College of Midwives of Ontario Defence Lawyers

Midwives, like many other professionals in Canada, must be adequately educated, licensed and regulated by the province in which they practice. Each province will regulate their professionals in their own way.

Each province in Canada is responsible for regulating the professionals working within that province. In Ontario, the College of Midwives is the regulatory body that protects pregnant clients and their new-borns by ensuring that midwives are able to provide competent and ethical care, and act when risks are identified. Midwives’ role is  provide care to pregnant people through pregnancy, labour birth and may practice in homes, clinics, hospitals and birthing centres. Some of the College of Midwives of Ontario’s main responsibilities include: registering midwives, ensuring the quality of midwifery care,  setting standards for the practice of midwifery and responding to and investigating any complaints or issues related to midwifery care. Because midwifery is a controlled practice, only individuals who are registered with the College of Midwives of Ontario are able to practice midwifery and use the titles of ‘midwife’ and/or ‘RM.’

Midwives are regulated by the Regulated Health Professions Act, 1991, the Midwifery Act, 1991 and the Regulations made under it, among other legislations, and are subject  to the College’s bylaws, standards of practice, polices and guiding documents. Midwives are also overseen by a Council of the College composed of 7-8 fellow midwives elected by the College’s members and 5-7 members of the public.

Under the Midwifery Act, aboriginal midwives in Ontario are permitted to provide care without being registered with the College. An Aboriginal person can use the title of ‘Aboriginal midwife’ and may present themselves as being qualified to practice as an Aboriginal midwife in the province of Ontario. However, Aboriginal midwives are not regulated by the College of Midwives of Ontario.

Midwives are regulated by a series of legislations, including the Regulated Health Professions Act, 1991the Health Care Consent Act 1996, Heath Facilities Special Orders Act 1990, Personal health Information Protection Act, 2004, and the Midwifery Act, 1991 and the regulations made under it. They are also subject  to the College’s bylaws, standards of practice, polices and guiding documents. The Regulated Health Professions Act applies to all health professionals in Ontario and lays out the standards of practice required. The Midwifery Act is specific to the College of Midwives of Ontario and sets out the scope of practice available under midwifery, the functions and composition of the College Council, requirements for the continuing Quality Assurance expectations of registered midwives and examples of professional misconduct.

Legal Information

Frequently Asked Questions

What can be Expected from a Midwife?
The Complaint Process
What Happens when a Complaint is Filed?
Can a Complainant/Midwife Appeal the ICRC’s Decision?
How Long Does it Take for a Complaint to be Processed?
Is Alternative Dispute Resolution Available?
What Happens at a Discipline Hearing?
What Happens if the ICRC finds the Midwife to be Incapacitated or Unfit to Practice?
Can a Midwife File for Reinstatement Following the Revocation/Suspension of their Certificate of Registration?
What Types of Acts or Omissions Give Rise to Professional Misconduct Complaints?
What Penalties Can a Midwife Face as a Result of a Complaint?
Active Practice Requirements for Midwives
When Must a Midwife Self-Report to the College of Midwives of Ontario?
Sexual Abuse by a Midwife

What can be Expected from a Midwife?

A client can expect that a midwife who is registered with the College of Midwives of Ontario:

  • Meets the standards of practice expected of the profession and are able to provide current practices,
  • Ensures that you will receive the tests, examinations, check-ups and referrals required
  • Informs you of your choices and respects your decisions about your care
  • Answers questions and is aware of your concerns
  • Continues to care for you and your new-born for up to 6 weeks after the baby is born

The Complaint Process

Midwives, like other regulated professionals, owe a duty of care to their clients. If there is a failure to discharge this duty of care, it could result in a formal complaint being filed with the College of Midwives  of Ontario. Anyone can make a complaint against a midwife, including friends and family of the client, or even a member of the public, and there is no time limit on when a complaint must be made. A complaint made by made in any recorded format, such as a letter, email, audio or video recording. The complaint should include: the complainant’s name, address, email and phone number, the name(s) of the midwife/midwives the complaint is being  made against, the name of the midwife’s midwifery practice, a statement that a complaint is being made and the issues on which the complaint is made, the date(s) of the incident(s), a description of the events transpired, the name of any hospitals or clinics associated with the complaint (if any), any relevant supporting documents, and the complainant’s expectation of the outcome.

The complaint may be submitted to the College through the College of Midwives of Ontario’s website, by post or through email.

What Happens When a Complaint is Filed?

Once the College of Midwives of Ontario receives the complaint, the complainant will be contacted within 2 working days to confirm receipt of the complaint and inform the complainant of any other documents that must be completed and returned to the College. After the College has received the relevant materials, the midwife will be provided a chance to respond to the allegations made against him/her.

