APA Type 1 – Modified Primary Care

APA Type 1 – Modified Primary Care

The CMO is accepting applications for APAs that meet the criteria below. These criteria have been identified to ensure the midwifery model and approach to care is accounted for, and that primary midwifery care service provision is maintained in all communities where midwives provide care.

APA Criteria

1. Evidence of need for alternate practice arrangements. For example:

a) Insufficient number of midwives to provide on call coverage for clients
b) Serving communities with unique needs
c) A midwife or midwifery practice group has identified a need for flexibility in their practice or community

2. Evidence where the APA remains consistent with the model of midwifery practice in Ontario along with clear evidence and rationale where it deviates from the model of midwifery practice in Ontario. If the APA midwife is mentoring a new registrant (NR), evidence that APA doesn’t significantly deviate from the midwifery model. In addition, assurance must be provided that under the APA an NR will continue to go to both home and hospital births, that continuity of care will be maintained, and that if there is an extension of scope, the NR is being supported in the practice.

3. Evidence of support from the community.

4. Practice protocols addressing the alternate practice arrangements will be developed by the member and approved by the College.

5. Informed choice document outlining arrangement of care will be developed.

6. There must be measureable and achievable objectives.

7. Quality Assurance Program requirements must be met by each midwife, as set out in the APA.

8. APA must ensure all providers share consistent information with clients, even if elements of the midwifery model, including continuity of care throughout pregnancy, labour and postpartum is not being delivered.

9. APA midwife must have a plan to collect and share client feedback, if APA is not applicable to the Quality of Care Evaluation.

10. APA midwife must allow CMO to access their applicable data from BORN; alternate practice arrangements are reviewed and evaluated annually by the College.

11. Proof 0f appropriate liability insurance must be made available to the CMO before the commencement of care under the APA.

12. Funding for the APA must be described as part of the midwife’s application.

13. APA midwife must be in good standing with the CMO. The CMO will consider factors such as the member’s history with the College, whether the member is currently under investigation, whether the member has terms, conditions and limitation in place, whether the member has been directed to complete a Specified Continuing Education or Remediation Program or whether the member has signed an undertaking with the College.

14. The midwife applicant must describe to the CMO the impact on herself, her clients, her community and any others who will be affected, if the APA is not approved by the CMO.

A member in an APA should consider a plan for how they may re-enter conventional midwifery group practice in the event the APA does not pass an approval or the midwife or the CMO chooses to discontinue it.

Reporting to the College – Active Practice Reporting and Quality Assurance Program

Members who participate in the APA program will benefit from the coordination between the Registration and Quality Assurance departments of the College. Details of each participant’s Active Practice Reporting, Quality Assurance Program and Registration requirements will be considered according to the care provided through the APA. This will help to maintain registration of members in the CMO and encourage growth of the profession. Please note that the APA program does not apply to call schedules at Midwifery Practice Groups.

Active Practice Reporting (APR) is a key component of registration at the College. Members are required to submit their active practice numbers every five years once initial home and hospital births are completed. If a member is participating in an APA that will affect any aspect of their APR reporting, this will be reflected in their College file. The shortfall in active practice will be noted but with no further action required. If the member chooses to return to a regular midwifery practice and there are elements of practice that the member has not conducted, a Panel will convene to determine an appropriate re-entry to practice strategy to allow for a safe and secure transition.

There may be elements of the Quality Assurance Program that a member may need modified as part of an out of scope/model APA and will be required should the member choose to return to regular midwifery practice.

Elements of the APR or QAP that are not going to be completed as part of an APA will be clearly listed in the member’s Letter of Agreement with the College. Any return to regular practice will be managed thoughtfully and practically.

Consideration by the Panel will be given to equivalency in the skills acquired by the member and contributions to communities served during the duration of the alternate practice arrangement.


Type1 Application

Type1 Application Renewal Form

Sample MOU for other practitioners involved


More Information

Johanna Geraci
Quality Assurance Manager
j.geraci@cmo.on.ca or 416-640-2252/1-844-640-2252 ext 230