Our midwifery study and training program consists of a three part formula incorporating antepartum, intrapartum, postpartum, newborn and reproductive health care, plus beginning, intermediate, and advanced practica.

1) Heart & Hands Coursework

Completion of thirteen comprehensive modules (beginning and advanced levels) requires approximately 810 hours of study;

2) Study Group Coursework

Completion of fifty-five topical modules requires approximately 1080 hours of study; and

3) Preceptor-Supervised Apprenticeship

Completion of clinical experience meeting the requirements for the North American Registry of Midwives (NARM) Certified Professional Midwife (CPM) credential and licensing through the California Midwifery Practice Act.

Part 1: Heart & Hands Coursework

Heart & Hands Midwifery Intensives have long been the starting point of instruction for aspiring midwives in the San Francisco Bay Area. As students in other areas began to express interest in the class, Heart & Hands was adapted to a modular coursework format so that students could have access to this material regardless of their location.

Heart & Hands Coursework provides an integrated overview of core knowledge and skills for midwifery practice and thus lays the foundation for the rest of the NMI program. Thirteen modules (ten beginning and three advanced; see below for details) incorporate didactic material and many activities for hands-on learning. Course materials are designed to accommodate students at various levels of sophistication. Beginners are always welcome! 

Heart & Hands Course Content includes:

"Personally, I loved the essay questions because they challenged me to express my own ideas and opinions on case studies. This practice in critical thinking really helped prepare me for real life midwifery situations."

~ a Heart & Hands student

  • History and Politics of Midwifery

  • Prenatal Care and Complications

  • Counseling and Communication Skills

  • Sexuality in the Childbearing Cycle

  • The Role of Intuition in Caregiving

  • Facilitating Labor and Assisting Delivery

  • Labor Complications and Transport

  • Perineal Assessment and Repair

  • Newborn Complications and Neonatal Testing

  • Postpartum Care, Breastfeeding, and Maternal Adjustment

  • Reproductive Health Care Throughout the Lifecycle

  • Case Histories: Prenatal, Intrapartum, Postpartum

  • Collaborative Care and Informed Choice

  • Charting

  • Venipuncture and Lab Work

  • Homeopathy and Herbs in Pregnancy and Birth

Click below to view a sample Coursework module:

Sample Heart & Hands Module 1


More About Heart & Hands Coursework

Heart & Hands Midwifery Intensives were originally founded by Elizabeth Davis in 1982. The class was developed at the request of a group of birth assistants seeking to acquire practical midwifery skills. Over the years and by demand, the class evolved to include basic introductory information and emphasis on the intuitive, interpersonal skills essential to effective midwifery care.

While Heart & Hands Coursework is part of the curriculum of National Midwifery Institute, Inc., the offsite and the onsite courses (offered in Sebastopol CA, an hour north of San Francisco) are available to students prior to (and regardless of) enrollment in NMI, in keeping with the belief that detailed information on birth, lifelong reproductive health, and midwifery should be available to anyone interested in exploring these subjects.

Upon enrollment in NMI, completed Heart & Hands Coursework transfers for full credit, and all tuition paid is deducted from the enrollment down payment. To learn more about the Heart & Hands courses, visit elizabethdavis.com.

NMI students enrolled in the Heart & Hands offsite format may choose to switch permanently to onsite attendance at no additional cost. Offsite students may also attend selected onsite classes on a drop-in basis—some are especially rich in hands-on practice; contact Elizabeth for schedule and cost. Fees for drop-in classes are payable in advance; space is not guaranteed until fees are paid. Once space is confirmed, fees are non-refundable and non-transferable.

Pretest to Study Group

Upon successful completion of Heart & Hands Coursework, all students enrolled in NMI receive a link to the Pretest, which must be taken before beginning Study Group Coursework. Students do not receive their scores after completing the Pretest, but when they take the test again upon completing Study Group, they are provided with both scores and an opportunity to see how much their knowledge has grown. This test aids Coursework Instructors and Educational Directors in assessing academic progress and determining appropriate coursework revisions.

Questions? Email elizabeth@elizabethdavis.com, or phone/text at (707) 695-6520.


"I loved Heart and Hands. It’s why I chose NMI as a school. I learned a lot from Elizabeth Davis and thought it was a very good midwifery primer. What an excellent teacher. There were some moments in that class that I’ll never forget." ~ an NMI student

Part 2: Study Group Coursework

As a follow-up to Heart & Hands Course Work, Study Group Coursework is intended to help students integrate didactic learning with clinical experiences in apprenticeship.

