This consultation period closed on June 30, 2023.
About this consultation:
On February 3, the College launched a consultation process proposing significant changes to the Registration Regulation under the Midwifery Act, 1991. We thank you for your comments and submitted changes to the Ministry on May 1, 2023.
The College has reviewed all of the feedback we received from registrants and stakeholders in our prior consultation. We are now requesting your feedback on one additional change.
We are proposing to add a new registration requirement as follows:
Applicants must provide satisfactory evidence of competency in fetal surveillance
This new requirement would be included in the Registration Regulation and would only take effect when individuals initially apply to the College at the time of entry into practise.
The rationale for adding the requirement is directly tied to the College’s main mandate to protect the public: fetal health surveillance is a core function in the practice of midwifery, and it is not sufficiently covered in the courses currently required for registration (neonatal resuscitation, emergency skills, and cardiopulmonary resuscitation)
How to provide feedback
You may submit your comments on this page below.
Midwife on June 30, 2023
I completely agree.
Midwife on June 29, 2023
I agree and would prefer a recertification every 3-5 years.
Midwife on June 27, 2023
I wholeheartedly agree with this requirement for registrants. The ability to interpret fetal health surveillance using appropriate assessment skills and terminology is critical for intrapartum care providers. Sadly, I repeatedly observe other allied health professionals, particularly physicians, using outdated terminology and assessment methods.
Midwife on June 27, 2023
I agree with the addition
Midwife on June 26, 2023
I agree to this inclusion that there is a New Registrant Requirement that “applicants must provide satisfactory evidence of competency in fetal surveillance” at time of registration. This because EFM is used frequently in clinical practice and while EFM by itself does not guarantee a safe/healthy outcome and we know that intervention of EFM can increase risk for cesarean section when used, I believe midwives should have the knowledge, skills and judgement to interpret a trace to the best of their ability/knowledge and be able to determine timely intervention if needed. It is an art to correctly interpret an EFM tracing and one that is learned with years of review in clinical practice scenarios in the context of “bigger picture” care. Midwives should unite in their practices supporting each other in acquiring this knowledge to safely interpret EFM.
The timing of how frequent afterwards is a separate entity to the initial question and an additional question that may be proposed to members of the CMO in the future.
Midwife on June 24, 2023
I completely agree
Member of the public on June 23, 2023
I agree with adding this in to competency.
Fetuses should be monitored throughout their whole time as a fetus. I though this already was a requirment to practice. we do not want most a positive pregnancy and child birth, we want most to be alive with our baby at the end, monitoring of the fetus for any and all of that time is central in my mind.
Midwife on June 23, 2023
I agree with the change and would be happy to see it as a regular, re-certification requirement similar to ESW, NRP, CPR.
Midwife on June 22, 2023
I support this recommendation. I further think that midwives should provide evidence of education/training in fetal health surveillance every two years. Apart from the clinical issues, FHS interpretation and response to FHS is one of the primary contributors to legal claims, to cases reviewed by the Coroner’s Committee and an area of increasing concern in intrapartum care. Hospitals increasingly seek evidence of FHS competence from staff. It would be well if the CMO were a step ahead.
Midwife on June 22, 2023
I oppose this change, as I feel it will not improve public safety, rather it will serve only to give the wrong impression that FHS/EFM guarantees better/safe outcomes and therefore if poor outcomes occur involving the use of FHS/EFM tools, therefore it must be the competency of the Midwife that should be brought under question.
Midwife on June 22, 2023
I am opposed to this requirement. The FHS course has SIGNIFICANT content on EFM which even the SOGC acknowledges “there is insufficient evidence to recommend or not recommend the use of EFM” (from the 2020 guideline #396.
Our hospital is also beginning to require this course. Just because the hospital endorses it, does not mean it makes sense.
Midwife on June 21, 2023
Absolutely not. This should NOT be a mandatory course for registration. Me saying this does not mean I don’t believe this is a useful course to take and upkeep. It is the responsibility of a midwife to ensure they are competent in all aspects of midwifery. More registration rules become more punitive for midwives and require more work for the college to enforce. Short sighted
Midwife on June 21, 2023
Full agreement with this change in regulation with ongoing recertification similar To NRP.
Midwife on June 20, 2023
Yes, I agree to requiring midwives to recertify in FHS every 2 years. Hospitals require this and makes sense in terms of competencies for midwives.
Midwife on June 20, 2023
I agree with adding fetal health surveillance competency to registration, for NR, and continued q2-3 years.
Midwife on June 20, 2023
This should be a requirement. It was at one point for about ?a year and then rescinded. Never understood that. It should be required every 2 years whether the midwife works in full scope or not. Some hospitals already require it.
Midwife on June 20, 2023
I agree this should be an NR requirement, with recertification every 2-3 years while working in a role requiring FHS competency.
