COLLEGE OF MIDWIVES OF BRITISH COLUMBIA

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1 COLLEGE OF MIDWIVES OF BRITISH COLUMBIA We are happy to provide you with information about midwifery education programs, in Canada and abroad, to assist you in choosing a midwifery education program as well as information about BC midwifery practice and requirements for registration. Midwifery Practice in BC The regulated practice of midwifery in BC began when the first midwives were registered in January Many people across BC worked together for the regulation and integration of midwifery into BC s health care system to ensure that women received safe, woman centred and evidence based midwifery care. Since 1998, only registered midwives have been legally allowed to use the title midwife and to practice as midwives in BC. The College of Midwives of BC was set up by government to regulate the profession, to set and maintain standards, and to assess midwives for registration. Midwifery practice in BC and across Canada is different from midwifery practice in many other countries. It includes: 1) Primary care: a midwife has primary care responsibility for her clients. Midwives care for a caseload of women and newborns from early pregnancy through to six weeks postpartum and only need to refer to other caregivers, such as obstetricians, according to the College s required list of indications for consultation. Women can access midwifery care directly and do not need a medical referral. Midwives do not work under the supervision of a physician as is the case in some regions of the world. 2) Evidence informed practice: midwives in BC are expected to keep up to date on current research on maternal and newborn care and incorporate appropriate findings into the care that they offer. 3) Informed choice: midwives provide comprehensive information to their clients and support women in making their own decisions about their care rather than acting as an expert authority and making such decisions on behalf of their clients. 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 six weeks postpartum so that each woman has a chance to get to know each midwife who might attend her in labour and so that the woman has a known care provider at her birth. 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). Midwives in BC provide a full spectrum of care. They do not generally specialize in prenatal and postnatal care or only manage births, as they do in many other countries, although occasionally a group of midwives providing continuity may be organized to have one midwife fill such a role for a period of time. 5) Choice of birth setting: BC midwives must provide healthy, low risk women with the choice of giving birth at home or in the hospital. Midwives have privileges at their local hospital where they provide primary care and work with support from nursing staff and other health professionals as needed. At home births they usually work in teams of two midwives. They generally have their own office where they provide prenatal and postnatal care. Early postnatal visits take place in the woman s home. BC midwives must be competent and comfortable working in both hospital and out of hospital settings. 6) Independent practice: midwives in BC are independent practitioners similar to doctors. They are funded by government through BC s Medical Services Plan and they manage their practices as businesses. Midwives are not employees as they are in many other jurisdictions. Issued: August 2013 Page 1 of 9

2 Routes to Registration in BC 1) Canadian Inter provincial reciprocity This route is strictly for those who have been registered as general or full registrants in other Canadian provinces or territories. To register in BC these Canadian midwives complete an application, a self study and orientation to BC midwifery practice, and a brief written examination to ensure they are prepared for practice in BC. 2) Graduation from an approved midwifery education program Specific Canadian midwifery education programs have been approved by the CMBC (see the list below) and their graduates can apply to register in BC. CMBC approval is provided only to education programs approved by the CMBC Registration Committee and whose graduates will meet all CMBC requirements for general registration. Graduates from approved programs from outside of BC complete a self study and orientation and a brief written examination similar to that for reciprocity applicants noted above. Approved program graduates must write and pass the Canadian Midwifery Registration Examination (CMRE). 3) Bridging for internationally educated midwives (MMBP) The route to registration for internationally educated midwives in BC is through the Multijurisdictional Midwifery Bridging Program (MMBP), which includes an application process, distance accessible and inperson intensive gap training and orientation to practice in BC, and a short clinical internship. There are midwifery education and clinical experience requirements that must be met in order to be eligible to participate, and English language fluency requirements and supports to meet those requirements. More detailed information, including information on how to determine if a midwifery education program you are considering would adequately prepare you for entry to the MMBP, is available at MMBP graduates must also write and pass the Canadian Midwifery Registration Examination (CMRE). The International Midwifery Pre registration Program (IMPP) in Ontario is another bridging program that prepares internationally educated midwives for registration primarily in Ontario. CMBC Approved Midwifery Education Programs All current CMBC approved programs are Canadian four year direct entry education programs leading to a university degree, or bridging programs leading to equivalency. All programs offer clinical experience working in a model of practice that is the same or very similar to the model in British Columbia. All graduates will meet CMBC requirements for general registration. British Columbia University of British Columbia Midwifery Program B Health Sciences Mall, Vancouver, BC V6T 1Z3 Tel: If you are an aboriginal woman considering studying midwifery, see our brochure attached to the end of this document for more information. Page 2 of 9

