The Course of Instruction
Each module in the midwifery program is completed in one month and the knowledge gained in each module provides the foundation for the next module’s learning activities. There are 38 required modules. Students attend class all day once a week and must complete an internship with one or more approved preceptors. The North American Registry of Midwives certification examination is the final examination required for graduation from the program. Students are in the classroom setting for a minimum of 912 clock hours of didactic instruction and practicum. Completion of the clinical portion of the program requires 2,000 hours of supervised clinical experience with an approved preceptor. The entire program requires a minimum number of 2,912 clock hours of education. Because of the prescribed program structure, enrollment status for all students is considered full time. Nizhoni reserves the right to alter, modify or change the order of modules at any time.
Student Orientation is provided to acquaint incoming students with the midwifery education program. Students meet with faculty, administrators, graduates, and student representatives from other cohorts to learn what they may expect in the midwifery program.
Modules 1 – 12:
The freshman year provides an introduction to the Midwives Model of Care,™ and a foundation of basic skills and knowledge needed to carry out the role of assistant midwife. At the end of the year students will be able to:
- Explain cultural competency, informed consent, and shared decision making, and describe how they affect the provision of care.
- Take a complete medical and obstetric history and appropriately document care in paper and electronic client charts.
- Counsel prenatal clients regarding nutrition, basic genetics, fetal development, teratogens, and the role of hormones in conception, pregnancy, birth, and the establishment of lactation
- Demonstrate comfort measures for labor, hand maneuvers for delivery, and competence assisting in the management of minor complications of birth and the immediate postpartum.
- Foundations of Contemporary Midwifery
(24 hrs. didactic)The introduction to the Midwives’ Model of Care establishes the context for professional midwifery practice. Students discuss the social and political landscape of contemporary midwifery and global, national, and local professional issues. Introduction to evidence-based best practices in midwifery.
- Practice Documentation (24 hrs. didactic)
Introduction to legal and ethical guidelines for documentation of patient care. Students apply medical terminology to simulated patient care scenarios. Informed consent is introduced as the cornerstone of the midwife-patient relationship.
- Introduction to Midwifery Skills (18 hrs. didactic, 6 hrs. practicum)
Universal precautions, aseptic technique, and basic midwifery skills with skills practice for clinical settings.
- Cultural Sensitivity and Communication Skills (24 hrs. didactic)
Communication, education, and counseling skills with emphasis on cultural sensitivity, learning styles, social styles, and versatility in human interaction.
- Complete Health Assessment (18 hrs. didactic, 6 hrs. practicum)
Detailed midwifery and medical history, evaluation of documentation provided by other health care providers, and performance of the complete physical examination.
- Intrapartum Care (24 hrs. didactic)
Skills to support the laboring woman and development of practices, skills, and attributes required to assist a primary midwife during labor, birth, and the immediate postpartum period. Introduction to fetal heart rate patterns and monitoring in labor.
- Midwifery Research (24 hrs. didactic)
Introduction to basic statistical applications used for midwifery and medical studies. Evaluation of research studies for merit and evidence-based practices.
- Foundations of Reproductive Science (24 hrs. didactic)
A review of reproductive anatomy and physiology, genetics, fetal development, and teratogenic complications related to pregnancy with applications to midwifery, preconceptional counseling, and referral to maternal-newborn specialists.
- Well-Woman Care (18 hrs. didactic, 6 hrs. practicum)
Well-woman exam, including Pap testing and vaginal cultures. Evaluation, treatment, and referral for treatment of sexually transmitted diseases. Study of human sexuality and options in family planning.
- Midwifery and the Law (24 hrs. didactic)
Laws relative to midwifery in the students’ intended areas of practice. Legislative systems as mechanisms for improving the legal climate of birth locally and globally.
- The Placenta (18 hrs didactic, 6 hrs practicum)
The structure and function of the placenta and umbilical cord in normal and complicated pregnancies. A functional overview of fetal circulation and the baby’s transition to extrauterine life after birth.
