Midwifery Regulation

Midwifery Regulation, M.R. 68/2000 The Midwifery Act , C.C.S.M. c. M125 Regulation 68/2000 Registered June 13, 2000 bilingual version (HTML) Table of Contents Section 1 Definitions REGISTRATION 2 Registers 3 Applications for registration 4 Registration of practising midwives 5 Election to practise in specified setting 6 Information in register of practising midwives 7 Temporary registration 8 Registration of non-practising midwives 8.1 Conditional registration 8.2 Extension of conditional registration 8.3 Re-applying for registration on conditional register 8.4 Conversion from conditional registration to midwife registration 8.5 Conversion from practising to non-practising 8.6 Conversion from non-practising to practising 8.7 Honorary registration 9 Registration of students 10 Renewals 11 Cancellation PRACTICE REQUIREMENTS 12 Screening and diagnostic tests 13 Drugs and devices 14 Minor surgical and invasive procedures 15 Standards of practice 16 Liability protection MISCELLANEOUS PROVISIONS 17 Committee to select public representatives 18 Review of this regulation 19 Coming into force Schedules A Laboratory and Diagnostic Tests B Drugs and Devices C Minor Surgical and Invasive Procedures DEFINITIONS Definitions 1 In this regulation, "Act" means The Midwifery Act ; («  Loi  ») "continuity of care" means providing care to the same woman through at least four prenatal visits, labour and delivery, the newborn examination and at least three postnatal visits; (« continuité des soins ») "examination" means the Canadian Midwifery Registration Examination or its equivalent approved by the college; (« examen ») "primary midwife" means a midwife who, in his or her practice, assumes primary responsibility for providing all aspects of midwifery care, including prenatal, intrapartum and postpartum care, and care of the newborn; (« sage-femme primaire ») "satisfactory" means satisfactory to the registrar. (« satisfaisant ») M.R. 31/2017 REGISTRATION Registers 2 In addition to the registers of practising midwives and students referred to in section 10 of the Act, the registrar must maintain the following registers: (a) a temporary practice register; (b) a non-practising register; (c) a conditional register; (d) an honorary register. M.R. 31/2017 Applications for registration 3(1) Every person who applies for registration must submit a completed application form to the registrar together with the fee provided for in the by-laws and a satisfactory criminal record check, child abuse registry check and adult abuse registry check. 3(2) Every application must disclose the following information about the applicant and his or her practice of midwifery or of any other regulated profession, whether in Manitoba or in another jurisdiction: (a) a finding by a professional regulatory body of professional misconduct, incompetence, or an incapacity or lack of fitness to practise; (a.1) any action taken as a result of a finding referred to in clause (a) including (i) a censure, reprimand or the imposition of conditions or educational requirements by a professional regulatory body, and (ii) the suspension or cancellation of the applicant's registration or licence to practise midwifery or another regulated profession; (b) a current investigation or proceeding by a professional regulatory body in relation to professional misconduct, incompetence or an incapacity or lack of fitness to practise; (b.1) each jurisdiction in which the applicant is or has been authorized to practise midwifery or any other regulated profession and whether the applicant is in good standing in that jurisdiction; (c) a denial of registration by a professional regulatory body; (c.1) any current or past restriction on, or suspension or termination of, the applicant's ability to practise midwifery or another regulated profession; (c.2) a termination for cause of employment or engagement as a member of the professional staff by a regional health authority or hospital; (c.3) a withdrawal of any of the applicant's privileges by a regional health authority or hospital; (c.4) a voluntary surrender of a licence or registration as a result of an agreement with a professional regulatory body; (c.5) a mediated settlement of a complaint; (d) an inquiry, investigation or inquest initiated under The Fatality Inquiries Act or similar legislation in any jurisdiction; (e) whether the applicant is the subject of a claim, has settled a claim or has had a judgment made against the applicant in relation to a civil claim in Canada or elsewhere respecting the applicant's professional practice or professional activities; (f) whether the applicant has entered a