About the Nizhoni Institute of Midwifery
Nizhoni is a Navajo word which conveys the spirit and practice of "the beauty way" as experienced and expressed through living in balance and harmony with the world. As midwives and students, we seek that balance as we honor both our valued birthing traditions and contemporary midwifery and medical knowledge. Graduates of the Nizhoni Institute of Midwifery are prepared to function as primary care providers for women throughout the childbearing cycle. As midwives, we bring harmony and balance to the work of labor and assist each woman to discover the transformative nature and experience of giving birth. As an institution providing midwifery education, we create and foster a strong commitment to excellence in midwifery practice in any given place or circumstance, once again honoring the practice of Nizhoni.
Midwifery Education Options in the United States
In the United States there are multiple routes of entry into the profession of midwifery. Students interested in midwifery may choose from four options:
- Become a Certified Nurse-Midwife or Certified Midwife
A student who is a registered nurse may enter a program approved by the American Midwifery Certification Board of the American College of Nurse-Midwives to become a certified nurse-midwife or CNM. These programs are university-affiliated and require a baccalaureate degree (in nursing or another field) as a prerequisite to application. A few programs allow non-nurses with a baccalaureate in another field to enter a three-year Master of Science program. During this time they study basic nursing, obtain a nursing degree and then complete a Master of Science in Nursing or a Master of Science in Midwifery. They are then allowed to take the ACC board examination for CNM licensure. The majority of CNMs in the United States practice in hospitals or birthing centers, although about 4% attend homebirths. A few ACNM-approved programs in the United States offer a direct-entry, Certified Midwife credential to non-nurses. However, at present only two states legally recognize the CM credential.
- Become a Physician-Assistant Midwife
A lesser-known route to midwifery is to become a Physician Assistant or PA. Physician Assistants must have a supervising physician and are allowed to practice to the full extent of their training, although they tend to have less practice autonomy in comparison to nurse-midwives or nurse practitioners. PA programs are university-based but program prerequisites, length of training, and the actual degree earned varies between programs. Physician Assistants may be required to take additional training in order to be able to attend births.
- Become a Naturopathic Doctor-Licensed Midwife
Students who complete an accredited course of study in naturopathic medicine may choose to fulfil requirements for licensure as a naturopathic physician-midwife as well. The naturopathic medical school must be residential and accredited specifically by the Council on Naturopathic Medical Education, the only accrediting body for naturopathic medical schools recognized by the U.S. Department of Education. At this time, fourteen states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands allow licensure of naturopathic physicians.
- Become a Licensed Midwife or a Direct-Entry Midwife
In some states, such as California, Florida and Washington, direct-entry midwives are licensed by the state with requirements for state-approved formal education or approved equivalency options. (These three states presently enjoy reciprocity of licensure.) In several other states, direct-entry midwifery is licensed or otherwise regulated but educational requirements involve alternate routes and/or the demonstration of didactic and clinical competency. And in other states midwifery practice is either legal but unregulated or illegal. In these situations, midwifery training is typically obtained by a combination of preceptorship and independent or group study.
Apprenticeship is a time-honored method of midwifery training but does have two significant weaknesses: first, many midwives do not actually teach needed didactic information to their apprentices. Second, apprentices tend to inherit and perpetuate a preceptor’s areas of knowledge deficit and may not have sufficient knowledge or experience to recognize their problem areas. The Nizhoni Institute of Midwifery combines the best of didactic education with preceptorship and is designed to meet the most stringent state requirements for midwifery licensure.
Preceptorship at the Nizhoni Institute of Midwifery.
The Nizhoni Institute of Midwifery prepares midwives in the theory and skills necessary to provide excellent midwifery care to healthy pregnant women and their newborns, including the ready identification of complications requiring consultation or referral.
The residential program provides a means for students to obtain formal midwifery education while preserving the advantages of the midwifery preceptorship model. By combining independent and group study, online discussion and classroom training with supervised clinical experience, midwifery students develop the necessary knowledge and skills essential for safe, entry-level midwifery practice. The format allows the student to integrate midwifery theory with practice and develop the analytical skills which provide the foundation for clinical problem-solving.
The Nizhoni Institute program meets course objectives through guided study, discussion, practice of clinical skills, and the use of multi-media materials and computer-based education. Learning activities are evidence-based and oriented toward the synthesis of didactic information with midwifery practice. Each student develops an individualized set of midwifery practice guidelines based on information gained from personal study and observation of clinical methodology during preceptorships.
