Journal of Midwifery & Women’s Health www.jmwh.org
Original Research
Prior Work and Educational Experience Are Not Associated
With Successful Completion of a Master’s-Level, Distance
Education Midwifery Program
Nancy A. Niemczyk, CNM, PhD , Alison Cutts, CNM, MS, Dana B. Perlman, CNM, MSN
Introduction: In order to increase and diversify the midwifery workforce, admissions criteria for midwifery education programs must not contain
unnecessary barriers to entry. Once accepted, students need to successfully complete the program. Many admissions criteria commonly used in
midwifery education programs in the United States are not evidence based and could be unnecessary barriers to education. The primary objective
of this study was to identify factors known during the admission process that were related to successful completion or failure to complete a
midwifery program educating both student nurse-midwives (SNMs) and student midwives (SMs); a secondary objective was to quantify reasons
for program noncompletion.
Methods: This master’s-level, distance education program educates a diverse group of both SNMs and SMs. A pilot, retrospective cohort study
examined all students matriculating at the program from fall 2012 on and scheduled to graduate by summer 2016 (N = 58). Demographic informa-
tion, admissions information, academic records, and advising notes were reviewed. Reasons for noncompletion were identified, and characteristics
were compared between students who did and did not complete the program.
Results: Program completion was not significantly associated with students’ status as nurses prior to admission, labor and delivery nursing expe-
rience, length of nursing experience, nursing degree held, presence of children at home, working while in school, or undergraduate grade point
average.
Discussion: Being a nurse, years of nursing experience, type of nursing degree, or labor and delivery nursing experience were not associated with
completion of this midwifery program.
J Midwifery Womens Health 2018;00:1–7
c
2018 by the American College of Nurse-Midwives.
Keywords: education, graduate, midwives/education, nursing, school admission criteria
INTRODUCTION
Midwifery in the United States faces 2 major workforce chal-
lenges: increasing the number of midwives and diversifying
the profession. More midwives are needed to care for women
in the nearly 50% of US counties that lack a maternity care
provider,
1
and a more diverse group of midwives is needed to
care for and address disparities in health outcomes for the in-
creasing number of women of color.
2
However, as of January
4, 2017, there were only 37 Accreditation Commission for
Midwifery Education- (ACME-) accredited and preaccredited
midwifery education programs in the United States that were
accepting new students. These had approximately 100 unfilled
spaces for students per year, 89% of which were in programs
that required a nursing degree.
3
Increasing the number and
diversity of midwives requires 1) that schools admit a larger
and more diverse group of students; and 2) that students, once
enrolled, successfully complete their education programs and
pass their certification examinations. In order to achieve these
goals, admissions criteria must be evidence based and not
contain unnecessary barriers to entry to the profession.
There is little research to determine which admissions
requirements are associated with successful completion of
Address correspondence to Nancy A. Niemczyk, CNM, PhD, 440
Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261.
Email: nan37@pitt.edu
graduate health education programs, including those in
midwifery or nursing.
4,5
Research has largely centered on
thepredictiveabilitiesoftheGraduateRecordExaminations
(GRE) and undergraduate grade point average (GPA).
6–9
Consistently, undergraduate GPA has been found to be associ-
ated with academic success in nurse practitioner programs.
5,6
Results differ on whether GRE scores are associated with suc-
cess, but in studies that showed that they were, the correlation
was weak,
6,8
and GPA was more strongly associated.
6,10
The
research does suggest that emphasis on GRE scores and GPA
is detrimental to increasing minority representation in grad-
uate programs.
11
The only study to explore the relationship
between other factors and success in nurse practitioner pro-
grams found that nurses with 6 or more years of experience
were significantly less likely than others to graduate within
4 years of entry; type of nursing degree was unrelated to
success; and compared to white students, black and Asian
students were significantly less likely to graduate within
4yearsandhadlowerGPAs.
5
No literature has explored the
relationship between factors such as working during school
and the presence of children in the home with academic
success in nurse practitioner or midwifery programs in the
United States.
