Supervised Practice

Standard on Supervised Practice

The College of Midwives of Manitoba (the College) is mandated to protect the public interest by regulating the profession of midwifery under the Midwifery Act and the accompanying Regulation. Therefore, the Board of Assessors of the College develops all supervised practice arrangements and may modify any supervised practice arrangement at its discretion. The Standard on supervised practice applies to registered midwives who require temporary supervision. Supervised practice means that a registered midwife has, for any reason a condition placed on her registration by the Board of Assessors requiring that another registered midwife supervises her practice. The condition is clearly indicated on the midwife’s annual registration card.

This supervision may consist of either:
1. General Supervision

The midwife is supervised in all aspects of practice for a maximum of 12 months and a normal minimum of 6 months

OR

2. Limited Supervision

Supervision only in specific circumstances for assessment of discrete areas of practice (e.g. at hospital births) for a maximum of 12 months.  If a midwife has a requirement for limited supervision, she may practise independently in all areas of midwifery except for the area under supervision.

Determining the Need for Supervision

Supervised practice is required if the midwife:

1. Has never worked as a registered midwife in Canada
2. Does not meet the currency requirements for renewal of registration with the College (Standard on Currency Requirements for Maintaining Registration)
3. Requests a period of supervision. A midwife may decide that her practice would benefit from a period of supervision
4. Wishes to expand the services she provides. For example if a midwife who has not provided primary care in a hospital setting wishes to do so, she would need supervision in that setting for a period of time
5. Is found, through a complaints, audit or disciplinary process of the College, to need supervision in a limited or general area of practice

Supervising Midwives
The supervising midwife will be a registered practising midwife who has:

• Demonstrated midwifery knowledge
• Clinical experience that meets or exceeds the requirements for initial registration
• Demonstrated practice experience in the Midwifery Model of Practice in Manitoba
• Has practised for one year without conditions on her own registration, except for the following:

-Supervision of in-hospital births may be provided by an approved physician working in collaboration with a registered supervising midwife

-Supervision of a discrete skill or competency e.g. suturing or IV skills, which may be provided by a physician, nurse or other practitioner authorized to provide such care

Supervision Agreements
Supervision agreements include:

• A named primary supervisor
• Named delegated supervisors to provide supervision in the absence of the primary supervisor
• Provision for alternate supervisors arranged on short notice (due to unexpected circumstances) in the following order of preference:

1. Registered midwife who has previously held a supervisory role
2. Registered midwife who is not under supervision
3. Physician

• Requirements for peer case review
• Requirements for the submission of quarterly reports to the Registrar from both supervisor and supervised midwife

For more detailed information about supervision agreements please contact the College to request the following documents:

• Procedure for the Establishment
• Implementation and Completion of Supervision
• Guideline for Supervision

General Expectations
It is expected that supervision will progress through the following stages:

• The supervised midwife will observe the provision of midwifery care by a registered midwife
• The supervised midwife will be directly supervised in the provision of midwifery care
• The supervised midwife will provide care without direct supervision. During this stage, supervision will take the form of regularly scheduled retrospective chart review. The supervisor or delegate must continue to attend all births with the midwife under general supervision. For the midwife under limited supervision, attendance at births by the supervisor will be specific to the individual supervision agreement (i.e. hospital births)
• To ensure that supervision is at arms length, the Board of Assessors may also assign an auxiliary supervisor as required to complete additional chart reviews and report separately to the College. All parties will discuss the process of appointment of the auxiliary supervisor

It is expected that the midwife under supervision actively seek out appropriate opportunities for learning.

It is expected that the midwife and her supervisor will collaborate with the Board of Assessors to complete the period of supervision. If the midwife and her supervisor are unable to work cooperatively, the midwife or supervisor may apply to the Board of Assessors for a new supervision agreement. Guidelines for appeals may be obtained from the College.