Course Overviews for the Nurse-Midwifery Education Program

By emphasizing an in-depth, focused approach to pelvic and breast assessment, the student learns the art of midwifery – that part of the profession which focuses on humane and respectful treatment of persons as individuals who may take different paths towards knowledge and growth. Teaching, counseling, and health education of people and their families and sensitivity to cultural diversity are integral components of midwifery care. It is important that midwives have knowledge of various philosophies of health education, skills in group leadership, and methods of evaluation. The student is also introduced to the Management Process, a method of collecting and analyzing information that is the foundation for the provision of safe health care to all people.

The Nurse-Midwifery Program at University of Iowa Health Care, in alignment with the American College of Nurse-Midwives Position Statement on Transgender/Transsexual/Gender Variant Health Care, acknowledges that midwives provide care to diverse populations that include transgender and gender non-conforming people who do not identify as women.  We aim to incorporate this recognition through curriculum presented throughout the program. While we have moved towards more gender-neutral language in some contexts, there are many contexts where the gendered experience of women and female physiology affects the health and experience of the people we care for, and for this reason we continue to include a focus on women’s health.

At the conclusion of the Advance Health Assessment course, the student will be able to utilize a culturally sensitive, trauma informed and person-centered approach in accordance with the Midwifery Management Framework: Process, Principles and Skills, to:

1. Obtain a complete reproductive health history.
2. Perform a gentle, systematic, and complete physical exam with an emphasis on the breast and pelvic exam.
3. Record findings in a thorough, legible and concise manner using appropriate terminology.
4. Identify normal examination findings and screen for abnormalities.
5. Identify uses of specific laboratory tests and their normal values.
6. Utilize a microscope to identify specific organisms/substances.
7. Demonstrate principles of health education, health promotion and Teaching/counseling as they relate to the care of people and their families.

Midwives must be equipped to assess and manage or refer common acute primary care problems. Ideally, midwives will practice in settings which promote continuity of care and encourage people to be active participants in all decisions regarding their health care. The purpose of this course is to provide you with understanding of your responsibilities in this role and to develop the skills needed to fulfill this role.

The Nurse-Midwifery Program at University of Iowa Health Care, in alignment with the American College of Nurse-Midwives Position Statement on Transgender/Transsexual/Gender Variant Health Care, acknowledges that midwives provide care to diverse populations that include transgender and gender non-conforming people who do not identify as women. 

We aim to incorporate this recognition through curriculum presented throughout the program. While we have moved towards more gender-neutral language in some contexts, there are many contexts where the gendered experience of women and female physiology affects the health and experience of the people we care for, and for this reason we continue to include a focus on women’s health.

At the conclusion of the Primary Care in Midwifery Course, the student will be able to utilize a culturally sensitive person-centered approach in accordance with the Midwifery Management Framework: Process, Principles and Skills to:

1. Understand the role of the midwife as a primary care provider.
2. Evaluate and manage primary care needs throughout the life cycle utilizing the principles of regular health screening, physical examinations, health education and counseling.
3. Understanding the pathophysiology of conditions midwives screen, diagnose and independently, collaboratively manage or indicate need for referral.
4. Utilize the midwifery management process in treating common acute health problems in pregnant and non-pregnant patients.
5. Identify barriers to social and structural determinants of health that may impact rural and underserved individuals.

To facilitate achievement of course module objectives, the pharmacology course will be threaded throughout the various modules during semesters one, two and three of the program.

Prescriptive legislation varies throughout the country, and in Iowa, a certified midwife is eligible to apply for prescriptive authority. Professional responsibility is achieved by attainment of core competence, knowledge update and maintenance of moral and ethical standards.

At the conclusion of the Pharmacology Course the student will be able to:

1. Utilize the principles of physiology and pharmacology (pharmacokinetics, pharmacodynamics, and pharmacotherapeutics):
   1. For the purposes of health promotion and disease prevention
   2. In the management of selected acute and chronic medical conditions encountered in the ambulatory setting
   3. In the management of the laboring or postpartum patient
   4. In the management of the normal newborn
   5. In the management of common gynecologic, gender and fertility conditions
2. Recognize the professional, legal, and logistical aspects of prescribing.

This course module broadens that view to look at the historical development of midwifery and maternal/child health programs, the importance of research on practice, the issues related to growing and sustaining midwifery practice and the importance of support of the profession beyond clinical practice.

