Registrar Report, November 2025

REPORT TO THE BOARD OF DIRECTORS – November 5, 2025

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

Designated Drugs and Substances Regulation

The College Registrar and Board Chair have signed the amended Designated Drugs and Substances Regulation, and we expect it to be filed in the coming weeks. The Board approved a regulation change to include the RSV monoclonal antibody under Vaccines and Immune Globulins (now categorized simply as Immunizations) authorized to midwives for prescription and administration by injection (Schedules 1 and 3 of the Designated Drugs and Substances Regulation). Following a 60-day public consultation, the Board held a Special Meeting on September 23, 2025 to approve the inclusion of this substance and apply for the regulatory change. The Ministry prioritized this amendment for this RSV season and it will come into force on the day it is filed.

Laboratory and Specimen Collection Centres Licensing Act

The College has been provided with the finalized list of additions to the Schedule 2 of the General Regulation of the Laboratory and Specimen Collection Centres Licensing Act, 1990 (LSCCLA). While the list remains embargoed, the expectation is that these amendments will be filed at a future date and will come into force upon filing. The expanded list will increase access to new laboratory investigations and point of care tests (POCTs) for midwifery clients and enable clients to receive more effective health care within the current midwifery scope of practice. The College is prepared for these changes and will provide necessary resources to assist midwives and members of the public in understanding the legislative changes.

Registration Regulation

In the time since our last regular Board Meeting, the College has not received an update from the Ministry of Health regarding our proposed changes to the Registration Regulation. Both the College and the Registration Committee are continuing to develop implementation policies and supporting systems based on the anticipated amendments.

Bill 2 – Protect Ontario Through Free Trade Within Canada Act, 2025

On April 16, 2025, the Ontario government introduced a new bill intended to strengthen interprovincial trade in response to U.S. tariff pressures. Among its initiatives is an expansion of a previous measure that allowed doctors, nurses, respiratory therapists, and medical laboratory technologists registered in another Canadian jurisdiction to begin working in Ontario immediately, provided they register with the relevant Ontario health regulatory college within six months. This expansion will now include midwives and 15 other regulated health professions. As previously reported, the College responded to the bill, supporting its intent but raising important concerns about maintaining public safety.

The Ministry of Health has since engaged the affected health regulatory colleges to gather input on implementation before finalizing its recommendations. The College emphasized the unique position of midwives as one of the few professions in this expanded group fully integrated into the public health system, meaning our implementation considerations are distinct. In particular, systems will need to be in place to ensure that midwives working under this exemption can provide care to the full extent of their role without administrative barriers.

Since then, the College has consulted with the initial four professions to learn from their experience and engaged with the Canadian Midwifery Regulators Council (CMRC) Registration Affairs Committee to understand potential risks across the country associated with this initiative. While we are still awaiting the regulation’s final provisions, we are proactively developing internal policies to minimize public risk and ensure that those practising under the As of Right exemption are subject to oversight and accountable for their practice.

Increasing Pathways to Registration

The College continues to collaborate with the Chang School of Continuing Education, with the first cohort of the International Midwifery Preregistration Bridging Program now underway. Since some candidates may not meet the birth numbers requirements for registration due the scarcity of clinical placements, and the regulation allows the College to issue supervised practice certificates, our focus is primarily on ensuring these candidates are well prepared for entry to practice and bridge the full range of skills and competencies required to practise safely in Ontario. Most candidates in the first cohort plan to practice in Ontario and are expected to be eligible to write the Canadian Midwifery Registration Exam (CMRE) in May 2026.

Establishment of the French Language Health Planning Centre

In response to the recent government announcement on the integration of midwifery into French-language health service planning, the College provided a submission to the Minister. Our submission highlights the importance of incorporating the midwifery profession into the governance and work of the new French Language Health Planning Centre and that a targeted strategy is needed to support Francophone midwifery education, registration pathways, infrastructure, and data collection. It also warned that without concrete action, access to culturally and linguistically appropriate midwifery care for Francophone communities is at serious risk.

Competency-Based Assessment Program

At its October 2025 meeting, the Registration Committee approved a policy to include a competency-based assessment as part of the process for approving requalification programs for class changes and for former registrants who resigned less than five years prior to their application to return to active practice. The Committee approved the use of the assessment in specific cases, such as when an individual intends to provide the full spectrum of midwifery care but has not practised at all in recent years. The College expects the number of candidates who would be eligible for this assessment will be very low. The objective assessment will help identify specific areas requiring further development, enabling eligible midwives to return to practise following tailored requalification programs. We will communicate with registrants and the public about the policy in the coming weeks, with the policy taking effect on January 1, 2026.