The didactic portion of the program is three years in length. Clinical experience with one or more approved preceptors requires approximately one to two years, based on the student’s level of experience upon entering the program. Student preceptorship usually begins approximately eight months into the didactic program and may take place in the student’s community or at an approved clinical site. Clinical experience involves supervised practice with a credentialed preceptor until all clinical competencies have been satisfactorily completed in accordance with the requirements of Nizhoni Institute of Midwifery and the North American Registry of Midwives. All classroom and clinical requirements must be completed successfully in order to graduate from the Nizhoni Institute of Midwifery. Students who need additional opportunity for clinical experience following the three-year program utilize an Integration Phase during which they obtain the necessary additional clinical experience under supervision by an approved preceptor.
Upon completion of all course requirements, including successful completion of the preceptorship, students pursue certification as professional midwives through the North American Registry of Midwives. The C.P.M. is a widely recognized credential and is increasingly acknowledged as the entry-level professional standard for midwives providing care in out-of-hospital settings.
Upon satisfactory completion of all course requirements, the Nizhoni Institute of Midwifery awards a Diploma in Holistic Midwifery Studies. The Institute promotes the highest standards in midwifery education but does not award degrees. Significant consideration was given to this decision which was made with the support of representatives from the California Bureau of Private, Postsecondary and Vocational Education and the Idaho State Board of Education. While there are midwifery programs that are approved by the state in which they are registered to grant degrees, state approval to grant degrees is significantly different from accreditation. Accreditation is a voluntary, rigorous process that typically requires several years to complete. Midwifery schools that choose to undergo accreditation do so because of their commitment to excellence in the field.
The number of midwifery schools in the United States is steadily increasing as women have more experience with the midwifery model of care. Some schools are approved by the state in which they reside to grant degrees. Some schools, such as Nizhoni Institute of Midwifery, offer diploma or certificate programs. Some schools are accredited by the Midwifery Education Accreditation Council (MEAC). Other midwifery schools hold neither state approval nor MEAC accreditation, nor do they intend to pursue it.
In the United States there are two types of recognized educational accreditation from the United States Department of Education: specialized accreditation and institutional accreditation. Specialized accreditation is awarded to programs within institutions or to professional schools. Institutional accreditation is awarded to colleges and universities. Institutional accreditation is granted by one of six recognized regional accrediting commissions: the New England Association of Schools and Colleges; the Middle States Association of Colleges and Schools; the North Central Association of Colleges and Schools; the Northwest Association of Schools and Colleges; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges. These accrediting bodies are recognized by the United States Department of Education (DOE) and the Council for Higher Education Accreditation (CHEA). Major universities in the United States are accredited by one of the six recognized commissions and attendance at a regionally accredited college or university significantly facilitates the recognition of degrees and credit transfers.
In contrast, attending a program that is only state-approved offers little chance of degree recognition or transfer of credits. For example, if a student receives a baccalaureate degree from a state-approved midwifery school and later decides to pursue a master’s degree in public health at a major university, the baccalaureate credits earned at the midwifery school will, in all likelihood, not be accepted for transfer by the university. In order to later pursue a master’s degree in public health, the midwifery program graduate will have to start over to obtain the bachelor’s degree from a college that is accredited by one of the six recognized regional commissions.
Students should be aware that not all accreditation associations are legitimate. Some diploma mills actually form their own "accrediting commissions" (often with names similar to those above) and then "accredit" their own programs. Some non-traditional schools join together to form accreditation organizations, but their accreditation is meaningless when it comes to a student’s ability to pursue an advanced degree at a major college or university or even to apply for licensure in a profession. For example, some schools of naturopathic medicine offer "accredited" programs, but graduates of these schools are not allowed to sit for state licensure as naturopaths because the "accrediting" body is not recognized by naturopathic licensing boards in states where naturopathic practice is legal.
Fortunately, midwifery has a respected mechanism for accreditation through the Midwifery Education Accreditation Council. MEAC offers specialized accreditation and is the only accrediting body recognized by the United States Department of Education for the accreditation of midwifery education schools and programs. Some states require graduation from an approved midwifery program to sit for licensure; these states often specify that the program must be a MEAC-accredited school. Graduating from a MEAC-accredited program facilitates the process of becoming a Certified Professional Midwife (CPM) through the North American Registry of Midwives. The CPM credential has become the “gold standard” for midwives who attend homebirths and birth center births. Typically it is the entry-level standard in states where midwives are licensed or registered.
Notice of Temporary Approval
This institution has received a temporary approval to operate from the Bureau for Private Postsecondary and Vocational Education ("Bureau"). A temporary approval is merely an interim designation the Bureau can authorize pending a qualitative review and assessment of the institution. At the time it is issued, the Bureau has not yet conducted a site visit. It is issued if the Bureau determines the institution’s operational plan satisfies the minimum standards listed in Education Code Sections 94900(a) or 94915 (a) and (b), which is applicable. The temporary approval will remain in effect for at least 90 days, but not more than 360 days in order to enable the Bureau to conduct the site visit and inspection of the institution. After that visit, the Bureau will then determine whether the institution should be approved on a permanent basis.
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