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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Advice About Taking On an Apprentice

Schedule a 30-60 min appointment.

Tell her you have a reliable helper right now and need to consider whether there is room in your practice for an apprentice .But...

Ask her about her interest in midwifery--how it came about, what her expectations are.

Tell her that midwifery is a lifetime commitment-24 hours a day, no vacations, weekends, etc. Not a lot of money to be made(for me, anyway) Ask her how supportive her husband and family are. Tell her this is usually a much bigger issue than you expect. Also tell her it isn't very glamorous. She may have second thoughts when she has come home after long hours working and is finally resting or making love with her husband ,the phone rings and several hours later she finds herself kneeling in a large puddle of blood and stool, and as soon as you've controlled the hemorrhage, the mom informs you she's decided not to breastfeed and wishes she'd had pain meds.

If she passes that test(she will)assign some basic reading. Becoming a midwife, by Carla Hartley, Hearts and Hands, Elizabeth Davis ,and Spiritual Midwifery are a good start.

Tell her that you may consider apprenticing her, but she will have to do the following: organize a self-directed course of study that you approve, observe and not offer any input the first several interactions with your clients. Under no circumstances can she offer any pregnant woman advice of any kind except under your supervision once you sign her up, because once she is working with you, she represents you. She will also have to be "on call"-I expect my students to abstain from alcohol and drug use, have babysitting arranged 24 hours a day, etc.,etc.

Then have her go read, discuss with family and seriously consider the impact on her life. Have her do the first exercises in Becoming a Midwife’ and talk about them with her husband.

This will usually weed out many less serious types.

If you decide she could be an asset to you see her again when she's followed your initial instruction. You need to know that she probably will not know what direction she wants to take until she's been a little more involved(probably).See how she handles being on call before you require those decisions, unless that is of major importance to you. If it is, spell it out .

If you decide to take her on, have her sign a contract spelling out confidentiality, both for your clients and all "personnel", on-call requirements, and that she will do nothing without your supervision and consent.

The last and probably most important thing is- if you really don't like her, it won't work. There needs to be a "chemistry" for this sort of relationship to be successful. You will spend A LOT of tome together. If you are uncomfortable with her, don't do it. Your clients don't need to be in the middle of a weird relationship.

P.S. I put a lot of emphasis on the husband's support, because this is the main reason for loss of a good apprentice. It’s very hard on an established relationship and there are times when either you loose the student or she looses her marriage(and has to go to work at Wal-mart to support the kids)

I teach a 4-saturday course to students, to outline BEGINNING midwifery assistance.  Skills- MUST know how to do a BP, injection, bimanual compression & neonatal resuscitation.   The psych-soc dynamic is super important, and requires some time before ever coming to a birth to see if we're compatible.  Then, the outline of how a midwife gives care can be learned over the course of care with several women.  When I apprentice someone I figure a year of doing everything- being on call, going to EVERY prenatal day, home visit, birth, postpartum and final visit, gives them an overview.  Then my apprentices go to Texas (Casa de Nacimiento) for 3 months, then come home and start catching babies, taking on their own clients and me overseeing their care.  I have never just hired an assistant.

I am responding to your request for suggestions with apprentice course outline topics. Don't have much time to help right now, but thought I would send a few of my key areas.

    1.. Assistant must have basic knowledge and skill. I require her to at least read Heart & Hands, Special Delivery, and my practice protocol. She should also be able to take vitals, judge Apgar scores, demonstrate sterile technique, and operate oxygen equipment. It's nice if she knows how to draw up meds, open packages for me to protect sterility, and assist with breastfeeding. The most safe situation occurs when midwife & assistant are both CPR / NRP certified, and run through practice drills for management of complications (shoulder dystocia, hemorrhage, neonatal resuscitation, cord prolapse).

    2.. Emotional maturity: The assistant should be able to keep calm no matter what takes place. She should also be humble in her role, recognizing that the mom is the one to take credit for the birth. She should NEVER challenge or contradict the midwife in front of the client. These professional questions or differences should be discussed privately, so that client's do not become unduly alarmed or confused.

    3.. Confidentiality: The assistant must understand that no client information is to ever be shared without the written consent of the client. Also, no MIDWIFE practice info is to be shared. I tell assistants that any concerns they have regarding my practice or business policies should be discussed with me. If they don't agree with what I do, then they are free to seek other midwives to work with.

    4.. I also think it's important for the assistant & midwife to outline expectations and roles at the birth. The primary midwife usually does the birth, while the assistant does labor support & newborn stuff. While the midwife watches for placental delivery & stability of mom, the assistant watches for newborn stability. Other practices organize roles & duties differently.

    5.. Clean up: The assistant should have clean-up duties specified.

    6.. Payment: Best to have compensation agreement in writing.

    7.. Supply organization. The assistant should be as familiar with how birth bags are packed as she is with her own hand. She needs to quickly know exactly where things are when needed.

    8.. Apprentice development: The midwife should clearly outline any plans for or against apprenticeship for the assistant. I usually want an assistant to attend at least 10 births with me before taking on student midwife duties. I prefer some college level knowledge (A & P, microbiology, health assessment, developmental psych, ethics) before they do assessments or births under supervision. This basic knowledge can come from college courses, distance-learning programs, self-study with midwife led testing, conferences & workshops, labor assistant training programs, etc. If the assistant is a nurse, I also require reading Midwifery Today journals & herbal books. Need to balance the medical stuff & the midwifery model. Apprentices should also have some of their own basic equipment, to develop familiarity with use as they learn.

All our apprentices must do an approved (may be self study) didactic course and be certified in CPR and Neonatal Resuscitation.  They must attend one childbirth class and La Leche League series They are required to attend all prenatals, home visits, births and postpartums.

While some midwives require their apprentices to purchase their own equipment, I decided it worked better to let them use my stuff.  I have several sets of everything except oxygen.  My rationale behind this it that they get a chance to try stuff out and then can buy what works best for them.  They must have their own equipment when they start taking on primary births.