10 HOURS OF CE FOR MIDWIVES AND NURSES (CNMs, RNFAs, and other nurses for whom this skill is within scope)

On-Demand Portion

Course curriculum for the

  • 01
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    • How To Take This Course, Including Ordering Your Supply Kit, and Scheduling Your Final Exam
    • Before we go on...
    • 1.1 Introduction
    • 1.2 Language Matters
    • Quiz 1
  • 02
    Equipment and Safety
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    • 2.1 Choosing The Right Instruments
    • Q&A Why Russian forceps?
    • Quiz 2.1
    • Bonus Section: Article on Left-handed Surgical Instruments
    • Bonus Section: Review of Instruments for Left-handed Midwives
    • 2.2 Proper Instrument Techniques
    • Visit our Supply Store (Optional resource)
    • Q&A: Why The Needle Spins
    • Quiz 2.2
    • 2.3 Choosing The Right Suture
    • Quiz 2.3
    • 2.4 Other Supplies
    • Q&A Lube on Suture
    • Quiz 2.4
    • 2.5 Safety and Sterilization
    • Q&A How Do You Pack Your Instruments?
    • Q&A How Long Do Instruments STAY Sterile?
    • A Guide to Your Supply Kit
  • 03
    Before The Repair
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    • 3.1 Mapping and Tear Prevention
    • Quiz 3.1
    • 3.2 Exam and Assessment Prep
    • Q&A Positioning the Client
    • Q&A Anesthetic Prior to Exam
    • Quiz 3.2
    • 3.3 Initial Exam and Assessment
    • Quiz 3.3
    • 3.4 Degree Determinations
    • Q&A Depth of Tear
    • Quiz 3.4
    • 3.5 OASIS Assessment
    • Q&A Dovetail Clarification
    • Quiz 3.5
    • Printable PDF: Methods for Assessing Anal and Rectal Injury (OASIS)
    • 3.6 Planning the Repair
    • Printable PDF: Suturing Do's and Don'ts
    • Quiz 3.6
    • 3.7 To Suture or Not To Suture?
    • Q&A To Suture or Not? Herbs for Healing?
    • Overview of Research on Suturing vs Not Outcomes
    • Bonus Section: Articles and Studies on Outcomes of Suturing vs Not
  • 04
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    • 4.1 General Considerations for Anesthetic
    • Quiz 4.1
    • 4.2 Considerations for Lidocaine
    • Q&A Allergic Reaction to Lidocaine
    • Quiz 4.2
    • Printable PDF: Lidocaine Reference Card
    • 4.3 Considerations for Ester Anesthetics
    • Quiz 4.3
    • 4.4 Methods of Anesthetic Administration
    • 4.5 Tissue Adhesive
    • Quiz 4.5
  • 05
    Knot and Stitch Techniques
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    • How To Use This Section
    • 5.1 Talkthrough: From Anchoring Knot to End Knot
    • Q&A Why does the cross-over stitch NOT cross the wound?
    • Quiz 5.1
    • 5.2 Medical Model Walkthrough: Anchoring Knot/Surgeons Knot/Instrument Tie
    • 5.3 Medical Model Walkthrough: Two Layer Suturing of the Vaginal Floor
    • 5.4 Medical Model Walkthrough: Subcuticular Running Mattress to End Knot
    • 5.5 Talkthrough: Labial Repairs
  • 06
    Practice Makes Perfect Suture-Along (Supply kit needed!)
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    • 6.1 Practice Makes Perfect: How to Use the Supplies
    • 6.2 Practice Makes Perfect: Curving, Curving, Curving
    • 6.3 Practice Makes Perfect: 1 cm Down, and Straight Across
    • 6.4 The Optical Illusion
    • 6.5 Practice Foam Walkthrough: Interrupted Stitches and Basic Technique Tips
    • Q&A Interrupted Stitches
    • 6.6 Practice Foam Walkthrough Part 1: Assessment and Anchoring Knot
    • Q&A Anchor Knot Placement Explanation
    • 6.7 Practice Foam Walkthrough Part 2: Anchor Knot to End Knot of Double Layer Sutures
    • Bonus Section: Walkthrough of LEFTIE Suturing
    • Close-up of End Knot
    • 6.8 Practice Foam Walkthrough: Locked Blanket
    • Retrieving a Lost Needle
    • Q&A Swelling, Adjusting Tension, and Timing of Repair
  • 07
    Documentation & Aftercare
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    • 7.1 Charting
    • Printable PDF: OASIS Assessment Informed Choice Template
    • Printable PDF: Checklist for Charting Postpartum Genital Injury Repair
    • Printable PDF: Client Informed Choice Suturing
    • Q&A Using Herbs and Bee Things
    • Q&A Soothing Itching
    • Q&A Detecting Infection and Follow-up Care
  • 08
    Tests, Evaluation, and Follow-Up
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    • Link to Written Test
    • Course Evaluation

Upon completion of this program, the learner will be able to:

  • Follow OSHA protocol for suturing
  • Assess post-childbirth genital injuries, including OASIS (third and fourth degree)
  • Plan the repair
  • Determine the appropriate local anesthetic, and administer local anesthetic
  • Perform instrument ties
  • Perform the following stitches: interrupted, basting stitch, locked blanket stitch, and locked mattress stitch
  • Proper charting for suturing
  • Provide clients with aftercare options
  • Instructor Bio:

    Holly Scholles, MA, CPM, is a homebirth midwife with over 40 years of experience, and was the founder and president of Birthingway College of Midwifery. She is also an anthropologist specializing in human reproduction and medical anthropology.