Most midwifery education programs have admissions re-
quirements that have not been rigorously evaluated. Of the
1526-9523/09/$36.00 doi:10.1111/jmwh.12716
c
2018 by the American College of Nurse-Midwives 1
✦ Registered nurses with labor and delivery experience were not more likely to successfully complete this distance midwifery
education program than other midwifery students, including those entering the program directly from fields other than
nursing.
✦ Type of nursing degree and years of practice were not associated with successful program completion.
✦ Many of the students who did not complete this midwifery program had unavoidable personal issues that prevented
continuation in midwifery education.
✦ Requiring nursing and specific nursing degrees and experience for admission to midwifery programs limits the pool of
potential midwives and may be a deterrent to increasing the size and diversity of the profession.
ACME- accredited programs accepting new students as of
January 4, 2017, 35 require a nursing license for admission
or prepare students for nurse licensure during the course of
the program; 11 require and 11 prefer nursing experience; and
2 require and 19 prefer labor and delivery nursing experience.
Theserequirementsmayserveasbarrierstopeopleentering
the profession.
Theprimaryobjectiveofthispilotstudywastoidentify
factorsknownduringtheadmissionprocessthatwererelated
to successful completion or failure to complete a distance
midwifery program educating both student nurse-midwives
(SNMs) and student midwives (SMs); the secondary objective
was to quantify reasons for noncompletion from the program.
The goal was to enable faculty during the admissions process
to better select students likely to succeed, guide improvement
insupportsforstudentsonceenrolled,andprovidedata
to help inform midwifery admissions nationally. The hy-
potheses were that registered nurses with labor and delivery
experience are not more likely to succeed than midwifery
students educated in disciplines other than nursing; that
part-time, working students may be at particular risk of
academic failure; and that many students who did not com-
plete the program were hindered by unavoidable personal
issues.
METHODS
Study Design, Setting, and Population
This was a pilot, retrospective cohort study that reviewed
academic records of former students at an ACME- accredited,
distance education midwifery program that educates both
SNMs and SMs, and grants the master of science degree in
midwifery. The mission of the program includes educating
students who reflect the racial, ethnic, and cultural diversity
of the country and making midwifery education accessible
to those who might not otherwise have access to graduate
education. In order to achieve this social justice mission,
faculty consider diverse measures of an applicant’s potential,
not only GPA or standardized test scores. Applicants must
hold a baccalaureate degree or higher in any field and have
a minimum GPA of 3.0. Exceptions to the GPA may be made
basedondemonstratedacademicgrowthorindicatorsof
potential to succeed. Neither the GRE nor nursing experience
is required, although the majority of applicants are registered
nurses. Applicants are required to have taken 2 semesters of
anatomy and physiology with a laboratory component, gen-
eral biology, microbiology, general chemistry, pathophysiol-
ogy, nutrition, sociology, general and developmental psychol-
ogy, and statistics prior to applying to the program. With the
exception of statistics, these requirements are waived for ap-
plicants who are registered nurses. The first semester con-
sists of course work in basic health care skills with a labora-
tory component, environments of health care, and concepts
of health and illness in clinical practice. This course work is
also waived for registered nurses. Students then continue or,
if registered nurses, enter the midwifery program in either a
full-time 2-year or part-time 3-year progression.
Instruction in this program is designed to be accessible
to working students with families. It is largely asynchronous
and conducted online with synchronous small group learning
spaced throughout each term of study. Problem-based learn-
ing is a central pedagogical technique threaded throughout
the curriculum.
12
Students attend 2 week-long on-campus
intensives during the midwifery program. The maximum
classsizeis18students.Proactiveacademicadvising,in
whichadvisorsmeetfrequentlywithstudentsandreachout
to them before problems are identified, is practiced, and
extensive advising notes are kept.