Unauthorized Practice

The College is increasingly aware of individuals who are providing care they are not authorized by law to provide, and looks into every report it receives. When the College has information that suggests an individual is engaging in a form of unauthorized practice, there are steps we can take to address the risk to the public. Each situation is assessed on a case-to-case basis. Since our last report to the Board, the College has issued one cease and desist letter. The College also obtained an Order from the Ontario Superior Court of Justice against Nidhi Seth, requiring Nidhi Seth to comply with Sections 27 and 30 of the RHPA.

Registrant Modelling & Health Human Resources Data

College staff have carried out several data initiatives since our last report, most notably developing in a stock-and-flow workforce model projecting labour market scenarios for midwifery in Ontario through to 2049. The model was developed using data from a variety of internal and external sources, including data from the AOM, BORN, and the Ontario Ministry of Finance, and provides a series of scenarios and considerations for mid-and long-term planning.

We have shared the following datapoints with the Ministry of Health and other key decision-makers in the sector.

Breaking Point: Why the Current Model Isn’t Meeting the Needs of Ontarians

A limited number of new midwives and an increasing number of exits from the profession create serious health care system challenges and threaten the sustainability of midwifery care.

Inadequate Numbers of Midwives to Care for Ontarians

Midwifery growth is declining. The profession grew by an average of 7% each year between 2015 and 2020, but this growth dropped to an average of 2% each year between 2020 and 2025. In 2024-25, the College saw growth of just 0.1%, due to a record-high number of exits from the profession.
Midwives attend approximately 19% of births in Ontario. According to a public opinion survey the College commissioned in 2024, 15% of pregnant people who did not receive midwifery care cited an inability to access midwifery care as a reason that they did not use a midwife for their birth. This demonstrates that there are not adequate numbers of midwives to meet the current demand.
Without intervention, what is a current issue of access to midwifery care will worsen: overall numbers of midwives would need to increase by between 5-12% during the next 10 years, and between 20-34% during the next 25 years to meet existing ratios of access to care with projected population growth.
One to two per cent of Ontario midwives retire each year. Other reasons for resignations, such as leaving the province to practise midwifery somewhere else, are more unpredictable. For example, almost 2% of Ontario’s registered midwives indicated they resigned in order to practise elsewhere in 2024-25.
In 2024-25, the midwives leaving Ontario to practise elsewhere chose British Columbia (30%), Alberta (17%), Newfoundland (17%), Quebec (13%). Other provinces and territories received the remaining 23% of exiting Ontario midwives, with no one remaining jurisdiction receiving more than 10%.
Although Ontario midwifery programs offer 90 seats annually, this does not reflect the number of midwives entering the labour force in Ontario. Over the past five years, only 56 to 65 Ontario graduates per year have registered with the College. Approximately a third of midwifery students either leave the program, leave the profession, or choose to work in another jurisdiction upon graduation.

Escalating Needs with Population Growth

External studies have reported 22,000 persons over a ten-year period were unable to find a midwife. To have met that need, over 15% more midwives than were practising would have been required every year. The 22,000 figure does not include people who did not add their names to a midwifery waitlist.
“[The World Health Organization] is recommending that all countries increase graduation of health personnel to reach 8-12% of the active workforce per annum…to maintain and improve capacity in relation to population needs and health system demand.” World Health Organization, WHO convenes the Fifth Global Forum on Human Resources for Health. To maintain just the current level of midwifery service to Ontarians, we would need between 80 and 220 new registrants each year for the 25-year period ahead.

Government Relations

As detailed above, the College has significant concerns about declining access to midwifery in the province. 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 many changes to improve access to care through addressing a lack of growth in the profession.

One such initiative has been our Government Relations Strategy, which guides our work in engaging with senior political and Minister decision-makers. Since our last regular Board Meeting, the College has participated in meetings with Minister Mike Harris, MPP Robin Lennox, Dr. Jane Phillpott, and senior Ministry staff. We continue to work with these key partners by sharing our data and proposals for improving access to midwifery care.

