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COVID-19: Information from the College




The College of Midwives of Ontario is closely monitoring the rapidly evolving COVID-19 pandemic and its effects and recognizes that this is a challenging time for midwives who are working 24 hours a day providing care to their clients. While the College’s responsibilities during this public health emergency have increased, our role and our mandate remain the same. This means the College provides midwives with information about their practice as it relates to College standards only (see March 16, 2020: COVID-19 – Information and Guidance for Members below) and does not provide clinical practice guidance other than to point you to reliable evidence-based sources.

Information about care during labour, birth, and the postpartum period is continually being updated, so the College recommends midwives frequently review information from the resources shared below, the Ministry of Health’s Guidance for the Health Sector and the information being posted by their member association.

Reminder: The College is currently operating a virtual office, and parcels and courier packages cannot be received. Please use regular mail and registered mail instead.

Latest Communications from the College

May 11, 2021: Renewal 2021 Announcement

In light of the ongoing circumstances surrounding the COVID-19 pandemic and the various pressures facing midwives, we are pleased to announce that we are streamlining renewal 2021 and extending the renewal period.   

1. Renewal Period

This year the renewal period will be extended, enabling midwives to successfully renew their registration up to November 1, 2021. Renewal will continue to be implemented online and more information about registration renewal will be available to midwives in the coming months.  

2. Continuing Competencies

As we shared in February 2021, the College has outlined two options for meeting the continuing competency requirements in neonatal resuscitation (NRP), cardiopulmonary resuscitation (CPR) and Emergency Skills (ES) for 2021. 

  • Option 1: Complete an approved continuing competency course(s) including the in-person component. 
  • Option 2: Complete the online components of an approved continuing competency course(s) and skills review/practice. 

To further assist in easing the administrative burden for midwives during this challenging time, practising midwives will not be required to upload training certificates and will only be required to complete a declaration within the renewal form noting completion of option 1 or option 2.  

Midwives should maintain records of activities undertaken should the College request the information at a later date.  

To review the options and requirements for 2021, click here.

3. Active Practice Requirements (APR)

This year, midwives will not be required to submit their annual active practice reports. While midwives are expected to continue practising in accordance with the conditions on their certificates of registration, including working towards meeting the active practice requirements, midwives are not required to report their birth numbers this year. 

May 11, 2021: Quality Assurance Reporting in 2021

In light of the extraordinary circumstances of the COVID-19 pandemic, midwives will not be required to report on their participation in the Quality Assurance Program for the 2020-21 year.  

The COVID-19 pandemic has posed tremendous challenges to Ontario’s health care system.  Midwives, as integral care providers in the system, have been under increasing pressure since March 17, 2020 when an Emergency Order was first enacted in Ontario. 

Since that time, midwives have been providing essential care to Ontario clients in a constantly shifting health care environment that is now at its most critical state since the COVID-19 outbreak was declared 14 months ago. 

Midwives have had to continually adapt their practice to keep up with changes such as revised clinical practice guidelines and recommendations on Infection Prevention and Control (IPAC). One recent example is the April 21 order, when  O.Reg 305/21 was enacted authorizing regulated health care providers to work outside their professions’ legislated scope of practice to meet the needs of our strained health care system. 

Working in this unpredictable environment has also led to the multiple reports of higher levels of stress and burn-out among health care providers than existed pre-pandemic. 

To alleviate some of the pressure midwives are experiencing and to recognize the ongoing learning they continue to participate in as a result of the pandemic, the College has decided to exempt midwives from their Quality Assurance Program (QAP) reporting this year. 

Midwives would have been due to report on your participation in the 2020-21 cycle of the QAP by October 1, 2021. An exemption means that you will not be required to report on your participation in the QAP for the 2020-21 year. 

We still encourage midwives to continue participating in quality assurance activities, but in an effort to reduce your administrative responsibilities, you will not be required to report. We will share details about how you will apply for the 2020-21 exemption as we approach the renewal period.  

