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Ministry Submission for Scope of Practice Changes

April 5, 2018

Note: This article was originally posted in our April 2018 newsletter, and has not been updated.

The College of Midwives of Ontario has made a submission to the Ministry of Health and Long-Term Care to request two scope of practice changes.

The College is requesting a change to the Laboratory and Specimen Collection Centre Licensing Act, 2015, that would grant midwives the authority to order laboratory tests within their scope of practice as defined by the Midwifery Act, 1991.

We are also requesting that the Ministry rescind the list in the Designated Drugs Regulation made under the Midwifery Act, 1991 to instead allow midwives access to any drug or substance approved by Health Canada, within the scope of midwifery practice, excluding any drug or substance prohibited to midwives under the New Classes of Practitioner Regulations.

We believe these changes are in the public interest. We know that a list of laboratory tests or prescription drugs is prone to being outdated because future gold standard testing and evidence-based prescribing cannot be predicted.

Midwifery clients are at risk of receiving sub-optimal care when midwives are not able to provide clients with best practice and follow the recommendations of constantly changing clinical practice guidelines. An example of this occurred when the Zika virus became a public health concern in Ontario in the summer of 2016. At this time, midwives spent a great deal of time contacting the College and laboratories to advocate for clients at risk who required Zika virus testing which was not in Appendix B.

Another example occurred in 2003, when ergonovine maleate, a drug specified in the College’s Designated Drugs Regulation to treat postpartum hemorrhage, became temporarily unavailable to the health care sector for a prolonged period of time. There was no alternative medication available through the regulation that allowed midwives to treat postpartum hemorrhage in situations where the first-line treatment failed.

Clients often choose midwifery care because midwives are the only professional that provides the option of a home birth and provides postpartum primary care at home. Many families choose this care because of these unique components of care. Those in midwifery care should have their choice in care provider respected and not penalized by the limits imposed on their care providers tests and medications. Midwifery clients should have access to the same tests and medications as clients who choose to have their care delivered by a family physician. A consequence of having to refer clients on for certain tests or prescriptions is that clients may simply choose not to access the care at all. This is not in line with the goals of the Ministry’s Excellent Care for All Act, 2010 to support a health care system that is accessible, appropriate, effective, efficient, equitable, integrated [and] patient-centred (Ministry of Health and Long Term Care, 2010).

Requiring midwives to consult with a physician only to order a laboratory test or prescribe a medication that is in scope also has the potential to undermine the clients trust in their midwife. The College receives inquiries from clients asking why their midwife, who they trust to deliver their care and their newborn’s care, is not allowed to order a blood test or prescribe a medication. From the provider’s experience, the College receives reports from midwives concerned about having to consult for a prescription for narcotics in early labour which is an increasing part of their care.

You can read our full submission to the Ministry by clicking here: Scope of Practice ChangesWe will update members and the public about the status of this submission in the coming months.

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