One of the Program goals is to “plan, develop, implement and evaluate midwifery services targeted to improve the health care delivery for vulnerable women.” In completing this course module, please keep that goal in mind as you explore the history of midwifery, community health needs and your professional role development.

Midwives have worked over the years to empower women to be able to give birth humanely and respectfully. They have organized, become politically active and created a midwifery knowledge base through research, practice and education.

Our professional organization, the American College of Nurse-Midwives, has been and continues to be instrumental in the growth of midwifery, and has developed a wealth of professional documents which support nurse-midwifery practice and education.

The transition from nurse to student midwife to graduate midwife to experienced midwife is gradual and continuous. Seminars in role transition aim to assist the initial change. Familiarity with current political and economic forces will assist in the ongoing growth of you as a midwife.

At the conclusion of the Professional Issues and Community Health (PICH) Course, the student will be able to:

1. Understand legal and legislative issues affecting the midwifery profession.
2. Describe the legal basis for nurse-midwifery and midwifery practice, and how legal status is obtained through the legislative process.
3. Develop skills in evaluating research and incorporating it into practice.
4. Identify factors associated with poor perinatal, infant, and maternal outcomes, and discuss strategies to address these issues.
5. Describe the history of midwifery practice in the US.
6. Outline the purpose and structure of the ACNM, standard setting documents, major committees and their functions, and resources for practicing CNMs/CMs.
7. Outline the structure and purposes of the AMCB and the ACME.
8. Discuss the historical developments in midwifery that have influenced the kind and amount of care delivered to women and children.
9. Describe a comprehensive and effective quality improvement process for CNMs/CMs.
10. Develop an understanding of standard safety initiatives to improve outcomes for mother and babies.
11. Discuss the current state of midwifery practice in the world.
12. Define the components of ethics and ethical midwifery practice.
13. Negotiate the role transition from nurse to certified nurse-midwife.

With the completion of the Advanced Ambulatory Care in Midwifery course students will increase their knowledge and clinical skills in screening for and managing selected complications. Part II of the Advanced Ambulatory Pathophysiology course content is integrated into this module because a solid grasp of the underlying pathophysiology is needed to evaluate and manage common complications in ambulatory midwifery care. The pathophysiology learning objectives are presented at the beginning of each unit, followed by the clinical management learning objectives.

Through clinical experiences, students will develop increased independence in the care of essentially healthy patients, progressing in their competence in gathering a comprehensive database, and making appropriate assessments and plans for patients with either gynecologic or antepartum complications. Throughout the course there is an emphasis on the proper identification of whether a condition is appropriate for independent midwifery management or requires consultation or referral.

For many women and gender non-conforming people, prenatal care or reproductive health visits may be the only time that health care is sought.  Midwives must capture these moments to thoroughly assess the lifestyle and health care needs of each patient, partnering with them to provide education regarding practices to maintain wellness, and empowering them to reach their health care goals. Midwives may use these opportunities to educate those we care for more about themselves in terms of their bodies and their psycho-social selves to help them become healthier throughout their lifetime.

The Nurse-Midwifery Program at University of Iowa Health Care, in alignment with the American College of Nurse-Midwives Position Statement on Transgender/Transsexual/Gender Variant Health Care, acknowledges that midwives provide care to diverse populations that include transgender and gender non-conforming people who do not identify as women.  We aim to incorporate this recognition through curriculum presented throughout the program. While we have moved towards more gender-neutral language in some contexts, there are many contexts where the gendered experience of women and female physiology affects the health and experience of the people we care for, and for this reason we continue to include a focus on women’s health.

At the conclusion of the Advanced Ambulatory Care in Midwifery Module the student will be able to provide a person and family-centered approach to care that is culturally aware and inclusive of diverse identities, per the Midwifery Management Framework: Process, Principles and Skills, to:

1. Manage the antepartum care of the essentially normal pregnant person with minimal supervision.
2. Evaluate and manage the family planning needs of the essentially normal person during the inter-conceptional period; counsel and refer people seeking termination of pregnancy, or assistance with infertility problems.
3. Evaluate and manage the gynecological care of the essentially normal patient who are experiencing minor gynecologic problems.
4. Work collaboratively with the interdisciplinary healthcare team to provide an integrated, holistic approach to the patient.
5. Integrate knowledge of pathophysiology into the assessment and management of persons with select complications.
6. Consult, co-manage, and/or refer with appropriate specialists to address the needs of the patient facing obstetric or gynecologic problems.
7. Integrate cultural, socioeconomic, religious factors to understand the patient’s response to minor obstetric or gynecologic complications.
8. Evaluate current literature and research and apply results to the assessment and management of obstetric and gynecologic complications.

