The Russian Birth Project

The Russian Birth Project

The Russian Birth Project
Information for Potential Participants

Thank you for your interest in The Russian Birth Project, an intensive internship for American midwifery students. This information should provide you with some of the answers to your questions about the program.

RBP: Background

The Russian Birth Project was founded in 1992 by Molly Caliger Rybak and her husband, Gheorghy Rybak, as a not-for-profit educational and charitable organization. At that time, Americans were just beginning to discover Russia. Major political, social and economic shifts were beginning to take place in Russia, and it became possible for westerners to do business there and for various organizations to exchange experiences with the Russian people.

The RBP was founded with the intention of offering American midwifery students an opportunity to gain experience with both normal and high-risk birth. It is directed mainly toward the direct-entry student who has the intention of earning the Certified Professional Midwife credential through the North American Registry of Midwives (NARM). However, midwifery students of all backgrounds and educational paths are encouraged to apply.

The Setting

Participants in the internship live in St. Petersburg, Russia, Russia's "window on the West". This 300-year-old city is Russia's cultural center. It simply overflows with opportunities to absorb art, theatre, opera, ballet, and music. It is a city of Russian Orthodox churches, whitewashed pastel-colored buildings, dozens of canals, and palaces. It is also a city of neo modern architecture, concrete-and-steel apartment buildings, pot-hole-covered streets, and icy winds. It inspires in one a sense of mystery and romance, attraction and repugnance. Its dramatic history lingers in the atmosphere and can be sensed as being at once tragic and glorious.

This city was built on a swamp by Peter the Great in 1703, at the expense of hundreds of thousands of workers' lives. It was renamed Petrograd after the 1917 Revolution, and later Leningrad. Peterburgians have a reputation of being hearty, longsuffering people. They endured the Siege of Leningrad during World War II, during which time the city was blockaded for 900 days and millions died, most of starvation. The citizens of St. Petersburg are known for their hospitality, their open, generous nature, and their high level of education.

Interns in the RBP are expected to soak up as much of "real life" in St. Petersburg as they might. This means they will have ample opportunity for developing friendships, learning about the reality of Russian life from the inside. Interns are strongly encouraged to research some of the city's and the country's history ahead of time. Familiarizing yourself with classics of Russian literature is also helpful: Tolstoy and Dostoyevsky are a good start. Naturally, the more familiar an intern can become with the Russian language, the easier it will be to communicate.

Interns live in shared apartments with other interns. In past years, the apartments have been close to the roddom, but sometimes the apartments are on the edge of the city, since downtown apartments are much more expensive and outside the RBP budget. In such a case, interns ride public transportation—which is quite extensive in St. Petersburg—to work. The cost of taking public transportation to work is included in tuition. Basic food is provided as part of the program fee, and is purchased for interns in order to save them the time and difficulty of shopping for food—often a harrowing undertaking for non-Russian-speaking foreigners. "Extras"--such as expensive, imported items--are not included in the basic food supplies and interns must procure these things themselves.

Living as Russians do in a typical apartment of a large city can be a challenge to some Americans. It is not uncommon for the unexpected to happen, for instance, the telephone may suddenly stop working, or your toilet will start to run endlessly. A more extreme mishap may be that suddenly your key breaks off in the door lock, or the elevator in which you are riding gets stuck between floors and you have to wait an hour until you are rescued. These things are part and parcel of Russian life. It helps to have a good attitude and a healthy sense of humor. In Russia, things do not always run as smoothly as we expect, which is why Molly has always said, “Murphy’s Law was invented in Russia, and was actually called ‘Murfsky’s Law’”.

Interns should be prepared to live without hot water for at least several weeks out of their stay in Russia. Hot water is always turned off every summer, during which time the pipes are cleaned in the apartment building.

Gheorghy’s job is to handle as efficiently as possible such unexpected events of Russian life. Interns should not hesitate to call upon him to deal with these unpleasantries.

The Clinical Setting

Under the Soviet system of healthcare, clinics and hospitals were organized by region. Within a city, a woman belongs to a particular healthcare region and may receive care at the regional prenatal clinic and then later at her regional roddom (birth house). Midwives and physicians tend to work in either a clinic or a roddom their entire career, and there is still little continuity of care. Most Russian women are cared for by one set of doctors throughout pregnancy and yet another set of doctors and midwives care for them in the roddom. Even within a roddom, there are separate staff for every department.

