Public Consultation: Professional Standards Second Consultation

Public Consultation: Professional Standards Second Consultation

Setting and maintaining high professional standards is fundamental to public protection and public confidence in the midwifery profession. We need to ensure that the College of Midwives of Ontario standards of practice clearly set out the high standards we expect of all midwives.

The development of the new Professional Standards for Midwives (Professional Standards) is a major step forward in reforming our current standards of practice. It forms the first phase of a wider program of work to streamline our approach to regulation to promote targeted and proportionate regulation in the public interest.

Public protection is at the heart of everything we do, and our principles-based approach to the standards is designed to benefit midwifery clients, the greater public, and the profession as a whole.  For more information on our new approach to regulation and what it means in the context of the standards of practice, please read our Consultation Paper.

Our first consultation on the Professional Standards was conducted this past summer.  You can read some of the comments from the first round of consultation here.

During the first consultation, we gathered feedback in three different ways: a survey, comments on the website, and e-mails sent directly to the College. We are grateful for the time and effort given by respondents who replied in detail to our first consultation, and we welcome both the support of, and challenges to, our proposals. The comments have provided us with a wide spectrum of views from midwives, regulatory and midwifery stakeholders as well as clients and the public.  You can read our response to the first round of consultation here.

In our response paper we,

  1. Report on the feedback we received and set out our response to all the issues raised in the first consultation.
  2. Propose changes to the Professional Standards made in response to the feedback received (Appendix A). Please note that where we have made changes to the Professional Standards, additions are shown in purple and deletions have a strikethrough.
  3. Provide a list of standards that will be rescinded with the implementation of the Professional Standards (Appendix B)
  4. Propose an implementation timeline (Appendix C)
  5. Invite further views on the revised Professional Standards by launching the second consultation. It is important that all respondents read our response before submitting their feedback. Please ensure your comments are submitted by 5pm on December 21, 2017. You can leave a comment here on the page, or write an email to either as an individual or together with your practice.


Questions & Answers

 Q: What are the Professional Standards that are proposed for midwives?

A:         You can read the proposed Professional Standards here.  We’ve made some changes in response to the feedback received in our first round of consultation, which you can see here. Please note that where we have made changes to the Professional Standards, additions are shown in purple and deletions have a strikethrough.

Q: What’s changing? Will the way that I practise midwifery change?

A: We want to reiterate that the Professional Standards sets out the minimum standards for the midwifery profession in Ontario. There is nothing in the standards that prevents midwives from continuing to work in the model of care as it is defined by the current college standards. For example, midwives can continue to work in groups of no more than four midwives, provide continuity of care in a way that ensures every client knows who will attend their birth and attend every birth with a second midwife. It is up to midwives to define midwifery in Ontario in a way that meets the needs of their clients as well as the minimum standards established by the College. The Professional Standards trusts that midwives know how to do this.

Q: When did this consultation start?

A:  This consultation started on October 19th 2017, and will go to December 21, 2017 at 5pm.  Earlier this summer, we held our first public consultations on the Professional Standards, which occurred over seven weeks in July and August.  You can see the comments from the first round here.    You can also see the timeline for the creation and implementation of the Professional Standards here.

Q: What’s happening next? How will these standards be implemented?

A:  The consultation goes to December 21st, so you can comment anytime between now and then.  We’re also holding a Member Education Day  on November 1st, and we’re inviting members to come and share their thoughts on the day.  If you can’t join us in person, please participate through our webcast.

After the consultation closes, we’ll take time to consider all feedback and incorporate changes in the Professional Standards document where appropriate.  In March 2018, the College Council will approve the final document, and Professional Standards will come into force in June 2018.  You can view our timeline for implementation here.

While our approach to regulation has changed, it won’t necessarily alter the way midwives work today.  Implementing the proposed changes will be relatively easy providing midwives continue to exercise sound professional and clinical judgment, and apply their knowledge and skills in the best ways possible in compliance with the legislation and regulations that govern their practice.

Q: Which standards are being rescinded, and what’s the rationale behind rescinding certain standards?

A:  You can see a list of all the standards that are being rescinded here, along with a brief overview of why they’re being rescinded. 

In our first round of consultation, we heard from some members that they were concerned about specific standards being rescinded.  We’ve addressed these concerns in our response paper, which you can read here.

