How do you become a midwife, anyway? Did you do a weekend course?

Yes, someone actually asked me that. In short, no. A degree in midwifery is not a weekend course.

Long story, well, long…

Midwifery is a four-year Bachelor of Health Sciences degree. In Ontario, the Midwifery Education Program (MEP) is a consortium offered through three universities: Laurentian University, Ryerson University, and McMaster University. ~90 students are accepted into the MEP consortium per year. The application process is rigorous and competitive. The Ontario Midwifery education program is internationally recognized as a gold standard for quality midwifery training programs. 

The first three semesters are spent on campus taking courses in Anatomy and Physiology, Reproductive Physiology, Pharmacology, Critical Analysis of Research Literature, Social Work, Women’s Studies, clinical skills and theory. We are required to be certified in CPR, neonatal resuscitation, emergency skills management, and fetal health surveillance (a course on how to interpret those strips when we are watching your baby on a monitor). These certifications are updated yearly or biannually.

After 3 semesters, midwifery students are sent into the world of clinical placements, which are decided by lottery. This first placement is 18 weeks long, and midwifery students are learning how to provide hands-on clinical care and how to manage normal variations in pregnancy. Throughout the final 2.5 years, we are in clinical placements and carry a full-time course load with weekly tutorials held online. We have papers and exams to write, and are responsible for ongoing research.

Third year is sandwiched between on-campus intensives in September and April where we take 2 emergency Screen Shot 2016-06-23 at 2.56.39 PMobstetric skills courses, including the Society of Obstetricians and Gynaecologists “Advances in Labour and Risk Management” course — this is quite enjoyable as it brings obstetricians, midwives, and family doctors together to practice the emergency skills that we’re all certified in and skilled at providing!  The other emergency skills course is specific to midwives and focuses on managing emergencies in out-of-hospital settings like home.

We also do regular practical exams called OSCEs. During OSCEs, we are presented with multiple clinical situations/obstetric emergencies, and are evaluated on our management. It’s all very exciting and dramatic in a way that birth almost never is (except perhaps on television: “Surprise! It’s twins! The second twin is breech. Now you have a retained placenta with a postpartum hemorrhage to manage — what’s your plan?”). I won’t lie: nobody really enjoys OSCEs. We’re all a bundle of nerves. Ultimately, though, they are a great way to work through managing emergencies in stressful-feeling situations.

The rest of third year is a series of month-long interprofessional placements. We rotate with an OBGYN, a neonatal intensive care unit (NICU) nurse, a labour and delivery (L&D) nurse, work with a designated population (examples include: rural midwifery, LGBTQ2IA and Aboriginal folks, teen parents, folks living with HIV/Hepatitis), and then an elective. For the elective, many choose to do a placement with a lactation consultant. Some also do placements in genetic, diabetes, or pelvic floor physiotherapy clinics, or with our professional association or college.

Screen Shot 2016-06-23 at 2.56.00 PMDuring our rotation with an OBGYN, we are exposed to a great variety of learning opportunities. Working with an obstetrician teaches midwifery students about further management of pregnancy and birth when it falls outside of our scope of practice. This helps us describe to clients what they might expect when we transfer care. We also use our skills to manage emergencies that come up during our shifts. During my OBGYN placement, I also learned how to triage patients and take histories, how OB clinic is run, and what it’s like to be on-call as an OBGYN. I learned about pessaries and how to identify prolapses. I participated in colposcopy clinic, saw LEEPs, and did many paps. I scrubbed in on a variety of surgeries, from cesarean sections — I had the pleasure of suturing some uteruses closed — to laparoscopic hysterectomies. I learned how to insert IUDs and how to prescribe different types of birth control.

Our nursing placements are also fabulously educational. Time in the NICU teaches us about the care of unwell and premature babies and how to best provide support to their parents. My L&D placement was opportune for learning about assisting anesthesiologists during epidural insertions and about running an oxytocin pump for induction or augmentation as these things are within midwifery scope. Among other things, we start IVs and mix medications, as well as administer narcotics. We also practice skills that the second midwife does, such as providing neonatal resuscitation as needed, monitoring newborn and maternal vitals in the early postpartum, and helping with breastfeeding.

4th year begins in May, and is comprised of a full year at a single midwifery clinic as a senior student. The goals of DSC_4159-1this year are: consolidation of skills and learning to coordinate and manage a full course of care for a client, including when complications arise. We take pages and make clinical decisions under the supervision of our preceptors.

When we graduate, we will spend our first year working in an established practice where we continue to receive mentorship. We have hospital admitting privileges, an OHIP provider number so we can order all routine labs and ultrasounds and a prescriber number so we can write prescriptions for medications.  The health system doesn’t usually grant those types of things to people who take a weekend course…

Crucial in all of this are our lovely clients. Thank you so much for being incredible teachers to us during your pregnancy, birth, and postpartum by allowing us to participate in your care! Your contributions to our educations are truly invaluable.

DSC_4096-1Becky Yurkowski is a student midwife at Generations Midwifery Care.  You can read more about her here.