The RBP has hosted internships at 6 different roddoms since its start in 1992. A roddom is chosen based on the receptiveness of its staff; its birth volume; and its availability during the internship period. The RBP has seen numerous changes in maternity care since its first year in Russia. At that time, all women labored in the same room and then gave birth together on birth tables set up beside each other in a communal delivery room. They recovered in the delivery room and were then taken to a shared post-partum room. In the early 1990s however, many roddoms in St. Petersburg began offering individual labor and delivery rooms with the participation of the husband if desired. The RBP contributed to some of the positive changes in St. Petersburg's maternity care system, and promoted such practices as: choice of birth position; delayed cord clamping; immediate bonding; and water birth.

The Russian maternity system differs considerably from the American. Nearly all deliveries are conducted in Russia by midwives who have graduated from a 3-year direct-entry midwifery college. Obstetricians are however "in charge" of all births, and have the final say as to how a birth should be "managed". RBP interns work side-by-side with Russian roddom personnel and are continuously under the supervision of Molly Rybak and the Russian staff.

Working in the Roddom

Interns work a manageable 5-day weekly schedule, Monday through Friday, with one day per week reserved for classes and case review. Classes provide a review of basic midwifery concepts as well as an emphasis on the theories and methods of classical midwifery as practiced in Russia. These skills and methods are further enhanced by a holistic approach which teaches the homeopathic philosophy of health. Interns are introduced to herbs, hydrotherapy, Russian folk medicine, and other alternative medicine modalities. Upon completion of the program, the student should have a solid grasp of the fundamental concepts of midwifery, an understanding of low-risk versus high-risk, and a holistic way of assessing potential clients to determine individual needs.

A maximum of six interns are accepted for any given internship. Interns work half of their shifts with Molly Rybak, and the other half under the supervision of the Russian staff together with a translator.

Interns work on all departments of a roddom: antenatal, labor & delivery, postpartum, and neonatal; however the bulk of the clinical hours are spent on the labor and delivery floor. They are assigned to be with women in labor on any given day, and they remain with that woman until she gives birth (within the confines of the schedule). Interns are permitted to observe cesarean sections provided they wear a mask.

Interns are taught the basic skills essential to practicing midwifery, and are encouraged to practice those skills under supervision of Molly Rybak. The skills an intern will be permitted to practice depend on her previous experience, theoretical understanding, and learning style. It is essential to remember at all times that we are guests of the Russian hospital and its staff, and it is not our purpose to change their way of doing things. Exchange of styles happens inevitably, however, but interns must come to Russia prepared to learn all they can from the Russians. This requires an open-minded, diplomatic attitude of humility and a desire to serve. Those interns who maintain such an attitude, regardless of past experience, have the most successful learning experience.

The number of total births attended by an intern varies from group to group. The birth rate cannot be predicted. Groups have attended as many as 100 and as few as 40 births. These births almost always include a number of higher-risk situations, such as vaginal twins and breeches, and cesarean sections. It is important to know that we cannot guarantee birth numbers. Interns should emphasize quality over quantity and should not come to Russia with inflexible expectations.

Proper work attire is expected of the interns, which includes: scrubs or scrub-type clothing covered by a white lab coat; comfortable, washable shoes which are to be worn only within the roddom; and some kind of head covering -- a plain, white cotton scarf works well.

Meals are brought from home and interns eat lunch and have tea in the staff kitchen, where they can heat up food, or meals are taken out at nearby cafes.

All medical personnel in Russia are required to undergo certain lab tests before being permitted to work. Interns must also undergo these tests. You may have them done in the US or in Russia. In Russia, they are far cheaper, and this will be an expense you have to pay for. More details about these tests is included in the information packet for accepted applicants.

Earning a Certificate of Completion

Those interns who fulfill all certificate requirements earn a certificate of completion from the RBP. Such interns also receive a letter of recommendation detailing the clinical experience and accomplishments of the intern. These documents add to your credibility as a midwife, whether it be for future clients, for finding employment, or for meeting licensing requirements.

A certificate from the RBP may or may not assist you in gaining legal midwifery status in your state. Your experience can be used toward earning the CPM credential, although most interns still need to obtain out-of-hospital birth experience in order to meet NARM requirements.