Study Group Coursework consists of fifty-five modules, with each module focused on a particular topic and its relevance to midwifery care. When Study Group Coursework is completed during apprenticeship, students may spread their work over twelve or more months. Students set their own pace with these studies, as long as they meet NMI’s minimum Satisfactory Academic Progress policy (a minimum of 2 modules submitted per quarter). See the Student Portal for more information on the order of module completion and post-tests.

Students begin Study Group Coursework with a set of ten foundational modules, which set the stage for more advanced module studies.

After completing the ten foundational modules, the remaining modules can be completed in any order, but we recommend that you ask your preceptor or Study Group Instructor for advice on which module might be best to work on next. Once you have decided, simply select the module you want to work on, and proceed. Study Group modules are highly topical, but together they provide a comprehensive picture of midwifery care. Submitting modules in the order you choose gives you the opportunity to apply relevant clinical experiences to your learning process.

The three final modules are about the set-up and practicalities of midwifery practice. These are to be completed just before you graduate from the program.  

"The modules encourage problem solving and differential diagnosis. After completing the course work I felt confident and well prepared for the NARM exam."

~ an NMI graduate


While Study Group modules are well suited to independent study, you may also wish to organize meetings with other NMI students in your locale, or join the Virtual Group facilitated by NMI.

Sample Study Group Module Topics

  • Life Science

  • Postpartum Care

  • Physical, Sexual and Other Abuse

  • OP, Brow & Face Presentations

  • Newborn Apnea, Hypoxia, Respiratory Distress

  • Renal and Urinary Tract Infection

  • Nutrition and Digestion

  • Pre-Eclampsia

  • Ruptured Membranes

  • Stillbirth and Miscarriage

  • Post Dates & Post Maturity

  • Lab Work & Other Clinical Assessment

  • Postpartum Mood Disorders

  • Preterm Labor

  • Meconium

  • Second Stage

  • Shoulder Dystocia

  • Substance Use and Abuse

  • Pelvic Health Birth Lacerations and Suturing

  • Third Stage

  • Consult, Transport & Transfer of Care

  • Placenta

  • Breastfeeding/ Chestfeeding

  • Breech

  • Cesarean and VBAC

  • Charting & Practice Guidelines

  • Anti-Racism in Midwifery

  • Ectopic Pregnancy

  • Liver and Jaundice

  • Gender and Sexuality

  • Fertility and Conception

  • Fetal Heart Rate Patterns

  • Embryology & Fetal Development

  • Fetal/Newborn Circulation

  • First Stage

  • Grief and Self Care

  • Hemorrhage

  • Gestational Diabetes

  • Genetic & Prenatal Screening

  • Pharmacology for Midwives

  • Normal Pregnancy

  • Physical Assessment

  • Hypertension

  • Research Literacy

Click below to view a Sample Study Group Module, updated edition*:

Sample SG Module 1: Third Stage

Virtual Online Group

Once a week, students have the opportunity to join and instructor and other students for a 1.5 hour online meeting. All students are welcome no matter where they are in the program or apprenticeship. During the meeting with discuss a midwifery topic, share resources, discuss apprenticeship and other student issues. This meeting is not mandatory but it is a great way to stay connected to the student community.

More About Study Group Coursework

Study Group was initiated by Shannon Anton in 1994, in response to apprentice midwives in the San Francisco Bay Area who expressed a need for a midwife-facilitated group learning process. Students who attended the first eighteen months of Study Group virtually defined the curriculum. Focus remained on the context of experiential learning, which moved the group from topic to topic.

In 2018, the original Study Group Modules were completely revised and updated by NMI Educational Director and current Study Group Instructor Erin Ryan, with assistance from Molly Dutton-Kenny. At this time, additional modules were also created, along with a new structure for sequence of submission (see above, Part 2)

Part Three: Preceptor-Supervised Apprenticeship

Knowledge and skills gained in the didactic/course work portion of the program prepare stu­dents for active participation at the onset of the apprenticeship experience. Students are respon­sible for selecting and securing their preceptorship. They may interview with potential preceptors at any time, and may choose to work with any midwife or other health professional meeting the criteria for precepting fac­ulty. While NMI preceptors do not need to apply or register as NARM Precepting Faculty, they must complete the NMI Preceptor application process and must meet the following minimum qualifications: 

  • Must be credentialed as a Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), Certified Midwife (CM), or Obstetrician/Gynecologist (OB/GYN).

  • Must be a licensed practitioner legally recognized by a state/jurisdiction to provide maternity care.

  • Must have an additional three years of experience after credentialing or fifty primary/co-primary births beyond entry-level CPM requirements.

  • Must have ten continuity of care births beyond entry-level CPM requirements.

  • Must have attended a minimum of ten out-of-hospital births in the last three years.

