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Study of Registration Practices of the
COLLEGE OF MIDWIVES OF ONTARIO, 2007

  1. 1. INTRODUCTION
  2. 2. BACKGROUND OF THE REGULATORY BODY
    1. a. Legislation
    2. b. Protected Titles
    3. c. Definition of the Profession
    4. d. Labour Market/Economic Trends
    5. e. New Developments Within the Profession
    6. f. Staffing
  3. 3. REGISTRATION PRACTICES
    1. a. Registration Requirements and Application Process
    2. b. Documentation Required from Internationally Trained Individuals
    3. c. Credential Assessment (Third Party and/or Internal)
    4. d. Academic/Program Requirements
    5. e. Work Experience Requirements
    6. f. Examinations
    7. g. Language Requirements
    8. h. Fees
    9. i. Third Parties
    10. j. Typical Length of the Registration Process
    11. k. Accredited Programs
    12. l. Internal Review/Appeal Process
  4. 4. BRIDGING PROGRAMS
  5. 5. MUTUAL RECOGNITION AGREEMENTS
  6. 6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY
    1. a. Nature and Frequency of Communication
    2. b. Backlogs
    3. c. Complaints Regarding the Registration Process
  7. 7. CHANGES SINCE THE 2005 SURVEY
  8. 8. REGISTRATION INFORMATION AND STATISTICS
  9. 9. SOURCES

ISBN 978-1-4249-6462-8 [HTML English version]


1. INTRODUCTION

The Office of the Fairness Commissioner (OFC) undertook a study of registration practices of Ontario's regulated professions during the fall and winter of 2007–2008. The purpose of the study was to understand each regulated profession's 2007 registration practices and to establish baseline data and information to enable the OFC to measure progress as it fulfills its mandate under the Fair Access to Regulated Professions Act, 2006.

This report reflects the registration practices of the College of Midwives of Ontario as of December 31, 2007. Information in this report was gathered from

The College of Midwives of Ontario also provided registration information and statistics for 2005, 2006 and 2007 through a standard spreadsheet designed by the OFC.

An analysis and summary of the findings for all of the regulated professions are contained in the OFC's Ontario’s Regulated Professions: Report on the 2007 Study of Registration Practices.

2. BACKGROUND OF THE REGULATORY BODY

a. Legislation

The College of Midwives of Ontario (CMO) operates in accordance with the Regulated Health Professions Act, 1991 and the Midwifery Act, 1993.

b. Protected Titles

Midwives in Ontario are regulated by the CMO. Individuals cannot practise midwifery, use the title “midwife” or hold themselves out to be such unless they are registered with the college.

c. Definition of the Profession

According to the Midwifery Act, 1993, "the practice of midwifery is the assessment and monitoring of women during pregnancy, labour, and the postpartum period and of their newborn babies, the provision of care during normal pregnancy, labour, and postpartum period, and the conducting of spontaneous normal vaginal deliveries."

Midwives in Ontario are primary caregivers. As such, they hold full legal responsibility for their clients and are not supervised by a physician or obstetrician. Midwives in Ontario never work in only one area of client care, such as prenatal or intrapartum care. They are required to provide full service to their clients in all trimesters, throughout labour and birth and for six weeks postpartum. Under normal circumstances a midwifery client and her newborn do not see any other health care practitioner during this time. All midwives must attend both home and hospital births. Midwives are required to hold admitting privileges in at least one hospital and to attend a minimum number of both home and hospital births per year to maintain their registration.

d. Labour Market/Economic Trends

Demand for midwifery services is high across the province. The shortage of family doctors and specialists in Ontario has led to an increase in the demand for midwives.

Ontario’s Ministry of Health and Long-Term Care allocates the funding for midwifery practices. While there is no guarantee of immediate employment, new registrants are usually able to find work, although they may have to relocate to a community where a midwifery practice has an opening.

Midwives work full-time or part-time, although they must work full-time for their first year of registration. Currently, there are close to 400 midwives working in Ontario, with approximately 40 new registrants joining the profession each year.

e. New Developments Within the Profession

The number of registrants with the CMO has grown significantly in 14 years. The Ministry of Health and Long-Term Care announced an expansion of the baccalaureate education program that will almost double in the next seven years the number of midwives enrolled.