guilty plea to, or has a conviction for, a criminal offence or an offence under any narcotic or controlled substances legislation in any jurisdiction; (g) whether the applicant has any outstanding charges in respect of any offence including an offence under any narcotic or controlled substances legislation in any jurisdiction; (h) any other information requested by the registrar. M.R. 31/2017 REGISTRATION OF PRACTISING MIDWIVES Registration requirements: practising midwives 4(1) The requirements for registration as a practising midwife are as follows: 1. The applicant must have satisfactorily completed one of the following: (a) The applicant must complete a program of studies leading to a degree, diploma or certificate in midwifery. The program must be approved by the college and must be based on the core competencies of midwifery established by the college. (b) The applicant must complete an assessment process approved by the college of the applicant's ability to perform the core competencies of midwifery. 2. The applicant must pass the examination. 3. The applicant must have the following clinical experience: (a) the applicant participated in at least 60 births in a clinical role, of which (i) at least 40 births have been as the primary midwife or as a student acting as the primary midwife under a midwife's supervision as part of an education program, and (ii) at least 15 of the births referred to in subclause (a)⁠(i) have taken place in the 36 months immediately before the application date; (b) the applicant provided continuity of care as the primary midwife or student acting as the primary midwife to at least three women; (c) the applicant conducted at least 75 prenatal examinations of which at least 45 have been conducted in the 36 months immediately before the application date; (d) the applicant conducted at least 75 postnatal examinations of which at least 45 have been conducted in the 36 months immediately before the application date; (e) the applicant conducted at least 15 initial newborn examinations in the 36 months immediately before the application date; (f) the applicant conducted at least 50 newborn visits of which at least 20 have been conducted in the 36 months immediately before the application date. 4. The applicant must provide satisfactory evidence that he or she has taken training in neonatal resuscitation and cardiopulmonary resuscitation within the 12 months immediately before the application date. 4(1.1) Despite subsection (1), an applicant who holds a current certificate or licence, in good standing, to practise midwifery in another Canadian jurisdiction may be granted a certificate to practise midwifery in Manitoba in accordance with the college's obligations under The Labour Mobility Act and if applicable, the "Notice of Measure to achieve a legitimate objective under Chapter 7 of the Agreement on Internal Trade" relating to midwifery, as amended from time to time. 4(2) [Repealed] M.R. 31/2017 4(3) To maintain registration as a practising midwife, a midwife must (a) assume primary responsibility for providing all aspects of midwifery care, including prenatal, intrapartum and postpartum care and the newborn's care, in accordance with the standards of practice approved by the college; and (b) meet the active practice requirements in accordance with the standards of practice approved by the college. M.R. 31/2017 Election to practise in specified setting 5 For three years after this regulation comes into force, a person who is eligible for registration as a practising midwife under section 4 may elect to be registered as a midwife who attends births only in a specified setting. Once registered, such a midwife is entitled to practise in accordance with the election unless his or her registration is cancelled, suspended or not renewed or further conditions have been placed on it. Information in register of practising midwives 6(1) For the purpose of clause 10(2)⁠(e) of the Act, the following additional information is to be included in the register of practising midwives: (a) each midwife's name, home address and telephone number and business address and telephone number; (b) the midwife's registration number and the date and type of registration; (c) where appropriate, the educational or training program in which the midwife is engaged; (d) the date the midwife's registration is cancelled or not renewed. 6(2) A midwife shall notify the registrar promptly of any change in the information referred to in clause (a) or (c). 