Healthcare

To Become a Registered Midwife (Pregnancy follow-up and birth in birth centers) in Ontario: Salary, Training, and Career Outlook.

by Occupations.ca Team
11 min read

Have you ever imagined guiding families through pregnancy, birth, and the first weeks with a newborn—often outside a Hospital setting? If you want a hands-on health career where you build long-term relationships and Support informed choice, becoming a Registered Midwife in Ontario—especially providing pregnancy follow-up and attending births in birth centres—could be the right path for you.

Job Description

Registered Midwives in Ontario are primary care providers for pregnancy, birth, and postpartum. You provide comprehensive, evidence-based care to healthy clients with low-risk pregnancies. You typically work in a continuity-of-care model, following each client from the first prenatal visit, through labour and birth, and up to six weeks postpartum. Clients choose where to give birth—at home, in hospital, or in a birth centre—and midwives support this choice within safe practice standards.

Midwives in Ontario are regulated by the College of Midwives of Ontario (CMO) and work within a defined scope that includes ordering lab tests and ultrasounds, prescribing select medications, and managing normal births. You collaborate with family physicians, obstetricians, pediatricians, and nurses when care needs to be transferred or shared. Many midwives have privileges at hospitals and deliver babies at the province’s two freestanding birth centres: the Toronto Birth Centre and the Ottawa Birth and Wellness Centre.

Key references:

Daily work activities

You split your time between clinic visits, on-call shifts for labour and birth, and postpartum home visits. Your day can include prenatal assessments, phone support, interprofessional meetings, and Quality Assurance tasks like documentation and data reporting. Because births are unpredictable, you work in call rotations with your practice partners.

Main tasks

  • Provide prenatal care: health history, physical exams, fetal monitoring, ordering tests and ultrasounds, discussing Nutrition, mental health, and birth planning.
  • Offer informed choice: explain options, Benefits, risks, and alternatives to support client-led decisions about tests, interventions, and place of birth.
  • Manage labour and birth at home, in birth centres, or in hospital, including continuous labour support and normal vaginal births.
  • Perform newborn care: initial assessment, routine newborn procedures (e.g., vitamin K), feeding support, and early detection of complications.
  • Deliver postpartum care: home visits in the first week, clinic visits up to six weeks, mental health screening, lactation support, and family planning counselling.
  • Prescribe select medications and order diagnostics within scope (per CMO standards).
  • Implement emergency skills when needed (e.g., neonatal resuscitation, managing postpartum hemorrhage, shoulder dystocia).
  • Collaborate with physicians and nurses when consultation or transfer of care is indicated.
  • Maintain clinical documentation and submit perinatal data to BORN Ontario.
  • Participate in on-call rotation, quality improvement, continuing education, and hospital/birth centre privileging processes.
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Useful references:

Required Education

Diplomas (Certificate, College Diploma, Bachelor’s Degree)

  • Bachelor’s Degree (required): A Bachelor of Health Sciences (BHSc) in Midwifery from an Ontario Midwifery Education Program (MEP) or an equivalent program approved by the regulator is the standard entry-to-practice route.
  • Certificate (bridging for internationally educated midwives): The International Midwifery Pre-registration Program (IMPP) provides a competency-based bridge for internationally educated midwives to prepare for registration in Ontario.
  • College Diploma (not qualifying for registration): There is no college diploma in Ontario that qualifies you for registration as a midwife. Related diplomas (e.g., Practical Nursing) do not replace the BHSc Midwifery requirement.

To practise in Ontario, you must register with the College of Midwives of Ontario and pass the Canadian Midwifery Registration Examination (CMRE).

Key links:

Length of studies

  • BHSc in Midwifery: 4 years of full-time undergraduate study, including clinical placements and on-call rotations.
  • IMPP (bridging for internationally educated midwives): typically 8–12 months (varies based on individual learning plans and assessment).
  • Additional requirements before practising:
    • Pass the CMRE.
    • Complete the CMO Jurisprudence Course.
    • Maintain certifications such as Neonatal Resuscitation Program (NRP) and Emergency Skills Workshop (ESW) (often required by hospitals and recommended by the AOM).
    • Obtain hospital privileges and/or birth centre credentialing if you plan to attend births in those settings.

