College of Midwives of Manitoba
 

Exploring Midwifery as a Career

We are happy to provide you with information about what is needed in order to become a midwife in Manitoba. Below you will find facts about midwifery practice, requirements for registration, and information about midwifery education programs. We hope that this will assist you to choose a midwifery education program that will enable you to successfully register as a midwife in Manitoba.

Midwifery Practice in Manitoba

Similar to a number of Canadian provinces, midwifery practice in Manitoba has been regulated relatively recently. In June 2000, the Manitoba Legislature proclaimed the Midwifery Act and the Midwifery Regulation, establishing midwives as primary health care providers. In 2000, the first group of midwives completed a one-time Assessment & Upgrade Program and was registered to practice.

By the same legislation, the College of Midwives of Manitoba (CMM or the College) was established as the regulatory body for the profession. All midwives who practice in Manitoba must be registered with the CMM. The requirements for registration are outlined in the Midwifery Regulation. Practising midwifery in Manitoba, or holding oneself out as a midwife, without being registered with the College of Midwives is illegal.

Currently, there are approximately 35 practising midwives providing services via regional health authorities in urban areas as well as in rural and northern Manitoba. They work in collaboration with other health care providers to deliver the best possible care to women and their families. Women who choose a midwife as their caregiver may birth their baby in hospital or in an out-of-hospital setting. At present, the demand for midwifery services exceeds the supply of midwives who can provide the service.

The Manitoba Model of Care

Midwifery practice in Manitoba is different from practice in many other countries. It includes:

  1. Primary care: Midwives are autonomous, primary health care providers whom clients may choose as their first point of entry to the maternity care system. They carry a caseload of women who they see throughout their care and only refer to other caregivers, such as obstetricians, according to a detailed list of indications for consultation. They do not work under supervision of a physician, as is the case in some regions of the world. In accordance with the Midwifery Regulation, midwives may order and interpret diagnostic and laboratory tests, may perform minor surgical and invasive procedures, and may prescribe and administer appropriate medications.

  2. Evidence-based practice: midwives in Manitoba are expected to read and interpret current research on maternity care and incorporate appropriate findings into the care that they offer.

  3. Informed choice: Midwives provide information to enable women to make their own decisions about their care rather than acting as the authority and making such decisions themselves.

  4. Continuity of care: Midwives work in small groups and provide all care within a continuity of care model seeing each woman in their care from early pregnancy to 6 weeks postpartum so that the woman has a chance to get to know each midwife who might attend her in labour. At least one midwife in the group is available on a 24-hour on-call basis (usually call is shared between two to four midwives so they can have time off-call).

  5. Choice of birth setting: Manitoba midwives must provide healthy, low-risk women with a choice of giving birth at home or in the hospital. Midwives have privileges at their local hospital where they work with support from obstetrical nurses and, when indicated, with other health professionals. At home births they usually work in teams of two midwives. They generally have an office/clinic where they provide prenatal and postnatal care. Early postnatal visits usually take place in the client's home. Manitoba midwives must be competent and comfortable working in both hospital and out-of-hospital settings.

Routes to Registration in Manitoba

There are three routes by which you may become eligible to apply for registration in Manitoba:

  1. Inter-provincial Reciprocity
    (applicants from other Canadian jurisdictions where midwifery is regulated)
    The Agreement on Internal Trade ("AIT") was signed by the government of Canada and the provincial and territorial governments in 1994. It is a written agreement intended to make it easier for people, investments and services to move across Canada. Chapter 7 of the AIT, the Labour Mobility Chapter, says that a qualified worker in one province must be granted access to similar employment opportunities in another Canadian jurisdiction. Changes to the AIT were approved in January 2009, to take effect as of August 1, 2009. Those changes require all Canadian jurisdictions to accept workers in regulated professions from other Canadian jurisdictions without additional material training requirements. There are some exceptions to that general rule, discussed below, but essentially if a midwife in good standing from a province where midwifery is regulated is applying to become a midwife in Manitoba, the AIT provides that the midwife must be accepted in Manitoba.