- Nutrition in Pregnancy (24 hrs. didactic)
The impact of nutrition in pregnancy, including prevention of complications such as preterm labor, anemia, preeclampsia, and abruptio placenta. The impact of nutrition on perinatal outcomes and long-term health indicators in women and infants.
Modules 13 – 24:
The Junior year provides more in-depth study of the provision of care in the prenatal period, labor and birth, and the immediate postpartum, and an introduction to the responsibiilties of the primary midwife. At the end of the year students will be able to:
- Describe the components of prenatal care according to the week of pregnancy and conduct a complete prenatal visit including screening for inter-partner violence, substance use, and depression.
- Identify, order, and interpret routine prenatal and fetal testing, follow up on results outside of the normal range, and consult appropriately
- Create care plans and oversee labor and delivery in conjunction with the primary midwife, including performing advanced skills such as IV administration, and perineal exam and suturing.
- Provide care for the mother and baby during the six week postpartum period.
- Diagnostic Testing in the Childbearing Year I (18 hrs. didactic, 6 hrs. practicum)
A survey of laboratory testing in pregnancy and introduction to the use of these tests to improve pregnancy outcomes. Students learn phlebotomy skills.
- Diagnostic Testing in the Childbearing Year II (24 hrs. didactic)
The uses of obstetrical and perinatal technologies in midwifery care. Selection of appropriate diagnostic tools during pregnancy to improve maternal-infant outcomes.
- Prenatal Care I (24 hrs. didactic)
Critical reasoning skills relative to facilitating health during pregnancy, provision of midwifery care, and treatment of common complaints during normal pregnancy. Risk assessment relative to normal birth is a central focus of this module.
- Prenatal Care II (18 hrs. didactic, 6 hrs. practicum)
Clinical skills involved in the provision of prenatal care. Students learn about the unique value of the home visit and explore the psychosocial impact of abuse issues relative to pregnancy, birth, and perinatal outcomes.
- Normal Labor and Birth (24 hrs. didactic)
The significance of neuro-hormonal pathways relative to labor and common variations that occur in normal childbirth.
- Pharmacology I: Intravenous Therapy for Midwives (18 hrs. didactic, 6 hrs. practicum)
Applications of basic chemistry to fluid and electrolyte balance. Selection and administration of IV fluids during pregnancy, labor, birth, and the postpartum periods.
- Complications of Pregnancy I (24 hrs. didactic)
Recognition and treatment of pregnancy complications from conception to 28 weeks gestation.
- Complications of Pregnancy II (18 hrs. didactic, 6 hrs. practicum)
Recognition and treatment of pregnancy complications from 28 weeks gestation to term.
- Assessment of Fetal Well-Being (18 hrs. didactic, 6 hrs. practicum)
Low- and high-tech approaches to the assessment of fetal well-being, including the indications for consultation and referral in the presence of complications.
- Perineal Integrity and Repair (12 hrs. didactic, 12 hrs. practicum)
Preservation of the perineum, lacerations, episiotomy, and techniques of perineal repair. Sterile technique, selection and use of sutures and surgical equipment, administration of local anesthesia, and use of both hand and instrument ties.
- The Postpartum Period (24 hrs. didactic)
The normal postpartum course with recognition and treatment of postpartum complications and application of appropriate practice guidelines.
- Care of the Normal Newborn (18 hrs. didactic, 6 hrs. practicum)
Indicators of normal neonatal transition and effective practices for stabilizing the baby after the birth. Complete newborn physical examination and care of the infant during the first six weeks of life, including metabolic screening and referral.
Modules 25 – 38:
The Senior year prepares the student midwife for independent practice as a Certified Professional Midwife and California Licensed Midwife. At the end of the year students will be able to:
- Choose from a wide range of allopathic and complementary modalities to support health in the provision of care during the childbearing year and throughout the lifespan.
