Alberta Health Services (AHS) has recently implemented a mandatory vaccine policy. The policy applies to all Midwifery Staff. This requires Midwifery Staff who are to continue providing AHS services to be vaccinated unless they are eligible for a medical exemption. Midwives are required to provide proof of vaccination against COVID-19 to AHS along with their practice leads, or take a leave of absence from AHS. For further information please refer to the communication sent out to AHS Midwifery Staff dated September 29, 2021.

Vaccines play an important role in protecting the most vulnerable, particularly those from communities who have been disproportionately impacted by COVID-19 and those who are in a higher risk category for severe illness, including pregnant people. The College of Midwives of Alberta (CMA) strongly encourages all eligible midwives and clients to get vaccinated.

No changes have been made to CMA requirements. CMA does not require AHS privileges as part of registration requirements.

Midwives who choose to take an LOA from AHS can maintain registration with the CMA, so long as they provide a current liability insurance certificate. The AAM has confirmed that liability insurance is not predicated upon AHS privileges. Midwives do not require AHS privileges as a part of their registration requirements.

No, the policy applies to all AHS Midwifery Staff and contracted service providers. AHS will not fund services provided by AHS Midwifery Staff who are not fully immunized regardless of where services are provided. For specific billing questions regarding clients currently in care, please contact the PMAO office for further guidance. If midwives maintain their CMA registration, those who choose not to disclose their status with AHS or decline to receive a vaccine would be able to enter into an agreement with a client in a private pay model. Please refer to CMA Policy# 17 Registered Midwives Contracting Private Pay Clients.  

According to AHS PMAO communication dated September 29, 2021 - Effective December 13, 2021 practice leads must have submitted a declaration of compliance form to AHS and cannot contract or employ any midwifery staff that are not fully vaccinated. 

When considering a new community midwifery practice, CMA expects midwives to uphold existing Standards of Practice, Code of Ethics, and professional conduct including maintaining competencies. 

For private pay billing policy information please see CMA Policy #17 Registered Midwives Contracting Private Pay Clients. This policy covers contracting with clients, schedule of payments, and sale of supplies and products to clients. 

For further guidance on the following topics which fall outside CMA regulatory mandate:

We recommend midwives contact AHS PMAO for Immunization policy interpretation on the following:

• process for taking an AHS LOA,
• midwifery practice clinic space, 
• second birth attendant funding,  
• working with another midwife or staff in the clinic, 
• compensation from AHS for contracted work up to and including December 13, 2021, and
• process for identification for planned community births.

We also recommend that you contact AAM to discuss the following:

• billing details related to clients, 
• contract interpretation for clinics,
• workload planning, and
• ability to transfer client care to hospital if needed.

CMA has been informed that midwives can take an LOA from AHS for up to 2 years. The CMA Standards of Practice, Code of Ethics and applicable policies must be followed by all midwives choosing to take an LOA from AHS and remain registered with the CMA.

Starting with the clients with due dates before December 31, 2021, you must arrange designated ongoing care with your clients in accordance with the CMA Standards of Practice on client-centered care and the CMA Informed Choice Policy # 18.

1) Explain your situation to the client(s),

2) disclose your professional plan, and

3) conduct an informed choice discussion to review the options for care available to them, based on the client’s choice of birthplace.

NOTE: CMA is finding that clients are SHOCKED and dismayed by this sudden change to their situations. This is an area where you will have to work very carefully with your clients.

CMA recognizes that interaction with clients on this subject may become emotional and difficult. Please consult the existing CMA Social Media Usage policy and the new draft CMA policy on Ending the Client/Midwife Relationship as indicated.

Options are in accordance with client-centered care:

a) If the client chooses a community birth, the client can stay with you under a private pay plan.

b)  If the client plans for a hospital birth, the client can go under care of another midwife who has hospital privileges from your former clinic or another clinic.

c) Client can go under care of their family doctor, low risk maternity physician or another physician who is willing to accept care.

d) If you and your client cannot come to an agreement, and you would formally terminate the relationship and discharge the client from your care. In this case, the client would be able to seek care from any care provider on their own. Depending on their due date, they could put their name back on the client data base on the AAM website.

CMA expects that this discussion should include all options. All midwives who will be taking an LOA from AHS are required to have a thorough discussion with their clients regarding their choice of birthplace and continuing midwifery care, including the limitations caused by the new mandate.

Documentation of your concrete plan of care and designated care provider must appear on the client chart with acknowledgement of agreement with the client; these are requirements of the CMA.

As per CMA Standards of Practice, midwives whose clients choose not to continue with their current midwife/care are required to find an alternative care provider for their clients. Clients should be made aware that another midwife may not be available to take their care and care may be transferred to a physician.

Clients are able to request their care be transferred due to a midwife’s vaccination status. The midwife should make an effective, courteous, and prompt referral to another midwife or physician in accordance with the CMA Standards of Practice.

Clear communication with the client, EMS and receiving care provider is imperative whenever an urgent transfer of care is identified. 

To ensure a safe and smooth transport from planned community birth to hospital, the CMA requires each registered midwife to have hospital arrangements in place before providing community birth services. Registered Midwives without Privileges (RMWPs) will not be able to go into AHS facilities to conduct a transfer of care report with the health care professional designated to receive information from a requested transfer of care. RMWPs will be expected to conduct a phone call report. A document from CMA will be emailed shortly, outlining details of this transfer of care event, as soon as all information is discussed with AHS.

If EMS transport to hospital from community is required, the midwife shall call EMS or RAAPID to initiate a transfer of care to the receiving MRP. A written communication report should accompany the client to ensure safe continuation of care. 

The client must be fully aware that the midwife would not be able to provide care within an AHS facility.

