Working Conditions – March 2006

While the model of midwifery practice and midwifery competencies are consistent across Canada, work arrangements vary. More information on pay & employment status, work sites, practice arrangements, and working with other health care professionals is provided below for the following regulated provinces and territories:

British Columbia, Alberta, Manitoba, Ontario, Quebec, Northwest Territories.

British Columbia

Pay & Employment Status

Midwives in British Columbia are independent practitioners. They are paid by the Medical Services Plan (BC government) for each course of care they provide to a client (up to $2,757.20 per course of care) and can bill up to a maximum of $110,288 per year. Full time practice is considered to be 40 courses of care per year. They must pay all of their expenses themselves, including registration fees, liability insurance (about $4,000 per year), office expenses (support staff salary, rent, phone, etc.), equipment and supplies, fees for second midwife of second birth attendant at home births, recertification courses, etc. Typically practice expenses range from about 25% to 45% of their fee annually leaving compensation for a full time midwife of approximately $60,796 to $82,782 per year. All midwives are covered by an EAP which provides access to confidential and professional counseling services, and may enroll, for an additional cost, in an optional Benefits Program to access extended medical and dental coverage and disability and life insurance.

The Midwives Association of British Columbia negotiates with the government for fee levels and manages the Midwives Protection Program which provides professional liability insurance coverage. For more information contact www.bcmidwives.com.

Work Site and Support

Midwives attend both home and hospital births. They have their own offices/clinics where they provide antenatal care and attend postnatal visits after the first week of home visits is completed. They have hospital privileges in at least one local hospital where they take their clients who choose hospital births. Nurses provide support during in-hospital labour and birth. Clients who prefer to give birth in an out-of-hospital setting generally do so at their own home with two midwives in attendance. There are currently no birth centres in BC. Midwives do one prenatal home visit and early postnatal visits take place in the client’s home or in hospital.

Practice Arrangements

Most midwives work in group practices where the costs of running a clinic are shared. They generally work in small teams of two or three midwives who carry a joint caseload, share prenatal and postnatal care and provide back-up for each other. At least one member of the group is on call at all times. Group practices have the opportunity to do regular peer review of the care they provide together. Some midwives work in solo practices where they call on other nearby midwives or doctors for back-up support and peer review. Solo midwives usually use a registered nurse as the second birth attendant at home births.

For each woman, one of her team of midwives is identified as her care coordinator. This midwife may attend most of the woman’s visits, with the other midwives only attending one or two visits, or the members of the team of midwives may alternate seeing the woman throughout her care. A midwife known to the woman must be on-call at all times. When the woman goes into labour, the midwife on-call from the team will act as her primary midwife for her labour and delivery. A second midwife from the team will attend the birth if it is a homebirth.

Most full-time midwives manage 40 births per year as primary midwife and attend a further 15 to 20 births as second midwife.

Working with other Health Care Practitioners

Midwives in BC work closely with other appropriate health care professionals to ensure the best care for their clients. They regularly discuss care options, consult for an expert opinion with obstetricians, paediatricians, or other appropriate specialists, and will transfer care as needed and in keeping with the College’s Indications for Discussion, Consult, and Transfer of Care. They work closely with obstetrical nurses during hospital births, and they collaborate with public health nurses for postpartum care. 

Midwives and other maternity care professionals often attend “Rounds� (inter-disciplinary hospital-based presentations) and recertification workshops together, and sometimes collaborate on research or other professional work together.

As in other parts of Canada, midwifery is still a relatively new profession in BC and other health professionals in many communities are still learning about midwives, their scope, knowledge and skills. Midwives starting practices in new areas will need to educate their communities about midwifery and work hard at establishing and maintaining supportive and collaborative relationships with other health professionals.  

Alberta

Pay & Employment Status

Midwives in Alberta are independent practitioners. Midwifery services are not publicly funded, and thus clients must pay directly for care provided.  The typical fee per course of care is $2500-2850 plus 7% GST (federal tax). Midwives must pay all of their expenses themselves, including registration fees, insurance, office expenses (rent, phone, etc.), equipment and supplies, recertification courses, etc. There are no benefits available at this time.

Work Site

Midwives have their own offices/clinics where they hold antepartum visits and some postpartum visits. They have hospital privileges in at least one local hospital where they take their clients who choose hospital births. Nurses may provide support during in-hospital labour and birth. Clients who prefer to give birth in an out-of-hospital setting generally do so at their own home with two midwives in attendance. There is currently one birth clinic in Calgary, for which the client must pay a fee.

Practice Arrangements

Most midwives work in group practices where the costs of running a clinic are shared, back-up can be provided for each other, and regular review of their practice can be done together. Some midwives work in solo practices where they call on other nearby midwives or doctors for back-up support and peer review.

