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Implementing the Professional Standards

Implementing the Professional Standards

Setting and maintaining high professional standards is fundamental to public protection and public confidence in the midwifery profession. We need to ensure that the College of Midwives of Ontario standards of practice clearly set out the high standards we expect of all midwives. This led us to develop the new Professional Standards for Midwives (Professional Standards) which were approved by Council on March 21st, 2018. They came into effect on June 1, 2018.

The public interest is at the core of everything we do, and our principles-based approach to the standards is designed to benefit midwifery clients, the greater public, and the profession as a whole.

With the implementation of the Professional Standards, the College has changed from more prescriptive standards to a principles-based approach that defines the fundamental ethical and professional standards that the College expects all practices and individual midwives to meet.

While we anticipate that the change to the new, more principles-based Professional Standards will not have a major impact on the way that midwives practise, it is incumbent on each member to ensure compliance as of June 1, 2018. Some new standards have been introduced, and practice owners have additional responsibilities. Midwives must work in accordance with the principles and standards set out in the Professional Standards, as a failure to maintain a standard of practice of the profession may amount to professional misconduct.

You can read the Professional Standards here.

Please review the Question and Answer section of our site below, and send in any questions you may have about the new Professional Standards. We’ll share some of the answers here to provide guidance to all midwives implementing the standards. If you have a question to share please email in to cmo@cmo.on.ca and we’ll get back in touch as soon as possible.

 

Questions and Answers

Q: How much will the way I practise midwifery change?

A: While our approach to regulation has changed, it won’t necessarily alter the way midwives work.  Implementing the proposed changes will be relatively easy providing midwives continue to exercise sound professional and clinical judgment, and apply their knowledge and skills in the best ways possible in compliance with the legislation and regulations that govern their practice.

The Professional Standards sets out the minimum standards for the midwifery profession in Ontario. There is nothing in the standards that prevents midwives from continuing to work in the model of care as it is defined by the current college standards. For example, midwives can continue to work in groups of no more than four midwives, provide continuity of care in a way that ensures every client knows who will attend their birth and attend every birth with a second midwife. It is up to midwives to define midwifery in Ontario in a way that meets the needs of their clients as well as the minimum standards established by the College. The Professional Standards trusts that midwives know how to do this.

Q: Are there new standards midwives must adhere to?

A:  The following new standards were introduced under each principle in the Professional Standards:

  • Demonstrating professional knowledge and practice: standards 4, 9, 10, 11, 12
  • Providing person-centred care: standards 13, 22
  • Demonstrating leadership and collaboration: standard 25
  • Acting with integrity: standards 35, 36, 44, 45, 46
  • Being committed to self-regulation: standards: 51, 52, 53

Q: I am a practice owner, what are my additional responsibilities in the new Professional Standards?

A: The new standards that apply to practice owners under each principle in the Professional Standards are:

  • Demonstrating professional knowledge and practice: standards 10, 11, 12
  • Providing person-centred care: standards 22
  • Acting with integrity: standards 45, 46
  • Being committed to self-regulation: standards: 53

 

Q: Which standards have been rescinded?

A:   You can see a list of all the standards that have been rescinded here,  along with a brief overview of why they were rescinded. We list all archived standards on our website here.

Q: I had an Alternate Practice Arrangement (APA) Type 2 with the College and used a second birth attendant who is not a midwife. What will change now that the minimum standard allows all midwives to use second birth attendants?

A: With the implementation of the Professional Standards for Midwives on June 1, the Model of Care standard was rescinded, and the requirement for two midwives at a birth was replaced by the requirement of either two midwives or one midwife and a second birth attendant. This eliminated the need for midwives to work in APA 2s, and the program ended. All midwives working with second birth attendants as of June 1, 2018 must follow the College’s current Second Birth Attendant standard.

On October 1st, a new Second Birth Attendant Standard will come into effect to reflect the changes in the Professional Standards. The major changes to the second birth attendant standard are as follows:·

  • Second birth attendants will now be required to obtain a certificate of completion in the Canadian Paediatric Society’s (CPS) Neonatal Resuscitation Program (NRP) every 12 months and in obstetrical emergency skills (ES) every 2 years. Please review the CPS’s eligibility guidelines for becoming an NRP provider.
  • The new standard has been revised to address the midwife’s responsibilities rather than the second birth attendant’s accountabilities because the College’s standards are setting minimum requirements for midwives.
  • The details about clinical care and descriptions about acceptable and unacceptable tasks in the current second birth attendant standard have been removed because the midwife working with the second birth attendant is responsible for ensuring the competence of the second birth attendant and can assign tasks and delegate accordingly.

This new standard will come into effect on October 1, 2018, and midwives are encouraged to review it well in advance in order to make any necessary changes. You can see the standard that comes into effect on October 1st here.

The College of Midwives of Ontario has heard that some members are concerned about revisions to the College’s revised Second Birth Attendant Standard that comes into effect on October 1, 2018.  Specifically, members have shared concerns that the Second Birth Attendant Standard is too high for a layperson to meet, as currently the Canadian Paediatric Society’s NRP course will only certify regulated health professionals. Similarly, we have heard that second attendants should not be required to complete the same courses as midwives with regard to the training in obstetric emergency skills. Click here for our response to these concerns. 

Q: Why was the Vaginal Birth After Caesarean Section (VBAC) and Choice of Birthplace position statement revised?

A:  The College has revised our position statement on Vaginal Birth After Caesarean Section and Choice of Birthplace to reflect changes in the new Professional Standards. You can click here to read our position statement on Vaginal Birth After Caesarean Section and Choice of Birthplace. 

The VBAC position statement was revised rather than rescinded at the request of numerous midwives during the consultation for the Professional Standards. Informed choice and choice of birthplace are the two standards that the College’s position is based on.

Q: I work only in a hospital, how am I expected to provide choice of birthplace?

All midwives working in midwifery practice groups must provide choice of birthplace at all times (standard #18). However, midwives providing care in physician-led practice environments where home birth is not provided (e.g. work only in a hospital or provide prenatal or postpartum care to physician clients) do not fall below standard #18 when they do not offer choice of birthplace. The standard is interpreted this way because hospital birth is implicit in these practice environments, and so clients are considered to have already made a birthplace choice. Take an example of a midwife who joins a collaborative care team of physicians. In this role, the midwife provides care to clients during the prenatal, intrapartum, and postpartum period. All clients of the physcian group give birth at the local hospital. The midwife does not fall below standard #18 because of the practice environment. If the midwife changes practice environments and joins a midwifery practice group, they are expected to meet standard #18.

Q: Do the Professional Standards impact interprofessional collaboration?

With the implementation of the Professional Standards, the College’s expectations around continuity of care and collaborative care have changed. Previously, midwives were required to work in “a small group of no more than four midwives” and required an Alternate Practice Arrangment to be able to work with physicians in their communities. Standards #17 and #25 of the Professional Standards set the College’s new expectations for continuity of care and interprofessional collaboration. All midwives are able to work interprofessionally with other health care providers as long as they are able to meet these standards.