Helpful links:

Where to study?

Ontario Midwifery Education Programs (MEP):

Bridging for internationally educated midwives:

Regulatory and professional bodies:

Salary and Working Conditions

How compensation works in Ontario

Midwives in Ontario are generally funded through the Ontario Ministry of Health Midwifery Program. Most work in midwifery practice groups as independent contractors under an alternative funding model tied to caseload (courses of care). Your income depends on:

  • Number of clients (births) you take per year.
  • Practice type and location (urban vs rural caseloads).
  • Role (practice partner/contract holder vs associate midwife).
  • On-call commitments, nights/weekends, and administrative responsibilities.

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Entry-level vs experienced salary

  • Entry-level (first years, reduced caseload while you build experience): approximately $80,000–$100,000 per year, depending on practice setting and caseload.
  • Experienced midwives (standard full caseload, established privileges, Leadership/admin duties): approximately $110,000–$150,000+ per year.
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Because income is tied to caseload and practice model, actual earnings vary. Review job postings and discuss compensation during interviews.

Hours and Scheduling

  • On-call: Expect 24/7 on-call rotations, including nights, weekends, and holidays, typically shared within your practice.
  • Workload: A common full-time caseload is around 30–50 births per year, with prenatal/postpartum visits and Travel time. Demand and call intensity vary by region.
  • Settings: Clinic, client homes (prenatal/postpartum care and home births), hospitals (if privileged), and birth centres.
  • Travel: You will often drive to clients’ homes and between clinical sites, especially if your practice covers a large geographic area.

Work environment and Safety

  • You will carry equipment for home and birth centre births, including emergency supplies.
  • You maintain certifications for NRP, ESW, and often CPR, and you follow CMO standards for safe care and informed choice.
  • Malpractice Insurance is arranged through the provincial program; see AOM for details: https://www.ontariomidwives.ca/insurance

Job outlook

Key Skills

Soft skills

  • Calm under pressure: Staying composed in fast-changing labour situations.
  • Communication and counselling: Explaining options clearly; supporting informed decision-making.
  • Cultural safety and humility: Providing respectful care to diverse families, including Indigenous, Black, newcomer, LGBTQ2S+, and rural communities.
  • Empathy and rapport-building: Forming trusting relationships across months of care.
  • Critical thinking: Recognizing when to consult or transfer care.
  • Teamwork: Collaborating with nurses, physicians, anesthesiologists, and paramedics.
  • Time Management: Balancing clinic, on-call, documentation, and home visits.
  • Resilience: Managing disrupted sleep, long hours, and emotionally intense situations.

Hard skills

  • Perinatal assessment: Fetal heart auscultation, Leopold’s maneuvers, growth tracking, and interpreting lab/Ultrasound results.
  • Intrapartum management: Labour support, normal vaginal birth, episiotomy/suturing when indicated, water birth (where permitted), and birth centre protocols.
  • Emergency skills: Managing postpartum hemorrhage, shoulder dystocia, neonatal resuscitation (NRP), and urgent transport.
  • Prescribing and ordering: Medications and diagnostics within scope (per CMO standards).
  • Fetal Health Surveillance (FHS): Interpreting electronic fetal monitoring and intermittent auscultation.
  • Newborn care: Initial exams, breastfeeding support, jaundice assessment, and early referral when needed.
  • Documentation and EMR: Accurate charting, incident reporting, and BORN Ontario submissions.
  • Hospital/birth centre privileging: Understanding bylaws, quality metrics, and interprofessional protocols.

Advantages and Disadvantages

Advantages

  • Continuity of care: You build meaningful relationships through pregnancy, birth, and postpartum.
  • Autonomy: As a primary care provider, you lead care within a clearly defined scope.
  • Choice of birthplace: Support clients in homes, hospitals, and birth centres—a unique aspect of Ontario midwifery.
  • Community impact: Improve access to culturally safe, family-centred care.
  • Clinical variety: Prenatal, intrapartum, newborn, and postpartum care with strong hands-on skills.
  • Professional growth: Opportunities in Teaching (MEP), leadership in practice groups, quality improvement, and rural/remote service.

