So you want to be a midwife….?

I regularly get approached by women who tell me, “I want to become a midwife…what should I do? I don’t know where to start…”

So you want to become a midwife! Admitting that you have a problem is a great first step. (in case it’s less obvious in print, that’s a joke – so you are required to at least chuckle before moving on)

First you need to understand that midwifery laws and regulations vary from state to state. I work out of Arizona where midwifery is legal and licensed. Please look up the laws in your state to see what your legal restrictions and regulations are….

Being that I’m in Arizona, I will only speak to midwifery as it relates here in Arizona.

STEP 1: Decide what your end-goal is…and in Arizona there are two options you have to choose from: CNM or LM. When looking up midwifery you can become overwhelmed by initials and definitions and it can become so cloudy and conglomerated that you want to bang your head against a wall. Let me simplify: in AZ, the only initials you have to worry about are those….CNM or LM. That’s it. Nothing else here holds legal water. CNM is a Certified Nurse Midwife; a nurse who got her masters in midwifery, carries malpractice and works in HOSPITALS in conjunction with OB’s. She rarely (if ever) does homebirths because her malpractice forbids it. LM is a Licensed Midwife; a midwife licensed by the Arizona Department of Health Services to attend homebirths. An LM does not have malpractice insurance and NEVER does hospital births as hospitals will not grant privileges to someone without malpractice insurance. (so yes, in many ways insurance is what keeps the CNM and LM in two totally different worlds) Our professions are related to be sure…. both of us are breeds of dogs, but a CNM is a Labrador and an LM is a Spaniel. Same…but very very different. So ask yourself: do you want to do hospital births as a CNM or homebirths as an LM?

If your answer is CNM – then I need to shoo you off to one of my wonderful CNM sisters who can answer your questions better than I can.

If your answer is LM – you may pass on to ‘step 2’….

Me with student Noelia who practiced as a doula and hypnobabies instructor for years before joining my practice

STEP 2: Immerse yourself into the birth community, learning as much as you can. I highly HIGHLY recommend that anyone interested in becoming a midwife first take a doula training and work as a doula for at least a year (a couple of years isn’t a bad thing). Midwifery is a lifestyle, one of being totally available to the client and being on call 24/7 – the experience you can gain as a doula can be invaluable. You can experience the lifestyle of a midwife without all of the time/money/commitment of being a midwife first. Many who want to become a midwife never become one because their VISION of midwifery is different than the reality – being on call, cleaning up messes, the non-glory portion of my job. Being a doula can give you education in the form of hands-on experience at births (not the medical aspect, but there’s much more to midwifery than the medical aspect), experience with the lifestyle, and you will learn TONS about what’s normal and what’s not normal at births. I also recommend (here in AZ) that you attend your closest Birth Circle meetings, Doula CARE meetings, AZ Student midwife meetings, etc….network, show that you are available, and listen and learn.

STEP 3: EDUCATE! Read, read, read……and this step will continue until you are….uuhhhh…..well….I’m still on this step after 15 years so I will let you know when it is likely to end if/when I reach that point. Anytime you hear a term or condition or anything you don’t know about, learn about it! Learn as much as you can. Subscribe to places like Medscape to receive emails weekly on studies/research that was released this week, check out ORGYN … there are tons of resources out there for you (and you can find them easily, so I’m not going to list them all here. My URL bookmarks is too long to list on any reasonable blog post (although maybe I will share my favorite bookmarks in a future blog post) Included in this step is to decide if you want to attend a midwifery school or just do self-study. Arizona doesn’t care WHERE you learn your information and knowledge so long as you know it! (and this is one area that I greatly respect the state) Therefore an official schooling isn’t required – wherever you need to go (or not go) to learn the information is up to you. If you want a formal school, there are unfortunately no midwifery schools in Arizona. There are many wonderful distance programs, however….(just do a quick search for “midwifery distance education”). Oh, and since you immersed yourself into the birth community (step 2), you have lots of friends by now that you can ask their experiences with different schools….

STEP 4: Order your application packet from the state. Sure you’re ready to jump in after doing all of the above steps? Okay…time to make it official and order your application packet from the state and begin filling it out. The website you want to go to is Arizona Department of Health Services department of special licensing.
You can call the phone number on the left side of the page and request an application packet be sent to you…I know that if you scroll down you will see a link to “licensing application” – but that does not have everything you need. You will need to send money to the state for your application packet that will have all of your paperwork in it.

