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Practice Advice

July 26, 2021


Practice Advice can be found in the summer 2021 edition of On Call. To subscribe to our quarterly newsletter, click here.

Case Scenario:
Midwife M told her client at their first appointment that a student would be involved in the client’s care.

When the client was in active labour at the hospital, the student attended to the client and checked the fetal heart rate without Midwife M present in the room. The client was surprised that Midwife M wasn’t present for this.

The student advised the client that Midwife M was outside the door of the room completing charting and could be called in to attend to the client if the client wished for her to be present.

Question:
Did Midwife M fail to meet any Professional Standards in this case?

Answer:
Pursuant to the Professional Standards, midwives are required to obtain consent from clients regarding any care provided, which includes care provided by students.

Midwife M should have asked the client for her consent for student involvement after conducting an informed choice discussion about it, instead of just stating that a student would be involved. This informed choice discussion should have also been documented.

In addition, when conducting an informed choice discussion about student involvement, it is important for midwives to discuss the extent of student involvement.

In this case, Midwife M should have informed the client about the kind of care the student could provide on her own without direct supervision from Midwife M. Therefore, while it was appropriate for the student to check the fetal heart rate during the client’s labour with Midwife M nearby, it was not appropriate that the client was not informed that this could occur and that the client was never given the opportunity to consent to it.

Relevant Professional Standards:

16 Recognize clients as the primary decision-makers and provide informed choice in all aspects of care by:
16.1 providing information so that clients are informed when making decisions about their care
16.5 ensuring treatment is only provided with the client’s informed and voluntary consent unless otherwise permitted by law
16.6 supporting clients’ rights to accept or refuse treatment
16.7 respecting the degree to which clients want to be involved in decisions about their care.

Do you have a question about professional practice or standards? Visit our practice advice page, or contact practiceadvice@cmo.on.ca.