Registrar Report, February 2026

REPORT TO THE BOARD OF DIRECTORS – February 25, 2026

Submitted by: Kelly Dobbin, Registrar and CEO

The Registrar-CEO Report assures the Board that the College operates effectively and achieves its strategic goals, and that the Registrar performs in accordance with the expected duties outlined in the Board’s Governance Policies.

The Registrar-CEO is accountable for the College’s performance in six main areas:

Strategic Leadership and Direction Setting
Development and Achievement of Goals
Reputation and Relationship Management
Financial Accountability and Management
People and Organizational Leadership
Board Governance and Engagement

Strategic Leadership and Direction Setting

Joining the Health Professions Discipline Tribunal

On January 1, 2026, the College joined the Health Professions Discipline Tribunal on a pilot basis, following the Board’s decision in November 2025. The College’s Discipline Committee, established under the Health Professions Procedural Code, now operates as the Ontario Midwives Discipline Tribunal. The Tribunal conducts hearings into allegations of professional misconduct and/or incompetence and Fitness to Practise matters referred to it by the Inquiries, Complaints, and Reports Committee. Historically, the College has seen few instances of referrals to Discipline, which informed its participation to join on a small volume basis. At present, there are no matters before the Tribunal.

Laboratory and Specimen Collection Centres Licensing Act

On December 15, 2025, the General Regulation under the Laboratory and Specimen Collection Centres Licensing Act was amended to include 34 additional laboratory investigations and point of care tests (POCTs) which registered and Indigenous midwives may now order and perform on their own authority. The expanded list increases access to tests for midwifery clients, and enables them to receive more effective health care within the current midwifery scope of practice. We communicated to the public and registrants as soon as we were notified that the new regulation was filed, and alerted our regulatory colleagues at the College of Physicians and Surgeons of Ontario and the College of Medical Laboratory Technologists of Ontario. We have also created a webpage on our site with more information, and questions and answers for midwives. Though this remains an interim step towards ordering lab tests to full midwifery scope, the collaborative effort between the College and the Ministry has significantly improved access to tests for Ontarians under midwifery care.

Rescinding the Blood Borne Viruses Standard

The Blood Borne Viruses Standard was rescinded effective January 1, 2026. As the Board is aware, the Quality Assurance Committee recommended to the Board in November 2025 that the standard be rescinded following an equity review and in consideration of policy changes from other health regulators in the province. The Board was satisfied that the requirements in the Professional Standards for Midwives to: manage their own illnesses to provide safe care; and to implement precautions to prevent compromised safety for their clients; appropriately manage the risk to clients.

The Professional Standards address the protection of clients from disease transmission, including diseases transmitted through exposure to blood. The rescinded Blood Borne Viruses Standard’s specific focus on blood borne virus transmission was determined to be disproportionate when other serious illnesses transmitted by other types of exposure (for example, measles, flu, COVID-19, etc.) were not singled out. The College believes that specific focus on transmission of blood borne viruses, such as HIV, indirectly stigmatizes individuals living with HIV, and applying certain rules primarily to this cohort of health care providers (who already face significant marginalization), and not to others who may live with similarly serious infectious diseases, may inadvertently communicate discriminatory views. As part of the College’s commitment to equity, it was important to consider these factors in decision-making about maintaining or rescinding this standard.

Of note, this change was announced to the public on December 1, 2025, which is World AIDS Day, a day which raises awareness of the lived experiences of individuals impacted by HIV and AIDS.

The College also prepared and circulated a new practice advisory for midwives on Communicable Illness and Transmission Prevention. The practice advisory communicates that it is a midwife’s professional responsibility to maintain current understanding of disease transmission risks, infection prevention and control (IPAC) best practice, and organization policies related to infectious disease exposure.

Registration Regulation

In the time since our last regular Board Meeting, we have not received an update from the Ministry of Health regarding our proposed changes to the Registration Regulation. Regardless, we continue to develop implementation policies and supporting systems based on the anticipated amendments.

