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Alternate Practice Arrangement (APA)

Alternate Practice Arrangement (APA)

The Alternate Practice Arrangement (APA) program is in place to support inter-professional care models and was developed in response to requests from midwives for flexibility in the delivery of midwifery care. Our APAs are both currently under review.

The two alternate practice arrangements that the College has developed are:

  • Type 1 – A midwife or midwifery practice works within a modified primary care model with other health care professionals and/or,
  • Type 2 – A midwife or midwifery practice that works with a second birth attendant who is not a registered midwife (formerly TAPA.)

Changes are coming to the College’s APAs. Read below for more information, and if you have further questions, please contact College staff at cmo@cmo.on.ca

APA Type 1 Extension for Members

Members who currently have an APA Type 1 with the College will have their APA extended until June 1st, 2018, without any renewal fee required. We are extending these arrangements because we are currently reviewing the program, and changes may be made. We will be in touch to let members know if the College Council makes changes to the program. If you have any questions in the meantime, please do not hesitate to get in touch with the College at cmo@cmo.on.ca

Changes are coming to APA Type 2

New Professional Standards for Midwives

The new Professional Standards require midwives to “ensure that every birth you attend as the most responsible provider is also attended by a second midwife or another individual competent to perform the role of second attendant.” With this new standard, we have eliminated the need for midwives to work in APA 2s, effective June 1st.

With the implementation of the Professional Standards, the Model of Care standard will be rescinded in the summer of 2018, and the requirement for two midwives at a birth will be replaced by the requirement of either two midwives or one midwife and a second birth attendant. For this reason, we revised the second birth attendant standard to better define the expectations for midwives who work with second birth attendants.

What does this mean for practices that currently have an APA type 2?

Your practice is able to continue with your APA type 2 until the Professional Standards come into force, and you will not have to renew this agreement with the College again. If you have any change to your arrangement, whether someone is leaving or you need to add a second birth attendant to your practice, you are still required to advise the College. You can contact the College by email at cmo@cmo.on.ca.

With the implementation of the Professional Standards, all midwives will be able to work with a second birth attendant, provided they have the competencies as defined by the Second Birth Attendant Standard. We have revised the Second Birth Attendant Standard to define what is required of an individual competent to perform of role of second attendant.

The College has established a minimum standard that is in the best interest of midwifery clients and their newborns. This new standard will come into effect on October 1 2018, and midwives are encouraged to review it well in advance in order to make any necessary changes. You can see the new standard here.