In addition to sharing the information we have about the declining growth of the profession, we put forward a proposal detailing how the College can play a key role as an important partner in developing Ontario’s first Reproductive Health Care Strategy. Our proposal demonstrates that midwives already have the expertise and education to alleviate some of the pressure on the health care system through a strategy that ensures Ontarians have access to the reproductive health care they need – in pregnancy, during labour, and the post-partum period, and also outside of these important life events. Examples set by nurse practitioners and pharmacists demonstrate how expanding and optimizing the scopes of health care providers can provide easier access to care for Ontarians. Our proposed Reproductive Health Care Strategy is appended to this report.

Strategic Planning

For the past year, the College has undertaken extensive work to prepare our next strategic plan. This work is multi-phased, and we have partnered with consultant, Yves Doyon of Doyon+, to facilitate an integrated human-centred design thinking approach to strategic planning. This collaborative process involving Board and committee members, as well as staff, and informed by our key stakeholders, the public and registrants, and system partners, has led us to this point. To date the following phases have been implemented:

Phase 1 – Foundations and Evidence Review

Risk assessment using the College’s risk register
Staff workshops reflecting on the current strategic plan, future needs and aspirations
Public Opinion Survey Data review
Registrant Survey Data review
System Partner Survey Data implementation and review

Phase 2 – Insights and Thematic Mapping

The above information was synthesized using value mapping, system framing, and empathy-based tools to surface tensions, patterns, and emerging opportunities based on the information from our public, registrant, system partners and staff data.
This led to the articulation of five initial thematic areas, each framed with supporting insights, design implications, and “How Might We…” questions to support strategic ideation.

Phase 3 – Strategic Planning Workshop and Refinement

Pre-reading materials in the form of a Foundations for Strategic Alignment: Insights, Priorities, and Prototype Framework were shared with Board, committee and staff prior to the June 24, 2025, strategic planning workshop day. These materials included an overview of the value mapping, emerging priorities/areas of focus, and guiding values/principles.
On June 24, 2025, Yves Doyon facilitated a strategic planning day with the Board, committee members and staff. The workshop focused on some of the critical themes emerging from the synthesis and engagement, including:
- Attrition and workforce sustainability: What is the College’s responsibility in responding to these challenges?
- The College’s role and jurisdiction: Where do we lead? Where do we influence? Where must we partner?
- Balancing regulatory delivery with transformation: How do we remain excellent regulators while adapting for the future?
- Internal capacity and constraints: What are we able to take on—and what must we let go of?
- System complexity: How do we respond to uncertainty while staying focused on the public interest?
In groups, participants worked through each emerging area of focus and considered whether they resonated, what might be unclear, what might be missing and how to College could address these issues and opportunities:
- Area of Focus #1: Regulatory Integrity, Clarity, and Innovation
- Area of Focus #2: Equity-Informed Engagement and Public Trust
- Area of Focus #3: Sustainable practice and professional flourishing
- Area of Focus #4: Strategic Partnership and System Collaboration
- Area of Focus #5: Quality, Risk and Public Accountability
All the written feedback from the workshop was recorded and was used consolidate the five thematic areas into four strategic priorities.

Phase 4 – Iteration and Testing

Following the retreat, the framework was refined across multiple iterations. Feedback loops with internal champions and the Executive Committee ensured alignment with operational realities and governance responsibilities, including but not limited to:
- Leadership team review and discussion of the strategic framework on August 7, 2025 with Yves Doyon.
- All staff in-person meeting with Yves Doyon facilitating on September 11, 2025 – review and feedback on shared understanding, alignment with current and/or upcoming work, and consideration of anything missing.
- Executive Committee meeting September 24, 2025 – review and feedback on Strategic Framework V. 6 including revised guiding principles, and a new glossary of terms.
- Leadership team in-person meeting on September 25, 2025 – strategic discussion of strategic priorities and possible initiatives, including viability and possible cost implications.
- System partner meeting with the AOM on October 15, 2025 to present the current strategic priorities, what we heard and why this direction, to obtain their initial thoughts on what resonates, possible areas for collaboration and alignment, anything missing.
All of this input has been used to update the strategic priorities and to help shape the presentation of them into the current strategic framework, which will be presented to the Board and committee members on November 4, 2025. The purpose of the meeting on November 4^th is to ensure that the strategic priorities align with the Board’s vision and reflect what we have heard. Once the Board confirms that the strategic priorities successfully translate the Board’s direction, staff will use the framework to develop the strategic plan for final approval by the Board in February 2026.
The four proposed strategic priorities are:
- Strengthen Regulatory Integrity, Clarity, and Responsiveness
- Advance Access, Equity, Reconciliation, and Cultural Humility
- Collaboration and System Alignment
- Enhance Organizational Capacity

Development and Achievement of Goals

Registration Renewal and Professional Development Portfolio Reporting

The College launched the registration renewal process on July 31, and closed the renewal period on October 1. Despite challenges such as the Canada Post strike, the process was smooth, with the vast majority of registrants completing their renewals on time. The College continues to work closely with those who have not yet renewed to minimize the risk of suspension or disruption to their registration.

