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Working Outside of the Midwifery Practice Group Model

May 22, 2019

On June 1, 2018, the Professional Standards for Midwives (Professional Standards) came into effect and allowed midwives practising outside of, or in addition to, the Midwifery Practice Group (MPG) model to do so without special arrangements with the College. Midwives currently working in this kind of arrangement can practise on their own authority as long as the care they provide is in the scope of practice as outlined in section 3 of the Midwifery Act, 1991:

The practice of midwifery is the assessment and monitoring of women during pregnancy, labour and the post-partum period and of their newborn babies, the provision of care during normal pregnancy, labour and post-partum period and the conducting of spontaneous normal vaginal deliveries.

When the care provided is outside the scope of practice, midwives must work under delegation to provide it.

What does it mean to work under delegation?

Delegation is the transfer of authority of a controlled act and is authorized under the Regulated Health Professions Act, 1991 (RHPA) and can be made by a health care provider to another health care provider or to an unregulated person. Therefore, a midwife can only delegate a controlled act that they are authorized to perform and can only receive a delegation for a controlled act they are not authorized to perform. The controlled acts authorized to midwives are set out in section 4 of the Midwifery Act, 1991. The College’s expectations for midwives who accept delegations are set out in the Professional Standards (see standard #31).

Active Practice Requirements

Some midwives practising outside of the MPG model are not providing intrapartum care. While midwives are not required, under the Midwifery Act, 1991 or by current College standards, to provide all aspects of midwifery care, they are still required to meet their Active Practice Requirements (APR) in accordance with the Registration Regulation. Members who do not provide intrapartum care may have terms, conditions and limitations imposed on their certificates of registration. Please click here to read more on the College’s APR process.

Contact the College

If you have a question about the scope of practice or College standards, please contact the Professional Practice Advisor by phone: 416.640.2252 ext. 230 or by email: practiceadvice@cmo.on.ca

If you anticipate a shortfall in active practice numbers, please contact the Registration Department by phone 416.640.2252 ext. 208 or by email: admin@cmo.on.ca

Working Outside of the Midwifery Practice Group Model FAQs

Do I need to inform the College if I work outside the Midwifery Practice Group (MPG) model or under delegation?

No- you do not need to inform the College. Midwives may practise outside the MPG model as long as they practise within the scope of practice (or under delegation) and comply with the standards of the profession.

How do I arrange for professional liability insurance and funding to work outside of the MPG model?

Please contact the Association of Ontario Midwives (AOM) for information about midwifery funding and professional liability insurance.

Can I work in my local hospital providing newborn care in addition to working as a midwife in an MPG? The newborns are physician clients and are not midwifery clients.

Yes – you can provide newborn care in your local hospital to clients admitted under a physician.  The care that you provide is conducted on your own authority as long as it is in the scope of practice and meets the standards of the profession. Controlled acts that are performed outside the midwifery scope of practice must be done under delegation.

I would like to work with physicians in a Community Health Centre providing care that is not in the Midwifery Scope of Practice (e.g. well-baby care). How do I arrange to work under delegation?

 Much of the care you will be providing does not include controlled acts so it will not require delegation. Other care, such as immunizing babies older than 6 weeks will require delegation. You must work together with the physicians to develop the process for working under delegation.