The CMO has requested an amendment to the Midwifery Act to implement a registration exam as a non-exemptible requirement. The regulation has not yet been passed.

f. Staffing

The CMO staff consists of seven full-time employees and one part-time employee. Two out of the seven employees are involved in the registration process.

3. REGISTRATION PRACTICES

a. Registration Requirements and Application Process

An applicant is defined as an individual who completes an educational program in midwifery, submits an application form and pays the application fee to the college.

i. Basic Requirements for Registration

The requirements for registration are:

ii. Classes of Registration

There are three classes of registration with the College of Midwives of Ontario: General, General with Conditions, and Supervised.

General

Registrants in the General class practise with no restrictions on their registration.

General with Conditions

Graduates of the Ontario Midwifery Education Program (MEP) are registered in the General with Conditions class. The college’s New Registrants Policy states that for the first year of practice, all new registrants must practise within an established Ontario practice, must work full-time and must attend births with an experienced midwife. Other than these conditions, the new registrant is like any other midwife in the province, and provides the full scope of midwifery care. Once the conditions of this policy have been met, the member’s registration class is changed to General.

Supervised

Graduates of the International Midwifery Pre-registration Program (IMPP) are registered in the Supervised class. The supervision is imposed to enable the supervised midwife to meet the clinical birth numbers required by the college’s registration regulation, as well as to make up any gaps in clinical skills identified during the International Midwifery Pre-registration Program.

Supervised midwives are fully registered members of the college and provide the full scope of midwifery care to their clients. They are paid at the same rate as all other new registrants. Supervision is for a minimum of three months but will typically last anywhere from six to 12 months. The supervised midwife has an individualized supervision plan prepared by the college prior to registration. Once the supervision plan is complete, the member’s registration class is changed to either General with Conditions or General, depending on whether the midwife is still in her new registrant’s year. A supervised certificate may only be issued for 12 months or less.

iii. Steps in the application process

Step 1 – Submission of Application

Application forms are provided by a CMO representative to MEP and IMPP students as part of their course materials. Midwives who wish to apply under reciprocity from another Canadian province must contact the college for an application form.

The completed application form is submitted to the college along with the following documents.

Step 2 – Review of Application

Applications are reviewed to determine whether they are complete. Applicants are contacted and informed of any missing information or documentation.

Step 2a – Supervision Plan (for IMPP graduates only)

When an application for an IMPP graduate is received, the college prepares an individual supervision plan for the applicant. This plan addresses both deficiencies in clinical hours and any gaps in clinical skills identified by the IMPP. A supervising midwife is designated. The applicant and all members of the practice she will be working with during her supervision must sign this supervision plan. The IMPP graduate’s application is not complete until the college receives the signed supervision plan.

Step 3 – Association of Ontario Midwives (AOM) Membership and Insurance

Once the application is complete, the college contacts the AOM to verify that the applicant is a member of that organization and that the applicant’s liability insurance has been arranged.

Step 4 – Registration

Upon receipt of verification from the AOM of both membership and insurance, the college issues a registration number and processes the registration documents. The new member may now begin providing midwifery services.

b. Documentation Required from Internationally Trained Individuals

i. Standard Documentation

Before applying to the college for the provincial licence, internationally trained midwives must attend the International Midwifery Pre-registration Program offered by Ryerson University. The IMPP is the only route to registration and practice in Ontario for internationally educated midwives. Applicants are required to submit their documents and information to IMPP. The documentation will be used to conduct a competency assessment.

