Midwifery Training Outside the US

MidwiferyEducationWhen we talk about midwifery training outside the US, we could focus the discussion in one of two ways.  One way would be to talk about the training available outside the US for those who will work outside the US.  The second is to talk about training outside the US for those who intend to work inside the US.  This discussion will be about the later — training outside the US to be licensed as a midwife in the US.

I’m going to direct you first to the list of midwifery training programs in the Natural Childbirth Directory. This page includes international training opportunities in addition to educational programs specific for licensing in other English speaking countries.  As you work through the programs on this list here are some things to think about.

Program Evaluation Questions

1. Will this program provide training that counts toward the training I need for midwifery licensing?  Some programs will and some will not.  It depends on how the programs interact with the certifying body you will use (whether that is in the US or not). Knowing what counts or doesn’t count allows you to make better decisions about how to use your limited time and money to design a training program to fit you.

2. What costs are involved?  Some programs include food and housing in the training fee, other programs require the students to secure food and housing.  You cannot compare programs if you don’t understand the full costs.

3. What learning opportunities will you have? Do those opportunities align with your current level of education? Will you be satisfied with a program that does not allow you to practice skills you’ve already mastered? Will you feel comfortable in a program that expects to you act independently with skills you have not yet mastered?

4. Does the schedule allow you adequate time to learn? Does the schedule allow adequate time for rest? Does the schedule allow adequate time to process the cultural differences you experience?

Ethical Considerations

If you have never traveled outside your home country, you may not yet be aware that ethical problems may exist in international programs. Here are some things to think about as you measure the value an international internship may have.

1. Do you speak the language? Some programs do not require you to speak the local language but on this point I usually disagree. If you are attending births, being able to communicate with the woman is important for building trust and maintaining the woman’s safety.  Think about what labor must be like if you have to try to interpret hand gestures and one word commands.  There is no way to provide adequate antenatal and postpartum care without being able to ask the woman questions, and understand her responses.  I have been in situations where I was expected to practice in hospitals where only one nurse spoke  a little English but no one else.  This was a major safety problem for me and the women I was serving.  If I cannot communicate the help I need to the team I am assigned, I cannot expect the support I need in an emergent situation. After being in some uncomfortable situations, my rule for myself is that I must speak the language unless I am there to teach — and then I must have a full time translator.

2. Can you legally provide the care you will be giving? Please realize that any country you plan to visit will have laws about who can and cannot provide care. An ethical program will ensure that you meet the standards of that country to qualify as a student and will require you to obtain the proper visa to be a student in that country. An ethical program will introduce you to the health system and the women you will be serving as a student. An ethical program will also give the women the option to not be cared for by a student.

3. Most importantly, ask yourself why you are seeking an international training opportunity. There are good reasons for international training, and there are reasons that are not ethically justified. For example, a good reason may be to gain experience in a different healthcare delivery system — an experience that may help you identify ways to improve the system where you live. Another good reason may be to to exchange skills with midwives — I had a great experience with a midwife who taught me to insert an IUD with sponge forceps (a common practice for her country but not mine),  and I was able to help her become familiar with a fetoscope (a tool I had easy access to and could leave with her). My favorite exchange was with a medical student in her maternity rotation.  I taught her techniques to suture without visible stitches, and she explained her country’s health system and how women obtain care. We built such a good rapport, that when we had a “stuck” baby she asked me if I knew anything else we could do.  I taught her (and the hospital obstetrician along with all the other medical students on that day) to use the tug-of-war technique.

Reasons that are not ethically justified usually revolve around romanticized ideas about “primitive” births. Others happen when a person wants to travel and uses midwifery as the excuse.  Though it may sound counter-intuitive, “I just want to help,” is also unlikely to end up in an ethically justified trip — especially if you answer “no” to ethical questions 1 and 2 above. Why? Because the one or two weeks you spend at a clinic — as a student who cannot work independently– will take midwives time away from the women they serve and won’t make a dent in the real problems of the health system. In some cases these programs can make it easier for policy makers to avoid funding programs that will ensure the women have adequate access to care.

I think this post probably sounds overly negative about international training, but I don’t really mean it to be. I do think there is a role for international training, but I think it is the exception rather than the rule. Mostly, I just want you to really think about what it is you hope to gain through an international experience that you cannot achieve by training within your home country.

Keep working through these questions…you are getting closer to finding your path.