View NMI's Policy Statement on Preceptor/Apprentice Relationships

As precepting midwives observe and document increasing skill in their apprentices, they are expected to respond by making additional responsibilities and practice opportunities available. Through a joint process of preceptor and self-evaluation, students document their accomplish­ments and progress at their own pace towards meeting NMI program objectives and mastering MANA core competencies. 

“This course was one of birthing myself as a midwife... I remind myself that I am in the early stages of labor, and I must be patient and sensitive to tune in to the pace at which this birthing wants to happen.”
~ an NMI Student

The Apprenticeship Experience

Apprenticeships are generally based in home birth or birth center practices. Students can also expect to attend hospital births in the event of transport, which gives them opportunity to learn about and observe obstetrical standards of practice. Students are required to attend a minimum of 2 planned hospital births, either as an observer, student assistant under preceptor supervision, or student primary midwife under preceptor supervision. These planned hospital births are not transports, but may follow a prenatal transfer of care. Additionally, during the course of training within a preceptor’s practice, students will likely have opportunity to consult with other health care providers if complications develop in caregiving or questions arise concerning a client's health status. Students may also have opportunity to accompany their precepting midwife to peer review sessions, and so may confer with other midwives in the community on practical and professional issues.

While apprenticeship can be completed in two years, three to four years is more common. Apprentices are usually on call 24/7 and are expected to attend all exams and births for every client in their preceptor's practice. Students occasionally do apprentice in practices with multiple preceptors and practices that allow on- and off-call hours, but this is less common.

Minimum Timeline Requirements

While students are not required to enter the program having already secured an apprenticeship, NMI maintains a minimum timeline for clinical experience requirements: 

  • Within 36 months of initial enrollment: student must secure an apprenticeship.

  • Within 42 months of initial enrollment: student must begin filing documentation of non-primary experience.

  • Within 60 months of initial enrollment: student must begin filing documentation of student-primary care under preceptor supervision.

Clinical Requirements for Graduation

Current clinical requirements for graduation from National Midwifery Institute’s Certificate Program are published in the NMI Handbook

Functioning in any role (observer, doula, family member, friend, beginning apprentice):

  • 10 Observe Births

Functioning in the role of student-assistant midwife under preceptor-supervision:

  • 20 Assist Births

  • 22 Assist Prenatal exams

  • 3 Assist Initial exams

  • 20 Assist Newborn exams

  • 10 Assist Postpartum exams

Functioning in the role of student-primary midwife under preceptor-supervision:

  • 25 Births attended

  • 75 Prenatal exams

  • 20 Initial exams

  • 20 Newborn exams

  • 40 Postpartum exams within 24 hours and 6 weeks of birth

Of the 25 required Student-Primary under Preceptor-Supervision births, 10 must be with clients for whom the apprentice provided Continuity of Care, with at least:

  • 1 prenatal exam in a student-primary or student-assisting role; and birth.

Of the 25 required Student-Primary under Preceptor-Supervision births, an additional 5 must be with clients for whom the apprentice provided Full Continuity of Care, with at least:

  • 5 prenatal visits spanning two trimesters;

  • Birth;

  • 1 newborn exam performed within 12 hours of the birth, and;

  • 2 postpartum exams occurring between 24 hours and 6 weeks following the birth.

Other Experience Details:

  • All Student-Assist prenatal exams, newborn exams, and postpartum exams must be completed before beginning the same categories of clinicals as student-primary midwife under preceptor supervision.

  • 18 Student-Assist births must be completed before beginning Student-Primary under Preceptor-Supervision births, or more at the discretion of the supervising preceptor.

  • A minimum of 5 home births must be attended in any role.

  • A minimum of 2 planned hospital births must be attended in any role.

  • Transports to the hospital from an out-of-hospital setting are limited to 3 out of the 25 Student-Primary under Preceptor-Supervision births: the first 20 Student-Primary under Preceptor-Supervision births may include 2 transports, and the remaining 5 Student-Primary under Preceptor-Supervision births may include 1 transport.

  • 10 out-of-hospital Student-Primary under Preceptor-Supervision births must occur within the last 3 years.

  • All required minimum clinical experience must occur within the last 10 years.

  • A minimum of 10 of the 25 Student-Primary Under Preceptor-Supervision births must be attended in the US or Canada and must occur in out-of-hospital settings.

  • NARM requires that the clinical component of a student’s midwifery education must be at least two years in duration. California Midwifery Practice Act requires for licensure: a program that is 84 semester units in length, with half of the program consisting of clinical practice (84 semester units equates to 3780 total contact hours, with half being 1890 clinical contact hours.) NMI requires a minimum student enrollment period of twelve months, provided that the student meets the NARM two-year clinical timeframe stated above.

