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Autumn On Call – Changes to the Prescribing and Administering Drugs Standard

November 15, 2019

Note: This article was originally published in our Autumn 2019 edition of our On Call newsletter, and has not been updated.

On October 9, 2019, the College of Midwives of Ontario’s (College) Council made two revisions to the College’s Prescribing and Administering Drugs Standard (Standard).

The revisions to the Standard are UNRELATED to the College’s current work on the proposed changes to its Designated Drugs Regulation. Once the amended regulation is approved by the government and comes into effect, further changes to the Standard will be made.

The following two revisions are effective immediately:

Revision 1: Council rescinded Appendix 1 to the Standard, which means that oxytocin is no longer limited to the post-partum period. Midwives can now work in accordance with the current Designated Drugs Regulation, which permits midwives to administer oxytocin by injection on their own authority, without any limitations.  

This revision reflects current midwifery practice, which includes induction and augmentation of labour. Midwives are authorized under the Midwifery Act, 1991 to perform amniotomies for induction and augmentation, but were prevented from using oxytocin for this purpose because the College’s Standard limited its use to the post-partum period.

While this change means midwives are now able to administer oxytocin on their own authority for induction and augmentation, midwives must administer oxytocin only if they have the required knowledge, skills, and judgment to safely do so.

In accordance with the Professional Standards for Midwives, when administering oxytocin for induction and augmentation, midwives must also meet the below standards. Failing to maintain a standard of practice of the profession constitutes professional misconduct under the College’s Professional Misconduct Regulation.

Work within the boundaries of the Midwifery Act, 1991 related to scope of practice and the controlled acts authorized to midwives.

Be competent in all areas of their practice.

Know, understand, and adhere to the standards of the profession and other relevant standards that affect their practice.

Offer treatments based on the current and accepted evidence, and the resources available.

Order tests or prescribe medications only when they have adequate knowledge of clients’ health and are satisfied that tests and medications are clinically indicated.

Be accountable and responsible for clients in their care and for their professional decisions and actions.

Consult with or transfer care to another care provider when the care a client requires is beyond the midwifery scope of practice or exceeds their competence, unless not providing care could result in imminent harm.

Revision 2: The term “prescription number” has been removed from the Standard to reflect current prescribing practices.

If you have any questions or require additional information, please email   practiceadvice@cmo.on.ca or call 416.640.2252 x 230.

Available Resources

The Association of Ontario Midwives (AOM) offers a course on Induction and Augmentation of Labour. In light of Council’s decision, the AOM is determining when it would be feasible to schedule this course. Interested midwives can email laura.darocha@aom.on.ca to indicate their interest and be placed on the waiting list.

Midwives who need to develop or update their knowledge and skills of oxytocin induction and augmentation can also refer to resources such as:

  1. The AOM resources at: www.ontariomidwives.ca/induction-augmentation
  2. Safe Administration of Oxytocin: Standardizing Practice to Promote Safe Induction and Augmentation of Labour, August 2019, The Provincial Council for Maternal and Child Health (PCMCH
  3. SOGC Clinical Practice Guideline on Induction of Labour (September 2013)