The IMPP uses World Education Services (WES) to verify documentation related to midwifery education. Applicants must provide evidence of graduation from an accredited midwifery program.

ii. Options for Applicants with Unavailable/Destroyed Documents

The IMPP sometimes has candidates who do not have access to transcripts or certifications. The IMPP's policy is that the program may use alternative methods of establishing that the candidate is a midwife, including written submissions by the candidate, other references where possible and, most critically, an in-person assessment of clinical competencies through an Objective Simulated Clinical Exam and by written exam, prior to entrance.

c. Credential Assessment (Third Party and/or Internal)

The CMO does not perform any type of internal credential assessment. It relies on the IMPP for credential assessments of internationally trained midwives. The IMPP conducts competency-based assessments.

d. Academic/Program Requirements

The requirement to have completed acceptable midwifery education is satisfied with proof of graduation from an approved midwifery program. Approved programs include:

In addition, applicants must be currently certified in CPR, ES and NRP. CPR and ES certification must be within the previous 24 months; NRP certification must be within the previous 12 months. The standard for NRP is the Heart and Stroke Foundation of Canada, the standard for CPR is Basic Rescuer Level C, and the standard for ES is the Association of Ontario Midwives’ ES workshop, Advances in Labour and Risk Management (ALARM), Advanced Life Support Obstetrics (ALSO) or Managing Obstetrical Risk Efficiently (MORE OB).

e. Work Experience Requirements

To be registered with the college, an applicant must have attended 60 births: 40 as a primary midwife, 10 home births and 10 hospital births. Continuity of care (prenatal, intrapartum and postnatal care) must have been provided in 30 of the 60 births.

The MEP enables its students to attend 60 births within the program. Internationally trained midwives are credited with 20 births, in recognition of their previous work experience, and must attend 40 births in the IMPP.

Internationally trained midwives are provided with a supervision plan upon completion of the IMPP. Applicants receive a report of their clinical clerkship so that any clinical hour deficiencies or gaps can be addressed during their supervised practice.

All internationally trained midwives come with practical clinical experience, obtained either in the workplace or during the clinical placement component of their education. At point of entry and throughout the first term of the IMPP, internationally trained midwives participate in written and clinical exams of midwifery competencies. These exams determine whether internationally trained midwives can move directly to a clinical placement and final exam (fast tracking) or whether they require a second term of courses in clinical knowledge and skills enhancement and professional communication before moving on to the clinical placement and final exam.

f. Examinations

Currently there is no registration examination; however, it is expected that a standardized national registration examination, the Canadian Midwifery Registration Examination (CMRE), will become a non-exemptible requirement for registration starting in May 2008. The CMRE is a seven-hour multiple-choice exam with no clinical component and was developed based on the Canadian Competencies for Midwives set by the Canadian Midwifery Regulators Consortium (CMRC) and the College of Midwives of Ontario (CMO).

The CMRE will be offered twice a year in Ontario, British Columbia, Manitoba, and Alberta. The registration examination will be offered in one location in each participating province except Ontario and Manitoba, where second sites will be offered to take into account northern midwifery education programs.

As of 2008, all applicants for midwifery registration in regulated jurisdictions (except Quebec) will be required to take and pass the CMRE. (The exam will be implemented in Quebec if and when legislation allows.) Candidates may choose to take the exam in English or in French. A “blueprint” of the exam, a list of reference materials and study tips are available on the CMRC website.

g. Language Requirements

The CMO does not administer any language proficiency tests. The Midwifery Language Proficiency Test (MLPT) is fully administered by the IMPP; it tests the reading, writing, and listening skills needed in order to practise as a midwife in Ontario. The test is profession specific, is available in English and French and is offered four or five times per year.

Applicants must achieve a score of 70 per cent in each of the four sections of the MLPT in order to register with the CMO.

The MLPT is offered and available to any internationally educated midwife; it is not necessary to be registered in the IMPP to take the test. Once a midwife has registered to take the test and payment has been received, a complete sample test is sent.

h. Fees

College application fee

$50

College membership – annual fee[2]

$1,500

Administration fee – annual

$35

Additional Fees

International Midwifery Pre-registration Program [3] (payable to Ryerson University)

Approximately $4,900

Ontario Midwifery Language Proficiency Test (MLPT)[4]

$195

Association of Ontario Midwives fees

$1,100 to $2,300

Canadian Midwifery Registration Examination (CMRE)[5]