By the time the Intrapartum Course begins, however, each student has discovered the level of responsibility and accountability midwifery demands, and the extensive amount of new knowledge and skills which must be mastered. Besides anxiety, a certain amount of self-doubt as to one’s capabilities is normal during this course. Working through these issues is an essential step in the evolution of nurse to student to midwife. Students should be reassured that this transition will be guided, supported, and encouraged by experienced nurse-midwife faculty who are invested in their success.

Each student brings to this course a different level of comfort and experience, but each is expected to carefully examine the rationale for their decisions and management no matter what their philosophy and beliefs about birth. Students are expected to provide intrapartum midwifery care in an environment which allows the patient and family to participate in the decision-making process. A respect for a variety of cultural forms and the unique needs of different populations is essential.

Furthermore, the Intrapartum Course is taught in conjunction with the Postpartum and Newborn Care Course, thereby allowing the student an opportunity to provide continuity of care throughout the woman’s hospital stay. This continuity should allow the student to fully assess her own midwifery management of her patient and develop a clear understanding of the family unit.

At the conclusion of the Intrapartum Course the student will be able to utilize a culturally sensitive family centered approach, in accordance with the Midwifery Management Framework: Process, Principles and Skills, to:

1. Manage the care of essentially normal patients and their babies during the intrapartum period.
2. Understand the pathophysiology of the conditions midwives screen for, diagnose, co-manage, and manage.

In the fall the seminars will move to complications, covered by both seminars and in-depth case presentations. A solid grasp of the pathophysiology underlying these complications is needed to evaluate and manage these complications.  While Advanced Physiology/Pathophysiology is a separate course, the information is integrated into this course.  The pathophysiology learning objectives are presented at the beginning of each unit, followed by the management objectives.

Consistent with the midwifery model, the care occurs with an understanding and acceptance of the family’s racial, cultural, educational, economic, ethical, and spiritual background and beliefs.  Experiences from birth through the first month of life can affect the parental-child relationship for years to come.  During this period, the student midwife has another unique opportunity to promote a lifetime of good health care and offer support and guidance during one of the most profound transitions in the human experience.

At the conclusion of the Mother-Baby course the student will be able to utilize a culturally sensitive family centered approach, in accordance with the midwifery Management Framework: Process, Principles and Skills, to:

1. Manage the care of essentially healthy person during the postpartum period.
2. Identify postpartum complications and appropriate intervention, and the need for consultation and physician referral if appropriate.
3. Encourage and promote maternal-infant bonding and facilitate optimal family relationships.
4. Manage the care of healthy term neonates.
5. Recognize and appropriately refer neonates with abnormalities.
6. Provide emergency management of care to neonates requiring resuscitation at delivery.

The Core Competencies in Nurse-Midwifery, which are the “fundamental knowledge, skills and behaviors expected of a new graduate,” should guide your progress. It is not expected you will function with the same degree of expertise and confidence as a seasoned Certified Nurse-Midwife by the end of this course, but it is expected that you will practice safely. Learning does not cease with the completion of this course or the completion of the program but is a life-long experience whose mastery is essential for maintenance of safe practice.  It is expected that during Integration you will develop behaviors which will guide your practice as a Certified Nurse-Midwife. Consider this a time to assess your strengths, evaluate for needed improvement, and demonstrate responsibility for independent initiative in the management of care as you would as a certified nurse-midwife.

During Integration you are laying the groundwork for your future career as a Certified Nurse-Midwife.   This course should promote the expansion of your understanding of midwifery care as continuous, comprehensive, and collaborative. Integration should promote connection to patients and colleagues. 

Take the time to enjoy this final stage of development, filled with anticipation of the birth of another midwife - you!  Welcome to a most rewarding profession.

At the conclusion of the Integration Course the student will be able to:

1. Utilize a culturally aware patient centered approach, in accordance with the Nurse-Midwifery Management Framework: Process, Principles and Skills, to:
   1. Manage the reproductive and gynecologic health care needs of patients
   2. Collaboratively manage the reproductive and gynecologic health care of patients with obstetrical, gynecological, or medical complications
   3. Manage the care of the healthy term neonate
2. Provide relevant patient education in an understandable and culturally appropriate format
3. Accept the responsibilities inherent in the profession of nurse-midwifery
4. Evaluate various CNM practice models and employment options
5. Participate in evaluation of the CNM educational experience (Program evaluation)