STEP 5: Feel overwhelmed by looking at all of the legal paperwork scattered in front of you – it’s slightly ridiculous, actually. Spend as long as you need on this step…

Stephanie with 2 of her students: Jen Bass and Crystal Pena. A good relationship is so important, and the three of us go great together!

STEP 6: Begin an apprenticeship. Wow, I almost laugh as I read that benign sentence….because it really is the Holy Grail of getting your license here. If you are really committed after doing all of the above steps, really feel this is a calling, and are ready (AND ABLE) to commit to becoming a midwife – then it’s time to find a midwife to work with and get the hands-on practice skills through an apprenticeship. It’s really not as simple as it sounds when you read that sentence: begin an apprenticeship. That means you need to find a midwife who you respect and whose practice is inline with your personality and philosophies – AND – she needs to like you as much as you like her -AND – she needs to have room in her practice for a(nother?) student – AND – be ready and willing to invest in you and your goals. This can honestly be the biggest decision you make…for many, this is the deal breaker. Don’t give up!!It’s a fierce commitment on behalf of both the apprentice as well as the midwife and is not to be taken lightly. You will likely spend the next few YEARS with this midwife, and I can tell you that breaking up is hard to do. Choose wisely, grasshopper….and pray….lots. It’s like looking for a husband, only there are just a handful of us available for you to date – and not only do you need to fall in love with one of us, but one of us needs to fall in love with you right back and pop the question!

STEP 7: Absorb everything! This is the prime of your life….when you get to learn and absorb as a sponge, you are lucky enough to be attending prenatals and homebirths as a birth professional without all of the burden of responsibility for making all of the decisions the midwife has. Enjoy this time….ride the ups and downs….take everything in and ask yourself how you will use this in your practice. Don’t try to become a clone of your preceptor midwife….learning what you do NOT want to do is as valuable as learning what you DO want to do. You will be documenting all of your experience in that packet the state had sent you in step 4 with your precepting midwife signing you off on everything you do.

STEP 8: Okay…you’re almost there…submit your application packet. It will probably be (literally) about 2” thick in a binder, and you will probably get tears in your eyes looking at it in your hands. Years of your life are in that binder, all of your hopes and dreams and experiences and this entire journey is chronicled in this binder you hold in your hands. It’s heavy – and it should be! You will probably have thumbed through it 40 different times saying to yourself, “Really? I’m not missing anything? Is it really ready to hand in??” You will go to downtown Phoenix because the post office will seem not reliable enough to be trusted with such an important thing and you will hand your application packet gingerly over to Pat Glass, the director of the licensing division for the midwives. You then go home in a daze and start praying, “please let it be okay…let it be accepted…please let everything be there…” You will never forget the day that you open the letter from NARM stating that they have been notified by your state that you qualify to sit for the NARM exam. (I actually just got physical tears in my eyes remembering that day!)

Spend a couple of months not working, but just studying for the NARM!

STEP 9: Sit for your exams. There are four exams that you are required to pass AFTER your completed application packet is accepted by the state: NARM, State rules/regs, Oral exam, Practical exam. The NARM is the supreme biggie when it comes to midwifery exams…it is a proctored exam that is only offered twice a year in Arizona (you can also travel to the MANA midwifery conference and take it there). The NARM takes all day to complete and costs around $700. When you get your results a few weeks later, you are required to celebrate for at least a day – tears and squeals are also fairly common, although not absolutely required. Once you have passed the NARM you will take your State Rules and Regs exam, Oral exam, and Practical exam – in that order and they will be taken relatively quickly! The state exam asks question with regards to what the state requires of an LM: restrictions and permissions granted by the state. The oral exam is just that: you sit down with an OB (currently I believe it’s Dr. Nichelle Whitehead) who asks you questions and tests your knowledge base (the director of the program is there to observe). Finally there is the practical exam…another all-day exam administered by 2 professionals while the director observes. This test is the hands-on exam where you are asked to perform certain skills and show how you handle certain emergent situations.

STEP 10: CELEBRATE – YOU EARNED IT! Take a good couple of weeks to a month off just to really feel proud of yourself….as you are now a licensed midwife in the state of Arizona!!! It probably took you a good 5-7 years of blood, sweat, and tears….ups and downs….and you made it! You are a legally licensed midwife in the state and ready to take on your own clients….congratulations, I know that your midwife is incredibly proud of you!

I hope this helps someone! I know that it’s long – but it’s a long process. I have actually tried to simplify it as much as possible….it’s obviously very much a life’s calling and takes incredible dedication…but as a midwife let me also tell you, it’s very VERY much worth it!