13
Included in this study were all students who matriculated
at the program in the fall of 2012 or later and who were
scheduled to graduate by summer of 2016. This time period
was chosen because major curriculum revisions were put into
place for the class entering in 2012, which were designed to aid
the transition into midwifery of students with backgrounds
other than nursing and better integrate master’s competen-
cies, formerly taught as a completion program, seamlessly
into basic midwifery education. All students had signed
an informed consent form when they accepted admission
allowing their deidentified academic records and personal
information to be used for research purposes. The study was
approved by the Philadelphia University Institutional Review
Board.
Information on the admissions requirements of mid-
wifery programs was gathered by a student research assistant.
She examined the websites of all ACME- accredited programs
listed on the American College of Nurse-Midwives website
as accepting new students as of January 4, 2017. If admis-
sionsrequirementswerenotclearlystatedonthewebsite,she
2 Volume 00, No. 0, xxxx 2018
Table 1. Composite Case Studies—Complexity of Factors Leading to Program Noncompletion
Academic reasons for noncompletion
Dinah
a
held a bachelor of arts degree, an associate’s degree in nursing, and a bachelor of science degree in nursing, with cumulative GPA of
3.49. International experience and the births of her children inspired her to midwifery. Dinah was in the part-time program, studying
on weekdays while her children were in school, and working three 12-hour shifts on weekends. During her second term, her car and
texts were stolen. She could not afford new texts and was embarrassed to tell her advisor. Subsequently, she failed an examination. When
she did notify her advisor of the theft, she had already failed a second examination and missed the deadline to withdraw, failing the
class. Despite the urging of her advisor, Dinah declined a leave of absence prior to course failure, entered into a learning plan for
improved communications, and successfully repeated the course the following semester. Subsequently, her son suffered a concussion,
requiring a substantial amount of Dinah’s care. Despite encouragement to do so, Dinah did not seek a leave of absence, extensions, nor
writing support prior to submitting 2 written assignments, and earned a C on both. Dinah and her advisor made a schedule for the rest
of the term and followed up by phone regularly. Dinah’s next 2 assignments were improved. At the end of the term, a mandatory
overtime shift caused her to submit a final assignment without input from the writing tutors, and she did not request an extension. She
earned an F due to failure to answer all parts of the assignment and substantial plagiarism of another student’s paper. She was dismissed
from the program for a second course failure per university policy.
Personal reasons for noncompletion
Eleanor
a
earned a BSN with a GPA of 3.51 and has been both a mother-infant and public health nurse. After taking Advanced Physical
Assessment and Advanced Physiology/Pathophysiology for Primary Care, Eleanor found she enjoyed primary care very much and did
well in the courses. In her third term of study, Eleanor found herself facing a divorce. She had 2 school-age children. She decided that a
family nurse practitioner course of study was a better fit both for her interests and for her lifestyle as a single parent and withdrew from
the midwifery program.
a
Not real name.
contacted program staff either by telephone or email for clar-
ification.
Completion and Noncompletion
A student graduate assistant, faculty member, and the
program director reviewed demographic information,
admissions materials, academic records, and advising notes
for all study participants. Records of students matriculated
at the time of data collection were reviewed by faculty only.
Data were collected on a standardized form including only
a study-specific identification number and then entered
into a database from that deidentified form. The key to the
identification number is kept locked in the primary inves-
tigator’s private office. The primary outcome was whether
ornotthestudentsuccessfullycompletedtheprogramand
was determined by review of advising notes and transcripts.
Reasons for noncompletion were classified as either academic
or personal, as they are reported to ACME, based on review
of advising notes. Many reasons were convoluted, reflecting
the complexity of women’s lives and the lives of students who
choose distance education (See Table 1 for composite exam-
ples of academic and personal reasons for noncompletion).
Decisions about whether noncompletion was due primarily
to personal or academic reasons in complex cases were made
by consensus of the study team.
Passage of the certification examination was determined
by documentation of certification on the American Mid-
wifery Certification Board (AMCB) website. Individual-level
data on first-time passing rates were not available because
AMCB does not provide these data to education programs.
