Nurse Midwifery

MidwiferyEducationAs we talk about midwifery education, I wanted to spend some time exploring different ways of categorizing midwives. I have had the opportunity to meet and work with midwives from around the world, and I am always amazed at how these categories do not always mean what I had been trained to think they mean.

The first case in point is nurse midwifery, a common midwifery training where I live in the United States.  My training as a midwife is as a nurse midwife.  The question is, what does it mean to be a nurse midwife?

In the most basic sense, a nurse midwife is a person who is trained first as a nurse, and then obtains midwifery education. What this looks like in practice may not always be what you expect.

Where I live the midwifery education is a master’s level program with advanced pharmacology and pathophysiology training. Regulations for nurse-midwives vary but do allow payment from public and private insurance, prescribing of pharmaceuticals and mostly independent practice. In my health system, nurse-midwives practice mostly in hospitals with obstetrical systems run by nurses.  The realities of the health system mean most nurse-midwives live and work in high-population areas in practices with obstetricians.

I have had the pleasure of working with nurse midwives in Kenya and Tanzania.  Though they do train as a nurse first, their training programs are different from those in the US and not equivalent to a master’s level degree. Training as a midwife is nearly universal for those who train as a nurse. Why? The need for health workers is so great, their health system cannot afford to not have all nurses trained in basic maternity care.  In their health system, nurse-midwives run the maternity wards.  In more remote areas, nurse-midwives run clinics providing all types of care and referring to physicians when necessary.

Two very different systems for training nurses as midwives, and two very different systems for integrating nurse-midwives into the health care system.

Benefits

Taking the regulatory and system issues out of the equation (because they vary by country), what benefit does training as a nurse-midwife provide?

1. Thorough understanding of the body as a whole, not only the reproductive parts.

2. Experience with health complications beyond pregnancy.

3. Learning to “think like a nurse”.  It consists of holistically assessing needs, planning care with the individual, and using education to help the individual reach their optimal health.

4. Education as a nurse can increase opportunities for work as university faculty.

Is Nurse-Midwifery For Me?

You might want to consider nurse-midwifery if:

1. You plan to provide care beyond basic maternity care.

2. You plan to provide care in low-resource areas (with low access to all types of health care).

3. You have a goal to be a midwife-researcher or faculty.

These lists may look different depending on the context of where you live.  Be sure to understand the unique challenges of nurse- midwifery in your country before making the final decision.  What unique benefits does nurse-midwifery have where you live?