Processing complaints is one important way we fulfil our mandate to protect the public. Information from complaints provides valuable insight into how midwifery care is experienced and how the complaint process can best support future care and the public’s trust in midwifery.
These insights help us identify where updates to standards, practice advice, or education for the profession may be needed. Reviewing complaint trends over time helps us identify the issues most often raised by the public. Our most recent analysis draws on complaint data from 2018 to 2024, alongside data from the five years prior to 2018.
Reviewing complaint trends over time helps us identify the issues most often raised by the public. Our most recent analysis draws on complaint data from 2018 to 2024, alongside data from the five years prior to 2018.
The following insights highlight key patterns identified through this data analysis.
- From 2018 to 2021, complaints to the College rose steadily, from 12 to 32 annually, likely reflecting pressures related to COVID-19. Numbers remained relatively stable in 2022 and 2023 at 34 and 37, before dropping unexpectedly to 20 in 2024. An unusually high number of complaints were received in the first quarter of 2025, which evens out the numbers to be fairly consistent year to year. While our numbers are staying somewhat stable, other colleges are reporting increasing complaint volumes.
- Registrar’s investigations (investigations that are not a result of a complaint) ranged from 1 to 9 cases per year between 2018 and 2024, with none in 2024. In 2020-21, we implemented the Registrar’s Investigations Decision-Making Tool, demonstrating a transparent and consistent manner of determining appropriate outcomes relative to risk to the public. Considering “right-touch” regulation and taking an educative or remedial approach as opposed to commencing an investigation has proven to be successful. We have issued 22 educative or remedial letters to registrants (an average of four per year), and to date, none of the registrants who received these letters have been subject to mandatory reports or subsequent complaints regarding their practice. This suggests that, for appropriate cases, “right-touch” measures have been an effective approach to public protection while reducing the need for formal investigations and expediting the process.
- The data shows that we process considerably more cases than the number of complaints received; on average, about 60% more. This is because a complaint often names multiple midwives, and each must be processed individually. Some complainants also name midwives who are midwifery practice owners, with the belief that they are also accountable for certain conduct.
- Complaints are typically submitted in narrative or story form. We focus complainant’s concerns by preparing a list of issues they review for accuracy to ensure their concerns are fully understood. Complainants average four issues per complaint, with few raising only one concern. The noticeable spike in issues per matter in 2021 (292) was due to a single complaint, highlighting how individual cases can affect overall trends. It’s important to note that the number of issues identified does not necessarily correspond to the seriousness of a complaint.
- The majority of new matters come from clients or their families, with midwives being next most frequent source, highlighting a notable trend of concerns being raised within the profession itself.
- From 2018 to 2022, prior to the introduction of the Ministry’s College Performance Measurement Framework, issues were tracked using the categories of the Professional Standards: Accountability; Acting with Integrity; Demonstrating Leadership and Collaboration; Demonstrating Professional Knowledge and Practice; and Providing Person-centred Care. Most complaints involved multiple themes, with many combining professional knowledge and practice, person-centred care, and professionalism concerns.
- Under the Demonstrating Professional Knowledge & Practice category, most concerns involved inadequate assessment or management of a client’s condition. The majority of matters were resolved by the Inquiries, Complaints and Reports Committee (ICRC) with no action, reflecting that while concerns were raised, most did not require regulatory action. A smaller group of cases resulted in medium‑high risk outcomes, including remedial activities (Specified Continuing Education or Remediation Programs; oral cautions; undertakings), and referrals to Discipline. The top themes included:
- Fetal health surveillance
- Hypertensive disorders of pregnancy
- Gestational diabetes management
- Group B streptococcus management
- Hyperbilirubinemia
- Assessment and repair of perineal tears
- Record-keeping issues appeared consistently, and were usually resolved with guidance rather than higher‑risk actions.
- Under the Acting with Integrity category, the most common themes of complaints included unprofessional interactions or comments made to a client or family member, a lack of empathy or honesty, inappropriate referrals to Children’s Aid Society, and failures to respond to pages or emails.
- Also under the Acting with Integrity category, we noted allegations related to unprofessional practice administration focused on managing the practice in a manner that supports the physical and mental wellbeing of both clients and midwives. Common themes included staffing and workload pressures; discrimination or bullying; compensation and administrative processes; and gaps in protocols or compliance. These concerns most often arose from complaints between midwives.
