The Future of Midwifery Education...Where are we heading?
by Daphne Singingtree, CPM
Chair, MANA Education Committee
Education in midwifery is at the forefront of a generational shift that will affect the future of midwifery.
Midwifery reemerged in the late sixties and early seventies with the growing women's and holistic health movement. The only route of formalized education for many years was nurse midwifery. Finding an alternative form of education was challenging. Most learned using apprenticeship, self study and informal courses or workshops. By choosing a less formal or structured education, midwives learned by a different paradigm. Learning became self directed and woman centered. Midwives learned primarily from other practicing midwives. Birth stories became more than anecdotal, but part of the wise woman tradition of learning. Midwifery education became like midwifery itself, an alternative to the traditional bio-scientific model, where individuality, creativity, diversity, and intuition are respected and encouraged.
For many, especially mothers of small children, this form of education allowed flexibility both in limiting time away from their children and expense, but mostly they were able to learn holistic midwifery in a way that structured traditional academia would not have allowed.
An entire generation of midwives trained in this manner, and NARM worked very hard to create a process to validate that educational method through the Portfolio Evaluation Process, preserving the apprenticeship model.
The new generation of aspiring midwives are looking at midwifery as a career they can use to support themselves, not a calling they have to make sacrifices to support. They want to bill insurance, practice legally, and serve more women then the less then 1% of women who deliver at home. Credentialing, licensing and more traditional education routes seem to be the answer.
MEAC has done an excellent job at accrediting direct entry midwifery schools which integrate some of the best qualities of the apprenticeship model with the structure of traditional academia. However as MEAC has to conform to the US Department of Education rules, it too becomes more bureaucratic and part of the system. With over 60 direct entry midwifery schools and programs in the US and only 10 accredited or pre-accredited, the accreditation process itself has become too expensive and difficult for most programs. There are trade offs, the benefits of accreditation mean the schools will be able to take financial aid, which will increase the numbers of low income and minority students, which in the long run will help the future of midwifery.
The trend in nurse midwifery program has been towards advanced degrees, direct entry programs are not far behind as more become degree granting. It is a wonderful development to be able to offer degrees in midwifery, this not only helps those who practice midwifery but also those who move on to other fields in public health and other related areas. On the other hand, are we moving to a system where it takes a college degree to deliver a baby? And is that not what an entire generation of midwives worked to avoid?
The traditional academic model is intrinsically elitist, hierarchal and limits graduates to those who work the system well. If the knowledge on how to deliver a baby at home safely is limited to those few who can manage the system, a fundamental human right of reproduction is impeded.
I have practicing midwifery and training midwives for over 28 years. I often see midwives who are solely apprentice trained that have gaps in their education that a structured academic program will fill. But often the best midwives have not been the best students. Midwifery is more then technical knowledge or an ability to work the system. Caring for women, rapport, compassion, strength, dedication, and love are not qualities that appear on any transcript.
We need to move forward and become more a part of the system, we still serve such a small percentage of the population. I believe we are heading in the right direction with accreditation, licensing, and degree granting. I just have to stop and wonder, on this slippery slope can we carry with us the knowledge of our sisters’ struggles and the values of our hearts?
First published MANA newsletter 7/2001
free to reprint if not edited and author credited
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