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The Latent Phase: From Student to Saveur, and the Argument for Hiring New Grads

By Stephanie Tillman, CNM, MSN

I have come to believe that one of the hallmarks of a great midwifery practice is ability to integrate new midwives. As a recent graduate, I was thankful for the six weeks of outpatient orientation and ten births my new practice required before the experienced midwives “cut the cord” and sent me out on my own. Despite feeling adequately supported clinically, the warmth and kindness I had found in my classmates while in midwifery school did not carry over into the midwifery world at my practice. I longed for the “fuzziness” offered to some of my fellow graduates, welcomed with a celebratory party, a formal introduction to the group, or even a complete orientation schedule. There is a way to welcome new midwives with needed clinical support and extended knowledge, grace, and love. And, of course, there is a way to toss them in. The great midwife practices likely utilize a mix of all of these methods for any new hire, but the best do so with special care and encouragement for recent graduates.

I continue to be amazed at how few job postings are open to new grads; how many explicitly advertise for “experienced” midwives only. What assumptions compel that purposeful exclusion? Is a lack of ability perceived in the most recently certified midwives? Is an absence of faith in the current midwifery educational system making us doubt that graduates are adequately equipped to begin independent practice?

Perhaps this concern stems from the harrowing emotional transition many new graduates, myself included, endure, and the time required to fully support that process. The initial anxiety, self doubt, stressful repetitive verification of evidence-informed care...we new grads run ourselves through the ringer to ensure adequacy when we first enter practice independently. Shouldn’t experienced midwives foster that? Shouldn’t they see that investment as developing a way of practice that would be beneficial for their patient population? Isn’t there enough patience to encourage and support and respect the process of a new graduate entering her work? Isn’t there enough time to show her how to care for women as you do?

I also remember the lack of confidence women had in my abilities during my student clinical rotations. When I walked into a room and introduced myself, “Hi, I’m Stephanie, I’m the student midwife working with you today,” women would look over my shoulder for the “real” midwife. It was as if they allowed me to bide my time and ask a few questions, but didn’t consider it an actual visit until the “real” midwife appeared. I assumed that was partly to do with my age, but I’m not much older today, and women never look over my shoulder now. “Hi, I’m Stephanie. I’m the midwife.” That shoulder-look reflected my feelings of personal and professional responsibility to the patients. I never felt wholly responsible for the care of the women assigned to me, because, then, they were only ever partially so. There is a responsibility gradient that is crossed very quickly as a new graduate: confidence must be backed-up with correct care. This gradient requires time and attention from others in the practice; great patient care includes support by each other regardless of experience.

When does the “new midwife” label pass? Is it when the new midwife starts to discuss others removing that label, or when others slowly forget to connect her hire date to her graduation year? When do days added to months equal a timeframe and an assumed level of exposure that make “new” or “recent” disappear? When is it appropriate for a midwife to think that about herself? When has one proved oneself?

I do not have these answers. I am only 8 months into my own practice, and feel at a crossroads. Certain days I feel incredibly confident, like experience and education are catching up with the needs of the women I serve. Other days, I feel completely lost, not sure that anything has stuck in my brain, unsure if I can walk into a room confidently as a “real” midwife. Perhaps this feeling never goes away. Maybe all midwives continue to be surprised by the wonders of women, healthcare, and birth.

Ideally, I would hope that I and all midwives continue to learn throughout our careers. That we will continue to be recent graduates of each new experience when we conquer it and take note of each new experience when we stumble over it. If we recognize that in ourselves, then a label of “new” midwife indicates an opportunity to guide and be with each other. I hope all practices truly consider hiring a new graduate: consider the opportunity for the practice as well as for the midwife herself to be welcomed into midwifery, to enter into this profession with a feeling of being wanted and respected and believed-in. To fully be “midwifed” into the profession. We can all fit a little more midwifing into our daily practice, especially for a member of our own profession, our own mantra, and our own life’s work. Let us be the best midwives we can, especially for each other.

Stephanie Tillman is a recently-graduated Nurse-Midwife now practicing full-scope midwifery in the urban United States, at a Federally Qualified Health Center (FQHC) and as a member of the National Health Service Corps (NHSC). With a background in global health and experience in international clinical care, the impact of public health and the broader profession of midwifery are present in all her thoughts and works. Stephanie's blog, Feminist Midwife, discusses issues related to women, health, and care. Find out more at and follow her on Twitter at @feministmidwife.

Posted By Barbra Elenbaas | 5/10/2013 10:47:55 AM



Any opinions expressed in this blog are those of the individual participant(s) and do not necessarily reflect the views of the American College of Nurse-Midwives. ACNM is not responsible for accuracy of any of the information provided by guest bloggers and/or members via the Comments section. We welcome all feedback – including comments, ideas and suggestions. We also welcome civil, friendly debates. However, any and all content that is deemed inflammatory or rude will not be posted.


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