Demographic, Academic, and Personal Measures
Risk factors for noncompletion were chosen based on
the results of an internal examination of 2 years of data
done as part of the ACME reaccreditation process. This
analysis found that all students who left the program for
academic reasons were nurses educated at least at the BSN
level who worked while in school. More than half had a
science GPA below 3.5, were part-time students, had labor
and delivery nursing experience, and had been nurses for
more than 5 years. That analysis also identified the courses
most frequently failed by students leaving for academic
reasons.
For the current pilot study, information about previous
educational background was obtained from resumes and aca-
demic transcripts submitted as part of the admissions pro-
cess. Previous work history was determined from resumes.
Program entry (SNM vs SM) and progression (2-year vs
3-year) were determined by review of the student’s individ-
ualized program plan. Undergraduate GPA was calculated as
theGPAsforallundergraduateworkweightedbynumberof
credits found on transcripts submitted as part of the admis-
sions process. Undergraduate science GPA was calculated as
the weighted average by number of credits for undergradu-
ate anatomy and physiology, general biology, microbiology,
pathophysiology, nutrition, and statistics courses. When no
pathophysiology course was present on the transcript, the
grade for medical/surgical nursing, if present, was substi-
tuted. GPA in the program and grades in specific courses were
determined by review of transcripts.
Researchersreviewedinformationvolunteeredonadmis-
sions materials including interviews and advising notes with
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Table 2. Demographic Characteristics of 58 Midwifery Students
Characteristic Value
Age at applica tion, median (IQR), y 34.5 (29-38)
Wome n, n ( % ) 57 (98.3)
Self-identied race, n (%)
a
White 45 (83.2)
Black or African American 7 (13.0)
Other and multiracial 2 (3.8)
Hispanic ethnicity, n (%) 4 (7.3)
Credits paid for by students who did not
complete the program, median (IQR), mode
b,c
8 (6-18), 6
Abbreviations: IQR, interquartile range.
a
N = 54.
b
N = 24.
c
Total credits for program = 62.
a tool to collect data on whether or not the student had chil-
dren at home and worked while in school. Work was defined
as any paid work. The ratings from professional recommenda-
tions and the recommendations of program faculty members
performing interviews were obtained from the admissions
materials.
Information on race and ethnicity based on self-
identification was collected and analyzed for internal use but
is presented here only in aggregate because small numbers
make it impossible to present results for students who did
and did not complete the program while maintaining student
confidentiality.
Statistical Analysis
Descriptive statistics are presented as means, medians, modes,
orpercentagesasappropriate.Fisher’sexacttestsand2-
sample t tests were used to compare characteristics between
students who did and did not successfully complete the pro-
gram. Statistical analyses were performed using SAS statistical
software release 9.4 (SAS Institute, Cary, NC).
RESULTS
Fifty-eight students matriculated into the midwifery program
in the fall of 2012 or later and were scheduled to graduate by
summer 2016. Demographic characteristics are presented in
Table 2; 24.1% of students identified as being black or African
American,Hispanicwhite,Asian,orofmultipleraces.Allstu-
dents who graduated became certified by AMCB. The first-
time pass rate for the program after the new curriculum was
fully implemented was 95% in 2015 and 89% in 2016.
Characteristics of students who did and did not suc-
cessfully complete the program are presented in Table 3.
Program completion was not significantly associated with
any of the factors related to previous nursing experience,
including whether or not the students were registered nurses
or had labor and delivery nursing experience, years of nursing
practice, or nursing degree held. There were no significant
differences in academic factors known to the admissions
committee when making admissions decisions, including
ratings on recommendations, ratings by the interviewer, or
having earned a previous advanced degree or mean under-
graduate and mean undergraduate science GPAs. Compared
to students who successfully completed the program, students
who did not complete the program were more likely to have
undergraduate GPAs less than 3.0 (33.3% vs 24.2%, P = .55)
and undergraduate science GPAs less than 3.0 (29.2% vs
18.2%, P = .65), but these differences were not statistically
significant. Failure of the first writing-intensive course was
significantly associated with failure to complete the program.