- Demonstrate the skills and knowledge to provide primary care under supervision during pregnancy, labor, birth, the 6 week neonatal/postpartum period, and between pregnancies.
- Comfortably navigate the details of creating and maintaining a successful midwifery practice.
- Describe midwifery in the US within the context of the global midwifery community and explain the role of midwifery model care on reducing health disparities and promoting the health of mothers, babies, and families in the US and around the world.
- Infant Feeding (24 hrs. didactic)
Biologic breastfeeding and management of common complications of nursing. Local and global politics that affect patterns of infant nutrition.
- Pharmacology II: Botanical Medicine (12 hrs. didactic, 12 hrs. practicum)
Botanical pharmacology as applied to women’s health care. Students learn practical skills for making herbal preparations of all types.
- Pharmacology III: Intravenous Skills Practicum (12 hrs. didactic, 12 hrs. practicum)
Techniques for starting an intravenous infusion. In combination with Pharmacology I, satisfies requirements for Intravenous Therapy Certification standards for midwifery practice in California and other states.
- Pharmacology IV: Intro. to Biomedical Pharmacology (18 hrs. didactic, 6 hrs. practicum)
Biomedical pharmacological treatment of problems during pregnancy, birth and the postpartum period. Correct techniques for administration of medications.
- Pharmacology V: Intro. to Traditional Chinese Medicine (12 hrs. didactic, 12 hrs. practicum)
Introduction to theories and philosophies of Chinese medicine, acupuncture, and acupressure, with applications to pregnancy and well-woman care.
- Pharmacology VI: Homeopathy for Midwives (12 hrs. didactic, 12 hrs. practicum)
Foundation principles of homeopathic practice with techniques for acute prescribing for mothers and infants.
- Intrapartum Complications I (18 hrs. didactic, 6 hrs. practicum)
Treatment of complications of labor and birth, including dysfunctional labor, recognition and evaluation of abnormal fetal heart rate patterns, meconium staining, and the needs of clients planning a vaginal birth after cesarean section.
- Intrapartum Complications II (18 hrs. didactic, 6 hrs. practicum)
Comprehensive overview of the management of complications of labor and birth, including hospital transport, recognition and treatment of shock, assisted and operative deliveries, hemorrhage, placental abnormalities, and shoulder dystocia.
- Intrapartum Variations (18 hrs. didactic, 6 hrs. practicum)
Overview of the management of variations of labor and birth, including face presentation, unexpected breech births, and multiple gestation.
- Complications of the Neonatal Period I (18 hrs. didactic, 6 hrs. practicum)
Neonatal complications and guidelines for treatment and referral of babies with complications to hospital-based providers.
- Grief and Counseling in the Neonatal Period (18 hrs. didactic, 6 hrs. practicum)
Support of women and families when birth outcomes are difficult and/or during a difficult postpartum/neonatal period.
- Midwifery Care in a Global Context (18 hrs. didactic, 6 hrs. practicum)
Review of research regarding measures of maternity quality improvement in order to examine trends and disparities in benchmarks of maternal-newborn and community health care. Consideration of global, national, and local health care services to improve access to midwifery resources.
- The Midwifery Practice (24 hrs. didactic)
Market analysis, business plan development, practice marketing, insurance coding and billing, and tax requirements for midwifery practices.
- Birth Disaster Preparedness Training (6 hrs didactic, 18 hrs practicum)
Four day camping retreat and disaster preparedness simulation exercise. Students will apply concepts and skills acquired over the duration of their educational program to roleplay typical experiences and common complications encountered during the normal provision of care, adapted to an atypical setting with minimal supplies and few modern conveniences.
The Integration Phase allows students additional time to complete necessary graduation requirements, including supervised internship, during which the student functions as the primary midwife under supervision. An Integration Phase lasts a minimum of three months and varies in structure according to the needs of the individual student. To aid in successful completion of the midwifery program, students entering the Integration Phase may be asked to complete an Individualized Learning Contract to clarify their academic and clinical goals.