Disadvantages

  • On-call lifestyle: Unpredictable hours, overnight work, and challenges balancing family life.
  • Physical demands: Long periods standing, lifting, driving, and carrying equipment.
  • Emotional intensity: Supporting clients through complex situations and outcomes.
  • Administrative load: Documentation, quality metrics, and data reporting.
  • Variable income: Tied to caseload and practice model; not a traditional salaried role.
  • Hospital privileging variability: Access and policies differ across hospitals and regions.
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Expert Opinion

If you’re considering becoming a Registered Midwife in Ontario, start by reflecting on your tolerance for unpredictability and your passion for relationship-based care. This profession rewards you with autonomy, trust, and continuity—but it also demands resilience and commitment to a 24/7 on-call lifestyle. Spend time talking with midwives in different settings—urban, suburban, and rural—to understand how caseloads, travel, and hospital relationships shape daily life.

Prioritize education programs that offer robust clinical placements and mentorship in birth centre environments if out-of-hospital birth interests you. During Training, lean into emergency skills (NRP, ESW) and Fetal Health Surveillance—these core competencies increase your confidence across all birth settings. You should also practice giving clear, unbiased Information to support informed choice, a cornerstone of midwifery in Ontario.

Finally, approach the career as a long-term team effort. The strongest practice groups protect sustainable call schedules, offer peer support after difficult cases, and invest in ongoing education. Ask about these factors when you interview. If you value autonomy, direct impact, and the privilege of being present at life’s pivotal moments, midwifery in Ontario—especially in birth centres—can be deeply fulfilling.

FAQ

Can I work primarily in a birth centre as a Registered Midwife in Ontario?

Yes. Many midwifery practice groups hold admitting/credentialed privileges at the Toronto Birth Centre and/or the Ottawa Birth and Wellness Centre. Your ability to attend birth centre deliveries depends on your practice’s credentialing and your clients’ eligibility. You will typically still maintain hospital privileges for transfers of care or clients who choose hospital birth. Birth centres: Toronto (https://www.torontobirthcentre.ca/) and Ottawa (https://ottawabirthcentre.ca/).

Do midwives remain primary providers if a client has an epidural or needs induction in hospital?

Often, yes—depending on hospital policies and the clinical situation. In many Ontario hospitals, midwives remain the most responsible provider for low-risk clients who choose epidural analgesia or undergo certain inductions, collaborating with anesthesiologists and nursing staff. If complications arise or risk increases, care may be shared or transferred to an obstetrician, as per local protocols and CMO standards.

What additional certifications help me succeed beyond the degree and CMRE?

Strong add-ons include the Emergency Skills Workshop (ESW), Neonatal Resuscitation Program (NRP), and Fetal Health Surveillance courses (SOGC). Many hospitals require these for privileging. Maintaining CPR and updating skills through the AOM’s continuing education options also helps. Links:

How do I find a student placement or observe midwifery care in Ontario?

Midwifery clinical placements are coordinated through the Midwifery Education Programs at TMU and McMaster. If you’re exploring the profession before applying, start by attending AOM events/webinars and contacting local practices to ask about informational interviews (formal shadowing is limited due to privacy and safety rules). Useful links:

What’s the difference between a registered midwife and a doula in Ontario?

A Registered Midwife is a regulated health professional and primary care provider who can order tests and ultrasounds, prescribe select medications, manage normal births, and provide postpartum/newborn care up to six weeks. A doula is a non-clinical support person offering emotional, physical, and informational support, but does not provide medical care or make clinical decisions. In Ontario, many families choose both a midwife and a doula for complementary support.

By focusing your training on Ontario’s standards and birth centre practice, keeping your emergency skills current, and learning how to balance on-call life, you can build a rewarding career as a Registered Midwife delivering safe, client-centred care across clinic, home, hospital, and birth centre settings.

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