CLARIFICATION: Uterine Balloon Tamponade (UBT) for Postpartum Haemorrhage (PPH)

Note: This article was originally posted in our August 2015 newsletter, and has not been updated.

The College Council has agreed that midwives have the legal authority to use uterine balloon tamponade (UBT) in emergency postpartum haemorrhage situations, when they have the knowledge and skill to do so. Midwives are not required to carry this tool as a part of their essential equipment for out-of-hospital births, nor are they required to have the knowledge and skill to appropriately use the device; however, there is nothing in law or College Standards preventing midwives from doing so.

In the event that midwives and midwifery practices choose to carry UBT in their out-of-hospital equipment they must be able to demonstrate that they have the necessary training, which would be achieved through regular participation in a CMO-approved emergency skills in obstetrics course that includes appropriate training in the use of UBT. The CMO’s Policy on Continuing Competency in Emergency Skills requires midwives recertify in Emergency Skills (ES) every 2 years as a condition of registration. The College approves each ES program and recognizes that ES programs in Canada are appropriately teaching and training midwives using the best available evidence and community standards.

It should be noted that the College maintains concerns about the use of UBT and its potential risks and benefits in clinical practice. There is insufficient evidence regarding the appropriateness of the use of UBT for management of PPH in low-risk populations and insertion of UBT in out-of-hospital settings without access to ultrasound.

According to the CMO’s Standard on Consultation and Transfer of Care, a PPH unresponsive to therapy requires a transfer of care to a physician. In emergency situations, however, when a transfer of care is not immediately possible (e.g., home birth), midwives are expected and required to manage situations that are not normal before and during transport to hospital. Pursuant to the Midwifery Act, midwives have the authority to use UBTs with the authorized act of “putting an instrument, hand or finger beyond the labia majora or anal verge during pregnancy, labour and the post-partum period”. The authorized act is to be carried out only within the scope of midwifery practice that, according to the Midwifery Act is “…the assessment and monitoring of women during pregnancy, labour and the post-partum period and … the provision of care during normal pregnancy, labour and post-partum period.”

Providing or attempting to provide services the member knows are beyond their knowledge, skills or judgement is considered an act of professional misconduct under the Health Professions Procedural Code and the CMO’s Professional Misconduct Regulation.