As of Right Exemption

As of January 1, 2026, new regulations took effect allowing midwives who hold an equivalent certificate in the general class from another Canadian jurisdiction to start practising in Ontario without being registered with the College. These individuals would be authorized to provide midwifery services and hold themselves out to be midwives for a period of six months while they wait for their registration from the College to be approved. The College, in collaboration with the Association of Midwives of Ontario, published a FAQ to help potential applicants and practices who may be interested in providing midwifery care under this exemption.

Increasing Pathways to Registration

Candidates in the first cohort of the International Midwifery Preregistration Bridging Program have begun their twelve-week clinical placements. All candidates who have indicated an intention to practise in Ontario have secured placements. Based on current progress, the College anticipates that most candidates will be eligible to write the Canadian Midwifery Registration Exam in May and, if successful, apply for registration shortly thereafter.

We continue to meet regularly with the Indigenous Advanced Education and Skills Council and the First Nations Technical Institute, which is developing an Honours Bachelor degree program in Indigenous midwifery. These discussions are focused on ensuring the degree program meets the regulatory requirements for graduates who may eventually seek registration with the College. In addition, we are exploring potential opportunities for collaboration to support midwives in upgrading their skills and competencies, in the interest of public safety.

Government Relations

As shared previously, the Regulated Health Professions Act, 1991, charges the College with the duty to work with the Minister of Health to ensure that the people of Ontario have access to adequate numbers of qualified, skilled, and competent midwives. This is a responsibility we take seriously, and we have implemented regulatory changes as appropriate.

We continue to implement our Government Relations Strategy, and since our last meeting, we have attended the Association of Ontario Midwives reception at Queen’s Park; met with MPP Jessica Bell; and are setting upcoming meetings with Ministers, MPPs, and senior Ministry staff.

We were invited to participate in the 2026 pre-budget consultation and made a written submission to the Standing Committee on Finance and Economic Affairs. In our submission, we shared some data on midwifery access, approaches taken by other provinces, and our conclusion that Ontario needs to invest in a Midwifery Strategy. An Ontario Midwifery Strategy would allow a system-level approach and ensure that Ontarians who seek midwifery care are able to access it. The letter we submitted is attached to this report.

Unauthorized Practice

On December 13, 2025, the Toronto Star published a story regarding the concerning use of unregulated birth attendants. While the circumstances described in the article are tragic, the article clearly distinguishes unauthorized practice from regulated midwifery and accurately references the steps we have taken to address this issue. An individual for whom we recently obtained a court order is featured in the article. As a result of this article, the College has received an increase in reports from the public and observed a corresponding trend in media coverage.

Unauthorized practice remains a concerning trend, and we continue to monitor developments, consider appropriate strategies, and act when it is appropriate to do so.

Complaint Trends

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.

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.

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.

Strategic Planning

Throughout 2025, the College undertook extensive work to prepare our next strategic plan. This work has been multi-phased, as we worked with our partner consultant, Yves Doyon of Doyon+, to facilitate an integrated human-centred design approach to strategic planning. The collaborative process was guided by the Board and Committee members, as well as staff, and was informed by the public, registrants, and system partners.

Prior to the Board and Committee Training Day on November 4, 2025, the Board was provided with the draft Strategic Framework document prepared by our consultant. At the training day, staff and the Board Chair presented the framework including the proposed new vision, four strategic priorities, and a new set of guiding principles. The Board was asked to review and to validate whether the framework reflected what we had heard and learned, and if it provided the appropriate strategic direction for our next phase of work.

Opportunities for discussion and feedback were provided throughout the presentation. The Board confirmed that the four strategic priorities resonated, and it was agreed that the priorities, with the desired outcomes, provided the right areas of focus and strategic direction for the College to fulfill its mandate effectively and efficiently.