    Exceptions, as mentioned above include but are not limited to: the right to require a fee upon application and registration; the right to require a midwife to complete a local jurisprudence course; the right to refuse registration to a midwife who is not of good standing or where there is evidence of bad character; or the right to refuse registration where the midwife has terms, conditions and limitations that are not generally used in Manitoba. Midwives from certain provinces may be subject to additional requirements. Specifics regarding these exceptions are available at the following website http://www.gov.mb.ca/tce/lmi/labourmobility/index.html

    If an applicant for registration in Manitoba is refused registration because she does not meet one of the non-exemptible registration requirements, that applicant is entitled to contact the official labour mobility contact in their home province for assistance.

  2. Graduation from an Approved Midwifery Education Program
    Education programs are "approved" by the CMM when it completes an extensive program assessment process determines that the program meets CMM education standards and policies. Approved program graduates must meet both the entry-level competencies and the clinical experience requirements as set out in the Midwifery Regulation, and must have written and passed the Canadian Midwifery Registration Exam. Graduates from approved programs from outside of Manitoba complete a self-study and orientation similar to that for reciprocity applicants noted above. All current CMM approved programs are four-year direct-entry education programs leading to a university degree. All programs offer clinical experience working in a model of practice that is the same or very similar to the model in Manitoba.

    Approved Programs to date:

    kanaci otinawawasowin (Aboriginal Midwifery) Baccalaureate Program (KOBP)
    University College of the North
    436 - 7th Street East,
    Box 3000,
    The Pas, Manitoba R9A 1M7
    Tel: (204) 627-8500
    (866) 627-8500 (Toll Free)
    https://www.ucn.ca/ics/Programs/

    Initial Approval Granted June 16, 2006
    British Columbia Midwifery Education Program
    University of British Columbia
    B54-2194 Health Services Mall,
    Vancouver BC V6T 1Z3
    Tel: 604-822-0354
    www.midwifery.ubc.ca
    Ontario Midwifery Education Program
    Laurentian University
    935 Ramsey Lake Road,
    Sudbury, ON P3E 2C6
    Tel: (705) 675-4822.

    * This program is offered in both English and French.
    www.laurentian.ca     		McMaster University Michael G. DeGroote Centre for Learning & Discovery
    (MDCL) Third Fl., 3103
    1200 Main Street West
    Hamilton, Ontario L8N 3Z5
    Tel: 905-525-9140, Ext. 26654
    www.fhs.mcmaster.ca/midwifery     		Ryerson University
    350 Victoria Street,
    Toronto, ON. M5B 2L4
    Tel: (416) 979-5104 or (416) 979-5271
    * This program offers part-time studies.
    http://www.ryerson.ca/~midwife/


  3. Bridging

    The Multi-jurisdictional Bridging Project (MMBP)
    The MMBP is a bridging program for midwives educated outside of Canada. It's designed to help midwives learn how to use their skills in a Canadian context. The MMBP is a 6 - 9 month pilot that will enable integration of foreign-educated midwives into Canada's provincial health care system and will assist them in preparing to meet the requirements for registering and practising as a Canadian midwife. The bridging program provides education, support, mentorship and assessment combining distance and online education formats with focused classroom and clinical exposure. The program is offered in partnership between Mount Royal College in Calgary and the Division of Midwifery at the University of British Columbia in Vancouver. A maximum of 4 weeks of 'intensives' currently take place in Vancouver, the remainder of coursework and clinical placements take place in your home province and home community where possible. More information is available at www.midwiferybridging.ca. More detailed information, including information on how to determine if an education program you are considering would adequately prepare you to be assessed through Bridging is available below.


