trying to make sense of it.

I really can't understand why the medical community in general is so biased against DEMs. What is the threat, if we both do the jobs we're supposed to do? It's my belief that their job is to be there for the high risk women. As far as I understand there's a decrease in the number of new OBs because of the high malpractice rates.

But I suppose its a power struggle. They say that societies that are the most restrictive towards women are really in awe of the power they have, especially towards creating new life. I see this as a twisted play on that. Midwives treat the whole woman and the whole baby, body and soul, and how can they ever compete with that?

Originally Posted by Midhusband

Greetings Xenia, SMWife and StudentMidwifeForums,

I joined this list some time ago, but this is my first post here. As for introductions, my name is Russ Fawcett and I am the Legislative Chair for the North Carolina Friends of Midwives. North Carolina (NC) is one of the 10 states in the US in which non-nurse midwives are considered as practicing midwifery without a license (a class III misdemeanor). Our objective is to pass legislation to license Certified Professional Midwives (CPM) in NC. In NC, there are 15 CPMs serving women who birth at home. There are 3 Certified Nurse Midwives (CNMs) who attend women who birth at home and we have one obstetrician who attends home births. The primary caregiver to home birthing families is the CPM and the current situation has many problems associated with it (continuity of care, transfer of care, etc…). For women who choose to birth at home, maternity care in NC is broken, and the leadership of the North Carolina Medical Society is perfectly happy with that.

On the subject of training, I think it would be great to have a gap analysis to really get a handle on this. At first glance, the two nurse midwifery programs appear similar (undergraduate degree in nursing and graduate training in midwifery). I would be interested in understanding how much OOH experience is available/required for UK midwives. There are several routes of training for the CPM, the most popular is the Portfolio Evaluation Process in which the training is largely in a clinical setting and the training is provided by a preceptor. The other fundamental route is through an accredited MEAC school. In this route, the didactic components are either classroom or online and I believe the clinical skills are also generally acquired through working with a preceptor. I am less familiar with the MEAC path, but they both end up with the same credential that is confirmed with the same examinations and skills requirements.

We recently had a comparative evaluation performed by Becky Bagley, CNM (the Director of the CNM program at East Carolina University) comparing the requirements to obtain the CPM, the CNM and the CM (the CM being the ACNM version of the Direct Entry Midwife). The general conclusion is that the CNM has a broader training associated with a broader scope of practice and that the CPM training requirements are comparable for care during the childbearing year (in some areas the CPM requirements are higher). The thing that gives midwifery adversaries heartburn and ammunition is that the CPM requirements are restricted to skills and training required for entry level midwifery (i.e. university training is not required). A key issue in the US is that the CNM program does not produce home birth midwives (only 1% of CNMs serve women who choose to birth at home). The vast majority of CPMs serve women who choose to birth at home (~100 home birth CNMs versus ~1400 CPMs). Again, I would very much like to see a gap analysis between the US CPM and the UK DEM. I doubt there is any perfect program and I think we in the US would benefit from a good understanding of how other midwifery-centric models view training.

My feeling is that the adversaries will always resist OOH birth and autonomous midwives. They will do anything they can to discredit them including misinformation and disdainful language. Amy is their champion and has been campaigning for several years now all over the internet. She is actually doing us (the Good Guys) a favor with her inflammatory remarks. So don’t be discouraged.

Russ

smwife · #7 (**permalink**) 14-Aug-2008, 09:50

Greeting to you Midhusband and congratulations on your first and most informative post! WOW!

It is interesting to say the very least. i find it truly shocking the differences between midwifery practice in the UK and USA (though comparatively our intervention rates are rising similarly to yours, despite midwives being the main caregiver antenatally and intrapartumally, there is still the predomination with hospital birth and the obstetric intervention that enevitably ensues). Our home birth rates are low (2%), with the main problem being lack of midwives in some areas, but more commonly the assumption that birth is supposed to take place in hospital now. In some areas of the UK ( South Wales for instance it is as high as 18%) it is a shame the rate is not higher, but we are often plagued by scare stories in the media of home births going wrong. Though sometimes assisted by celebrities having home births.

I think it would be really good for all of us UK student midwives to hear alot more from yourself with regards to the changes you are attempting to make to maternity care in NC, I wish you luck and sincerely hope you succeed!!

So feel free to continue to post, your comments are most welcome and we all look forward to hearing much more from you.

Thanks very much for posting!

smwife · #8 (**permalink**) 14-Aug-2008, 10:05

Originally Posted by Midhusband

Greetings Xenia, SMWife and StudentMidwifeForums,

I joined this list some time ago, but this is my first post here. As for introductions, my name is Russ Fawcett and I am the Legislative Chair for the North Carolina Friends of Midwives. North Carolina (NC) is one of the 10 states in the US in which non-nurse midwives are considered as practicing midwifery without a license (a class III misdemeanor). Our objective is to pass legislation to license Certified Professional Midwives (CPM) in NC. In NC, there are 15 CPMs serving women who birth at home. There are 3 Certified Nurse Midwives (CNMs) who attend women who birth at home and we have one obstetrician who attends home births. The primary caregiver to home birthing families is the CPM and the current situation has many problems associated with it (continuity of care, transfer of care, etc…). For women who choose to birth at home, maternity care in NC is broken, and the leadership of the North Carolina Medical Society is perfectly happy with that.