New Registrants are considered members of the AHS midwifery staff, and under the same mandate as all Registered Midwives. The New Registrant Program is a program managed by the CMA. New Registrants who either are not choosing to comply with the AHS policy or have mentor(s) who are not choosing to comply with the AHS policy must contact the Registrar at the CMA as soon as possible. A new mentor arrangement is needed.

Students are required to be vaccinated. For students who have a preceptor who chooses to not comply with the AHS policy, a new preceptor arrangement is needed. For information please contact Mount Royal University BMid Program. 

Second Birth Attendants in community birth do not require AHS privileges. AHS is clear that there will NOT be a co-midwife’s funding paid to them via AHS for midwifery services. Further deliberation will occur among AHS, CMA, and AAM about this matter.

AHS has confirmed that they will not be providing funding for any midwifery services for midwives who are on an LOA. According to the CMA Policy# 17 Registered Midwives Contracting Private Pay Clients, you can charge clients for care in alignment with the current compensation arrangements for midwives in Alberta. CMA expects you to follow this policy in terms of setting up a contract with any private pay clients.

In these transition times it is easy to misjudge your stamina and capability with a midwifery workload. CMA states in the Workload Policy that about 35-45 COC-equivalents may be the optimal goal for a full-time midwife. While CMA records birth number reports from midwives every year at renewal, exact true numbers may not be reflected. Midwives are strongly encouraged to pay attention to their workload obligations, get enough sleep, and monitor themselves well to be able to practice with adequate energy and appropriate professional judgement.

It is each midwife’s professional responsibility to ensure that they are fit to practice and make safe decisions regarding clinical workload.

Please see the CMA policy: Policy# 19 Midwifery Workload.

Registered Midwives currently registered with the CMA will remain so until December 31, 2021. Registration Renewal for 2022 will be open from early November until December 10/21. RMs have the option to renew their registration or take an LOA. If you do not inform the CMA about your 2022 registration status, that path ultimately leads to a suspension and cancellation of registration with CMA.

An LOA can be taken on the CMA register if you have been fully registered as a midwife in the 2021 year. You can take an LOA from the CMA for up to two years. During this time, your name will appear on the “suspended” category on the register. Beyond two years in this category, you will have to start your registration application from the beginning. If you re-register before the two year mark, upon return, you would have to meet the Continuing Competence requirements related to your compulsory assessments (NRP, ES, FHS, CPR, etc.), your birth numbers requirements and any other competence requirements from CMA. If you do not meet the requirements, you may have to go through CMA Registration Committee’s review.

** RMs who are currently on an LOA are encouraged to contact CMA for information about your specific situation.

If you plan to work in Alberta in a community midwife capacity, you must be registered. If you are not registered with the CMA, the client’s drug insurance company will not honor your prescriptions, you will not have a Practice ID, and you will not be able to access the lab.

In additions, you may face legal action from CMA re: use of midwife title or doing midwifery care without registration.

You can pay for three months and the fees will be prorated. At the three month mark, your registration status will change to “Suspended” due to an LOA and you can keep this status for up to two years with the CMA.

Midwives are required by the CMA to provide evidence-based recommendations regarding all vaccinations, in line with the midwifery standards of practice, provincial, and federal public health guidance. Information should be given to clients regarding protection and prevention measures, including vaccinations, masking, hand-washing, and social distancing, and that information must be grounded in science and best practice.

CMA expects that midwives will conduct an informed choice discussion with clients around getting the vaccine. Midwives should ask clients what they already know, to be able to provide factual evidence and dispel some concerns and myths surrounding the COVID-19 vaccine, and then go through what, when, where, how and why the vaccine may be recommended for them. An informed choice discussion should include the risks and benefits of the option, the risks and benefits of the alternatives, including to do nothing or wait. Clients should have the opportunity to ask questions and the midwife should support their decision. The discussion and decision clients have made must be documented in the chart. See the Informed Choice policy for more information.

A registered midwife must comply with the CMA Standards of Practice at all times, regardless offsetting or hospital privilege status. Just like usual, based on the Standards of Practice, CMA will require that you conduct an unbiased, complete Informed Decision-making process with your client. Client choice is based on the completeness of your informed choice discussions. You will document the conversation and the decision the client made in their chart.

The CMA does not have a policy regarding mask wearing for midwifery clients, however, mask-wearing continues to be required for all indoor activities per the Government of Alberta legal restrictions. The College does require midwives to follow current best practice for infection prevention and control which includes wearing masks during all client interactions during the COVID-19 pandemic. If clients do not wish to wear a mask, or are unable to, practices should have face shields available. Hand washing or hand sanitizer is strongly encouraged prior to all clinical interactions. For more information regarding provincial masking requirements please see the Alberta Government’s website on COVID-19 restrictions during the pandemic and the Infographic.

Midwives are reminded to rely on verifiable evidence-based information from reliable sources when communicating with their clients in person and/or on social media platforms about issues related to the pandemic. If you are providing advice that does not align with best evidence or information being provided by public health officials and all levels of government, your comments or actions can lead to harm and make you vulnerable to be the subject of a complaint or Registrar’s investigation. The CMA’s Standards of Practice provide a framework for decision making in a wide range of situations. This includes offering treatments based on the current and accepted evidence and resources available. Midwives must practice with integrity and recognize the inherent power imbalance in the midwife-client relationship may be magnified by the current pandemic. As such, any messaging should be clear and correct. Please see CMA Policy #14 on Social Media Usage.

COVID-19 testing is done by self-referral. Direct clients to the self-assessment questionnaire created by the Government of Alberta to request COVID-19 testing at alberta.ca/covid. COVID-19 vaccinations are carried out by Public Health. More information on booking vaccinations for clients is available on the government website.