Quality Assurance Program in 2022 and beyond

The College is also making changes to the QAP in coming years. Some of the biggest changes include: 

  • Moving from a 1-year to a 3-year reporting cycle, 
  • Reporting by members registered in all classes of registration, 
  • Accepting both peer and interprofessional case reviews with no limit on the number of interprofessional reviews, 
  • No pro-rating of activities for members registered in the inactive class for part of the year, and 
  • Using learning goals to track continuing professional development activities.

We will provide more information on how the changes to the QAP will affect your reporting later this year but wanted to give a brief overview of the changes now. If you have any questions please feel free to email qap@cmo.on.ca and we will be in touch. 

April 22, 2021: Midwives may be redeployed to provide hospital-based care outside of scope

The College has just received a memo from the Ministry of Health providing information on new directives in effect in Ontario. The new regulation is available to read here: Ontario Regulation 305/21 Regulated Health Professionals, made under the Emergency Management and Civil Protection Act, 1990.
 
A new order under the Emergency Management and Civil Protection Act, 1990 (EMCPA) authorizes health care professionals including midwives to provide patient care services outside their regular scope of practice and enables hospitals to employ, contract, appoint or otherwise engage regulated health professionals from out-of-province.
 
Under this new order, health professionals, including midwives, from Ontario or out-of-province are authorized to engage outside of their regular scope of practice provided it is necessary for the health care professional to provide such services to respond to, prevent, or alleviate the effects of the COVID-19 outbreak. The services provided must also be consistent with the duties that have been assigned or the privileges that have been granted by the hospital.
 
The College interprets this new order to apply only to practising midwives providing care within a hospital (who are either employees of or hold privileges in that hospital).  It does not permit midwives to practise outside of scope while they are working in a clinic or home setting.
 
This is a change from recent orders as it allows regulated health professionals with hospital privileges to provide care outside of scope, not just under delegation but under their own authority, as long as the services are consistent with the duties that have been assigned or the privileges that have been granted by the hospital.
 
While this order allows midwives to work outside of scope and care for individuals who are not pregnant, recently postpartum, or newborns, midwives are still required to work within their abilities and only deliver services they are reasonably qualified to provide. A member of the College continues to be subject to the jurisdiction of the College for incompetence that occurs while the member provides services under this new order.
 
Registered midwives who are authorized to practise in other Canadian jurisdictions may be employed by Ontario hospitals under this new order. These midwives do not have to register with the College of Midwives of Ontario and are not permitted to work as midwives in the community setting with midwifery practice groups or at birth centres.
 
The College has just become aware of these changes and will continue to monitor the situation. Should we have any additional guidance we will be in touch in the coming days. In the meantime, we are asking midwives to let us know if you have any questions about experiences you have working in hospitals under this new regulation.
 
I know that this is a very hard time to provide health care in Ontario. I want to let you know how much we appreciate all that you are doing to keep your clients, communities, and families safe during this extraordinary time.

Regards,

Kelly Dobbin
Registrar-CEO
College of Midwives of Ontario

April 9, 2021: COVID-19 Postponement of the Canadian Midwifery Registration Exam

On April 9, 2021, the Canadian Midwifery Regulators Council announced that the May 6, 2021 sitting of the Canadian Midwifery Registration Exam (CMRE) was being postponed due to the status of the ongoing COVID-19 pandemic. The exam may be rescheduled prior to the fall sitting which is due to take place on October 28, 2021.

To eligible for registration in Ontario, applicants must have successfully completed the Final Clerkship Exam and will be asked to sign an Acknowledgement and Undertaking agreeing to write the CMRE at its next sitting.

If you have any questions, please contact the Registration department at regadmin@cmo.on.ca or by phone at 416 640 2252 ext. 222

April 9, 2021: Registration Information for New Applicants in 2021

The College’s updated Application for Registration form can be found here  and click here to access the Registration Application Handbook.

