Public Consultation – Alternative Practice Arrangements

10 Aug 2022

The Midwifery Regulatory Council of Nova Scotia (MRCNS) is currently considering permitting Alternative Practice Arrangements (APAs) for Registered Midwives in Nova Scotia.

About this consultation

The mandate and legislated duty of the Midwifery Regulatory Council of Nova Scotia (Council) is to serve and protect the public interest by regulating the practice of midwifery. The Council registers qualified, competent midwives to provide safe, high-quality care to birthing people and their families in Nova Scotia. We ensure midwives meet the highest standards through (1) Regulating the practice of midwifery in accordance with the registration, licensing and professional conduct processes set out in the Midwifery Act and the Council’s regulations (2) Establishing, maintaining and promoting Standards of Midwifery practice (3) Approving and promoting the Code of Ethics

MRCNS’s commitment to evidence-based regulation requires a robust approach to policy development. This means revisions to the Council policies and standards are based on numerous factors including an evaluation of risks of harm, research, and an analysis of options and impacts. This process ensures that our regulatory tools are implemented to mitigate risk and serve the public interest. 

Consultation with midwives, regulatory organizations, and the public is an essential part of our policy development process, and in keeping with our mandate to serve and protect the public interest by regulating the practice of midwifery. 


Since the inception of Midwifery Act in Nova Scotia in 2009 Registered Midwives have only worked within the standard employment model for the either of the two heath authorities, the IWK and Nova Scotia Health. 

The Alternate Practice Arrangement (APA) process has been developed to support interprofessional care models and in response to requests from midwives for flexibility in the delivery of midwifery care outside of the health authorities. 

Key points

APAs are carefully monitored and transparent perinatal care arrangements that offer midwifery care outside the standard model.

APA’s  are midwifery care, subject to all MRCNS regulations, bylaws and standards of practice, requiring an exemption from Standards 6.1, which outlines comprehensive midwifery care throughout pregnancy, labour, birth and the postpartum period. 

APAs are established based on community, client and/or provider need. This may include but is not limited to serving a population of clients with unique social and/or medical requirements, and/or sustainable practice amongst midwives and/or other perinatal care providers.

APAs are intended to support those midwives who have innovative proposals to contribute to the health care needs of their community, or who require flexible work options to remain in the profession. 

How can you participate?

Please review the proposed MRCNS Policy of Alternative Practice Arrangements and the associated documents, application for an Alternative Practice Arrangement and Letter of Agreement.


  1. Are risks of harm to the public addressed? For example, does the policy have sufficient detail?
  2. Would this policy increase access to midwifery care for the public?
  3. Is there anything missing?

How to provide feedback

You may submit your comments on this page.

All comments are reviewed before being posted publicly.  The MRCNS reserves the right to refuse to post feedback, in whole or in part, that, in its sole discretion: is unrelated to the policy or issue under consultation; contains complaints and/or compliments about named midwives; is abusive, obscene, harassing/threatening or includes defamatory or libelous comments.

Your name and email will not be published with your feedback; however, you will be identified as a member of the public, a midwife, or a partner in healthcare. Email addresses are required to ensure that individuals provide feedback only once. If you prefer to provide feedback using a different format, including email, or if you have any questions about the consultation, please contact the Registrar at

This consultation process is in place until September 5th, 2022

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