The Panel may conduct an investigation into the complaint. This process may include interviews of witnesses, obtaining medical records and other documents, as well as speaking with the midwife’s colleagues or employers. The ICRC (Inquiries, Complaints and Reports Committee) will then decide whether further investigation is needed. If a further investigation is required, the ICRC may also request health records that may be relevant to the complaint and/or engage a third-party investigator to conduct interviews with the complainant or any other party that may provide important information on the matter. Before coming to a decision, the ICRC will provide the midwife with a copy of the investigations of the findings and permit them to have another opportunity for a written submission. When the investigation is completed, the matter will be forwarded to a panel of the ICRC, to be deliberated by fellow midwives, as well as members of the public.

Some actions the ICRC may take include:

  • Taking no further action if the Panel believes that the midwife did not contravene the standards of the profession
  • Offering advice or recommendations
  • Requiring the midwife to complete a specified continuing education or remediation program
  • Giving oral caution to the midwife before the panel
  • Requiring the midwife to sign an acknowledgement and agreement between the midwife and College for certain restrictions to be placed on their practice
  • Referring allegations to the Discipline Committee if there is an allegation of professional misconduct or incompetence
  • Referring the allegations to the Fitness to Practise Committee if the allegation is related to the midwife’s physical or mental condition

The ICRC does not have the power to make findings of guilt or the ability to impose penalties on the midwife.

A finding of professional misconduct can have very serious implications on a Midwife’s ability to practice. If a midwife becomes aware that a complaint has been filed against them, they should not hesitate to contact qualified legal counsel as soon as possible. Our Firm can help guide you through this process to ensure you receive the best possible outcome in your case.

Can a Complainant/Midwife Appeal the ICRC’s Decision?

Where the complainant or midwife objects to the findings of the investigation or to the ICRC’s decision, they may request for a review by the Health Professions Appeal and Review Board, which is an independent board appointed by the Government of Ontario.

How Long Does it Take for a Complaint to be Processed?  

The period of time  under which a complaint will be processed will vary based on the circumstances, as well as the complexity of the case. Typically, a decision will be rendered within 150 days from the date the complaint is received.

Is Alternative Dispute Resolution Available?

Where the parties are willing, the complainant and midwife may enter into an alternative dispute resolution process whereby a third party facilitator will come to settle the issues in a manner that is satisfactory to all the parties involved. This is an alternative route to the formal complaint process and allows the parties to resolve the issues in a way that is mutually agreeable. The alternative dispute resolution is available for most issues and complaints. However, alternative dispute resolution is not available where the complaint has been referred to the Discipline Committee, and/or the complaint does involves an allegation of sexual abuse. The contents of the alternative dispute resolution will remain confidential.

A benefit of the alternative dispute resolution process is that cases will often be completed sooner than those settled though the formal complaints process, and may be processed within 60-120 days, as compared to the typical 150 days the formal complaints process requires.

What Happens at a Discipline Hearing?

If the ICRC forwards a complaint to the Discipline Committee, a formal hearing will then take place. This typically takes place where there are allegations that the midwife has committed an act professional misconduct, is incompetent, or other complaints of a similarly serious nature.  The discipline hearing will operate similar to a legal trial. After hearing all the evidence, if the Discipline Committee finds that there has in fact been a case of professional misconduct or incompetence, they may:

  • Order a revocation of the midwife’s Certificate of Registration
  • Order a suspension of the midwife’s Certificate of Registration for a period of time
  • Impose a term, limit or condition to the midwife’s Certificate of Registration
  • Order the midwife to appear before the panel to be subject to an oral reprimand
  • Impose a fine of up to $35,000

If either party is unsatisfied with the decision, an appeal of the decision can be made by application the Superior Court of Justice (Divisional Court of Ontario).

What Happens if the ICRC finds the Midwife to be Incapacitated or Unfit to Practice?

Where the ICRC finds that the midwife may incapacitated or unfit to practice, they may refer the midwife to the Fitness to Practise Committee for an incapacity hearing. This happens where the ICRC believes the midwife’s condition is affecting their ability to practice the profession safely and that they could possibly pose a risk to the public. If the midwife is indeed found to be incapacitated or unfit to practice, the Committee may:

  • Order a revocation of the midwife’s Certificate of Registration
  • Order a suspension of the midwife’s Certificate of Registration for a period of time
  • Impose a term, limit or condition to the midwife’s Certificate of Registration

A midwife may apply to vary the terms or conditions of their certificate of registration at any time unless the order has stipulated that a that the terms or conditions must remain for a certain period of time, in  which case, an application may only be brought after that time period has passed.

