The Transition to Clinical Practice for New Registrant Midwives in Ontario, Canada

  • Christine Sandor
  • Beth Murray-Davis
  • Meredith Vanstone
  • Corey Bryant


Midwives in Ontario are integrated into the provincial health-care system, providing primary antenatal, intrapartum, and postpartum care to low-risk women throughout pregnancy and for 6-week postpartum. Midwives are educated through a 4-year direct-entry, university-based Bachelor of Health Science program or, if internationally trained, through a 9-month bridging program. During the first year of clinical practice, newly qualified midwives are known as new registrants and are subject to a number of practice restrictions outlined by the College of Midwives of Ontario (CMO). While there is limited research regarding the new registrant year, a qualitative study identified three phases—building, bridging, and being—through which new registrants progress as they transition to clinical practice. There is considerable variation with respect to the experience of new registrants during the transition to clinical practice; however, four elements—preparation, orientation, mentorship, and ongoing education—help new registrants navigate the experience of commencing clinical practice. In order to offer a more standardized approach to supporting Ontario midwives in the first year of clinical practice, it may be beneficial for midwifery stakeholders to look to established transitional models employed in midwifery communities outside of Canada.


Midwifery Midwives New graduate New registrant Transition to practice Ontario Canada 



Association of Ontario Midwives


Billable course of care


College of Midwives of Ontario


Canadian Midwifery Registration Exam


Midwifery Education Program


Midwifery First Year of Practice Program


List of Terms

Full scope

Midwives who maintain care for low-risk clients who require oxytocin infusion for induction or augmentation of labor and/or epidural analgesia

Limited scope

Midwives who are required to transfer care to an obstetrician when a client requires epidural analgesia and/or oxytocin infusion for labor induction or augmentation

New registrant

Registered midwife in the first year of independent clinical practice

Primary call

Call model where midwives carry a caseload of four clients per month; off-call time typically includes one or two weekends off call per month and 2–3-month vacation per calendar year

Primary midwife

Midwife who assumes responsibility for the care of a women during the intrapartum and immediate postpartum period (Ontario Regulation 168/11 1991)

Second midwife

Midwife in attendance at a birth who assumes responsibility for the immediate assessment and care of the newborn following birth (Canadian Midwifery Regulators Consortium 2010)

Shared call

Call model where midwives work in teams of two to four and clients are assigned to a team rather than to a particular midwife; midwives within the team rotate call coverage with at least one midwife from the team on call at any time