Midwife on June 19, 2023
In absolute support of this requirement. I think there are some issues with availability of courses, but this is one that can be addressed and will be if it becomes a college requirement.
Midwife on June 19, 2023
The Ontario Fetal Health Surveillance Steering Committee recommends recertification every 2 years for all OBS providers, as per the Canadian Fetal Health Surveillance Steering Committee. This is an important opportunity for critical interdisciplinary discourse and discussion with our colleagues on a regular basis, especially as FHS is high priority for HIROC.
Stakeholder on June 19, 2023
It would be better if the college can make it in a such a way that, it be within a standard a or guidelines and a professional development
Which be discussed in mandatory workshops and seminars for all midwives.
Midwife on June 19, 2023
I totally agree to adding this as a registration requirement and would support re-certifying a 1-2 years. This is an important skill and necessary to be competent. Refreshers, if taught well are an amazing refresher!
Midwife on June 19, 2023
I agree that it should be something required for registration as well as an ongoing 2-3 year recertification process, however I think either the CMO or AOM needs to make a course (and preferably one that can be done online like what UBC has) so that we can do this recertification. It’s been very challenging finding courses through hospitals that are available when we are off call.
Midwife on June 19, 2023
Completely agree
Midwife on June 19, 2023
I agree that FHS competency should be demonstrated by all midwives, whether NR or GR. If it is made a part of the requirements for renewing one’s license every year, then it should be required every 2 to 3 years, as mentioned by others. I also don’t think it should matter if you are working the traditional midwifery route or in an ECM…if you are a midwife registered with the college, you should be required to meet the same competencies.
Midwife on June 19, 2023
I agree with the proposed addition. And agree with many others, that evidence of competency should be renewed q2 or 3 years. Research is ongoing & national guidelines change. Midwives must maintain currency in FHS skill.
Midwife on June 19, 2023
I agree this requirement for NR for sure for entry and for RM q 2-3 years for those who can run oxytocin for IOL/Augmentation and doing NST.
Midwife on June 19, 2023
I agree.
Midwife on June 19, 2023
I agree this should be a component of registration for NR’s. It should be a mandatory requirement every 3-5 years thereafter.
Midwife on June 19, 2023
I support this requirement. However, it should be a rolling recertification every 2-3 years, similar to NRP, CPR & ESW, applicable to both NR & GRs, regardless if full or part scope.
Midwife on June 19, 2023
Yes I agree, and support ongoing renewal for competency as with NRP, ESW and CPR.
Midwife on June 19, 2023
I agree to add FHS as a requirement for CMO re certification on a a 3 year base.
Midwife on June 19, 2023
Initial registration – yes. Every NR should have FHS (being able to properly discern IA and cEFM). I see this need as many RMs do not have “full scope” in hospitals and this skill might be lost. I personally feel adding it yearly is a lot. Many hospitals require it if new on-boarding midwives – or when their scope expands to induction, etc.
I have not found courses easily and readily available. Especially the full 8 Hr in person.
It would be nice if CMO had an online option that offered the 8hr and the refresher.
Midwife on June 19, 2023
I agree that it should be added with a recertification every 2-3 yrs
Midwife on June 19, 2023
I agree that it should be a requirement for initial registration BUT only ongoing every 3 years for Registered Midwives who are required to interpret EFM as part of their role.
For example, midwives working in EMCMs who do not do NSTs or provide intrapartum care should be exempt with a clause to recertify if they resume attending births.
Midwife on June 19, 2023
I support this requirement for registration. In addition, I think recertification Q 2 years is a good idea unless not providing this clinical care
Midwife on May 30, 2023
I agree this should be added. Especially as knowledge of FHS is required for the CMRE. I also agree with the comments stating it should require recertification every few years **BUT** only for those midwives working in roles requiring interpretation of EFM
Midwife on May 23, 2023
I agree that it should. We took on an internationally trained midwife once only to find out this skill was completely lacking. Fetal Health Surveillance encompasses both proper IA and EFM which guides every labour.
Midwife on May 21, 2023
Yes I agree this should be included.
Midwife on May 18, 2023
Very important to remain current with these guidelines. (As an aside NRP every year is alot! Why are our standards for this higher than any other provider)
Midwife on May 12, 2023
Yes I agree, with ongoing renewal for competency q2-3 years
Midwife on May 10, 2023
I support FHS for NRs and also GRs every 2-3 years
Midwife on May 3, 2023
I support this requirement. However, it should be a rolling recertification process similar to NRP, CPR.
Midwife on May 3, 2023
I do support a CMO registration requirement to show competency in fetal health surveillance (which includes IA and EFM interpretation). In my opinion, it should not only be mandatory as an initial registration requirement, but similar to CPR and ESW, to be renewed every 2-3 years.