A midwife may also appeal the ICRC’s finding of incapacity/unfitness to practice  to the Divisional Court within 90 days of the decision’s issuance. The Court has the power to affirm, rescind, or rehear the case in whole or in part.

Can a Midwife File for Reinstatement Following the Revocation/Suspension of their Certificate of  Registration after being found Incapacitated/ Unfit to Practice?

A midwife is able to apply for the reinstatement of their certificate of registration after 1 year has passed since their certificate was first revoked or suspended. If this request is refused, another application may be brought 6 months after the first application. The Fitness to Practice Committee will then hold a hearing the deliberate the matter. Their decision to, or not to, reinstate the midwife is final and cannot be appealed.

What Types of Acts or Omissions Give Rise to Professional Misconduct Complaints?

There are many different reasons why a client may wish to file a formal complaint against a midwife. Some examples of incidents that give rise to a complaint may include:

  • The midwife fails to maintain the standards expected of them by the profession, including providing practice that is out of date
  • The midwife abuses a client (verbally, physically, or sexually)
  • The midwife practices the profession while under the influence of a substance, or while knowingly suffering from an illness or other dysfunction that impairs their ability to practice
  • The midwife discontinues urgent professional services without the client’s consent and there is a lack of alternative services are available
  • The midwife practices the profession while there is a conflict of interest
  • The midwife fails to provide a truthful, understandable or appropriate explanation of the nature of an assessment, intervention, or other service after a request for an explanation
  • The midwife charge excessive fees in relation to the services being provided

What Penalties Can a Midwife Face as a Result of a Complaint?

As noted in previous sections, there are several courses of action the ICRC may take, including: offering advice or recommendations, requiring the midwife to complete a specified continuing education or remediation program, giving oral caution to the midwife before the panel, requiring the midwife to sign an acknowledgement and agreement between the midwife and College for certain restrictions to be placed on their practice, referring allegations to the Discipline Committee if there is an allegation of professional misconduct or incompetence, or referring the allegations to the Fitness to Practise Committee if the allegation is related to the midwife’s physical or mental condition.

If the complaint is forwarded to the Discipline Committee, they may: Order a revocation of the midwife’s Certificate of Registration, order a suspension of the midwife’s Certificate of Registration for a period of time, impose a term, limit or condition to the midwife’s Certificate of Registration, order the midwife to appear before the panel to be subject to an oral reprimand, or order the midwife to pay a fine of up to $35,000.

Active Practice Requirements for Midwives

Midwives holding a certificate of registration are required to actively practise the profession in order to maintain currency,  as well as maintain the ability to practise in all settings.

This requirement is satisfied where the midwife provides midwifery care over a one year period to at least 20 women, 10 of whom are served as a primary midwife, with at least 5 births occurring in a hospital, and at least 5 in a residence, remote clinic or birth centre. Alternatively, this requirement may be satisfied where the midwife provides midwifery series over a 2 year period to at least 40 women, 20 of whom are served as a primary midwife, with 10 births Orr cueing in a hospital and another 10 in a residence, remote clinic or birth centre. After 2 consecutive years of being able to satisfy either of the above requirements, a midwife may satisfy the requirement for active practice by, in any following 5 year period, providing midwifery care to at least 100 women, at least 50 of whom are served as a primary midwife, with at least 25 births occurring in a hospital setting, and another 25 in a residence, remote clinic, or remote birth centre.

When Must a Midwife Self-Report to the College of Midwives  of Ontario?

Under the Regulated Health Professions Act, 1991, a midwife must report to the College where:

  • The midwife has been found guilty of an offence or
  • The midwife is subject to bail conditions or any other restrictions
  • The midwife is a member of another professional body in any jurisdiction
  • The midwife is being subjected to a proceeding for professional misconduct, incompetency for any profession in any jurisdiction
  • The midwife is being disciplined, suspended or required to resign, terminated or subjected to any similar action at the place of their employment
  • The midwife becomes aware of any unsafe practices, unprofessional conduct or incapacity by their co-workers

The mandatory report should be made as soon as possible after becoming aware of the circumstances. A failure to file a mandatory report could be deemed an act of professional misconduct and may affect the midwifes’ ability to practice. Failing to make a mandatory is also a provincial offence. Where there is a failure to make a mandatory report, a midwife could face a fine of up to $50,000, and the corporation can be liable for up to $200,000.

Sexual Abuse by a Midwife

The College of Midwives of Ontario has a strong zero tolerance policy towards sexual abuse by midwives against their clients. Sexual abuse can include: sexual relations with a client, touching a client in a sexual manner, asking the client to touch themselves or the midwife in a sexual manner, any sexual gestures, making sexualized comments or jokes, asking personal questions of a sexual nature, etc.

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