  1. Association of Ontario Midwives. Maintaining primary care for clients who access induction, augmentation or epidural; 2011, January. pp. 1–4.Google Scholar
  2. Association of Ontario Midwives. Association of Ontario midwives. 2015. Available at: Accessed 25 Oct 2017.
  3. Association of Ontario Midwives. Choice of birthplace. 2017a. Available at: Accessed 23 Nov 2017.
  4. Association of Ontario Midwives. Midwifery Q & A. 2017b. Available at: Accessed 23 Nov 2017.
  5. Butler MM, Hutton EK, Mcniven PS. Midwifery education in Canada. Midwifery. 2016;33:28–30.CrossRefGoogle Scholar
  6. Cameron C. Becoming and being a midwife: a theoretical analysis of why midwives leave the profession. CJMRP. 2011;10(2):22–8.Google Scholar
  7. Canadian Association of Midwives. Midwifery education in Canada. 2015. Available at:
  8. Canadian Association of Midwives. Midwifery education in Canada. 2017a. Available at:
  9. Canadian Association of Midwives. Midwifery across Canada. 2017b. Available at: Accessed 25 Oct 2017.
  10. Canadian Midwifery Regulators Consortium. Canadian model of midwifery practice. 2010.Google Scholar
  11. Canadian Midwifery Regulators Consortium. Requirements for initial registration as a midwife in a Canadian jurisdiction. 2011.Google Scholar
  12. Casey K, et al. The graduate nurse experience. J Nurs Adm. 2004;34(6):303–11.CrossRefGoogle Scholar
  13. Chandler GE. Succeeding in the first year of practice: heed the wisdom of novice nurses. J Nurses Staff Dev. 2012;28(3):103–7.CrossRefGoogle Scholar
  14. Charnley E. Occupational stress in the newly qualified staff nurse. Nurs Stand. 1999;13(April):7–13.Google Scholar
  15. Clements V, Fenwick J, Davis D. Core elements of transition support programs: the experiences of newly qualified Australian midwives. Sex Reprod Healthc. 2012;3(4):155–62.CrossRefGoogle Scholar
  16. College of Midwives of Ontario. New registrants policy. 2005.Google Scholar
  17. College of Midwives of Ontario. Guidelines to the new registrants policy. 2006.Google Scholar
  18. College of Midwives of Ontario. Consultation and transfer of care. 2014a.Google Scholar
  19. College of Midwives of Ontario. Epidural monitoring and management. 2014b.Google Scholar
  20. College of Midwives of Ontario. Induction and augmentation of labor. 2014c.Google Scholar
  21. College of Midwives of Ontario. The Ontario midwifery model of care. 2014d.Google Scholar
  22. College of Midwives of Ontario. Second birth attendants. 2015.Google Scholar
  23. College of Midwives of Ontario. New registrant clinical experience reporting form. n.d. pp. 1–2.Google Scholar
  24. Duchscher JEB. Out in the real world newly graduated nurses in acute-care speak out. J Nurs Adm. 2001;31(9):426–39.CrossRefGoogle Scholar
  25. Duchscher JB. A process of becoming: the stages of new nursing graduate professional role transition. J Contin Educ Nurs. 2008;39(10):441–50.CrossRefGoogle Scholar
  26. Ellis C. Assessment of the midwifery education program at the University of British Columbia – a survey of graduates and midwife mentors. Can J Midwifery Res Pract. 2013;12(1):8–18.Google Scholar
  27. Fenwick J, et al. Surviving, not thriving: a qualitative study of newly qualified midwives’ experience of their transition to practice. J Clin Nurs. 2012;21(13–14):2054–63.CrossRefGoogle Scholar
  28. Fink R, et al. The graduate nurse experience. J Nurs Adm. 2008;38(7):341–8.CrossRefGoogle Scholar
  29. Heitz LJ, Steiner SH, Burman ME. RN to FNP: a qualitative study of role transition. J Nurs Educ. 2004;3(9):416–20.Google Scholar
  30. Hughes AJ, Fraser DM. “SINK or SWIM”: the experience of newly qualified midwives in England. Midwifery. 2011;27(3):382–6.CrossRefGoogle Scholar
  31. International Confederation of Midwives. International definition of the midwife. 2017.Google Scholar
  32. Jordan R, Farley CL. The confidence to practice midwifery: preceptor influence on student self-efficacy. J Midwifery Womens Health. 2008;53(5):413–20.CrossRefGoogle Scholar
  33. Kaufman K, et al. Graduates’ views of the Ontario midwifery education program. Can J Midwifery Res Pract. 2007;6(1):7–12.Google Scholar
  34. Lavis JN, Hammill AC. Care by sector. In: Lavis JN, editor. Ontario health system: key insights for engaged citizens, professionals and policymakers. Hamilton: McMaster Health Forum; 2016. p. 209–69.Google Scholar
  35. Mattison CA, Lavis JN. Delivery arrangements 2: workforce. In: Lavis JN, editor. Ontario health system: key insights for engaged citizens, professionals and policymakers. Hamilton: McMaster Health Forum; 2016. p. 175–207.Google Scholar
  36. Midwifery Education Program. Policy and information handbook. 2017.Google Scholar
  37. Ontario Hospital Association. Resource manual for sustaining quality midwifery services in hospitals. 2010.Google Scholar
  38. Ontario Regulation 168/11. Midwifery Act, 1991. 1991. Available at: Accessed 10 Jan 2018.
  39. Pairman S, et al. The midwifery first year of practice programme: supporting New Zealand midwifery graduates in their transition to practice. N Z Coll Midwives J. 2016;52:12–20.CrossRefGoogle Scholar
  40. Robertson LJ, Griffiths S. Graduates’ reflections on their preparation for practice. Br J Occup Ther. 2009;72(3):125–32.CrossRefGoogle Scholar
  41. Rosenfeld P, et al. Nurse residency program. JONA: J Nurs Adm. 2004;34(4):188–94.CrossRefGoogle Scholar
  42. Sandor C. Building, bridging, being: the transition to clinical practice for new registrant midwives in Ontario: McMaster University; 2018.Google Scholar
  43. The G. Raymond Chang School of Continuing Education. International midwifery pre-registration program (IMPP). 2014. Available at:
  44. University of British Columbia. Internationally educated midwifery bridging program. 2015. Available at: Accessed 28 Apr 2015.
  45. van der Putten D. The lived experience of newly qualified midwives: a qualitative study. Br J Midwifery. 2008;16(6):348–58.CrossRefGoogle Scholar
  46. Versaevel N. Why do midwives stay? A descriptive study of retention in Ontario midwives. Can J Midwifery Res Pract. 2011;10:29–45.Google Scholar
  47. York Community Services Centre & Community Midwives of Hamilton MPG#110. Agreement between the transfer payment agency and the practice group. 2009.Google Scholar
  48. Zinsmeister LB, Schafer D. The exploration of the lived experiences of the graduate nurse making the transition to registered nurse during the first year of practice. J Nurses Staff Dev. 2009;25(1):28–34.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Christine Sandor
    • 1
  • Beth Murray-Davis
    • 1
  • Meredith Vanstone
    • 2
  • Corey Bryant
    • 1
  1. 1.Department of Obstetrics & GynecologyMidwifery Education Program, McMaster UniversityHamiltonCanada
  2. 2.Department of Family MedicineMcMaster program for Education Research, Innovation & Theory (MERIT), McMaster UniversityHamiltonCanada

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