- Under the Demonstrating Leadership and Collaboration category, most allegations related to failures to coordinate care or arrange alternate care; challenges in interprofessional collaboration; gaps in ongoing or continuity of care; and issues arising in transfer of care situations. In many instances, these concerns reflected clients’ expectations of care, such as anticipated involvement of an obstetrician or a high level of supportive care following a transfer, rather than departures from professional standards.
- Under the Accountability category, complaints most often related to the supervision of students and reflected client expectations regarding the midwife’s accountability for care provided by students, the level of oversight involved, and clarity about the student’s continued role within the care team.
- Under the Demonstrating Professional Knowledge & Practice category, most concerns involved inadequate assessment or management of a client’s condition. The majority of matters were resolved by the Inquiries, Complaints and Reports Committee (ICRC) with no action, reflecting that while concerns were raised, most did not require regulatory action. A smaller group of cases resulted in medium‑high risk outcomes, including remedial activities (Specified Continuing Education or Remediation Programs; oral cautions; undertakings), and referrals to Discipline. The top themes included:
- In 2023, the College began tracking themes using the Ministry’s College Performance Measurement Framework categories of Billing and Fees, Communication, Competence/Patient Care, Harassment and Boundary Violations, Record Keeping, and Other: Practice Management. While the category names changed, the overall trends remained consistent. Clinical concerns were further tracked using the subcategories of antenatal, intrapartum, and postpartum care. This enhanced approach made it easier to identify patterns and highlighted the emergence of timely assessments as a recurring theme. Although this issue had been present in prior years, the revised tracking methodology provided greater clarity and visibility.
- Between 2019 and 2024, the number of cases referred to Alternative Dispute Resolution (ADR) ranged from one to nine per year (1, 2, 5, 9, 6, 6). Most midwives are open to participating in ADR; however, clients must also consent for the process to proceed, and many choose not to. In 2021, the College expanded the criteria for ADR, which resulted in a brief period of increased uptake. While ADR allows clients to have more input into the resolution of complaints, many clients decline to participate, citing a desire not to be involved or feelings of anger or trauma that make participation difficult.
- Between 2021 and 2023, only two complaints were processed by the Inquiries, Complaints, and Reports Committee as frivolous or vexatious, which is consistent with prior trends.
- Between 2019 and 2022, the College held four discipline hearings. Three cases involved clinical concerns, reflecting themes outlined in the College’s trending topics, and one addressed an ethical matter. Three hearings were uncontested, and one was contested. Allegations included failing to maintain professional standards, practising while in a conflict of interest, and engaging in conduct considered unprofessional or unbecoming. One case did not result in a finding of professional misconduct. Where professional misconduct was found, penalties ranged from reprimands and reflective essays to requirements for indirect supervision, completion of an ethics and professionalism course, chart reviews, and in one case, a one-month suspension. The Inquiries, Complaints, and Reports Committee has not referred a matter since 2022.
- In 2021, the Inquiries, Complaints, and Reports Committee set a benchmark to resolve complaints within 269 days 80% of the time. The ICRC has continued to reduce timelines since 2021 from 269 to 157 days in 2024. We continue to look at our processes to resolve complaints in a fair and compassionate manner, understanding that complaints are stressful for everyone resolved, and closing them quickly where possible is in the public interest.
Reviewing complaints and trends over time provides valuable insight into how midwifery care is experienced and how expectations align with professional standards. This is particularly important in our rapidly changing world, where medical disinformation is widespread and client expectations are high. The data and analysis highlights areas where enhanced communication, clarity of roles, and consistent clinical practice support both client safety and quality care.
For more information, see the appended document that includes some graphs of the information discussed.
Key learnings include the importance of:
- Clear communication and professional boundaries, ensuring clients understand the roles of midwives, students, and other health care providers.
- Maintaining thorough documentation and consistent record-keeping practices.
- Coordination of care and collaboration within interprofessional teams.
- Practice management that supports an ethical and safe, sustainable workload and a respectful workplace culture.
- Timely, evidence-based clinical care that aligns with professional standards.
- Managing client expectations about availability, care processes, and the scope of midwifery practice.
These insights demonstrate how complaint data informs regulatory oversight, supports midwives in providing safe and professional care, and helps the public understand the scope and responsibilities of midwifery practice. By focusing on learning and system-level improvements from our complaint data, the College continues to fulfil our mandate to protect the public while promoting quality midwifery care.