For each client, there will usually be one primary midwife and a second midwife. The primary midwife will manage the client’s care, attending most visits and managing the labour and delivery. The second midwife will usually attend one antepartum visit in order to meet the client, and will attend the birth if it is a homebirth. In cases where the primary midwife is unavailable (often due to more than one birth occurring at the same time), the second midwife would manage the birth.

Generally, full-time midwives manage an average of 40 births per year as primary midwife and attend a the same number or less as second midwife.

Working with other Health Care Practitioners

Midwives in Alberta work closely with appropriate health care professionals to ensure the best care for their clients. They regularly discuss care options, consult for an expert opinion, and transfer care to obstetricians, paediatricians, or other appropriate specialists as needed and in keeping with the provincial and regional Policies on Consultation and Transfer of Care. Most work closely with obstetrical nurses during hospital births, and they collaborate with public health nurses for postpartum care.

Midwives and other maternity care professionals often attend “Rounds� (workshops) and recertification workshops together, and sometimes collaborate on research or other professional work together.

Midwifery is a new, small, and non-funded profession in Alberta and as such other health professionals are still learning about midwives, their scope, knowledge and skills. Midwives starting practices in new areas will need to educate their communities about midwifery and work hard at establishing and maintaining supportive and collaborative relationships with other health professionals.

Manitoba

Pay & Employment Status

Most midwives in Manitoba are employees of Regional Health Authorities. Their salary range is $68,230.24 to $80,203.96 depending on location and on their years of service. Overhead expenses for their office, equipment, supplies, and professional liability insurance are paid for by their employer. Midwives are entitled to participate in life insurance, disability insurance, employee assistance plan, and extended health, dental and pension plans. Some of these benefits are paid for by the employer and some are cost shared by the employer and the midwife. Midwives salary is based on a 40 hours work week. Midwives work flexible and variable hours and are not generally entitled to overtime pay, however they are entitled to ‘bank’ time to take off at a later date. Midwives are entitled to 3 to 6 weeks of paid holidays per year depending on years of service plus approximately 9 statutory holidays (depending on location of work). All midwives are members of a union. Unions differ by regional health authority.

It is also possible to set up private practice in Manitoba. Midwives in private practice are paid directly by the women to whom they provide service. Midwives in private practice are responsible for paying all of their own expenses (including office, equipment, supplies and professional liability insurance).

Work Site

Midwives in Manitoba either work in community health clinics or community midwifery clinics. The majority of prenatal care and some postpartum care is provided in the clinic, although prenatal visits are sometimes done in the client’s home, depending on the needs of the client. Early postpartum care is provided either at the hospital or in the client’s home. Midwives attend both out-of-hospital and hospital births. They have hospital privileges in at least one local hospital where they take their clients who choose hospital births. Nurses provide support to the midwife during in-hospital labour and birth. Clients who prefer to give birth in an out-of-hospital setting generally do so at their own home with two midwives in attendance. There are currently no birth clinics in Manitoba.

Practice Arrangements

There are usually 3 to 4 midwives working together in a group practice at each community clinic with midwifery services, although in some rural or northern locations midwives may work in solo practice or with one other midwife. Group practices have the opportunity to do regular chart review of the care they provide together. Midwives who work in solo practices arrange for back-up services from other health care providers in their community.

Many midwives in group practices work in small teams of two or three midwives who carry a joint caseload, share prenatal and postnatal care and provide back-up for each other. The client meets each midwife regularly throughout her care. Other midwives designate one primary midwife and a second midwife. The primary midwife manages the client’s care, attends most visits and manages the labour and delivery. The second midwife will usually attend one prenatal visit in order to meet the client, and will attend the birth as a second attendant if it is a homebirth. In both cases a midwife known to the woman must be on-call at all times.

Most full-time midwives manage 30 to 40 births per year as primary midwife and attend a further 10 to 20 as second midwife.

Working with other Health Care Practitioners

Midwives in Manitoba work closely with appropriate health care professionals to ensure the best care for their clients. They regularly discuss care options, consult for an expert opinion, and transfer care to obstetricians, paediatricians, or other appropriate specialists as needed and in keeping with the College’s Standards for Consultation, and Transfer of Care. They work closely with obstetrical nurses during hospital births, and they collaborate with public health nurses for postpartum care.

Midwives and other maternity care professionals often attend “Rounds� (workshops) and recertification workshops together, and sometimes collaborate on research or other professional work together.

As in other parts of Canada, midwifery is a new profession in Manitoba and other health professionals are still learning about midwives, their scope, knowledge and skills. Midwives starting practices in new areas will need to educate their communities about midwifery and work hard at establishing and maintaining supportive and collaborative relationships with other health professionals.