For all upcoming Midwifery Education Program (MEP) and International Midwifery Pre-Registration Program (IMPP) graduates planning to apply for registration this spring, please note the following:

  • Updated registration application forms, requirements, acceptable supporting documents, process and payment procedures, has been posted on the College’s website here.  
  • Complete applications will be processed as quickly as possible, generally within 10 business days of receipt of a complete application where all requirements are met.
  • Applicants may begin completing the required Jurisprudence Course at any time. For more information, please visit the website here

February 4, 2021: NRP, CPR and ES Continuing Competency Requirements for 2021

Recognizing the ongoing disruptions to available training in neonatal resuscitation (NRP), cardiopulmonary resuscitation (CPR) and emergency skills (ES) due to the COVID-19 pandemic, the College has reviewed its continuing competency requirements, and current course offerings and has determined how applicants and midwives may best meet the training requirements in 2021.

Applicants for registration and midwives applying to move from the Inactive to the General class, as well as practising midwives renewing their registration by the October 1, 2021 deadline have two options to provide satisfactory evidence of continuing competency in NRP, CPR, and ES.

Option 1:
Complete an approved continuing competency course(s) including the in-person component.

Option 2:
Complete the online components of an approved continuing competency course(s) and skills review/practice.

The addition of Option 2 is a temporary measure intended to address the fact that in-person components of courses may not be available, while recognizing the importance of ongoing skills training and the safety of applicants and midwives.

To review the options and requirements for 2021, click here.

Midwives are reminded that regardless of the College’s continuing competency requirements, the Professional Standards for Midwives (#2) require midwives to maintain competence in all areas of practice, and therefore midwives are expected to take action to address any gaps in their knowledge, skill or judgment related to NRP, CPR and ES as needed.

December 22, 2020: Clarification re: COVID-19 tests midwives are authorized to perform

On April 1, 2020, the College sent midwives frequently asked questions (FAQs) with guidance relating to COVID-19. One of the FAQs stated that midwives were able to order and perform COVID-19 testing. However, the FAQ did not state that midwives require a delegation to perform nasopharyngeal swabs. 
 
The information provided in the April FAQ was updated on December 21, 2020, to clarify the authority of midwives to perform COVID-19 tests. This updated FAQ (also provided below) replaces the content in the April FAQ relating to COVID-19 testing, and midwives should use it as guidance for their practice decisions relating to COVID-19 testing.
 
Midwives are permitted to perform some, but not all, tests for COVID-19.

Midwives are not permitted to perform nasopharyngeal swabs (NPS) and deep nasal swabs on their own authority as they require the performance of the controlled act of “putting an instrument, hand or finger beyond the point in the nasal passages where they normally narrow.” Under the Midwifery Act, 1991, midwives do not have the authority to perform this controlled act. Midwives are only permitted to perform these tests under delegation if they have the knowledge, skills, and judgment to safely do so.

Midwives are permitted to perform anterior nasal swabs and throat swabs, as they do not require the performance of a controlled act. Midwives must only perform these tests if they have the appropriate training to do so and must follow Public Health recommendations for testing. While NPS is the optimal specimen collection method for COVID-19 testing, as per the current Public Health Ontario guidance, when NP swabbing cannot be performed, including in remote and low resource communities where there is not a health professional with the requisite or delegated authority, combined swabbing of the throat AND both nostrils (anterior nares) is a preferred alternative method. 
 
Access the College’s COVID-19 FAQs for midwives by clicking here

April 1, 2020: COVID-19 – Frequently Asked Questions Now Available

 The College of Midwives of Ontario has answered Frequently Asked Questions (FAQs) for midwives and their clients to provide them with appropriate information and guidance during the COVID-19 pandemic. These FAQs are now available on the College’s website.
 
The College encourages midwives to share the FAQs for Midwifery Clients with their clients to help address questions related to the changes in the care they are receiving at this time.
 
The College will continue to update these frequently asked questions as new questions are asked, and as information becomes available.
 

March 26, 2020: COVID-19 – Postponement of the Canadian Midwifery Registration Exam

The College of Midwives of Ontario is aware that the Canadian Midwifery Registration Examination (CMRE) scheduled for May 7 has been postponed and individuals who were registered to write the exam have been notified of the cancellation by the Canadian Midwifery Regulators Council.