Database Implementation

The College continues to work on implementing the new cloud-based database as planned. We remain focused on system and process configuration to ensure a smooth transition. Implementation will proceed into the new year as we continue to prioritize stability and reliability.

Launch of the Competency-Based Assessment Program (CBAP)

The College is recruiting assessors to support the Competency Based Assessment Program. Following selection of the assessor pool, CBAP assessments will be available for both referred candidates from other Canadian provinces and territories in addition to midwives from Ontario who seek requalification here. This launch marks the end of several years of program development and program piloting, which has produced a validated assessment program to support national goals for midwifery registration and sustainability. The College will be posting more information about the program to our website in the coming weeks in anticipation of the final stage in achievement of this initiative under Strategic Priority 1: regulation that enables the midwifery profession to evolve.

Results from Registrant Survey

As previously reported, the College conducted a survey of registrants to advance our initiatives under Strategic Priority 2: effective use of data to identify and act on existing and emerging risks, to better understand client’s needs and expectations of midwifery care. This survey will also serve as a baseline, tracking midwives’ perceptions of the College so we can better understand the impact of our work, an initiative under Strategic Priority 3: building engagement and fostering trust with the public and the profession. The survey was in the field from May 21, 2025, to June 4, 2025, and 363 midwives participated.

Key findings included:

An overall high satisfaction with the College and our work; with 91% of midwives finding a great deal of personal value in midwifery being a regulated profession and 75% of midwives believing that regulation helps a great deal to protect the public.
Nearly all midwives (98%) reported that they understand the College’s responsibility and mandate, with 47% reporting they understand it very well, and 51% reporting they understand it somewhat well.
Just over four-in-ten (43%) of midwives reported having gone through a panel process. Of those who had gone through the process, 74% felt that they were treated fairly and respectfully; and 71% felt confident that the decision was made in the public interest.
The College’s website is the most important source of College information for midwives, with 84% of midwives reporting they find it useful and have visited it recently. In addition, the online newsletter and webinars are useful to the majority of midwives (67%, 63%).
When we asked midwives how well the College supports them in complying with regulatory change, midwives were divided. Only 40% said the College does an excellent or good job in providing support, while another 37% said a fair job and 16% a poor job.
Most midwives said they refer to College policies and standards; and the majority (79%) said the documents are effective in providing support. However, 53% of midwives said the material is only “somewhat clear,” suggesting an area for improvement for the College.

Through the survey, we gained some key insights that will help shape how we engage with registrants going forward. This data has also informed the creation of our next strategic plan.

Reputation and Relationship Management

Engagement. Collaboration. Evolution. Our 2024-25 Annual Report

This year, our annual report is centred around the theme of Engagement. Collaboration. Evolution. In the report, we demonstrate how we use data to inform our engagements with the public and the profession; in our collaboration with our system partners; and as we drive the evolution of midwifery regulation. We have highlighted some positive stories we can learn from data — the results of our public engagement survey; our approach to data-sharing with system partners; and another year of surpassing our benchmarks in key program areas. Our Registration Department monitors the numbers of entries and exits from the profession each year, and that data has an important story to tell us as well: a decline in growth of the profession and decreasing access to midwifery care for Ontarians.

The annual report was submitted to the Minister of Health and posted to our website prior to the September 30, 2025 submission deadline. It is appended to this report.

Summer Edition of On Call Digital Newsletter Published

This edition of the College’s digital newsletter included practice advice, our public consultation on the Designated Drugs and Substances Regulation, a new pathway to College registration for Indigenous midwives, information on our survey for midwives, Board highlights from our June 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 60.8% of subscribers, and 4.1% 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.

Student Engagement

One of the activities in our Student Engagement Strategy is to visit midwifery education program classrooms and provide essential information about our mandate and the steps for registration upon program completion. We regularly engage with students to ensure that they are well-informed about our work and processes from the outset, facilitating a smoother transition as they embark on their midwifery career.