On the subject of training, I think it would be great to have a gap analysis to really get a handle on this. At first glance, the two nurse midwifery programs appear similar (undergraduate degree in nursing and graduate training in midwifery). I would be interested in understanding how much OOH experience is available/required for UK midwives. There are several routes of training for the CPM, the most popular is the Portfolio Evaluation Process in which the training is largely in a clinical setting and the training is provided by a preceptor. The other fundamental route is through an accredited MEAC school. In this route, the didactic components are either classroom or online and I believe the clinical skills are also generally acquired through working with a preceptor. I am less familiar with the MEAC path, but they both end up with the same credential that is confirmed with the same examinations and skills requirements.

We recently had a comparative evaluation performed by Becky Bagley, CNM (the Director of the CNM program at East Carolina University) comparing the requirements to obtain the CPM, the CNM and the CM (the CM being the ACNM version of the Direct Entry Midwife). The general conclusion is that the CNM has a broader training associated with a broader scope of practice and that the CPM training requirements are comparable for care during the childbearing year (in some areas the CPM requirements are higher). The thing that gives midwifery adversaries heartburn and ammunition is that the CPM requirements are restricted to skills and training required for entry level midwifery (i.e. university training is not required). A key issue in the US is that the CNM program does not produce home birth midwives (only 1% of CNMs serve women who choose to birth at home). The vast majority of CPMs serve women who choose to birth at home (~100 home birth CNMs versus ~1400 CPMs). Again, I would very much like to see a gap analysis between the US CPM and the UK DEM. I doubt there is any perfect program and I think we in the US would benefit from a good understanding of how other midwifery-centric models view training.

My feeling is that the adversaries will always resist OOH birth and autonomous midwives. They will do anything they can to discredit them including misinformation and disdainful language. Amy is their champion and has been campaigning for several years now all over the internet. She is actually doing us (the Good Guys) a favor with her inflammatory remarks. So don’t be discouraged.

Russ

With regards to the differences in training, I may offer an example of the course structure at my university (hopefully other current students will follow as though there are distinct minimum standards and guidelines as giverned by the Nursing and Midwifery Council (NMC) many university degree course vary slightly in structure and means of assessment.

Direct entry students have split theory and practice times, these are five weeks in university alternating with five weeks in clinical practice, during the first year there are practice competencies to be achieved at level one, with assignments to be completed (also at level one) so practice is mainly shadowing a mentor and the gaining of practical and theoretical skills. Half of the first year practice placement is carried out in a community setting, working within a community midwifery team. We learn the basic skills such as asepsis, blood pressure analysis, Urinalysis etc. We also focus on normality in pregnancy and childbirth (though once we begin placement within the hospital, this is rarely seen, most students start clinical practice in the second semester of their first year so after 20 weeks training).

Theoretical assessment is by assignment, though there are presentations, seminars and tutorials also, and an exam in human biology for our course. Practice is assessed by an 'Assessment of Practice Portfolio' this contains competencies to be signed off, the student must formatively discuess her competencies to be met, how she is developing etc at the start of each placement and then summatively at the end, she is assessed and any competencies achieved are signed off. A different portfolio is given each year and all competencies contianed within it must be achieved to progress on the course. All assignments must be passed with a minimum percentage of 40%, though they can be resubmitted once (more with extenuating circumstances)

On our course assinments are four per semester, we have three modules each semester, each module is therfore assessed by assignment with the fourth being a reflective assignment on practie placement scenario.

We complete alternative placements during the second year of training to enhance and develop our knowledge and skills and to appropriately understand interprofessional working. We also do this in year three for a few weeks in areas such as theatres, and NICU. We then undertake a few weeks community caseloading, where we work independently but with support within a community midwifery team looking after women in the anteantal, intrapartum and postnatal periods. We must also have successfully delivered normally a minimum of 40 babies during the three years of the course.

In order to qualify all of these aspects are taken into consideration, the student is judged to also be of good character by the most senior midwifery pathway lecturer and thne must wai for her registration from the NMC. And must also face another criminal records assessment in order to practice as a newly qualifed midwife.

Once these are gained and she has secured employment she is usually limited to practice in the hospital setting until she has consolidated her pratcie and passed further competencies such as suturing and cannulation in order to progress form a band 5 to a band 6, this would after a period of between 6-24 months then enable her to owrk in a community setting.
I hope that gives you some insight, feel free to post here or pm me for any further information.

How do US midwives qualifications compare to the UK and other countries?

How do US midwives qualifications compare to the UK and other countries?

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