    4. Other Midwifery Education Programs

    There are many different midwifery education programs around the world and many different models of practice in which students may work. Each program is designed to meet different standards that may or may not be similar to the standards that you will be required to meet in order to work in Manitoba. It is possible to become registered in Manitoba without learning to practice in a model that is exactly like midwives practice in Manitoba, but it is to your advantage to try to gain experience that is as similar as possible. However your education is organized, you will need to have training and experience as a primary caregiver in antepartum, intrapartum, postpartum and newborn care. It is common to make up some gaps in experience as a conditional registrant working under supervision in Manitoba. However, as only very discrete gaps in knowledge or skills can be made up in supervision, you should aim for an educational program that follows current, evidence-based standards for the full scope of midwifery care from the beginning of pregnancy to 6 weeks postpartum for mom and baby.
    Be aware of what you will not learn in a given program: Many programs only provide clinical experience in a hospital setting or only in an out-of-hospital setting. Where experience in a hospital setting is offered, in some programs this experience is substantially gained in poorer nations where ill-equipped hospitals and authoritarian models of care do not give students the opportunity to learn about what it is like to work in a Canadian style hospital and where language barriers limit learning related to communication. In some jurisdictions, such as many US states, midwives providing home births are not allowed to work in hospital and may not have collegial relationships and guidelines about transfer protocols as we have in Manitoba.
    Many education programs provide very limited experience working in a continuity of care model. Some have limited education regarding newborn care. In some parts of the world, standards of care are not based on current evidence, as is expected in Manitoba. Sometimes midwives are not given the opportunity to learn about providing informed choice to their clients. Sometimes midwives are supervised by doctors and are not educated to become primary caregivers.

    Other Midwifery Education Opportunities in Canada

    In addition to the approved educational programs listed above, there is a program in Quebec where the model of practice is very similar to that in Manitoba. This program is offered in French only.
    Université du Québec à Trois Rivières
    Casier postal 500, Trois Rivières, QC G9A 5H7
    Midwifery Program Tel: (819) 376-5045 or 1-800-365-0922
    www.uqtr.ca

    Midwifery Education Outside Canada

    Many registered midwives in Manitoba have obtained their education in programs outside of Canada. Below is information about the countries that provide midwifery education in English and that are most commonly attended by those who plan to work in Manitoba.

    New Zealand
    The model of practice in New Zealand is very similar to that in Manitoba, except that midwives may work as employees in hospital and/or as independent practitioners. There are five accredited midwifery educational programs in New Zealand that follow a nationally approved curriculum. All programs are three-year direct entry programs that lead to a Bachelors degree in midwifery.

    United Kingdom
    There are a number of models of practice prevalent in the United Kingdom ranging from hospital based shift-work style to community-based caseload midwifery with continuity of care ("continuity of carer" as it is called in the UK). Although education programs are increasingly including experience working with continuity of care, it is unlikely that a student educated in the UK would gain the majority of her experience in that model. Likewise, most UK students gain all or most of their intrapartum experience in a hospital setting, although it is sometimes possible to gain some homebirth experience working in community midwifery. Certain aspects of newborn care, such as a complete newborn assessment, are often not carried out by midwives in the UK. UK midwives offer informed choice and practice using standards based on current evidence, as in Manitoba. Both direct entry and post-nursing midwifery programs are currently offered in the UK. Direct entry programs are three to four years long and they lead to a diploma or a university degree. Post-nursing programs are usually 18 months long.

    United States of America
    There are a number of different models of midwifery practice in the United States. Midwives work with different scopes of practice and different standards according to the type of midwifery license they hold and differing state legislation. The different types of US midwifery certifications or licenses are:
    - Certified Nurse-Midwife
    - Certified Midwife
    - Certified Professional Midwife
    - Licensed Midwife
    These are awarded following verification that specific education and standards are met (see below). In addition, in certain States, midwives can practice without a license or certification; these midwives are usually referred to as lay midwives. Nurse-midwifery educational programs are primarily post-nursing programs that lead to a Masters degree and to certification as a Certified Nurse-Midwife (CNM). These programs are generally about two years in length and are offered at recognized and regionally accredited universities. All nurse-midwifery education programs are accredited by the Division of Accreditation of the American College of Nurse Midwives. Most nurse-midwifery students learn exclusively in a hospital setting and many work in an environment that has a more interventionist approach than is the case in the Manitoba model, although in some states CNMs do attend home births. It is rare for students to gain experience with continuity of care. Due to the nursing component, the scope of practice of US nurse-midwives is sometimes broader than for Manitoba midwives and can include working with women defined as high-risk. The American College of Nurse Midwives (ACNM) also has standards for accrediting direct-entry education programs where the nursing skills needed for midwifery are integrated into the program in a way that is similar to the Canadian model of midwifery education. A number of US direct entry programs meet these standards and are accredited by ACNM. These programs lead to a credential as a Certified Midwife (CM).