Megan McCarrell presented to third year Midwifery Education Program students at Toronto Metropolitan University on September 2; and on October 1, Nadja Gale, Victoria Marshall, and Megan McCarrell provided an introductory presentation on regulation and the College of Midwives to first year students at Toronto Metropolitan University. The topics included midwifery regulation in Ontario, self-regulation of a health professions, and aspects of standards and scope of practice in midwifery practice. The students were encouraged to ask questions, participate in case scenarios, and discuss regulation as a group for shared learning.

We have also reached out to McMaster University to discuss how the College can share resources with students in its midwifery education program.

Indigenous Advanced Education Skills Council and First Nations Technical Institute

The College has been working with both the Indigenous Advanced Education and Skills Council and the First Nations Technical Institute to support the development of the Indigenous midwifery program. This work follows the Board’s decision to recognize the Council as the designated body with authority to identify Indigenous midwifery baccalaureate degrees as equivalent to Ontario midwifery degrees for entry to practice under the Registration Regulation. The College’s role has been primarily advisory, helping to guide program development to ensure alignment with the Registration Regulation requirements and to support the success of candidates who choose to enrol in the program.

The Office of the Ontario Fairness Commissioner (OFC)

We recently met with our OFC compliance analyst for our annual check-in. Our discussion focused on offering alternative pathways for francophones midwives, internationally educated health care providers who could not enrol in the International Midwifery Preregistration Bridging Program, and attrition in the profession.

Ontario Midwifery Strategy Council Meeting

The College met with the Association of Ontario Midwives, representatives from the Midwifery Education Program (MEP), staff from the Ottawa Birth Centre and the Toronto Birth Centre, and staff from the International Midwifery Preregistration Bridging Program on September 22, 2025. We discussed areas of mutual interest and made a commitment to further our discussions to develop action plans on the issues related to access to midwifery care and preceptor shortages.

Financial Accountability and Management

Statement of Operations

The Q1 and Q2 Statements of Operations were approved by the Executive Committee and are presented under the Executive Committee’s report to the Board for your information.

2024-2025 Audited Financial Statements

The College’s 2024-25 Annual Report and approved Financial Statements (approved by the Board in June) were submitted to the Deputy Premier and Minister of Health, Hon. Sylvia Jones in September, as per our requirements under s.6 of the Regulated Health Professions Act, 1991.

People and Organizational Leadership

Human Resources

Abinaya Kalanandan left the organization in September. We are grateful for her many contributions to the Quality Assurance department and the broader organization. We wish her all the best in her future endeavors. Recruitment for the Coordinator, Quality Assurance and Assessments is currently underway.

Strategic Planning

As planned, all staff have been involved throughout the strategic planning process to date. Strategic planning has been a standing item on monthly staff meeting agendas to keep everyone informed on progress, to foster engagement and shared goals and understanding, and to obtain staff input. Staff feedback and work have informed revisions to the strategic priorities and guiding principles.

Board Governance and Engagement

Governance Newsletter

On October 14, 2025 the College issued the first edition of our governance newsletter called Regulatory Roundup to all Board and committee members. This new newsletter is designed to keep Board and committee members connected and informed about the College’s work between meetings.

We have heard that some members would like to receive more consistent updates and learn more about what is happening at the College and in the sector more generally. To facilitate this, we will be sharing this newsletter on a bimonthly basis, and editions will include various items such as highlights from recent meetings, updates on key decisions, and insights into policy and regulatory developments shaping midwifery in Ontario. We’ll also share resources for ongoing learning, opportunities for involvement, and updates on strategic priorities and initiatives. Our goal is to strengthen understanding of self-regulation and good governance, celebrate progress, and provide timely, relevant information to help guide our shared work in the public interest. We welcome your feedback and thoughts.

Governance Modernization

The Governance and Strategy team continue to work with the Executive Committee to review and make recommendations for updates to the College’s governance structure and practices. Our governance modernization work has been informed by sector trends and Ministry expectations, best practices from across jurisdictions and grounded in this organization’s operational realities. To move ahead on our recommendations, we are proposing that the Board approve the establishment of a non-statutory Nominations Committee, which will assist us in facilitating moves towards broader governance modernization goals, including revised recruitment and appointment processes for the Board, committees, and Chairs, as well as increased separation between Board and statutory committee roles, and further embedding equity, diversity and inclusion principles into our governance processes. This recommendation is detailed in the Briefing Note under item 9 in the agenda. In addition, Board Directors and Committee members will be introduced to this topic as part of the agenda for the Board and Committee training day on November 4, 2025.