In Manitoba, Canada, the Legislation regulating the profession of midwifery requires that a person must be registered with the College of Midwives of Manitoba to practice midwifery. There are three routes to registration:
The practice of midwifery in Manitoba may be very different from the way that midwives from other jurisdictions are used to practicing.
The Manitoba Model of Care
Midwifery practice in Manitoba is different from practice in many other countries. It includes:
- 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.
- 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.
- 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.
- 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).
- 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.
In Manitoba:
- Midwives are primary caregivers. This means that midwives have full legal responsibility for their clients and are not supervised by a physician or obstetrician.
- Midwives provide complete antepartum, intrapartum and postpartum care to the mother and newborn to six weeks postpartum. Under normal circumstances, a midwifery client and her newborn would not see any other health care practitioner during this time.
- Midwives must attend both out-of-hospital and hospital births. All midwives must hold admitting privileges in at least one hospital and perform a minimum number of out-of-hospital and hospital births per 2 or 5-year period. Fulfilling these requirements is mandatory for continued registration.
- Most midwives work in group practices. Each practice group of midwives is required to provide continuity of care to their clients by providing 24-hour on-call service. This means that every midwife works on 24-hour call for lengthy periods of time. They do not work shifts.
- All midwives are required to provide full service to their clients. This means that midwives never work only in one area of client care, such an antepartum or intrapartum care.
- Midwives are required to provide clients with full information regarding their care to assist them in making decisions about their pregnancy and birth.
- Midwives are, among other things, responsible for performing I.V. administration and venipuncture, prescribing, episiotomy, suturing, physical assessment, well-woman gynaecological exams and complete newborn assessment. They are responsible for ordering and interpreting all routine laboratory tests and screening procedures.
Health Services Delivery in Manitoba
Manitoba is divided into 11 health service regions known as Regional Health Authorities (RHAs) that together serve the entire Manitoba population. (For more information on RHAs and a regional map, go to their website at www.gov.mb.ca/health/rha.) Each RHA is responsible for ensuring that all residents of the region have fair and equitable access to necessary health services.
The majority of health services are provided at no cost to Manitobans. Midwifery is a publicly funded service, which means that a Manitoba woman may seek maternity care from a midwife just as she might from a family physician or an obstetrician.
Most Manitoba midwives are employees of RHAs and, as such, are included in the liability insurance of their employer. Currently midwifery services area available in 6 of the 11 RHAs. The midwifery legislation requires midwives to work in both the out-of-hospital setting and the hospital setting.
How Midwifery Positions Are Funded
The provincial government provides funding to the Regional Health Authorities (RHAs) for midwifery positions. This means that a position may, or may not, be available in the area in which you wish to practice and you may be required to relocate in order to work. From time to time, all the funded midwifery positions may be filled.
Although most midwives are employees of Regional Health Authorities, it may be possible for midwives to work in private practice. This means you may set up your own practice in the location of your choice.
Manitoba Health does not cover midwifery care provided under this model, which means that women must pay for these services themselves.
Further information about midwifery practice in Manitoba and Canada may be found through the following organizations:
Government of Manitoba (MB Health)
Manitoba Association of Midwives (e-mail)
Canadian Midwifery Regulators Consortium
Canadian Association of Midwives
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The College is currently involved in developing a bridging program for internationally educated midwives called the Multi-jurisdictional Midwifery Bridging Program (MMBP). The MMBP supports midwives who have been educated outside of Canada in making the transition to working in the Canadian health care system and in the Canadian model of midwifery. Both a seven-month program, with intensives, distance accessible components and a three month clinical placement, and an accelerated option are available. It's designed to help midwives learn how to use their skills in a Canadian context. 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 5 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. For more information on applying to the Multi-jurisdictional Midwifery Bridging Program, go to www.midwiferybridging.ca. This site is being updated regularly.
It may also be helpful to ensure you have done the following prior to deciding whether to pursue registration in Manitoba.
Education programs are approved by the CMM when it completes an extensive program assessment process that 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 (http://cmrc-ccosf.ca/node/23). Graduates from approved programs from outside of Manitoba complete a self-study and orientation specific to midwifery practice in Manitoba. All current CMM approved programs are Canadian 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. Click here to see the Education Principles supported by the College of Midwives of Manitoba
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.