6(3) For the purpose of clause 10(3)⁠(d) of the Act, all of the information referred to in subsection (1) is public information, other than a midwife's home address and home telephone number. TEMPORARY REGISTRATION Requirements for temporary registration 7 An applicant qualified to practise midwifery in another jurisdiction who wishes to practise in Manitoba in a particular circumstance is eligible for temporary registration as a practising midwife if he or she (a) applies to the registrar stating the particular circumstance and the proposed length of time that he or she wishes to practise; and (b) provides satisfactory evidence that he or she is qualified in the other jurisdiction and is eligible to be registered in Manitoba in accordance with the requirements under section 4. M.R. 31/2017 REGISTRATION OF NON-PRACTISING MIDWIVES Registration of non-practising midwives 8 An applicant is eligible for registration as a non-practising midwife if he or she has been registered as a practising midwife by the college but intends to take a leave of absence from the practice of midwifery. M.R. 31/2017 CONDITIONAL REGISTRATION Conditional registration 8.1(1) A person may apply to have the person's name entered on the conditional register (a) as a supervised practice candidate; or (b) as an examination candidate. 8.1(2) The applicant must agree to practise in accordance with the conditions or restrictions specified on the conditional register. 8.1(3) An applicant is eligible for conditional registration as a supervised practice candidate if the applicant (a) participated in at least 60 births in a clinical role, of which at least 40 births have been as the primary midwife or as a student acting as the primary midwife under a midwife's supervision as part of an education program; (b) conducted at least 75 prenatal examinations; (c) conducted at least 75 postnatal examinations; (d) conducted at least 50 newborn visits; (e) has successfully completed training in neonatal resuscitation and cardiopulmonary resuscitation within the 12 months immediately before the application date; (f) has passed the examination; (g) intends to begin supervised practice to attain (i) the requirement of participation in at least 15 births in a clinical role as the primary midwife, and (ii) the requirements set out in item 3(b) to (f) of subsection 4(1); and (h) is able to complete the requirements referred to in clause (g) within 12 months of supervised practice. 8.1(4) An applicant is eligible for conditional registration as an examination candidate if the applicant (a) has successfully completed all academic and clinical course requirements to become eligible to take the examination; (b) has successfully completed training in neonatal resuscitation and cardiopulmonary resuscitation within the 12 months immediately before the application date; (c) intends to begin practising under the supervision of a midwife before taking the examination or while awaiting the results of the examination; and (d) has successfully completed the requirements in items 1 and 3 of subsection 4(1). 8.1(5) An examination candidate must take the examination at the first available opportunity in Manitoba after having the candidate's name entered on the conditional register. 8.1(6) The conditional registration of an examination candidate expires on the day after the college receives the examination results and notifies the candidate of the results. 8.1(7) The conditional registration of an examination candidate who does not pass the examination expires on the day after the college receives the examination results and notifies the candidate of the results. 8.1(8) Registration on the conditional register as a supervised practice candidate must not be for a period of more than 12 months. 8.1(9) Subject to section 8.2 (extension), a person's registration on the conditional register is cancelled at the end of the applicable time period set out in subsection (7). M.R. 31/2017 Extension of conditional registration 8.2(1) As an exception to subsection 8.1(7), the board of assessors may, in exceptional circumstances, grant one extension of the time period to a supervised practice candidate. 8.2(2) An application for the extension must (a) be in writing; (b) be made before the expiration of the applicable time period set out in subsection 8.1(7); and (c) set out the reasons for requesting the extension. 8.2(3) The extension may not be for more than 12 months and is subject to any terms or conditions imposed by the college. M.R. 31/2017 Re-applying for registration on conditional register 8.3(1) Despite subsection 8.1(1), a person who was registered as a supervised practice candidate but who did not attain the requirements for registration as a practising midwife as set out in clause 8.1(3)⁠(g) within the applicable time period may only reapply to have his or her name entered on the conditional register as a supervised practice candidate with the approval of the board of assessors. 