$750

i. Third Parties

Name of Third Party Relationship to Regulatory Body

International Midwifery Pre-registration Program (IMPP)

Provides a bridging program for internationally trained midwives

Association of Ontario Midwives

Provides required liability insurance to members

Canadian Midwifery Regulators Consortium (CMRC)

Administers the registration exam starting May 2008.

j. Typical Length of the Registration Process

For applications that are complete, the registration process takes between two and four weeks. There is a two-year time limit for the application process starting from the completion of the education program. When the Canadian Midwifery Registration Examination (CMRE) is implemented, the two-year period will start after the applicant has written the exam.

k. Accredited Programs

The Ontario Midwifery Education Program (MEP) is a four-year baccalaureate degree offered at three Ontario universities: Ryerson University, Laurentian University and McMaster University. In Canada, there are six accredited programs including these three in Ontario. The others are baccalaureate degree programs in Quebec, British Columbia and Manitoba.

l. Internal Review/Appeal Process

The CMO’s registration appeal process was developed in accordance with and to meet the requirements of the Regulated Health Professions Act. A proposal by the Registrar to refuse to issue a licence to an applicant must be referred to the Registration Committee.

The Registration Committee is composed for three professional members and two public members.

If the Registration Committee directs the Registrar to refuse to issue a registration, or to impose terms, limitations or conditions on a registration, the applicant can appeal to the Health Professions Appeal and Review Board (HPARB). Registration decisions are issued in writing to the applicant and include reasons for the decision. Applicants can access all the information concerning the decision with respect to their case.

The information about appeals of decisions will be made available on the CMO’s website.

The IMPP assesses midwives within the framework of the courses offered at Ryerson University. Students who want to appeal their course results must use the university’s appeal process.

4. BRIDGING PROGRAMS

The International Midwifery Pre-registration Program (IMPP) is operated by a consortium made up of Ryerson University’s G. Raymond Chang School of Continuing Education, College of Midwives of Ontario (CMO), and Ontario Midwifery Education Program (MEP). The program is funded by the Ontario Ministry of Citizenship and Immigration, Labour Market Integration Unit.

IMPP is a nine-month part-time bridging program. It is the only route to registration and practice in Ontario for internationally educated midwives. It provides:

The IMPP is intended for experienced internationally trained midwives, fluent in English, who have practised midwifery within the past five years. On average, 25 candidates are enrolled per year.

5. MUTUAL RECOGNITION AGREEMENTS

Currently, the CMO has a mutual recognition agreement with British Columbia, Manitoba, Alberta, Northwest Territories and Quebec.

6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY

a. Nature and Frequency of Communication

The CMO has frequent contact with applicants throughout the registration process. In addition, the college makes presentations about registration to midwifery students in Ontario.

b. Backlogs

Currently there is no backlog in the registration process.

c. Complaints Regarding the Registration Process

Dissatisfaction with the registration process is addressed by the college in the following ways: applicants are provided with further explanation of registration decisions, information about opportunities to appeal decisions is provided, feedback about the registration and renewal processes is noted and taken into account during departmental reviews.

7. CHANGES SINCE THE 2005 SURVEY

The Ministry of Citizenship and Immigration conducted a survey in 2005 to collect information about occupational regulatory bodies in Ontario.

Since that time a career map was developed in collaboration with the Labour Market Integration Unit, Ontario Ministry of Citizenship and Immigration. In addition, a certification in Obstetrical Emergency Skills (ES) was added as a registration requirement. A document containing the Canadian Competencies for Midwives was developed between the CMO and CMRC.

8. REGISTRATION INFORMATION AND STATISTICS

Definitions used in these tables:

Alternative class of licence: a class of licence that enables its holder to practise with limitations; additional registration requirements must be met in order to be fully licensed. Alternative classes of licence granted by the College of Midwives of Ontario are specified under the tables below

Applicant: an individual who has applied to start the process for entry to the profession.

Applicant actively pursuing licensing: an applicant who had some contact with the College of Midwives of Ontario within the year specified.

Inactive applicant: an applicant who had no contact with the College of Midwives of Ontario within the year specified.