Ontario

Pay & Employment Status

Midwives in Ontario are independent practitioners. They are paid through transfer payment agencies funded by the Ontario Ministry of Health and Long-Term Care. Each midwife is paid a fee for each course of care she provides to a client based on her level of experience as a midwife. An additional 18% of the experience-based fee goes towards the midwife’s benefits plan. A payment for a full course of care ranges from $2,540 to $3,075. In addition, for each course of care the midwife is paid an amount for the second midwife at the birth and for operating expenses. These amounts do not vary with experience. Midwives also receive an allowance for their midwifery and office equipment, second attendant equipment, and their professional liability insurance is fully covered. Expenses that they pay themselves include registration and professional fees, recertification courses, etc. After paying for those practice expenses that they must cover out of their fee, full-time midwives are left with compensation that ranges from approximately $69,000 to $92,000 plus 18% for benefits.

The Association of Ontario Midwives negotiates with the government for fee levels and professional liability insurance. For more information contact www.aom.on.ca.

Work Site

Midwives have their own offices/clinics where they hold prenatal visits and some postpartum visits. They have hospital privileges in at least one hospital where they take their clients who choose hospital births. Clients also have the option of giving birth at home. Two midwives attend every birth, both in and out-of-hospital. There are currently no birth clinics in Ontario. Early postpartum visits take place in the client’s home or in hospital.

Practice Arrangements

Most midwives work in group practices where the costs of running a clinic are shared, back-up can be provided for each other, and regular review of their practice can be done together. Group practices have the opportunity to do regular peer review of the care they provide together. Midwives may work in solo practices in smaller communities if this arrangement is approved by the Ministry of Health and Long-Term Care.

For each woman, one of her team of midwives is identified as her care coordinator. This midwife may attend most of the woman’s visits, with the other midwives only attending one or two visits, or the members of the team of midwives may alternate seeing the woman throughout her care. A midwife known to the woman must be on-call at all times. Two midwives will attend her birth, one as her primary and the other as second midwife. The primary midwife attends in active labour and the second midwife usually arrives closer to second stage and both stay until mother and newborn are stable after the birth.

Most full-time midwives manage 40 births per year as primary midwife and attend a further 30 to 40 as second midwife.

Working with other Health Care Practitioners

Midwives in Ontario work with appropriate health care professionals to ensure the best care for their clients. They discuss care options, consult for an expert opinion, and transfer care to obstetricians, paediatricians, or other appropriate specialists, as needed, and in keeping with the College’s Indications for Mandatory Discussion, Consultation, and Transfer of Care.

Midwives and other maternity care professionals often attend “Rounds� (workshops) and recertification workshops together, and sometimes collaborate on research or other professional work together.

As in other parts of Canada, midwifery is still a relatively new profession in Ontario and other health professionals in many communities are still learning about midwives, their scope, knowledge and skills. Midwives starting practices in new areas will need to educate their communities about midwifery and work hard at establishing and maintaining supportive and collaborative relationships with other health professionals.

Quebec

Pay & Employment Status

All midwives in Quebec work as autonomous professionals under a contract with a local community health centre. Midwives are paid by salary with a range from $42,500 to $72,000. An additional $3600 is paid to full-time midwives for “unsociable� hours, with a proportionate amount to part-time midwives. Equipment and supplies are provided by their employer. The cost of professional liability insurance is share by the community health centre and the midwife, who has $750 deducted from her pay annually. Benefits include a pension plan, maternity leave, sick days, and mandatory minimal health insurance (which includes options for dental, life insurance, and other “extras�). Full-time midwives get 4 weeks paid holidays, as well as statutory holidays off.

Work Site

Midwives in Quebec work in birth centres where they hold antepartum and later postpartum visits.  Most births also take place in these birth centres, although clients may also choose to have a home birth. In cases where the community health clinic has an agreement with a local hospital, the midwives can also offer their clients the choice of hospital birth. Early postpartum visits usually take place at the client’s home.

Practice Arrangements

Midwives work in teams at each birth centre. The size of this team varies from 3 to 11 midwives depending on the size of the communities served, however most midwifery teams include 6 - 8 midwives. Midwives provide back-up for each other, and carry out peer review together.

For each woman, one of her team of midwives is identified as her care coordinator and primary midwife. She may attend most of the woman’s visits, with a second midwife only attending one or two visits, or she may alternate visits with the second midwife during the last trimester. A midwife known to the woman must be on-call at all times. The midwife on-call when the woman goes into labour will act as her primary midwife for her labour and delivery. The second midwife, or if necessary another midwife from the team, will also attend the birth.

Most full-time midwives manage 40 births per year as primary midwife and attend a further 40 as second midwife.

Working with other Health Care Practitioners

Midwives in Quebec work closely with appropriate health care professionals to ensure the best care for their clients. They regularly discuss care options, consult for an expert opinion, and transfer care to obstetricians, paediatricians, or other appropriate specialists as needed and in keeping with the Order’s Regulation respecting cases requiring consultation with a physician or transfer of clinical responsibility to a physician.