The College understands that this will affect individuals who were looking to register with the College upon completion of the exam and is currently reviewing its registration processes to address this issue. The College will provide and post more information to its website shortly.

If you have any questions, please contact the registration department, regadmin@cmo.on.ca or 416.640.2252 ext. 222.

March 23, 2020: Help Respond to the COVID-19 Pandemic

The College of Midwives of Ontario is grateful that both current and former midwives are asking how they can help during the COVID-19 pandemic. On Friday, the College outlined a plan to help expedite applications from Inactive members wishing to return to the General class.  Please review that notice here.  

In addition to this, the Ministry of Health is seeking experienced health care providers who are inactive or retired to consider being deployed within the health sector to assist with provincial efforts to stop the spread of COVID-19. This employment would not require you to become registered with the College in the General class as you would not be providing midwifery services.

If you are able to use your former clinical experience to support your front-line colleagues in some capacity, please click here to sign up.  

March 20, 2020: Inactive Midwives Who Wish to Return to Practise

In an effort to enhance midwifery resources in Ontario, the College is revising its class change processes to expedite registration for midwives who are currently not practising but wish to return to the General class. We recognize that there might be challenges to meeting all registration requirements at this time (e.g. there is currently no access to emergency skills workshops), and the College is working on changes to the registration process to allow access to the profession in a timely manner while ensuring that College members re-entering the profession are suitable to practise. We feel confident that the implemented changes will be in the public interest.

The College is currently reviewing its approach to the following requirements:

  1. Satisfactory evidence of competency in neonatal resuscitation
  2. Satisfactory evidence of competency in cardiopulmonary resuscitation
  3. Satisfactory evidence of competency in emergency skills
  4. Completion of jurisprudence course

If you wish to return to the General Class, you should proceed with an application even if you are concerned that you might not meet these requirements. The College may require you to sign an undertaking or take other steps to address competency issues.

The College is waiving the class change fee. You can apply for a certificate of registration in the General class by completing the application for certificate of registration class change from Inactive to General and submitting it to the College’s secure dropbox here. A college staff member will be in touch with you regarding the status of your application within 2 business days.

The College will provide more information about the class change process as it becomes available.

Practising midwives

The College is aware that there is currently reduced or no access to NRP, CPR and emergency skills workshops across the province that will affect midwives’ ability to successfully renew their College membership for 2020/2021. The College is closely monitoring the situation and will provide more information in the coming week.

March 20, 2020: Requirements for Health Care Providers

The College of Midwives of Ontario brings your attention to the latest Directive from the Chief Medical Officer of Health that directs Regulated Health Professionals to stop providing non-essential services.

Midwives provide both essential and non-essential services to their clients during pregnancy, birth, and the postpartum and newborn period.  Midwives are in the best position to determine what care is essential for an individual client in a particular moment in time and are asked to use their discretion to limit direct contact with clients when the care is deemed non-essential.  Midwives are encouraged to provide care to their clients remotely when it is acceptable to do so.

To read the Directive in full, please click here.

The College of Midwives of Ontario will continue to ensure that members have access to the most trusted sources of information in order for them to continue to provide safe and competent care to their clients.

March 19, 2020: COVID-19 – Managing Health Worker Illness and Return to Work

Ontario’s Chief Medical Officer of Health has released a memo outlining enhanced public health measures to mitigate the spread of COVID-19 in Ontario. This memo includes recommendations to all parts of the health sector on the following issues:

  • Travel and Return to Work
  • Practice Social Distancing and Facilitate Virtual Arrangements
  • Ongoing Screening, Self-Monitoring and Self-Isolation
  • Heath Workers Who Work in Multiple Locations
  • Continuity of Operations and Curtailing Non-Essential Services
  • Return to Work after Illness

To read this memo, please click here. The College of Midwives of Ontario will continue to ensure that members have access to the most trusted sources of information in order for them to be able to provide safe and competent care to their clients.

March 16, 2020: COVID-19 – Information and Guidance for Members

We know that you have questions about what impact the novel coronavirus may have on your role as a regulated practitioner and your clinical decision-making as COVID-19 spreads in the communities where you practise. We recognize that in these challenging circumstances you may not be able to meet all College standards and that there may be a need for you to adjust your practice to be able to provide appropriate care to your clients and their newborns.