8.3(2) Despite subsection 8.1(1), a person who was registered as an examination candidate but who did not pass the examination is not permitted to re-apply to have his or her name entered on the conditional register as an examination candidate. 8.3(3) For the purpose of this section, the "applicable time period" means (a) the time period referred to in subsection 8.1(7); or (b) if an extension has been granted under section 8.2, the time period of that extension. M.R. 31/2017 CONVERSION Conversion from conditional registration to midwife registration 8.4 A supervised practice candidate or examination candidate is entitled to have his or her registration converted from the conditional register to the register of practising midwives if the candidate (a) has attained the requirements for registration as a practising midwife referred to in clause 8.1(3)⁠(g), if a supervised practice candidate; (b) has passed the examination, if an examination candidate; (c) provides any information that the council may require, in the form and within the time set by the council; (d) pays the fee provided for in the by-laws; and (e) provides evidence that the candidate meets the liability insurance requirements of section 16. M.R. 31/2017 Conversion from practising to non-practising 8.5 A midwife is entitled to have his or her registration converted from the register of practising midwives to the non-practising register by (a) providing any information that the council may require, in the form and within the time set by the council; and (b) paying the fee provided for in the by-laws. M.R. 31/2017 Conversion from non-practising to practising 8.6 A non-practising midwife is entitled to have his or her registration converted from the non-practising register to the register of practising midwives if he or she (a) provides any information that the council may require, in the form and within the time set by the council; (b) establishes that he or she meets the active practice requirements in accordance with the standards of practice approved by the college or has successfully completed a refresher course to establish competency as required by the board of assessors; (c) pays the fee provided for in the by-laws; and (d) provides evidence that he or she meets the liability insurance requirements of section 16. M.R. 31/2017 HONORARY REGISTRATION Honorary registration 8.7(1) The council may award honorary registration to any person (other than a person registered on a register referred to in section 10 of the Act or clauses 2(a) to (c)) who has made a substantial contribution to the profession of midwifery. 8.7(2) An honorary registrant must not engage in the practice of midwifery. M.R. 31/2017 REGISTRATION OF STUDENTS Registration of students 9 In addition to the students referred to in section 16 of the Act, a person who is completing a refresher or upgrade of his or her education and experience, which has been recommended by the board of assessors, is eligible to be registered as a student. M.R. 31/2017 RENEWAL OF REGISTRATION Renewal of registration 10 A midwife is entitled to have his or her registration renewed by (a) paying the registration fee provided for in the by-laws; (b) providing any information that the college may require in the form and within the time set by the college; and (c) providing evidence of continuing competency in accordance with criteria established by the college. CANCELLATION OF REGISTRATION Cancellation of registration 11(1) The registrar shall inform the complaints committee if he or she is satisfied on reasonable grounds that a midwife (a) has failed to disclose any of the information required by subsection 3(2); or (b) has made a false or misleading statement in an application for registration or for renewal of registration or in responding to a query or communication from the college. 11(2) After reviewing a matter referred to it under subsection (1), the complaints committee may direct the registrar to cancel the midwife's registration. PRACTICE REQUIREMENTS Screening and diagnostic tests 12 A midwife may order and receive reports of the screening and diagnostic tests listed in Schedule A. Drugs and devices 13(1) A midwife may prescribe and administer the drugs and prescribe the devices listed in Schedule B. 13(2) Subject to subsection (3), a midwife may administer a drug that is not listed in Schedule B but only under a physician's direction. 