Since November, we concluded our project work with our consultant, Yves Doyon, as planned. Based on the Board and Committees’ feedback on the Strategic Framework, College staff completed the next phase of work to create the strategic plan, including identifying key initiatives and projects that will enable us to achieve the strategic priorities and support the desired outcomes over the next three years. This work enabled us to develop a costed strategic plan to inform budgeting. The Board is now asked to review the proposed final strategic plan for approval at this meeting. Please refer to Agenda item 5 for details.

Development and Achievement of Goals

Launch of the Competency Based Assessment Program

We are pleased to announce the launch of the Competency Based Assessment Program. As of January 1, 2026, referrals from the Registration Committee in Ontario, and from other provincial and territorial midwifery regulators are now being received. The College spent several years developing and piloting the program to produce a validated assessment program which supports national goals for midwifery registration, sustainability, and safe practice. In the third quarter, we finalized contracts for our assessors; held orientation and training to ensure readiness for the launch; and connected with representatives from other midwifery regulators to share details about the program. We look forward to conducting the first assessment in the coming weeks.

Addressing Ableism in Health Care Webinar

On December 3, 2025, we partnered with the College of Audiologists and Speech-Language Pathologists of Ontario to host a webinar on Addressing Ableism in Health Care, presented by Dr. Hilary Brown (University of Toronto). Held on the International Day of Persons with Disabilities, the session offered an important opportunity to reflect on how health systems – including midwifery care – can more effectively identify, interrupt, and prevent ableism.

Throughout the session, Dr. Brown highlighted how ableism can emerge in clinical interactions, decision-making, and health policy, and emphasized the importance of inclusive, person-centred approaches to care. During the presentation, Dr. Brown emphasized how these discussions align with the College’s Professional Standard for Midwives which require registrants to provide person-centred care that respects each client’s individual needs, preferences, and lived experiences.

The recording of the webinar was emailed to all registrants and is available on the College’s website.

Reputation and Relationship Management

Winter Edition of On Call Digital Newsletter Published

This edition of the College’s digital newsletter included information about expanded access to laboratory and point of care tests for midwifery clients; changes to the Designated Drugs and Substances Regulation; why the College rescinded the Blood Borne Virus Standard; practice advice; the recording of our recent webinar on ableism in health care; and Board highlights from our November meeting. Our digital newsletters are sent to our full email list of approximately 3,000 subscribers. This includes registrants, system partners, members of the public, staff, and Board and Committee members. The email was opened by 58% of subscribers, and 7.7% of subscribers clicked a link from the email to read more or access a resource. These metrics are fairly consistent each issue, and higher than industry-standard. Our email marketing service sets our industry benchmark as 36.5% open rate, with a 3.9% click rate.

Northern Ontario Midwifery Symposium

The Northern Ontario Midwifery Care Research Project conducts research to identify challenges and opportunities in providing midwifery care in rural, remote and northern areas, and to develop recommendations to strengthen maternity care in these communities.

The College staff attended the project’s symposium in Thunder Bay in person and online to discuss research findings; hear from registered midwives, Indigenous and francophone midwives, and clients; and to better understand how the College could contribute, within our mandate, to advancing midwifery-led reproductive care in Northern Ontario.

Financial Accountability and Management

Statement of Operations

The Q3 Statement of Operations was approved by the Executive Committee at its most recent meeting and is included in the Executive Committee’s report to the Board for your reference.

2026-2027 Budget

The proposed 2026-27 budget was presented to the Executive Committee in January. The budget development process was collaborative, incorporating staff input and data trends to project expected revenues and expenses, based on planned activities and assumptions. The 2026-27 budget represents the first year of the next costed Strategic Plan. The Executive Committee is now submitting the proposed budget to the Board for approval. Please refer to Agenda item 7 for details.

People and Organizational Leadership

Human Resources

We are pleased to announce that Natalie Dalcourt joined the College in November 2025, as the Coordinator of Quality Assurance and Assessments. Natalie brings over a decade of experience in the regulatory field, having held roles in quality assurance, professional practice, and governance.