Member: an individual who is currently able to use the protected title or professional designation of “midwife.”

Languages in which application information materials are available
Language 2005 2006 2007
English

Yes

Yes

Yes

French

No

No

No

Other(s)

 

 

 

Countries where internationally educated applicants were initially trained in midwifery
Applications received 2005 2006 2007
Largest number

N/A

N/A

N/A

Second-largest number

N/A

N/A

N/A

Third-largest number

N/A

N/A

N/A

Fourth-largest number

N/A

N/A

N/A

Fifth-largest number

N/A

N/A

N/A

Staff employed by the College of Midwives of Ontario
Number of staff 2005 2006 2007
Involved in registration process

2

2

2

Involved in appeals process

2

2

2

Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario)
Members Ontario Other Canadian Provinces USA Other International TOTAL
Total members

310

7

N/A

89

406

Non-practising members

30

0

N/A

6

36

Applicants processed by the College of Midwives of Ontario in 2005

 

Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario)
In 2005 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

37

2

N/A

10

49

Applicants actively pursuing licensing

37

2

N/A

10

49

Inactive applicants

0

0

N/A

0

0

Applicants who met all requirements and were authorized to become members but did not become members

0

0

N/A

0

0

Applicants who became members

37

2

N/A

10

49

Applicants who were authorized to receive an alternative class of licence but were not issued a licence1

0

0

N/A

0

0

Applicants who were issued an alternative class of licence1

0

0

N/A

10

10

1 The alternative class of licence was Supervised Class.

Applicants processed by the College of Midwives of Ontario in 2006

 

Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario)
In 2006 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

38

2

N/A

11

51

Applicants actively pursuing licensing

38

2

N/A

11

51

Inactive applicants

0

0

N/A

0

0

Applicants who met all requirements and were authorized to become members but did not become members

0

0

N/A

0

0

Applicants who became members

38

2

N/A

11

51

Applicants who were authorized to receive an alternative class of licence but were not issued a licence1

0

0

N/A

0

0

Applicants who were issued an alternative class of licence1

0

0

N/A

11

11

1 The alternative class of licence was Supervised Class.

Applicants processed the College of Midwives of Ontario in 2007

 

Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario)
In 2007 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

49

0

N/A

9

58

Applicants actively pursuing licensing

49

0

N/A

9

58

Inactive applicants

0

0

N/A

0

0

Applicants who met all requirements and were authorized to become members but did not become members

0

0

N/A

0

0

Applicants who became members

49

0

N/A

9

58

Applicants who were authorized to receive an alternative class of licence but were not issued a licence1

0

0

N/A

0

0

Applicants who were issued an alternative class of licence1

0

0

N/A

9

9

1 The alternative class of licence was Supervised Class.

9. SOURCES

Canadian Midwifery Regulators Consortium website: http://cmrc-ccosf.ca/node/23. Last accessed: January 22, 2008.

College of Midwives of Ontario website: http://www.cmo.on.ca/default.asp. Last accessed: January 22, 2008.

College of Midwives of Ontario and Ministry of Citizenship and Immigration. “Access to the Midwifery Profession in Ontario.” Ministry of Citizenship and Immigration website. http://www.citizenship.gov.on.ca. Last accessed: January 22, 2008.

International Midwifery Pre-registration Program website: http://ce-online.ryerson.ca/ce_2007-2008/program_sites/program_gateway.asp?id=2161. Last accessed: January 23, 2008.

Representatives of the College of Midwives of Ontario met with staff of the Office of the Fairness Commissioner on December 10, 2007, to provide further information for this study.



[1] Midwives who are general registrants in another province of Canada where midwifery is regulated may be eligible for registration under a mutual recognition agreement (see section 5 below).

[2] In the first year of practice, the membership fee is pro-rated.

[3] Plus textbooks and clinical equipment (approximately $500).

[4] This fee is separate from the tuition cost of the IMPP.

[5] As of May 2008, the CMRE will be administrated by the Canadian Midwifery Regulators Consortium (CMRC). The fee is expected to be $750, but the exact amount will be confirmed closer to the examination.