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Standards Review: NEW

Standards Review: Important Changes Coming into Effect on June 1st, 2021

At its December meeting, Council made a number of important decisions regarding College standards of practice that will come into effect on June 1, 2021.

These changes follow two rounds of consultations with midwives, including a 9-week public consultation held last year during which midwives, the public and a wide range of stakeholders took the opportunity to provide feedback on our proposals.

The following changes were approved.

  1. The following standards of practice will be rescinded
    • Consultation and Transfer of Care Standard (CTCS)
    • When a Client Chooses Care Outside Midwifery Standards of Practice
    • Delegation, Orders and Directives
  2. The following document will be implemented
    • The Midwifery Scope of Practice describes the legislative scope of practice and will replace the CTCS.
  3. The following standards and guiding documents will be amended
    • The Professional Standards for Midwives to:
      • set minimum expectations for midwives after a transfer of care (standard #26)
      • include additional standards on delegation (standard #31) and to revise the definition of “delegation” in the Glossary of Terms
    • The Guideline on Ending the Midwife Client Relationship to provide guidance to midwives in situations when a client chooses care that falls below a standard of the profession.

See the revised documents.

Why is the College making these changes?

In 2016, we adopted a principles-based approach for developing the standards of practice; an approach that relies on broad principles, rather than rigid rules that midwives must follow. Adopting this approach required a review of all of the College’s existing standards in two discrete phases. The first phase of the standards review involved developing and implementing the Professional Standards for Midwives and rescinding 25 of the College’s existing standards on June 1, 2018. The second phase of the standards review involved developing a document describing the midwifery scope of practice so the CTCS could be rescinded, and revising the Professional Standards for Midwives and the Guideline on Ending the Midwife Client Relationship to allow for the rescinding of the standards When a Client Chooses Care Outside Midwifery Standards of Practice and Delegation, Orders and Directives. For more information about our rationale for making these changes, see the consultation paper.

What have midwives said about these changes?

In May 2019, we consulted with midwives about the CTCS. This consultation found overall support for rescinding the document and replacing it with a document describing the legislative scope of midwifery practice. The findings from the consultation can be found in the consultation paper (see pp. 4-6).

Between August and October 2020, we launched a second consultation about the proposed changes. Twenty-seven responses were received of which twenty-three were from midwives or midwifery students, three were submitted on behalf of midwifery practice groups, and a letter was submitted by the Association of Ontario Midwives (AOM).

Responses were mostly supportive of the overall approach to rescinding the CTCS and implementing a guiding document on the scope of practice. Some respondents felt that rescinding the CTCS and implementing the new Midwifery Scope of Practice will increase the autonomy of midwives, support interprofessional collaboration and put client safety first. Some respondents felt the opposite expressing concern that rescinding the CTCS will erode the scope of practice and create more tension with interprofessional colleagues.

All of the responses were taken into consideration and led to a number of important changes that were reviewed by the Quality Assurance Committee (QAC) in November 2020 and accepted by Council in December 2020. Changes from two reviews by the AOM were also incorporated.

The findings from the consultation, including our response to the second round of consultation can in the consultation paper.

What does this mean for my practice?

Rescinding the CTCS will change your practice because specific indications for consultation and transfer of care will no longer be set out in a College standard. Instead, as primary care providers, midwives will be expected to consult and transfer care based on the legislative scope of practice set out in the Midwifery Act, 1991 and their individual competence and professional judgment. The Midwifery Scope of Practice was developed specifically to provide regulatory guidance to midwives about working within the midwifery scope of practice and what to do when a client’s clinical condition or the care they require is no longer in the midwifery scope. We also developed decision-making tools to assist midwives in determining which clients and what activities are in the midwifery scope of practice and when to transfer care or to accept a delegation. Practices may develop consultation and transfer of care protocols taking into consideration their practice setting, community standards as well as their client base.

Rescinding the standard Delegation, Orders and Directives will not change your practice. The term has been more clearly defined and additional standards have been added to the Professional Standards for Midwives.

Rescinding When a Client Chooses Care Outside Midwifery Standards of Practice will not change your practice. The requirements set out in the standard are now included in the Guideline on Ending the Midwife Client Relationship.

How can I find out more about these changes?

We will be holding one or more webinars this spring to answer any outstanding questions midwives have about the legislative scope of practice. Midwives will be asked for questions in advance. The number and type of questions will determine how many webinars will be held. Please watch out for this opportunity to participate and have your questions answered.

Please review the amendments made to the Professional Standards for Midwives, the Guideline on Ending the Midwife Client Relationship as well as the Midwifery Scope of Practice document. If you have questions involving any of these documents and need clarification, please contact us for practice advice at practiceadvice@cmo.on.ca

Related links

Downloadable documents