13(3) A midwife may prescribe or administer a drug not listed in Schedule B if each of the following conditions is met: (a) the minister gives the council written notice that a public health emergency exists in all or part of the province, which necessitates that midwives be able to prescribe a drug not listed in Schedule B; (b) the council approves midwives prescribing those drugs under any conditions that the council considers appropriate until the state of emergency ends. M.R. 31/2017 Minor surgical and invasive procedures 14 A midwife may perform the minor surgical and invasive procedures listed in Schedule C. Standards of practice 15 A midwife shall comply with the standards of practice approved by the college, including standards concerning the following: (a) consultation with and transfer of care to a physician; (b) out-of-hospital births; (c) in-hospital births; (d) record-keeping; (e) continuing competency. M.R. 31/2017 Liability protection 16(1) Every member of the college who provides clinical services shall obtain, or be covered by, and maintain liability insurance coverage of not less than $7,000,000 per occurrence or $14,000,000 per year issued by a company licensed to carry on business in the province. 16(2) A member is not required to carry liability insurance if he or she is exclusively employed by a regional health authority and does not practice midwifery outside the scope of the employment. M.R. 31/2017 MISCELLANEOUS PROVISIONS Committee to select public representatives 17(1) The committee referred to in clause 8(5)⁠(a) of the Act, which is to recruit and select public representatives to serve on the council and college committees, shall consist of the following members: (a) one person appointed by the Women's Health Clinic; (b) one person appointed by the college who is a member of the college; (c) one person appointed by the standing committee established under clause 8(5)⁠(b) of the Act; (d) two persons who have used the services of a midwife who are not members of the college. 17(2) The persons referred to in clause (1)⁠(d) are to be selected by the members appointed under clauses (a), (b) and (c) from nominations received from the public. One of them must be a resident of northern or rural Manitoba. 17(3) The first members of the committee appointed under clauses (a) and (b) are to serve for a two-year term and the remainder are to serve for a three-year term. Thereafter, members are to serve for a three-year period. 17(4) No person may serve as a member of the committee for more than two consecutive terms. 17(5) The committee shall develop the criteria and the process for nominating and selecting public representatives to serve on the council and college committees. Review of this regulation 18 Not later than 5 years following the day this regulation comes into force, the college shall (a) review the effectiveness of the operation of this regulation after consultation with such persons affected by the regulation as the college considers appropriate; and (b) if it considers it advisable amend or repeal the regulation. Coming into force 19 This regulation comes into force on proclamation of The Midwifery and Consequential Amendments Act , S.M. 1997, c. 9. SCHEDULE A (Section 12) LABORATORY AND DIAGNOSTIC TESTS For a Female Chemistry: alanine transaminase (ALT) albumin alkaline phosphatase aspartate transaminase (AST) bilirubin unconjugated bilirubin total bilirubin conjugated blood tests to detect genetic or neural tube abnormalities in the fetus blood tests to detect the genetic carrier status of the mother blood urea nitrogen (BUN) creatinine ferritin fibrin split products fetal fibronectin folate gamma glutamyl transferase (GGT) glucose including glucose tolerance test (GTT) lactate dehydrogenase (LDH) newborn metabolic screening pregnancy (urine and blood, including quantitative hCG) thyroid-stimulating hormone (TSH) triiodothyronine (T3) thyroxine (T4) total protein 24-hour urine for protein uric acid urinalysis — routine (includes microscopic examination) vitamin B12 Cytology: cervical specimens (Pap smears and liquid-based cytology (LBC) including for human papillomavirus (HPV) detection) Diagnostic imaging: pelvic and obstetrical ultrasound Haematology: complete blood count: haematocrit (Hct) haemoglobin (Hgb) red blood cell count (RBC) and indices mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) platelets white blood count (WBC) with differential Kleihauer betke test (KB) partial thromboplastin time (PTT) prothrombin time, international normalized ratio (PT/INR) sickle cell hemoglobin electrophoresis Immunohaematology: antibody screen for blood group related antibodies blood group and type crossmatch direct antiglobulin test (DAT) Microbiology: cervical, vaginal, throat and anal or rectal rapid tests and cultures and sensitivities for group B streptococcus gonorrhea yeasts trichomonas gardnerella vaginalis bacterial vaginosis urine for culture and sensitivities chlamydia and gonorrhea nucleic acid detection wound swabs for culture and sensitivities swabs for nucleic acid detection of chlamydia gonorrhea herpes simplex virus (HSV) Serology or Immunology: Rh blood type test hepatitis virus antigen or antibody human immunodeficiency virus (HIV) antibody or antigen rubella antibody toxoplasma antibody syphilis serology cytomegalovirus antibody varicella zoster antibody parvovirus antibody X-ray: abdominal pelvic For an Infant Chemistry: newborn metabolic screening (Chemistry) bilirubin direct Coombs test glucose Haematology: complete blood count: haematocrit (Hct) haemoglobin (Hgb) red blood cell count (RBC) and indices mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) platelets white blood count (WBC) with differential antibody screen for blood group related antibodies blood group and type Microbiology: swabs from the eyes and umbilicus for culture and sensitivity X-ray: clavicle For the Father or Current Partner Immunohaematology: Rh blood type test Serology or Immunology: hepatitis virus antibody or antigen human immunodeficiency virus (HIV) antigen or antibody syphilis serology Microbiology: urine for chlamydia and gonorrhea nucleic acid detection Chemistry: blood tests to detect the genetic carrier status of the father M.R. 31/2017 SCHEDULE B (Section 13) DRUGS AND DEVICES 1. injectable, oral or topical antibiotics for the treatment of vaginal or cervical infections, including gonorrhea, chlamydia, syphilis, bacterial vaginosis, trichomonas, and group B streptococcus, and for the treatment of urinary tract infections and mastitis 2. injectable, oral or topical antibiotics for the treatment of the father or current partner for chlamydia and gonorrhea 3. anti-emetics for the treatment of nausea and vomiting in pregnancy 4. oral or topical antifungal agents for maternal vaginal infections, irritation of the nipple, or candidiasis of the nipple, or for thrush in the infant 5. injectable or oral drugs for the management of anaphylaxis 6. antihaemorrhoidal agents with hydrocortisone 7. Bacille Calmette-Guérin (BCG) vaccine 8. topical cortical steroids for the treatment of irritation of the nipple or candidiasis of the nipple, or for thrush in the infant 9. crystalloid or colloid intravenous solutions 10. drugs for increasing breast milk supply 11. drugs for the resuscitation of the newborn 12. hepatitis B immune globulin 13. hepatitis vaccine 14. hormonal contraceptives 15. herpes simplex virus (HSV) antiviral prophylaxis 16. inhalation analgesia 17. intrauterine contraceptive devices, cervical caps, diaphragms 18. injectable or topical local anaesthetics for repair of perineal, vaginal or labial laceration or episiotomy, and for providing pain relief during injections and intravenous cannulation 19. measles, mumps and rubella (MMR) vaccine 20. neonatal ophthalmic prophylaxis 21. narcotic antagonists — for narcotic-induced depression in a neonate 22. diclofenac (oral) 23. naproxen (oral) 24. over-the-counter medications, devices or therapies commonly used in conditions arising in pregnancy or the post-partum period, or for the newborn 25. oxygen 26. prostaglandins for post-partum use 27. Rh immunoglobulin 28. silver nitrate or drugs for the treatment of granuloma 29. tryptophan 30. vitamin K 31. sodium bicarbonate 32. uterotonics 33. vaccines for the prevention of influenza 34. severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine 35. tetanus-diphtheria-acellular pertussis (Tdap) vaccine 36. varicella vaccine 37. tranexamic acid M.R. 31/2017 ; 101/2024 SCHEDULE C (Section 14) MINOR SURGICAL AND INVASIVE PROCEDURES 1. amniotomy 2. bladder catheterization 3. episiotomy 4. repair of episiotomy and tears 5. injections, intravenous cannulation, venipuncture 6. fitting of cervical caps and diaphragms for contraceptive purposes 7. insertion of intrauterine contraceptive devices 8. collection of cytologic smear of cervix 9. insertion of airway in the neonate 10. oral intubation of the neonate 11. placement of orogastric tube in the neonate 12. umbilical venous catheterization of the neonate 13. placement and removal of spiral electrode on the fetus 14. emergency manual removal of the placenta 15. phototherapy for newborns 16. newborn hearing screening in accordance with The Universal Newborn Hearing Screening Act , but only in a facility with at least 75 births each year 17. uterine balloon tamponade M.R. 31/2017 ; 101/2024