Midwives and other maternity care professionals often attend recertification workshops together, and sometimes collaborate on research or other professional work together.

As in other parts of Canada, midwifery is a new profession in Quebec and other health professionals are still learning about midwives, their scope, knowledge and skills. Midwives will need to educate their communities about midwifery and work hard at establishing and maintaining supportive and collaborative relationships with other health professionals.

Northwest Territories

Pay and Employment Status

Typically midwives in the Northwest Territories are employed by the Health and Social Services Authorities. The salary range is $76,713 to 90,850 depending on practice location and on the midwives’ years of service with the Government of the Northwest Territories. The pay range is currently under review (July 06). In addition, midwives receive an annual Northern Allowance based upon the remoteness of the community in which they are employed, the rates range from $2,302 to $14,093. Furthermore, midwives can apply for annual Professional Development Funding to participate in professional development opportunities. Professional Development Initiative rates applicable to various communities range from $2,000 to $4,880. Midwives are entitled to annual leave, starting from 16.5 days annually and to 12 designated paid holidays (statutory holidays), 5 mandatory leave days, and 3-5 professional development days. Additionally, midwives earn 15 days of sick leave credit annually. The overhead expenses for office, equipment, supplies, and professional liability insurance (up to $10 Million) are paid for by the employer. Midwives are entitled to participate in life insurance, disability insurance, employee assistance plan, and extended health, dental and pension plans. Some of these benefits are paid for by the employer and some are cost shared by the employer and the midwife. Midwives in the Northwest Territories are members of the Union of Northern Workers. Their salary is based on a 37.5 hours work week. In accordance with the Collective Agreement midwives work flexible hours to meet practice and client needs. Midwives receive compensatory leave at the rate of time and one half for all hours worked greater than 150 hours over a 28-day period. In addition midwives are entitled to receive stand-by payment when on call.

Work Site

Midwives in the Northwest Territories either work in Health Centres, Medical or Midwifery Clinics. Prenatal care is typically provided in a clinic setting, although at times prenatal visits are done in the woman’s home, depending on the needs of the client and her family. Early postpartum care is provided either at the health centre, hospital or in the client’s home depending where the birth took place. Follow up postpartum visits are either provided at home or in the clinic. In the Northwest Territories, midwives attend hospital births and births outside of hospital with specialist care (community health centres and homebirths). Midwives have hospital privileges in the local hospital in the community they practice in and may apply for hospital privileges at Stanton Territorial Hospital in Yellowknife. Nurses and/or a midwife provide support to the midwife during in-hospital labour and birth. Clients who prefer to give birth at home generally do so with two midwives in attendance.

Practice Arrangements

Midwives ordinarily work in partnership or group practice with other midwives to provide primary care and 24-hour coverage to women and their newborns. In some communities, particularly where there are insufficient numbers of midwives to provide 24-hour coverage on a year-round basis, midwives may provide primary care in association with other practitioners, i.e. nurses or nurse practitioners. The caseload of each midwife may be lower than 30 to 40 per year as in most Canadian jurisdictions, however the practice not necessarily less busy. Midwives may be involved in other aspects of care such as well woman care, therapeutic abortion counseling and follow-up care, and family planning. In addition, midwives provide leadership and expertise in maternity education and training of other health care providers.

Midwifery Care in Multidisciplinary Environment

Midwives in the Northwest Territories collaborate with other health care providers with informed client consent and in the best interests of the client with the understanding that the client is the primary decision-maker about her own health. Midwives work within a multidisciplinary framework. Obstetricians, pediatricians, neonatologists, family physicians, nurses, nurse practitioners, public health nurses, social workers, nutritionists, and mental health workers are among the caregivers who may be involved in aspects of the care of the childbearing woman and her newborn from time to time. The roles and responsibilities of the various caregivers, and the relationships amongst caregivers, are clarified through the development of local policies and structures that ensure:

• The midwife is the primary care provider for the mother and newborn as per scope of midwifery practice unless primary responsibility is transferred to another caregiver.
• The midwife maintains a current record of midwifery care of mother and newborn and ensures that this information is available to other practitioners in the multidisciplinary team.
• The midwife is a member of a maternity care working group. The purpose of such an inter-disciplinary forum is to promote client safety and optimal client care through enhancement,  coordination, and integration of services to maternity clients.
• Midwives practice in accordance with the Standards for Collaborative Care, Guidelines for Medical Consultation and Transfer of Care to a Physician to ensure optimum client care. The goal of collaboration is to balance continuity of care with the provision of appropriate levels of service to meet the specific needs of each client in such a way that individualised client care is optimised.