These clinical experiences are sufficient to meet NARM certification standards for entry-level midwifery practice, California licensing requirements as well as the licensing requirements of many states.

At this time, NMI is not accepting new out-of-country clinical placements (with exceptions - see below). United States residents interested in obtaining clinical training abroad may choose to do so, but the clinical experiences that they attend while abroad will not count toward NMI's clinical experience requirements for student-assistant under preceptor supervision or student-primary under preceptor supervision phases of clinical training. Students applying with advanced placement or transfer students with clinical experience obtained prior to enrollment who do not meet the exceptions below may be able to count out-of-country clinical experiences that they obtained with qualified preceptors prior to January 1, 2015.

  • Clinical experiences obtained in Canada and/or the United Kingdom may be able to be counted toward NMI's clinical experience requirements for graduation.

  • Applicants who are native or naturalized citizens of countries not listed here, and who secure preceptorships with midwives who are also native or naturalized citizens and are credentialed and legally practicing, may be able to document clinical experiences that will count toward NMI's clinical experience requirements for graduation.

Contact NMI to discuss your unique situation.

Sample Forms

Included are samples of NMI's clinical experience documentation forms and evaluation forms, for both student-assistant under preceptor supervision and student-primary under preceptor supervision phases of apprenticeship training. Enrolled students have access to current forms in the Student Portal.

Experience Documentation Forms

Evaluation Forms

Academic Honesty Policy

Honesty is a core value within National Midwifery Institute. The members of its community both require and expect one another to act with civility, personal integrity, and respect for one another’s dignity, rights, and intellectual property. This requires participation from all members of the NMI community to help create and maintain an environment in which all can succeed through the fruits of their own efforts. An environment of academic integrity is requisite to respect for self and others. NMI requires that each member of the NMI community adhere to the following principles and rules and pursue academic work in a truthful and straightforward manner, free from deception or fraud.

In order to complete their enrollment at NMI, students sign an  Academic Integrity Agreement. [internal note: As of August 31, 2018, the Academic Integrity Agreement will have  been distributed to all current NMI students: Current students are required to return their completed version to NMI no later than December 31, 2018. As of August  31, 2018, all applicants are required to sign the Academic Integrity Agreement in order to complete enrollment in our program. The Academic Integrity Agreement includes a commitment not to engage in or tolerate acts of falsification, misrepresentation, or deception. Below is a list of specific actions that NMI considers academic dishonesty, as well as our procedure for addressing violations.

Definitions of Academic Dishonesty

Cheating: Cheating is defined as fraud, deceit, or dishonesty in an academic assignment, or using or attempting to use materials, or assisting others in using materials that are prohibited or inappropriate in the context of the academic assignment in question, such as:

  • Copying or attempting to copy from others during an exam or on an assignment.

  • Communicating answers with another person during an exam.

  • Preprogramming a calculator, cell phone, pager, PDA or other electronic device to contain answers or other unauthorized information for exams.

  • Using unauthorized materials, prepared answers, written notes, or concealed information during an exam.

  • Allowing others to do an assignment or portion of an assignment, including the use of a commercial term-paper service.

  • Submission of the same assignment for more than one course without prior approval of all Instructors involved.

  • Collaborating on an exam or assignment with any other person without prior approval from the instructor.

  • Taking an exam for another person or having someone take an exam for them.

  • Using resources on an exercise that was intended by the Instructor to be completed without resources.

Plagiarism: Plagiarism is defined as use of intellectual material produced by another person without acknowledging its source, for example:

  • Wholesale copying of passages from works of others into modular course work without acknowledgement.

  • Use of the views, opinions, or insights of another without acknowledgment (i.e using sources without citation or attribution).

  • Working with another individual on an assignment, sharing information and files, and then turning in separate identical copies of that assignment as one’s own individual work.

False Information and Representation, Fabrication or Alteration of Information:

  • Furnishing false information/representation in the context of an academic assignment.

  • Fabricating or altering information or data (such as clinical experiences) and presenting it as legitimate.

  • Providing false or misleading information to an Instructor or any other NMI official or staff person.

Academic Misconduct: Other academically dishonest acts, including but not limited to:

  • Allowing another student to use their work and claim it as their own.

  • Tampering with the work of another student.

  • Facilitating other students’ acts of academic dishonesty.

  • Attempting to falsify an excuse in order to receive an extension on a deadline.

It is the responsibility of all students, faculty, and staff to report any violations of NMI’s Academic Integrity Policy to a Course Work Instructor or to one of the the Program’s Educational Directors.


I love the way this school trains midwives--with knowledge and experience together through the schoolwork and the hands-on.  I appreciate NMI so much for the kind of teaching you offer.
~ an NMI student

To learn more, view the NMI Handbook.