Midwife on May 3, 2023
I fully support adding FHS course to the competency requirement part along with NRP, ESW and CPR. FHS is an essential part of practicing midwifery.
Midwife on May 2, 2023
There needs to be a distinction between Fetal Health Surveillance and Electronic Fetal Monitoring. Being specific about the objective is really important.
Fetal health surveillance could be interpreted as a generalized term to include monitoring fetal wellbeing throughout pregnancy and labour. This could include interpretation of u/s, monitoring growth and FHR/NST/EFM at any point in the pregnancy and/or labour.
I do feel that competency in EFM is very important but question the need to attach a requirement to a Regulation. Prescribing specific competencies can be problematic if the landscape or competency changes and it has proven to be very difficult to update or change Regulations in a timely manner. Also courses in EFM are fairly limited and this further restricts access to acceptable courses.
Does the College feel the argument to including EFM in the Regulations is compelling enough to risk locking it in a Reg? Would it not be better suited to keep within a Standard or Guideline or an integral part of the professional development portfolio and the peer and practice assessments.
Midwife on May 2, 2023
Yes, every 2 years
Midwife on May 2, 2023
This is a definite requirement. Midwives who do not work in full scope or who transfer care for oxytocin will not be able to obtain this competency through day to day management. It should also be required to be renewed every 2 to 3 years.
Midwife on May 2, 2023
I agree that this should be a college requirement, with recertification required every 3 years.
Midwife on May 2, 2023
This is a very good step, and ongoing 2- or 3-year certification should be added.
Midwife on May 2, 2023
Yes – annual competency in fetal health surveillance should be mandatory.
Midwife on May 2, 2023
I agree, and recertification regularly in a short refresher.
Midwife on May 1, 2023
I agree to adding the fetal surveillance requirement to Registration – as well as required periodic recertification.
Midwife on May 1, 2023
I am in agreement with this addition to the registration regulation.
Midwife on May 1, 2023
Fetal Surveillance should definitely be a part of initial registration and an on going competency at annual registration like CPR , NRP , ESW .
Midwife on May 1, 2023
I agree with FHS being a required competency at initial registration and think it should be an ongoing competency with regular recertification required.
Midwife on May 1, 2023
I’m in agreement that this should be required when registering but also should be done as a refresher every 2-3 years
Midwife on May 1, 2023
I agree that at initial registration this is a good idea, but we all become more competent as we use fetal surveillance day in and day out. There are so many other competencies that we have to keep up, that it becomes overwhelming.
Midwife on May 1, 2023
Agree. Ongoing competency. But once you’ve done 10 times can it be required less often ?
Midwife on May 1, 2023
Totally makes sense. I support this change as a requirement for new registrant midwives.
Midwife on May 1, 2023
FHS should be a requirement for initial registration and ongoing every 2 years.
Midwife on May 1, 2023
Agree
Midwife on May 1, 2023
I agree competency in EFM should be required for registration and definitely proof of fluent competency should be necessary to keep practicing as a registered midwife
Midwife on May 1, 2023
I don’t object to this requirement in principle, since I think this is probably something we all recognize as essential, but I’m curious about why this skill would be singled out. Midwives should be able to demonstrate competence in a wide variety of skills not covered by the courses required for registration. We should be able to start IVs, safely prescribe medications within our scope, and conduct normal births, for example. I would like to better understand why this skill specifically is being highlighted as a requirement.
I would hope that “satisfactory evidence of competency” would also be clearly defined.
Midwife on May 1, 2023
I agree
Midwife on May 1, 2023
I disagree with this being mandatory.
This is part of understanding that a midwife should have knowledge about and keep her/himself updated as necessary.
Midwife on May 1, 2023
The program has changed three times since I registered. Recertifying should be required every 2-5 years
Midwife on May 1, 2023
I agree and it should be a regular requirement on renewal every 2-3 years.
Midwife on May 1, 2023
Should be required for certification and recertification.
Midwife on May 1, 2023
I agree with FHS being a required competency at initial registration and I would recommend that it become an ongoing competency with regularly recertification required (such as every 2 years, like emergency skills).
Midwife on May 1, 2023
I am in support of the recommendation of adding the new registration requirement to show competency in fetal health surveillance
Midwife on May 1, 2023
I agree.
Midwife on May 1, 2023
This should absolutely be required.
Midwife on May 1, 2023
If this is going to be added, it should be required to re-certify every few years. Just doing one course for initial registration isn’t going to ensure competency…needs to be ongoing and updated every so often.
Midwife on May 1, 2023
Should require ongoing recertification
Midwife on May 1, 2023
I agree this need to be added as part of competency requirment
Midwife on May 1, 2023
I am in support of adding the new registration requirement to show competency in fetal health surveillance