Certified professional midwife Gina Gerboth reflects on why she believes, based on her own experience, that studying midwifery abroad is an important part of a well-rounded midwifery training. Having studied at the Yayasan Bumi Sehat birth center in Bali, Indonesia in 2009, Gina speaks to the value of gaining experience in a high-risk, high-volume setting, and of learning diverse practices from midwives with varied backgrounds. Most of all, she says, she came to realize the true importance of midwives in the global context.
A few years ago I went on a journey to fulfill some of the clinical requirements for my NARM application at Robin Lim’s birth center, Yayasan Bumi Sehat in Bali, Indonesia. I was pursuing the PEP process to become a certified professional midwife, and was eager to attend more births, as well as gain clinical experience in a birth center setting.
At the time that I decided to supplement my midwifery education with an experience abroad, I was living in a small city in the United States with a low homebirth rate, and I felt I needed to go someplace with a higher volume of births. I was also having a difficult time finding the right “fit” with a preceptor, and I felt a growing desire to meet and learn from other midwives who operate with different sets of protocols and practices. Furthermore, while I had attended approximately forty births before leaving for Bali, the vast majority of those were homebirths. Only a handful of them were hospital births, and I was feeling very anxious to learn more about the birth center or clinic setting.
The reasons for which I initially chose to study midwifery abroad turned out to be different than what I now consider to be the most beneficial things to come from the experience. Some aspects of my experience in Bali, such as the high volume of births I ultimately attended, were exactly what I had in mind before I left. However, much of what I took away from my time there was quite different than what I had expected.
I found that what I came away with after my experience in Bali met, and even exceeded, my expectations. I not only learned from the wonderful midwife Robin Lim, but from local Indonesian midwives as well, who ultimately taught me as much, if not more, than any other preceptor I have ever had. During my stay on site, there were also two visiting midwives. One was an Australian midwife who loved to discuss research, protocols and best-practices with me, and the other was a Canadian midwife who demonstrated for me the various clinical skills that are not often performed here in the United States, or that we don’t adequately teach to new midwives. Most importantly, she taught me what it looks like to be a good preceptor, and when the time comes for me to have a student, I know her guidance will be invaluable. All of these teachers allowed me to be imperfect—they were only a step away if I needed their help.
In this international context I also learned that birth generally works (something I already believed with religious fervor), but that true obstetrical emergencies are real and can happen at any time. In Bali, I observed for the first time complications such as pre-eclampsia and breech presentation. I managed more postpartum hemorrhages, sutured more tears, and evaluated for transport more often that I had ever before or have yet to repeat. With our low-volume practices here in the United States (combined with our more stringent risk-assessment protocols), it will take many years before I see the number of complications I dealt with in that short time again.
Most importantly, I learned that midwives are essential to the health and safety of women. Here in the United States, it can be very discouraging to be a midwife. We are swimming against the cultural currents of maternity care, and homebirth almost feels privileged and elitist. Collaboration with doctors and hospitals is often painful and demeaning. Abroad, I knew our work was important to many women—not only in the ways I know we are important to our clients here, but in critical, lifesaving ways. There are emergency medical services available to them when needed, but with educated and adequately equipped midwives, those services can be reserved for those that need them (rather than 99% of the population)—and when they are utilized there is mutual respect between physician and midwife.
One of the challenges I found to studying and practicing midwifery abroad was that I did not have the opportunity to form the type of midwife-client relationship that is the cornerstone of the Midwives Model of Care, both due to time and language barriers. The continuity of care there did not look the same as it does in the United States, where you establish a relationship with a client early on and see it through as the primary care giver. There you might host group prenatal clinics, in which 50 women could be seen in an evening by several different midwives, while four women labor at the same time. I would like to see how this could be evolved for future aspiring midwives as they embark on their journeys abroad.
There may be those who criticize training abroad, or those who believe that what the aspiring midwives learn will not be applicable at home. However, I disagree with them. While I do not think that all of one’s experience should come from abroad if their intention is to practice as a homebirth midwife here in the United States, I think learning abroad is an important part of a well-rounded training. To be sure, until we address the deficiencies in training midwives in the United States – from the bullying of apprentices, to the lack of volume and practice with high-risk situations – I think training abroad remains a legitimate approach to gaining important clinical skills.
I am certain I am a better midwife because of my time studying midwifery abroad in Bali.
Gina Gerboth is a Certified Professional Midwife and International Board Certified Lactation Consultant assisting births at Midwives of the Rockies. She began her path to midwifery 12 years ago, during the birth of her second son. She first became a breastfeeding peer counselor, then began her midwifery apprenticeship after many years of study. She gained a great deal of clinical experience at Yayasan Bumi Sehat birth clinic, in Bali. Gina lives in Denver, where she is pursuing further midwifery studies. She is married to her high school sweetheart and has three boys, two of whom were born at home.
Note: Yayasan Bumi Sehat is not a Midwife International clinic or program site, however Midwife International acknowledges and admires the outstanding work done by Ibu Robin Lim and the other midwives who are part of the organization.