It is a requirement of the RBP program that all interns work toward earning a certificate of completion. Requirements of receiving a certificate are:

  • attending all clinic and class work at scheduled times unless she cannot due to illness;
  • receiving a passing grade on all quizzes;
  • receiving a passing grade on all skills assessments;
  • demonstrating respect and diplomacy toward all women and staff with whom she works;
  • satisfactorily completing all RBP charts for women with whom she works;
  • respecting the rights and needs of other interns and working in a team spirit;
  • completing a final essay and handing it in before her departure from Russia;
  • following all rules of the program (as described in the Statement of Commitment, which the intern receives after being accepted into the program);
  • having all fees paid in full, including telephone bills.

Educational Philosophy of the RBP

As founder of the program, it is my belief that education is all around us, all the time. It is not a process that happens passively, in which information is "bestowed" on another. It does not necessarily happen as a result of strict structure, memorization or learning by rote. Learning is not always even dependent on the ability or intelligence of a person.

I believe that learning happens as a result of a person recollecting in mind and body through a process of reflection. "Reflection" in this sense means "making real" some bit of information that already exists on other levels of existence. As many writers, poets, saints and others have said through the ages: All that is possible to be known is already known in the universe; it is merely a matter of remembering.

Whether it means remembering how to birth a baby, remembering how to midwife, or remembering the details of a complicated equation, the knowledge can only be recollected when there is sufficient "reflective power". I believe that the birth process serves as a unique analogy for this phenomenon. The student of midwifery undergoes an analogous birthing experience in her midwifery education. As in birth, the intern is called upon to labor, to be humble, longsuffering, and non-resisting.

The Russian internship experience is more difficult for most interns compared with other internship routes. The social, economic, political chaos of Russia is overwhelming for many. The differences in midwifery practices are met by some interns with uncompromising resistance. Some interns consider that their way is superior to the Russians' methods, and are unable to let go of their beliefs even temporarily. In addition, the cultural differences are sometimes difficult for Americans to understand. We are used to thinking about things in a certain way, and this way differs from the Russian way. Americans are trained to have the attitude that "the customer is always right". In a hospital birth situation, this means that American women demand services from the doctor, because they are paying for them. The Russian roddom system is quite different: medical services are free or low-cost (unless a woman is giving birth in a privatized wing of a roddom); medical personnel are among the lowest paid of all workers in Russia; and roddoms are rather stark, unadorned institutions which at times are lacking in even the most basic of supplies. The 1990's have seen most medical workers going for months without a paycheck. Russian women do not have the option of medicated pain relief in labor. All these factors and more contribute to the Russian woman's approach to birth, which is in contrast to the American woman's.

Such a difficult situation, however, is part of what makes the internship a wellspring for growth. The American student is challenged to embrace a different reality, and to do it gracefully, and with a sincere attitude of service. Such an attitude is its own reward, which ultimately makes for a midwife who will be more insightful, compassionate and capable.

Who is Eligible for the Program?

Applicants must meet the following prerequisites:

  • must be currently engaged in midwifery study (i.e., enrolled in a midwifery school, correspondence course, or apprenticeship), or has completed such a program of study (if you have questions about this requirement, please contact Molly);
  • must be certified in CPR for adults and infants;
  • must have evidence of testing negative for HIV (required by the roddom);
  • must be a high school graduate

Additionally, applicants must successfully complete an application. The most successful interns are not necessarily those who have attended a lot of births. The most successful candidates are those who find learning opportunities in their everyday lives. They are not limited by strict ideals of how birth "must" be. They are prepared to humble themselves and learn about different realities. They are prepared to face the darkest side of themselves, knowing that midwifery, like birth, is often painful, and they welcome this challenge as a unique catalyst for transformation.

Please consider this decision thoughtfully. The Russian Birth Project is enormously challenging. Before investing time and money, we urge you to consider your appropriateness for the program. If you have doubts or questions, feel free to contact Molly at (319) 656-3962.

Cost of the Program

Cost of the ten-week internship is $4000. ALL FEES ARE NON-REFUNDABLE. This includes:

  • a ten-week internship in a Russian maternity hospital with hands-on training and weekly classes, supervised by American and Russian obstetric personnel;
  • living arrangements in a shared apartment with other interns;
  • basic food;
  • a Certificate of Completion and letter of recommendation for those who successfully complete the program.

The fee does not include the following:

  • cost of airfare to and from St. Petersburg;
  • cost of passport, visa, and necessary supplies for the internship;
  • miscellaneous purchases, shopping, cultural excursions, travelling within Russia;
  • phone interview with Molly Rybak;
  • other expenses you incur in Russia (phone bills, medical bills, etc.)

How to Apply