However, midwives along with other members of the healthcare team must balance philosophical approach against the need to generate income to survive. There is no right or easy answer for this challenge. However, midwives are finding that employers include productivity requirements in their contracts.
The agreement may come in the form of a guaranteed base salary plus productivity bonus, or a group or individual-based productivity or RVU target beyond which bonuses may be expected, or even a purely productivity-based formula. The individual challenge to each practice and each midwife is to generate the income needed to survive and thrive while holding to core values of midwifery and nursing: woman- and family-centered care, empowerment of women as partners in healthcare, health promotion, disease prevention, and health education.
Midwifery education occurs within the context of our current health system and the influence of this climate on education deserves close scrutiny. Surprising to many people, Educating midwives in the hospital may also limit the numbers of experiences students have with normal, physiologic birth practices. Effects of the medicalized approach inherent in the hospital setting can also be mitigated by midwives maintaining a clear focus on what works best for women.
Increasing educational experiences at free-standing birth centers and home births is a logical solution to the culture encountered in hospitals. To further examine the challenges of increasing access to midwifery care through educating larger numbers of midwives, major challenges to this objective are grouped into three areas below: midwifery education programs, students, and clinical experience sites.
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Two programs prepare CMs. Four of the 39 midwifery programs offer a DNP only. Certificate programs are also available for nurse practitioners who hold a graduate degree in nursing. The education of student midwives often begins with the admission of those who understand the work they embark on and the needs of women and families.
The majority of nurse-midwifery students enter with a nursing labor and delivery background. Others bring experiences from other areas of nursing and healthcare as well as more diverse fields. A long-standing debate in midwifery education centers on the value of previous labor and delivery experience. Students without this experience may express idealized visions of birth but may be unable to clearly verbalize an understanding of the skills required for midwifery practice.
These students can create unique challenges in acquiring the skills needed to meet current standards and use the technology. To be successful, students may need additional time to master basic skills and incorporate complex concepts into bedside care. In high volume, high-risk tertiary settings, these needs provide additional stressors for students, preceptors, staff, and faculty. These clinicians may have developed a medicalized birth approach and may have never cared for a laboring woman without an epidural unless the woman presented with an imminent birth.
As another challenge to students in acquiring midwifery education, tuition for graduate degrees continues to rise while funding for financial aid decreases.
Students are now required to accept more of the financial burden of higher education, potentially leaving less time for study and inviting more stress in the pursuit their goal. However, the good news is that midwifery students will see a positive return on their investment in professional and personal satisfaction as well as economic benefits. Midwifery students realize cost benefits primarily by receiving larger salaries and fringe benefits over the length of their midwifery careers compared to salaries they would have made as labor and delivery nurses. Accordingly, CNMs may potentially realize an Preceptors and clinical sites are major contributors to the midwifery education process.
Their reciprocal bond with education programs is one of mutual dedication to the profession. Preceptors serve as role models and teachers, imparting clinical expertise and setting safety limits Lichtman et al. Unfortunately, the introduction of electronic health records and increased productivity demands make it more difficult for preceptors to accept, justify, and commit to sharing clinical experience due to increased demands on their time. Still, growth of the midwifery profession depends on mutual collaboration between clinical sites and preceptors.
As alternative learning experiences, midwifery students gain clinical expertise through simulation, role play and other methods, but obtaining direct patient contact in the company of an experienced preceptor who is appropriately licensed and certified is where the majority of learning takes place and is critical to the education process. Clinical experiences occur in outpatient as well as inpatient facilities. Midwifery education programs are competency-based; ACME requires that each student achieve a minimum number of direct patient contact clinical experiences ranging from preconception care, primary care including common health problems, family planning and gynecology , antepartum, intrapartum, newborn, postpartum care, and breastfeeding support ACME, This competency-based format differs from APRN programs that require students to accrue a specific number of clinical hours.
In addition, students must meet the credit requirements of their midwifery programs. In spite of challenges inherent to clinical education, midwifery education programs provide tangible and intangible benefits to practices. Students share their personal knowledge with preceptors and provide a fresh perspective.
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Midwifery preceptors experience professional growth that comes with serving as a faculty member, increased morale due to mentoring students and professional satisfaction in contributing to educating future midwives and increasing access to midwifery care. Moreover, Fagerlund and Germano reported that students provide quantifiable benefits to clinical practices through a decrease in recruitment costs for future midwives and through services provided.
Given the many advantages of precepting a clinical midwifery student, including financial benefits, more clinical practices may want to consider partnering with a midwifery education program in educating future midwives. The midwifery profession has faced and worked through many barriers over the past century, resulting in significant progress in providing access to care to women and families. One wonders what Mary Breckinridge would think of current healthcare and the changes to midwifery practice and education. However, midwives must continue to collectively and collaboratively work for change in our healthcare delivery system and specifically in the culture surrounding birth.
Within daily midwifery practice exists many opportunities to create the relationships needed to build a network of change. Great changes begin with small acts, for example creating a relationship with a legislator, educating a physician colleague, creating trust relationships with colleagues, locating and following up on a contact at an insurance corporation, and having the persistence to start and finish a bylaws change at a healthcare institution.
To use a tried-but-true midwifery example, overcoming barriers is like birthing a baby; the gestation may be long but the birth rewarding, or put another way, labor may be difficult, prolonged, and painful but the end result is worth the work. Changes in midwifery, however, depend on a strong workforce. So as a dedicated workforce, let us take the barriers, create challenges from them, and watch the opportunities blossom!
State By State
Deborah S. She has been certified as a nurse-midwife since and actively involved in nurse-midwifery education for over 20 years. Walker has a long record of HRSA Division of Nursing funding that implemented increased educational innovation and diversity. Since , WSU nurse-midwifery graduates have launched new Detroit midwifery practices expanding the availability of care in an underserved area of extreme poverty. She was the ACNM Southeastern Michigan chapter chair from through , during which time she became actively engaged in the political challenges facing advanced nursing clinical practice in Michigan.
She has continued to work with other advanced practice registered nurses APRNs in Michigan in order to bring about the changes needed to break down barriers to practice. She has served a variety of diverse populations of women in the Michigan communities of Bay City, Saginaw, and Metro Detroit. She was a team member of a Rotary International sponsored Vocational Training Team to assess maternal and infant mortality in East Timor. She has incorporated many complementary treatments into her practice and is a Reiki Master and has studied Aromatherapy and Acupressure for use in labor and birth.
In , she spent a year consulting with St. Criteria for programmatic accreditation of midwifery education programs with instructions for elaboration and documentation. Retrieved from www. State legislative and regulatory guidance. Midwifery education programs. Standards for the practice of midwifery. Midwifery: Evidence-based practice.meizemslecleafeeds.tk
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