Strategic Planning

All staff have continued to be meaningfully involved in the development of the new strategic plan. Since the November 2025 Board meeting, the leadership team met to identify the key initiatives and work that will support each strategic priority to help inform budgeting and annual operational planning. On January 8, 2026, the entire staff team met in-person to validate the proposed initiatives, and refined the guiding principles and vision statement, as now presented in the Strategic Plan document which is included under Agenda item 5.

Board Governance and Engagement

Thanking Public Board Director Marianna Kaminska

On March 7, 2026, Marianna Kaminska’s Order in Council will expire, drawing her time on the Board to a close after seven years of service.

Marianna has been a dedicated and engaged Board Director and has served on nearly all the College’s statutory committees – Quality Assurance; Discipline/Fitness to Practice; Inquiries, Complaints, and Reports; and Client Relations. In addition, Marianna was Chair of the Client Relations Committee in 2020-21 and elected to the Executive Committee as a Public Member at Large from 2019-24. Marianna was also a member of the strategic planning working group in 2020-21, which was instrumental in developing the 2021-26 strategic plan.

Over the past seven years, Marianna has made numerous meaningful contributions to the College, and we are sincerely grateful for her commitment and leadership.

As our Board currently sits at the minimum number of Public Appointed Directors, we have been assured that the Public Appointments Secretariat is aware of our need for an additional appointee as soon as possible so we can remain constituted.

Governance Modernization

As part of the College’s ongoing work to modernize our governance structure and practices, the Executive Committee recommended the creation of a new non-statutory Nominations Committee, which the Board approved at its November 5, 2025, meeting. Staff put a call out for applications in December and received a high volume of interest. After reviewing a shortlist of top applicants, the Executive Committee made a recommendation for a slate of members to be appointed to the inaugural Nominations Committee. The Board will consider this slate for approval as part of the Executive Committee report submitted for this meeting.

Professional Board Director Elections

On January 30, 2026, the College launched the 2026 Professional Board Director Election by sending a call for nominations to all registrants via email. This election is to fill three positions and will take place during the month of April. Further details about the opportunity, the scope of the commitment, and the timeline for the election have been made available to registrants on our website. The Board Chair and College staff also scheduled information sessions on February 6 and 12, providing an opportunity for interested individuals to learn more about joining the Board and ask any questions. Registrants interested in standing for election have until the end of the day on Friday, February 27, 2026, to submit their nomination package to the Registrar.

This year, staff are taking a new approach to sharing information regarding the election with registrants. For the past few elections cycles the College has used procedural-focused messaging. This year, staff will be employing call-to-action style communications, underscoring that midwives have always played a central role in shaping how the profession is regulated and that self-regulation works because of engaged midwives working in the public interest. This new messaging approach will also be more direct about the benefits registrants can expect to receive from participating (leadership development, professional growth, and making an impact beyond practice). To this end, staff have gathered testimonials from Professional Directors to help demonstrate the value gained from holding a Board position, and plan to reach out directly to key groups – such as new registrants – to support their involvement.

Third-Party Board Effectiveness Review RFP

As required by the College’s Governance Policies, specifically GP 10 Governance Evaluation, the Board will evaluate its effectiveness on an annual basis, and a third-party assessment of the Board’s effectiveness will be completed at least once every three years.

To this end, on December 16, 2025, we posted a request for proposals (RFP) for a governance consultant to assist us with implementing a third-party Board effectiveness assessment.

By working with a consultant to undertake this review, we are not only ensuring compliance with our Governance Policies, but we are meeting the expectations set by the Ministry’s College Performance Measurement Framework.

As previously discussed with the Board and the Executive Committee, the Board effectiveness review should build on the Board’s current annual evaluation process and help identify and strengthen key metrics for evaluating the Board’s performance in carrying out its governance responsibilities in the public interest.

We received seven proposals from governance consultants to conduct a third-party Board effectiveness review, all of which were reviewed and evaluated. The Executive Committee made the final selection, and the contract was awarded to TBG MacNiven.