    The US also offers a wide variety of other direct-entry midwifery education programs. The majority is offered by small private schools. The programs can last from a few months to four years and they range from formal educational programs incorporating classroom study and supervised clinical placements to self-study distance education theoretical courses and apprenticeship style training. Most US direct-entry programs base their curriculum on the competencies set by the Midwives Alliance of North America (MANA) and most ensure their graduates meet the standards set by the North American Registry of Midwives (NARM). Some direct-entry programs do not lead to certification or licensure of any kind. Some programs are accredited by the Midwifery Education Accreditation Council (MEAC), the US body that sets educational standards for direct-entry midwifery programs. MEAC accredited schools ensure that graduates meet NARM requirements and thus can gain certification as Certified Professional Midwives (CPM). It is important to note that despite the use of "North America" in their organizational names, MANA, NARM and MEAC are US-based organizations and the competencies and standards of practice they use are not necessarily the same as those accepted by the provinces and territories that regulate midwifery in Canada. Students in these US direct entry programs usually work only in out-of-hospital settings, although some do offer hospital experience, usually in poorer nations with different equipment and standards than we have in Manitoba hospitals. Often standards for inter-professional communication and collaboration with other health professionals are different than in Manitoba. Students may or may not gain experience with continuity of care.

    Australia
    There is a great diversity of midwifery models of practice in Australia from hospital to community-based. Although many midwives work in strictly hospital-based environments that do not offer continuity of care or choice of birth setting, some do offer woman a model of care that is similar to that in Manitoba. There is a strong movement towards midwifery as an independent primary-care profession. Midwifery practice is evidence-based. For many years, midwifery education in Australia was exclusively post-nursing hospital-based training. In the early 90s there were changes to the delivery of midwifery education so that post-nursing midwifery education is now offered at universities. These programs are usually one year in length and lead to a Graduate Diploma in Midwifery. More recently, three-year direct-entry programs have been developed which lead to a Bachelor degree in midwifery. There have been numerous criticisms within Australia regarding the inconsistencies between various midwifery programs. There is work being done to try to standardize programs nationally.

    Other Countries
    There are midwifery education programs around the world. The standards and models of practice vary widely. You are advised to learn as much as you can about the similarities and differences between the practice of midwifery in the country you are considering and that in Manitoba.

    Midwifery Education Program Approval (MEPA)

    The College is committed to recruiting midwives with diverse backgrounds, experience and knowledge. The College supports multiple routes of entry to midwifery. To this end, it may be possible to engage in a program of self-study. Such a program would involve approval by the College of Midwives of Manitoba, and the establishment of a formal relationship with a midwife preceptor. Once the program of self-study is complete it would be necessary for the candidate’s knowledge and skills to be assessed through the PLEA Process to measure eligibility for registration as a midwife. The CMM is currently pursuing legislative changes to ensure that this unique option remains open to interested individuals. This process can be lengthy. Please check this site or contact the Administrative Officer at admin@midwives.mb.ca if you would like to be advised of when these changes are made.

    How to Select a Midwifery Education Program

    As noted above, there are a wide variety of midwifery education programs around the world. Ideally, the program that you select will teach a model of practice that is similar to that practiced in Manitoba and ensure that graduates meet the CMM's registration requirements upon graduation. CMM approved programs are the best option.

    If you are unable or don't wish to attend a CMM approved program, we recommend that you thoroughly evaluate potential programs prior to making a decision to attend. Remember that any gaps in the academic or clinical education you receive (in relation to CMM requirements and core competencies) must be discrete enough that they can be addressed within no more than 12 months of supervised practice in Manitoba.