    Holly Scholles

    MA, CPM

Terms and Conditions

Due to the small cohort format of this course, there are different terms and conditions than our purely on-demand online courses. These Terms and Conditions are needed in order for the course delivery process to be smooth for you, the fellow members of your cohort, and the next cohort (that will be using your supply kits once returned). 

By enrolling in this course, you are agreeing to these Terms and Conditions, so please read them carefully:

1. Upon enrollment, you will have instant access to the on-demand portion. The on-demand portion (with the exception of portions marked as "bonus" content) must be completed by one half hour prior to your small group session. 

2. You also must pass the written test with an 80% or greater by one half hour prior to your small group session.  

3. Attendance and participation in the small group session is required. The small group session for this cohort is: 

Thursday, June 8th, 2023

Pacific: 9:15am to 12:30pm

If you cannot attend the small group session for any reason, including not completing 1 and 2 above, you may attend the make-up session listed below, for an additional $100. You may also choose to take this session in addition to the standard session, if you would like additional practice, and feedback from the instructor (same fee). The make-up session for this cohort is: 

Thursday, June 15th

Pacific: 9:15am to 12:30pm

(additional $100 fee applies)

4. After you attend a small group practice session, you must also attend a 1 hour private session with Holly Scholles, which will include a skills test. Sessions are available the same day as the small group session, and the same day as the make-up session. Upon enrollment, you will be able to sign up for a testing session using an online scheduler.

Private skills test sessions are available for this cohort (each private session is 1 hour - for example, 1pm to 2pm):

Thursday, June 8th


Thursday, June 15th

Pacific: 1pm to 4pm

We provide six test slots for the six students per cohort. If you cannot make any of the available times, you may request an alternate test time outside of those appointment slots, which may be arranged for an additional $100 fee.

If you are unable to pass your skills test, there will be a $100 fee for a second (or third) private skills test session. 

Your skills test must be completed within 2 weeks of your original small group session date.

5. After completion of steps 1-4 above, you will be emailed a Priority Mail postage paid return label for your supply kit. You will need to print this label, and then arrange for a (free) USPS pick-up, or drop the package at any post office.

Supply kits not sent back within 2 weeks after your private session will incur $5/day late fees up to the replacement cost of the kit, unless an extension is granted. Any missing items, or items damaged beyond normal wear-and-tear, will be charged the following replacement costs:

  • metal file - $10
  • needle holder, Russian style forceps, hemostat, or scissors - $20 per item
  • clamp stand - $20

(If you purchase the optional Keeper Kit, #5 does not apply, as those with Keeper Kits do not need to return anything.)

6. MEAC requires you complete a course evaluation. We'll send you a direct link and a reminder after your skills test.

7. Your CE Certificate for 10 hours of continuing education will be sent via email once Steps 1-6 are complete, and any fees incurred during those steps have been paid in full. The date on the certificate, once sent, will be the date your passed your skills test. 

(For example, if your small group cohort is on Thursday, September 17th, you sign-up for your skills test to be the same day, send your supply kit back the next day, the earliest you would receive your certificate would be Monday, September 21st. But your certificate would be dated for the 17th, as that was the day you passed your skills test.)

Refunds and Cohort Exchanges

A full refund is available if ALL the following conditions are met:

1. Less than 10% of the on-demand portion has been accessed.

2. It has been less than 30 days since enrollment.

3. It is more than 30 days until the small group cohort.

If it has been more than 30 days since enrollment, and/or more than 10% of the on-demand portion has been accessed, but still more that 30 days until the small group cohort, then you may switch to a different small group cohort, if available, at no additional fee.

This course was designed to meet the requirements of the hands-on Category 1 course for the NARM Midwifery Bridge Certificate, and for the new "LD&D Renewal" for Oregon LDMs

If you are a midwife in Colorado, please email jesica@HiveCE. We have a low-cost supplemental course you will need to take along with Hands-On Suturing in order to meet the requirements for your state.

This course is appropriate for CNMs, RNFAs, and other nurses who perform post-childbirth perineal repairs. It is not appropriate for all nurses. Course completion does not authorize the learner to use skills outside their scope. Please refer to your state guidelines for determining scope of care.

HiveCE is an approved provider of continuing education by the California Board of Nursing, and this course meets the California Board of Nursing criteria for 10 hours of continuing education. Provider approved by the California Board of Registered Nursing, Provider Number 17686, for 10 contact hours.

Approved by MEAC for 10 hours of CE, approval number M2122-78-0601DE.

Midwives of Color/Student Midwives of Color may receive a partial scholarship for this course. Please email [email protected] to request this scholarship.

NARM Midwifery Bridge Certificate?

Are you taking this course for the

  • + Online Bridge Bundle (below)

    We have designed a Midwifery Bridge Certificate bundle that will supplement the hands-on courses to get you to ALL the right numbers for Bridge course hours - both in each category, and the overall total!

  • + One Non-HiveCE Hands-On Course

    You'll also need to take one MBC Category 2 (newborn) hands on course. Most people achieve this - or already have achieved this - by taking NRP. Whatever course you choose to meet this requirement, it will need to be at least 3 hours to reach the total hours required by NARM for the Midwifery Bridge Certificate.

  • = ALL Midwifery Bridge Certificate Course Requirements

    Those three components will meet or exceed the course requirements for the NARM Midwifery Bridge Certificate.

It's the most streamlined way to meet all your NARM Bridge requirements.

These 9 online courses provide 40 MBC approved hours, in the required categories.

Healing Passage, by Anne Frye, CPM

Options for Spiral Bound copy, or special offer for online eBook of