3 McMaster University Midwifery Education Program Michael G. DeGroote Centre for Learning & Discovery (MDCL) Second Fl., Main Street West Hamilton, ON L8S 4K1 Tel: , Ext Ontario Ryerson University Midwifery Education Program 350 Victoria Street, Toronto, ON M5B 2K3 Tel: (416) * offers part time studies. Laurentian University Midwifery Education Program 935 Ramsey Lake Road, Sudbury, ON P3E 2C6 Tel: (705) * This program is offered in both English and French. 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 BC. This program is offered in French only and currently has interim CMBC approval which allows students to participate in clinical placements in British Columbia but not for BC registration. Université du Québec à Trois Rivières Programme de Baccalauréat en pratique sage femme 3351, boul. des Forges, Trois Rivières QC G9A 5H7 Tel: (819) poste femme The University College of the North in Manitoba offers a Kanaci otinawawasowin Bachelor of Midwifery program: and Mount Royal University in Alberta offers a Bachelor of Midwifery program: Neither of these programs have applied to be considered for approval by the CMBC. If you are Considering Midwifery Education Programs Outside of Canada 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 British Columbia. While the clinical experience component of the MMBP provides participants with some experience in the Canadian continuity based model of care, it is to your advantage to gain as much experience in a similar continuity and choice based model as possible during your midwifery education. However your education is organized, you will need to have education and experience as a primary caregiver in antepartum, intrapartum, postpartum and newborn care. Any discrete gaps in required competencies or clinical experience can be addressed in through the Multi jurisdictional Midwifery Bridging Program, as long as you meet MMBP entry requirements. However, as the MMBP is only designed to address discrete gaps in knowledge or skills, you should attend an educational program that follows current, evidence informed standards across the full scope of midwifery care from the beginning of pregnancy to 6 weeks postpartum for both mother and newborn. Page 3 of 9

4 Midwifery Education outside Canada 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 homebirths are not allowed to work in hospital and may not have collegial relationships and guidelines about transfer protocols as we have in BC. 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 BC. 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. Education Abroad Most Commonly Chosen by those who wish to Practice in BC Many registered midwives in BC 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 BC. Graduates of these programs must complete the MMBP and pass the Canadian Midwifery Registration Examination in order to be eligible to register in BC. New Zealand: New Zealand has two different models of midwifery. One model is similar to that in British Columbia, where midwives work as independent practitioners offering continuity of care and choice of birth place, and midwives may also work as employees in hospital. 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 Bachelor s degree in midwifery. Programs are offered at Otago Polytechnic (Dunedin), Christchurch Polytechnic Institute of Technology (Christchurch), Massey University (Wellington), Waikato Institute of Technology (Hamilton), and Auckland University of Technology (Auckland). For general information on midwifery in New Zealand, contact: New Zealand College of Midwives (professional association) PO Box , Edgeware Christchurch, 8143 New Zealand Tel: Fax: Midwifery Council of New Zealand (regulator) PO Box Manners Street Wellington, 6142 New Zealand Tel: Fax: Page 4 of 9

5 Australia: Similar to New Zealand, midwives in Australia may work in community based practices offering continuity of care and choice of birth place, and many midwives work as employees in hospitalbased environments. There is an increasing movement towards midwifery as an independent primarycare 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 in the delivery of midwifery education to offer both post nursing midwifery education at universities (usually a one year program leading to a Graduate Diploma in Midwifery) and three year direct entry programs leading to a Bachelor degree in midwifery. For more information: Australian Nursing and Midwifery Council GPO Box 400, Canberra City ACT 2601, Australia Tel: Australian College of Midwives PO Box 87, Deakin West ACT 2600, Australia Telephone: 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, most students educated in the UK do not gain the majority of their experience in that model. Most UK students gain all or most of their intrapartum experience in a hospital setting, although it is sometimes possible to gain homebirth experience working with a community midwife. 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 BC. 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. For information about midwifery education in the UK: NHS Careers Tel: *provides list of university programs The Nursing and Midwifery Admissions Service Rosehill, New Barn Lane Cheltenham, Gloucestershire GL52 3LZ Tel: * for diploma level programs only Page 5 of 9

6 For general information about midwifery in the UK: Nursing and Midwifery Council (regulator) 23 Portland Place, London W1B 1PZ Tel: uk.org Royal College of Midwives (professional association) 15 Mansfield Street, London W1G 9NH Tel: 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 Master s 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 BC 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, some aspects of the scope of practice of US nurse midwives may be broader than for BC midwives and can include working with women defined as high risk, while their scope may be more limited in other areas. 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). For more information about nurse midwifery and ACNM certified direct entry programs contact: American College of Nurse Midwives (ACNM) 8403 Colesville Road, Suite 1550, Silver Spring MD USA Tel: (240) Fax: (240) Page 6 of 9

7 The US also offers a wide variety of other direct entry midwifery education programs. The majority are 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 directentry programs base their curriculum on the competencies set by the Midwives Alliance of North America (MANA) and 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 BC hospitals. Often standards for inter professional communication and collaboration with other health professionals are different than in BC. Students may or may not gain experience with continuity of care. It is important to note that some graduates from US direct entry schools have been found to be ineligible for the MMBP because their programs do not adequately prepare graduates for Canadian bridging or practice. For more information on direct entry midwifery programs in the USA, contact: Midwifery Education Accreditation Council PO Box 984, La Conner, WA USA Tel: (360) Midwives Alliance of North America 611 Pennsylvania Ave, SE #1700, Washington, DC USA Tel: North American Registry of Midwives 5257 Rosestone Dr, Lilburn, GA USA Tel: Note: Certification as a Licensed Midwife is gained by meeting educational and experience requirements in a specific US state. These requirements differ by state and are not necessarily tied to specific educational programs or competency requirements. Other Countries: There are midwifery education programs around the world. The standards and models of practice vary widely. We advise you to learn as much as you can about the similarities and differences between the practice of midwifery in the country you are considering and the standards and model of midwifery in BC before enrolling in a program outside of Canada. Page 7 of 9