    Suggested Steps for Evaluating Potential Programs

    1. Ensure that your education program meets the MMBP eligibility requirements (available on the Bridging website www.midwiferybridgin.ca
    2. Ask about the academic and clinical curricula and ensure that the school oversees both components. Check also that there is a back and forth learning process so that whatever you learn in academic classes is integrated into your clinical education and vice versa. Learn about the program's evaluation forms and processes so that you are sure that you will be given appropriate and unbiased support and feedback throughout the program. Check that you will be learning to independently manage prenatal, labour and birth, postnatal, and newborn care to six weeks postpartum. Make sure that the program has set out clear competencies that you will be learning and that the program is well organized to ensure that all competencies are taught. Ensure that the program teaches critical thinking and skills in evaluating research and promotes evidence-based practice.
    3. Ensure that by graduation you will meet the clinical requirements for prenatal, birth, postpartum and newborn care. Make sure that the program documents your experience and provides you with a record of it (and can provide the CMM directly with a record of your clinical experience as well as a transcript of your academic marks).
    4. Compare the list of competencies that you will learn in the program to the CMM's Core Competencies (available on the CMM website: (www.midwives.mb.ca) to identify any gaps. Be aware that some competency lists are more detailed than others so that the number of items on a list does not indicate its breadth. You may need to enlist the help of someone with midwifery experience in order to fully understand any differences.
    5. Learn about how midwifery is practiced in the location where you will gain clinical experience and consider any implications. Speak to the program about whether it is possible to get experience in a location where practice is similar to that in Manitoba. Note: only students registered in CMM approved programs can do clinical placements in Manitoba so gaining experience in Manitoba is not an option if you enroll in a non-approved education program. Your school may not realize this; you may have to make sure that they know that you cannot stay in Manitoba for the clinical component of your training.
    6. Ask to speak to graduates of the program to find out about their experiences. Ask about what they liked or didn't like. Find out if they felt competent and confident to practice completely independently by the end of the program. If any graduates have registered successfully in Manitoba, speak with them about their experiences going through PLEA and working in Manitoba. Get hints regarding potential areas where you may want to try to gain additional experience or education.
    7. Find out if the program is accredited and if so, what this means (sometimes accreditation refers only to financial and logistical matters; sometimes it refers to educational content; and sometimes to both). Ask about the midwifery instructors and preceptors - what is their academic and clinical experience? Exposure to experienced practitioners who were themselves educated in diverse programs provides the best opportunity for learning.

    Preparing for Midwifery Education and Practice

    It is important to fully understand what being a midwife in Manitoba means to your lifestyle. You must be prepared to be on-call frequently and to work long hours, sometimes through the night. You must be willing and able to travel on your own to births, sometimes in the middle of the night (most midwives have cars to be able to do this). You will need to give priority to responding to clients' needs and have flexible childcare arrangements to allow you to respond quickly. Many aspiring midwives find that it is very helpful to train and work as a doula for a period of time in order to see if the on-call nature of the job suits them and to confirm that becoming a midwife is what they want to do. This experience can also be an asset when applying to midwifery education programs. Some midwifery education programs, including all of the CMM approved programs, are competitive to get into. In order to strengthen your application, you may wish to take relevant courses and/or volunteer in reproductive health related organisations. Useful courses include reproductive anatomy & physiology, health & physical assessment of the adult and neonate, nutrition, general counselling, labour support, breastfeeding/lactation counselling, neonatal care, human growth and development, women's health, women's studies, childbirth/prenatal education, critical appraisal of research, pharmacology and complementary therapies. Some of these courses can be found at local universities and community colleges and can be taken separately from complete programs. You may also wish to attend workshops and conferences that cover topics on perinatal health and wellness. The Midwives Association of Manitoba is the professional association for Manitoban midwives. For more information, contact midwivesofmanitoba@gmail.com. The Canadian Association of Midwives (CAM) website provides information about midwifery in Canada at www.canadianmidwives.org. The Canadian Midwifery Regulators Consortium website, provides information about midwifery registration across Canada at http://www.cmrc-ccosf.ca/.