Personal characteristics such as working while in school or
having children at home did not differ between groups, but
students who did not complete the program were more likely
to be students in the part-time 3-year progression rather than
in the full-time 2-year progression (50.0% vs 26.5%, P = .10);
yet here, too, the difference was not statistically significant.
Duringthetimeframeofthisstudy,24studentsdid
not complete the program; excluding 3 students who left
the program within days of enrollment when they were
not awarded a competitive federal traineeship, 21 students
(38%) who began coursework did not complete. Students
who did not complete the program typically left early; the
median number of credits paid for by students who did
not complete was 8, and the modal number was 6, out of a
total of 62 credits. Of the students who did not complete the
program, reasons were primarily academic for 15 (62.5%) as
opposed to primarily personal for 9 (37.5%); however, this
difference was not statistically significant (P = .22). Examples
of academic reasons for attrition included dismissal for failing
2 courses, dismissal for plagiarism, and withdrawal pending
dismissal for course failures. Examples of personal reasons for
leaving the program included unplanned pregnancy, divorce,
competing demands on time (such as work, young children,
or elderly parents), personal or family illness, and decisions
not to become a midwife or to pursue other career options.
DISCUSSION
As hypothesized, registered nurses with labor and delivery ex-
perience were not more likely to successfully complete this
midwifery education program than other midwifery students,
including those who are not nurses, and who enter the pro-
gram with an educational background in other fields. Type of
nursing degree and years of practice were also not associated
with successful program completion. These findings are con-
sistent with other US studies that have found number of years
of nursing experience is not associated with a student’s success
in graduate nursing programs,
5,14,15
although this study is the
first to include student midwives who do not have a nursing
degree prior to admission. An evaluation of the first 2 years of
the certified midwife program at the State University of New
York Health Science Center at Brooklyn found that no student
midwives withdrew or were dismissed from the program.
16
Studies that have evaluated nurse practitioner students sim-
ilarlyfoundthattypeofnursingpreparationandwhetheror
not a student had a previous advanced degree were not related
to student success.
5
Students attending the program part time were twice as
likely not to complete it when compared to full-time students,
although that difference was not statistically significant.
Students who choose a part-time path, just like students
4 Volume 00, No. 0, xxxx 2018
Table 3. Factors Associated With Successful Program Completion Among 58 Midwifery Students
Factor
Did Not Successfully
Complete Program
(n = )
Successfully Completed
Program (n = ) P
a
Prior academic factors
Registered nurse, n (%) 21 (87.5) 31 (91.2) .68
BSN, n (%) 16 (66.7) 22 (64.7) .99
Previous advanced degree, n (%) 4 (16.7) 7 (20.6) .99
Advanced placement, n (%) 3 (12.5) 4 (11.8) .99
Science GPA ⬍ 3.0, n (%)
b
7 (29.2) 6 (18.2) .36
Undergrad GPA ⬍ 3.0, n (%)
b
8 (33.3) 8 (24.2) .55
Mean science GPA, mean (SD)
b
3.25 (0.56) 3.25 (0.47) .99
Mean undergrad GPA, mean (SD)
b
3.24 (0.37) 3.29 (0.37) .65
Admissions factors
Highly recommended on interview, n (%)
c
18 (81.8) 25 (75.8) .74
Recommendations rate above average, n (%)
d
24 (100) 31 (96.9) .99
Academic factors at the program
3-year progression (part-time), n (%) 12 (50.0) 9 (26.5) .10
Failure or withdrawal in first writing-intensive graduate course, n (%)
e
6 (54.6) 0 (0.0) ⬍.001
Failure or withdrawal in first physiology-intensive graduate course, n (%)
f
2 (12.5) 0 (0.0) .10
Program GPA ⬍ 3, n (%) 10 (41.7) 0 (0.0) ⬍.001
Wor k e x per i e n c e
Labor and delivery nursing experience, n (%) 13 (54.2) 17 (50.0) .79
5 or more years as RN, n (%) 15 (62.5) 20 (58.8) .99
Social factors
Children at home, n (%) 15 (62.5) 28 (82.4) .13
Working while in school, n (%) 23 (95.8) 27 (79.4) .12
Abbreviations: BSN, bachelor of science in nursing; GPA, grade point average; RN, registered nurse.
