He Hu applied to take upgrading courses for experienced midwives from the College of Midwives of Manitoba in 1999. This upgrading program was funded by the Manitoba Government. This was a one-time initiative to ensure that there would be registerable midwives at the time of proclamation of the Midwifery Act on June 12, 2000. He Hu underwent a qualifications assessment and took an English communication skills test. She then attended the first three-month, 18-module upgrading session offered by the College. Shortly after, she passed the North American Midwifery Exam (the credentialing exam for Manitoba prior to June 12, 2000).