July 10, 2018
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.
As midwives are aware, the College rescinded the standard requiring two midwives at every birth, as there is no evidence to support the need for two primary care providers at a birth. There are, however, recommendations that every birth be attended by a primary care provider and a second individual who has primary responsibility for the newborn, including the skills to perform neonatal resuscitation.
For our Second Birth Attendant Standard, we are following a recommendation from Public Health Agency of Canada, 2000. Although this source is 18 years old, we refer to it in the absence of current national guidelines or recommendations regarding the complement of care providers at a birth.
The College has a duty to the public to set a minimum standard of required performance for midwives. Our Second Birth Attendant Standard assures that midwifery managed home births, where there are fewer human resources to rely on, are attended by a skilled second individual.
That is why College Council made a decision to require that all second birth attendants who provide care in homes or other out-of-hospital locations hold a certificate of completion in NRP. This brings Ontario in line with other midwifery regulators in Canada such as British Columbia, Alberta, Saskatchewan, Manitoba and Nova Scotia.
Council also decided to require second birth attendants who provide care in homes or other out-of-hospital locations to hold a certificate of completion in an obstetrical emergency skills program. The revised standard requiring all second birth attendants hold certificates of completion is the College’s way of assuring the public that their care providers have demonstrated the knowledge and skills required to participate in an obstetrical emergency.
The College relies on the organizations delivering the programs to determine participant eligibility, course content, and the process for certification. Access to care and advocating for change are not the purview of the College. The College recognizes the Canadian Paediatric Society as the experts even if their eligibility criteria limit the pool of potential second birth attendants.
We have an obligation to Ontario families, and are unable to lower our standard if some midwives do not agree with the available courses or if some second birth attendants are unable to participate in them.
It is essential to remember that the College is only one small part of a complex system of care that works in the public interest, and the quality of clients’ care is the culmination of decisions made by many organizations with a stake in midwifery. Revisions to the Second Birth Attendant Standard exemplify the limits to our statutory powers and our reliance on other midwifery stakeholders. For issues that fall outside our remit, the onus is placed on the organizations with more expertise in this area.