a
P values from Fisher’s exact test or 2-sample t test as appropriate.
b
n = 57; 24 did not complete and 33 did complete.
c
n = 55; 22 did not complete and 33 did complete.
d
n = 56; 24 did not complete and 32 did complete.
e
n = 45; 11 did not complete and 34 did complete.
f
n = 50; 16 did not complete and 34 did complete.
who choose distance education, may have complex lives with
competing responsibilities and hope that part-time, distance
education will allow them to achieve their educational goals
while also fulfilling their personal responsibilities.
17,18
They
may have more complicated lives than students choosing
full-time study and thus may be less likely to be able to
balance the competing demands. Alternately, compared to
a 2-year education program, 3 years may simply provide a
50% greater opportunity for unexpected illnesses, births,
or deaths to occur, making it more difficult for students to
complete their education. Uniquely, we explored working
while in school and presence of children at home, and found
that these were not associated with successful program
completion. Future research should include whether there are
measures of work (eg, maximum number of hours, timing of
shifts) or parenthood (type of child care, age of children) that
are associated with academic success.
Similar percentages of students left the program for aca-
demic and personal reasons, although these were often in-
tertwined. International studies have also found that many
students leave midwifery programs for personal reasons. A
study of noncompletion from an Ontario midwifery program
found that health concerns and births were leading reasons for
withdrawal from midwifery school.
19
Similarly to our study,
aBritishstudyfoundthatamajorreasonfornoncomple-
tion from midwifery programs was deciding that midwifery
was the wrong career,
20
and a study of reasons for with-
drawing from distance education programs in nursing and
health studies found that personal reasons included life cir-
cumstances,workcommitments,learningstyle,andevolving
career aspirations.
18
The 62% completion rate by students who began course-
work is consistent with rates of 50% to 80% reported by
other graduate, health, distance education programs and
likely reflects the realities of students who seek distance
education.
17,18
Across disciplines, on-site programs tend
to have higher completion rates than distance education
programs.
18,21,22
It is thought that students choosing distance
education may think they cannot succeed in traditional
programs because of their complex lives involving obligations
to children, aging parents, employment, and mortgages.
18
Reliable information on completion of midwifery and
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nurse-practitioner programs is not publicly available for easy
comparison, and comparison of program completion between
institutions is hindered by lack of standardized definitions
for terms such as attrition, retention, persistence, graduation
rate, and student return. Completion was chosen as the most
relevant measure, but noncompletion is higher than the more
frequently cited attrition, making comparison difficult.
23
A study of factors related to completion of one institution’s
on-site nurse practitioner programs found that while 77%
of students overall graduated within 4 years, only 44% of
African American students did, suggesting that subgroups
of students are more likely not to complete graduate health
programs.
5
This study is the first to our knowledge to explore factors
associated with success in a US distance education midwifery
programandoneofthefirsttoexplorehowpersonalfactors
such as having children at home affect completion in a dis-
tance education program. Our study is limited by a relatively
small sample size and by having been conducted in a single
institution, although it includes complete information on sev-
eral cohorts of students.
It is not known how comparable the student body in this
program is to the general population of midwifery students;
aslightlyhigherpercentageofstudentswereraciallyoreth-
nically diverse (not non-Hispanic white) compared to mid-
wifery students nationally (24.1% for this program, 19.3% na-
tionally in 2013, and 21.9% nationally in 2014).
3
As part of
the program’s mission to diversify the midwifery profession,
thecurriculumisdesignedtobeaccessibletostudentswith
educational backgrounds not limited to nursing and with a va-
riety of types of work experience, as is consistent with the In-
ternational Confederation of Midwives Global Standards for
Midwifery Education.