As you know, the College’s Professional Standards for Midwives is designed to be flexible and provides a framework for decision-making in a wide range of situations. You should exercise your professional judgment, in every situation, to provide care that is in your clients’ best interest within the limits of the midwifery scope of practice and your competence in line with the current guidance available from Public Health, the Ministry of Health, and the hospitals.

We encourage you to work collaboratively with your peers and other health care practitioners to implement enhanced infection prevention and control measures to protect yourself and your clients from infection risks. It is essential that everyone follows provincial public health directions and guidance.

If you cannot meet a standard of the profession, ensure that your clients receive best care possible in the current circumstances and document your rationale for the decision you made. You are accountable and responsible for clients in your care and your professional decisions and actions must be justifiable at all times. If you have any questions about meeting the Professional Standards or other College requirements, please contact the College at practiceadvice@cmo.on.ca.

We are aware that there could be reduced access to Emergency Skills, CPR and NRP certifications during the pandemic as well as an increase in class change requests from Inactive to General. We are closely monitoring the situation and will address any issues as needed. 

As announced earlier, the College is currently operating as a virtual office in an effort to minimize College staff exposure to COVID-19 to both protect our team and reduce possible associated service disruptions. College staff continue to be available via email and telephone as usual during this time.

Contact Details

For inquiries relating to professional practice advice: practiceadvice@cmo.on.ca or 416.640. 2252 ext. 230.

For registration inquiries, including initial registration, the status of your application, renewal, class change, NRP, CPR, ESW, public register and letters of professional conduct and in good standing: regadmin@cmo.on.ca or 416.640. 2252 ext. 208.

For inquiries relating to complaints, reports, or unauthorized practice and general information about the complaints, discipline or ADR process: conduct@cmo.on.ca or 416.640. 2252 ext. 224.

For inquiries relating to the quality assurance program: qap@cmo.on.ca or 416.640. 2252 ext. 227.

For inquiries relating to accessibility and privacy: operations@cmo.on.ca or 416.640. 2252 ext. 225.

March 13, 2020: College of Midwives of Ontario Providing Services Remotely

Due to the COVID-19 pandemic and the threat of community spread, the College of Midwives of Ontario will be temporarily operating a virtual office as of March 16, 2020, until further notice.   This decision was made to minimize College staff exposure to COVID-19 to both protect our team and reduce possible associated service disruptions. 

The College has systems in place to ensure that staff are fully equipped to provide services to the public and members while working remotely.  The College expects to operate with few disruptions, none of which will affect the College’s public protection mandate.  The identified disruptions are as follows:

  1. The College office will be unavailable for unscheduled visits. In person meetings can be arranged when there are accessibility or accommodation requests.   
  2. Courier packages cannot be received at the College office.  Please use mail and registered mail which will be received at an alternative location.   

College staff can continue to be contacted via email and telephone as usual during this time. The College will provide you with a response within two business days.

Who to contact?

For registration inquiries, including initial registration, the status of your application, renewal, class change, NRP, CPR, ESW, public register and letters of professional conduct and in good standing: regadmin@cmo.on.ca or 416.640.2252 ext. 208.

For inquiries relating to complaints, reports, or unauthorized practice and general information about the complaints, discipline or ADR process: conduct@cmo.on.ca or 416.640.2252 ext. 224.

For inquiries relating to the quality assurance program: qap@cmo.on.ca or 416.640.2252 ext. 227.

For inquiries relating to professional practice advice: practiceadvice@cmo.on.ca or 416.640.2252 ext. 230.

For inquiries relating to accessibility and privacy: operations@cmo.on.ca or 416.640.2252 ext. 225.

Recommended Resources

We encourage members to regularly review the following websites for the most accurate and up to date information about COVID-19:

Office of the Chief Medical Officer of Health

If you have any questions about meeting the Professional Standards or other College requirements, please contact the College at practiceadvice@cmo.on.ca.