Q: What did you learn from the first consultation?

A: We reviewed answers to the open-ended questions in both the survey and the website and, in combination with the letters and e-mails, identified some key issues and concerns. From this analysis, the following key themes emerged:

  1. There was strong agreement with our approach to streamlining our standards of practice that would allow midwives to practice more flexibly and in more innovative ways. There was strong support, particularly from other regulators, for our increased focus on the clients and the broader public interest.
  2. There was a broad welcome for the Professional Standards by the profession and members of the public. This was tempered by expressions of concern that midwives might not have the knowledge, skills and judgement to practice competently in the absence of prescriptive rules, that we should have clearer expectations for midwives and that more detail was needed in the Professional Standards.
  3. Some respondents, including the Association of Ontario Midwives (AOM), were firmly opposed to our overall approach to informed choice, continuity of care and choice of birthplace and felt they should remain as individual standards. The AOM, for example, felt that rescinding these model of care standards could result in poorer clinical outcomes because of the potential for medically unnecessary transfers of care and disrupted continuity of care.
  4. Some respondents were opposed to rescinding particular standards (e.g. VBAC and Choice of Birthplace, When a Client Chooses Care Outside Midwifery Standards of Practice) with the implementation of the Professional Standards. They argued midwifery is a marginalized profession and midwives require advocacy tools (in the way of our existing standards).
  5. A few respondents made requests for guidance to help practices understand our expectations and to achieve the right outcomes for clients.

You can read more about the feedback we received, and how we responded to it, in our response paper here.

Q: Has the Professional Standards document changed from the first consultation period?

A:  Yes, we’ve taken all feedback into consideration and changed our Professional Standards document where appropriate.  You can read the updated document here. Where we have made changes to the Professional Standards, additions are shown in purple and deletions have a strikethrough.  We’ve also responded to all feedback we received in our response paper, which you can read here. 

Q: I’d like to share my feedback, but I want to make sure it counts. What are you doing with feedback received in this round of consultation?

A: All feedback is incredibly important to us, and helps us to shape our Professional Standards document.

If you like the general direction of the document but don’t want to leave a long and detailed comment, that’s still helpful. Just comment to let us know you think we’re on the right track, and we can use that feedback too.

You can see how we carefully considered all the feedback we’ve received in the first round of consultations here.


Professional Standards: Second Consultation Documents

Response Paper

Appendix A: Professional Standards for Midwives

Appendix B: List of Standards to be Rescinded with the Implementation of the Professional Standards for Midwives

Appendix C: Professional Standards Creation and Implementation Timeline

Appendix D: Formal Feedback

Appendix E: Comparison Between the Professional Standards and the College’s current standards on informed choice, continuity of care and choice of birthplace.

Appendix F: Hierarchy of Documents Governing the Midwifery Profession


Feedback Form

All Feedback

  1. Midwife

    I want to see flexibility on the way midwives work. I am burnout after 30 years of profesional practice.
    I agree that we should follow standards of practice and clinical guidelines of profesional competency. However, I felt that we are being push to do more and more, long hours, and limited time off, neglecting our health, family and personal joy.
    I want to see the opportunity to have flexibility to work with other care providers, work on shift and provide excellent care to clients and to be involve in research without adding more hours to my practice.

    • Are you a: Midwife
    • Organization: On Leave
    • On behalf of: Yourself
  2. Midwife

    I would like to comment on this second consultation request. I have been an Ontario midwife for a long time and have watched the profession change dramatically. Especially in expanded scope and increased responsibility. The proposed changes are a welcome attempt to align the CMO standards with midwifery today. While growth and change can be challenging to accept and adopt it is imperative that the profession and professional standards adapt to these changes. Midwifery is a regulated health profession and as such it is the responsibility of each midwife to follow the evidence in the provision of care. The comparison of other regulated health care professional governing bodies has demonstrated that the CMO is significantly more restrictive. The scope of midwifery is much too restrictive for the profession in my opinion. Midwives are experts in many important skills that can be utilized in other ways and in other jobs. Midwives need the opportunity to work differently in many different ways in order to remain in the profession. I truly hope that the profession can grow and develop with the times. Protecting the model from so long ago is not allowing the profession to grow!

    • Are you a: Midwife
    • On behalf of: Yourself