24
Students entering midwifery directly
may not be as successful in other programs, which may not be
designed to meet their learning needs. Yet the results of this
pilot study demonstrate that it is possible to educate individ-
uals who have a variety of backgrounds to be midwives in the
United States, with equal chance of success.
An additional limitation is that only one possible mea-
sure of student success, program completion, was measured.
It is plausible that students with labor and delivery nursing
experience may have higher GPAs while in midwifery school
or be able to spend less time studying. Studies of graduate
health programs have found undergraduate GPA to be associ-
ated with graduate GPA.
5,6,9,25
Program completion was cho-
sen as the outcome because midwifery education is compe-
tency based, and all students who graduate have demonstrated
competence in midwifery.
The study also has the inherent limitations of the retro-
spective cohort design, including being limited to only data
that were collected for other purposes. Future work should
include prospective data collection with tools specifically de-
signed for the purpose and collect data such as more detail
about hours worked during the program, family responsibili-
ties, disabilities, first language, and ease of entry into clinicals.
Program faculty are using these data to explore issues
around the specific courses for which failure is associated with
program noncompletion and whether admissions interviews
and recommendations can be tailored to better predict suc-
cessful students. Since life circumstances were so often related
to both academic failures and withdrawal from the program
for personal reasons, the faculty are exploring use of a social-
determinants-of-health tool after students have been accepted
to identify at-risk students who may benefit from early out-
reach from their advisor so they can see advisors as approach-
able advocates. Additionally, the academic success center at
the university piloted and has adopted online, synchronous
video writing tutor support for students in graduate health
programs.
Admissions requirements for graduate health programs
have often been based on expert opinion and commonly used
requirements for test scores or type of degree or work experi-
ence may differentially limit admission of qualified minority
students.
4,11
A commitment to increasing and diversifying the
midwifery profession requires careful scrutiny of admissions
requirements for midwifery education programs and explo-
ration of effective methods to support students through per-
sonally and academically demanding education.
CONCLUSION
Wefoundnoevidencethatbeinganurse,yearsofnursingex-
perience, type of nursing degree, or labor and delivery nursing
experience were associated with successful completion of this
master’s-level, distance education midwifery program. With
100 unfilled midwifery education program seats nationally,
and significant racial disparities in maternal and newborn
health outcomes, results of this pilot study suggest that there
needs to be rigorous scrutiny of admissions requirements for
student midwives to ensure that there are no unnecessary bar-
riers to education, which might include requirements for spe-
cific nursing degrees or experience, which might limit the size
and diversity of the profession.
AUTHORS
Nancy A. Niemczyk, CNM, PhD, is director of the Nurse-
Midwifery Program at the University of Pittsburgh, School of
Nursing, and midwife emeritus, the Midwife Center for Birth
and Women’s Health, both in Pittsburgh, Pennsylvania.
Alison Cutts, CNM, MS, attends births at home and in hospi-
tal in private practice in southeastern Pennsylvania.
Dana B. Perlman, CNM, MSN, FACNM, is director of the
Midwifery Institute at Jefferson in Philadelphia, Pennsylvania.
CONFLICT OF INTEREST
Dana Perlman, CNM, MSN, FACNM, is director of the Mid-
wifery Institute at Jefferson. Nancy A. Niemczyk, CNM, PhD,
is a former assistant professor at the Midwifery Institute of
Philadelphia University.
ACKNOWLEDGMENTS
The authors thank Nora Kupiec, SN, for her assistance with re-
search for this manuscript, and Barbara Hackley, CNM, PhD,
for her comments on the manuscript. Funding was provided
by The Midwifery Institute at Philadelphia University; the
Provost’s Office at Philadelphia University; the University of
Pittsburgh, School of Nursing; and the University of Pitts-
burgh, Provost’s Office.
6 Volume 00, No. 0, xxxx 2018
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