NARM Policy Statement on Preceptor/Student Relationships

In validating the apprenticeship as a valuable form of education and training for midwifery, NARM appreciates the many variations in the preceptor/student relationship. In upholding the professional demeanor of midwifery, it is important that each party in the relationship strive to maintain a sense of cooperation and respect for one another. While some preceptor/student relationships develop into a professional partnership, others are brief and specifically limited to a defined role for each participant. 

Effective January 1, 2017, all NARM preceptors must be registered before supervising any clinicals documented on a student’s NARM Application. Skills/clinicals signed off after that date by a preceptor who is not registered with NARM will be invalid. 

To help NARM candidates achieve exceptional training and a satisfactory relationship from their apprenticeship, NARM makes the following statements: 

1. All preceptors for NARM PEP applicants must be currently registered with NARM as a Registered Preceptor. Forms may be found on the NARM website or managed through Certemy. In order to qualify as a NARM Registered Preceptor, the midwife must document their credential as a Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), Certified Midwife (CM); or must be a licensed practitioner legally recognized by a state/jurisdiction to provide maternity care. A preceptor must have an additional three years of experience after credentialing or fifty primary/coprimary births beyond entry-level CPM requirements. A preceptor must have attended a minimum of ten out-of-hospital births in the last three years. It is the student’s responsibility to verify the preceptor’s registration status by asking their preceptor or contacting NARM. 
2. The clinical components of apprenticeship should include didactic and clinical experience, and the clinical component must be at least two years in duration. The average apprenticeship which includes didactic and clinical training typically lasts three to five years. In the PEP Application, the dates from the earliest clinical documented in Phase 1 or 2 until the last clinical documented in Phase 3 must span at least two years, or the applicant should enclose a statement explaining additional clinical experiences that complete the requirement but are not charted on these forms. Additional births may also be reflected on Form 102 Birth Experience Background. 
3. It is acceptable, even preferable, for the student to study under more than one Registered Preceptor. In the event that more than one preceptor is responsible for the training, each preceptor will sign off on those births and skills which were adequately performed under the supervision of that preceptor. Each preceptor who signs for any clinicals on Forms 111 or 112 must fill out and sign the Verification of Birth Experience Form. All numbers signed for must be equal to or greater than the numbers signed for on Forms 111a-d and 112a-e. The student should make multiple copies of all blank forms so each preceptor will have a copy to fill out and sign. These forms should be filled out and signed by the preceptor, not the applicant. 
4. Effective January 1, 2022, all NARM Registered Preceptors working with NARM PEP applicants must have a work agreement signed by the student and the preceptor. This work agreement must clearly define the job description for the student and preceptor, plan for regular reviews of the student’s progress and completion of the student’s NARM paperwork, financial compensation plan (if any) for the student and the preceptor, criteria required for the preceptor to sign off on NARM paperwork, and information regarding the NARM’s Preceptor/Student Accountability process and how that will be used for complaint resolution if the student and preceptor have a conflict they cannot resolve themselves. 
5. The student, if at all possible, should have the NARM application at the beginning of the apprenticeship and should have all relevant documentation signed regularly throughout each phase rather than waiting until the completion of the apprenticeship. 
6. Preceptors are expected to sign the application documentation for the student at the time the skill is performed competently. Determination of “adequate performance” of the skill is at the discretion of the preceptor, and multiple demonstrations of each skill may be necessary. Documentation of attendance and performance at births, prenatals, postpartums, etc., should be signed only if the preceptor agrees that expectations have been met. Any misunderstanding regarding expectations for satisfactory completion of experience or skills should be discussed and resolved as soon as possible, however the preceptor makes the final determination. 
7. The preceptor is expected to provide adequate opportunities for the student to observe clinical skills, to discuss clinical situations away from the clients, to practice clinical skills, and to perform the clinical skills in the capacity of a primary midwife, all while under the direct supervision of the preceptor. This means that the preceptor must be physically present when the student performs the midwife skills. The preceptor holds the final responsibility for the safety of the client or baby and should become involved, whenever warranted, in the spirit of positive education and role modeling. Preceptors who sign clinicals but refuse to complete the Final Verification Form without a justifiable reason, risk having their preceptor status revoked. If there is a concern, the clinical skill should not be signed off in the first place. 
8. Preceptors who sign off on experiences they did not witness risk losing their ability to sign as a preceptor in the future and also risk losing their NARM Certified Professional Midwife (CPM) credential. 
9. NARM’s definition of the Initial Prenatal Exam includes covering an intake interview, history (medical, gynecological, family) and a physical exam. These exams do not have to occur all on the first visit to the midwife, but the student should perform at least 20 of these exams on one or more early prenatal visits. The Initial Prenatal Exam should be performed by the student midwife at their first encounters with the client over no more than two visits for the purpose of screening suitability for out of hospital birth. It includes an intake interview, history (medical, gynecological, family), and physical assessment. The client must be offered all the assessments listed in Skills Verification Form 201a, Maternal Health Assessment, “Performs a physical examination.” NARM respects the right of the client to decline the physical exam as a whole or in part. When the client exercises this right of refusal, this should be noted in their chart, and the Initial Prenatal Exam may still count on Form 112b even without a full physical examination. 
10. Prenatal Exams, Newborn Exams, and Postpartum Exams as Assistant Under Supervision (forms 111b-d) must be completed before the same category of clinicals may be verified as Primary Under Supervision (Forms 112 b-e). However, Prenatals, Newborn Exams, and Postpartum Exams as a Primary Under Supervision may begin before the Primary Under Supervision births occur. 
11. Births as Assistant Under Supervision (Form 111) are births where the student is being taught to perform the skills of a midwife. Just observing a birth is not considered Assistant Under Supervision. Charting or other skills, providing labor and birth support, and participating in management discussions may all be done as an assistant in increasing degrees of responsibility. The student should perform some skills at every birth listed on Form 111a and must be present throughout labor, birth, and the immediate postpartum period. The student must complete 18 of the Assistant Under Supervision births before functioning as Primary Under Supervision at births. 
12. Births as a Primary Midwife Under Supervision (Form 112) means that the student demonstrates the ability to perform all aspects of midwifery care to the satisfaction of the preceptor who is physically present and supervising the student’s performance of skills and decision making. 
13. Catching the baby is a skill that should be taught and performed during the Assistant Under Supervision phase. The Primary Under Supervision births require that the student be responsible but under supervision for all skills needed for labor support and monitoring of mother and baby, risk assessment, the delivery of the infant, newborn exam, and the immediate postpartum assessment of mother and baby. If the mother or father is “catching” the baby, the Primary Under Supervision is responsible for all elements of the delivery. If the preceptor catches the baby, then that birth qualifies as Assistant Under Supervision for the student. 
14. The preceptor holds final responsibility for all prenatal care, the birth, and postpartum care done by the student. This applies to all phases including Phase 4 that only requires births. 
15. Attendance at a birth where either the student or preceptor is also the client will not be accepted for verification of the required clinicals.