8 How to select a Midwifery Education Program As noted above, there is a wide variety of midwifery education programs around the world. Ideally, the program that you select will teach the competencies required for midwifery practice within the context of a model of practice that is similar to that practiced in BC and ensure that graduates meet the CMBC s general registration requirements upon graduation. CMBC approved programs are your best option. If you are unable or don t wish to attend a CMBC 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 MMBP or CMBC requirements) must be discrete enough that they can be addressed within the MMBP, a program that is six to nine months long. Questions to Ask 1) 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. 2) 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 have managed at least 40 births and that you will have significant experience managing prenatal and maternal/newborn postnatal care. Make sure that the program documents your experience and provides you with a record of it, as well as provides an official transcript of your academic marks. 4) Compare the list of competencies that you will learn in the program to the CMBC s Competencies of Registered Midwives (available on the CMBC website: to identify any gaps. Be aware that some competency lists are more detailed than others and 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 these differences. 5) 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. 6) 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 BC. Note: only students registered in CMBC approved programs can do clinical placements in BC, so gaining experience in BC is not an option if you enroll in a non approved education program which currently includes all programs outside of Canada. Your school may not realize this; you will need to make sure that they know that you cannot stay in BC for the clinical component of your training. Page 8 of 9

9 Preparing for Midwifery Education and Practice It is important to fully understand what being a midwife in BC 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 need to drive a car to be able to do this). You will need to have flexible childcare arrangements so that you can give priority to responding to clients needs and be able to respond quickly. You will also need to be prepared to manage your own business and keep careful records. 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. For more information on becoming a doula see The Midwives Association of BC is the professional association for British Columbian midwives. They have both supporting and student membership categories. For more information, see The Canadian Association of Midwives (CAM) website provides information about midwifery in Canada at The Canadian Midwifery Regulators Consortium (CMRC) website, with information about midwifery registration across Canada, can be accessed at ccosf.ca. Page 9 of 9

10 WHAT IS A MIDWIFE? Midwives are registered health professionals who care for women and their babies during pregnancy, birth and for the early weeks of the baby s life. This includes all care in pregnancy, attending women in childbirth, and all care for the newborn baby. Midwives support women in making choices for themselves and their babies. Midwives attend births in hospitals or at women s homes. BC Midwives are paid by the Medical Services Plan (MSP). Aboriginal midwives in practice before 1995 may practice traditional midwifery on reserves. New midwives must graduate from an accepted educational program and register with the College of Midwives of BC. Only those registered may use the title midwife. Committee on Aboriginal Midwifery College of Midwives of British Columbia West 7th Avenue Vancouver, BC V6J 4S6 Phone: (604) Fax: (604) We are dedicated to ensuring that women and their families receive a high standard of midwifery care. Are you an Aboriginal woman who cares about healthy babies? Become a Registered Midwife and provide personal, professional care to your community

11 Routes to Midwifery Registration Midwifery education at UBC leads directly to registration with the College of Midwives of BC. University of British Columbia B Health Sciences Mall, Vancouver BC V6T 1Z3 Tel: SUPPORTS FOR ABORIGINAL MIDWIFERY STUDENTS AT UBC UBC Midwifery Program The UBC Midwifery Program reserves a seat for a qualifying aboriginal student each year. Students may self-identify as Aboriginal on their university application or by separate contact. UBC Midwifery has established a Committee for Aboriginal, Rural and Remote Education with a mandate of developing core curricula, clinical placement opportunities, mentors, and a database of university resources to support Aboriginal midwifery students at UBC and externally. First Nations House of Learning Phone: Aboriginal Student Recruiter-Advisor Sarah Lalonde Phone: sarah.lalonde@ubc.ca Aboriginal Student Finance and Awards Division of Aboriginal People s Health Laurentian, McMaster and Ryerson s Midwifery Programs in Ontario are approved for registration in British Columbia. Université du Québec à Trois Rivières currently has interim approval for student placement. University College of the North has not yet applied for approval in BC. Laurentian University Sudbury, ON Tel: (705) This program is offered in both English and French. McMaster University Hamilton, Ontario Tel: , Ext Ryerson University Toronto, ON Tel: (416) For information regarding supports for Aboriginal students at universities outside of BC, please contact the individual Midwifery program. Université du Québec à Trois Rivières Trois Rivières, QC Tel: (819) poste 4065 This program is offered in French only. University College of the North Kanaci Otinowawosowin (Aboriginal Midwifery) Baccalaureate (KOB) Program Manitoba OTHER SUPPORT Midwives Association of British Columbia Midwives Association Aboriginal Committee E. 15th Avenue Vancouver, BC V5T 2P6 Phone: (604) Fax: (604)