Standards set minimum expectations that must be met by any midwife in any setting or role. Standards guide the professional knowledge, skills, and judgment needed to practise midwifery safely. Standards of practice are approved by the Council of the College.
The Professional Standards for Midwives
The Professional Standards for Midwives (“Professional Standards”) describes what is expected of all midwives registered with the College of Midwives of Ontario (“College”). The Professional Standards sets out the College’s minimum requirements regarding your practice and conduct, and helps you achieve the best outcomes for your clients and the public.
All midwives involved in client care hold the role of a trusted professional. There are duties arising from this role and obligations owed to others, including your clients, the public, your peers, other health care providers, and your regulator.
It is your responsibility to be familiar with and comply with the Professional Standards. You must use your judgment in applying the principles to the various situations you will face as a midwife. While no standard can foresee or address every issue or ethical dilemma which may arise throughout your professional career, your decisions, and actions must be justifiable.
You must always act in accordance with the law. The Professional Standards is not a substitute for legislation and regulations that govern the midwifery profession in Ontario. If there is any conflict between the Professional Standards and the law, the law prevails.
Midwives provide care in a variety of settings including homes, clinics, hospitals, and birth centres, so you must also be aware of, and work in accordance with, the rules set by each of the locations where you practise, including institutional policies and procedures, and community standards. When those institutional policies and procedures in your community standards are less stringent than, or contradict the Professional Standards, you must comply with the Professional Standards. While many standards are compiled, written down, and formally approved by the College, other standards are not documented and are unwritten expectations that describe the generally accepted practice of midwives who work in similar contexts in Ontario. In addition to the Professional Standards, the College has approved other written standards, which are available on the College’s website.
Five (5) mandatory principles form the Professional Standards. These principles define the fundamental ethical and professional standards that the College expects all practices and individual midwives to meet when providing midwifery services. The standards are not negotiable or discretionary. You must be able to demonstrate at all times that you work in accordance with the principles and standards set out in the Professional Standards. A failure to maintain a standard of practice of the profession may amount to professional misconduct.
You must practise according to the standards expected of you by:
- Demonstrating professional knowledge and practice
- Providing person-centred care
- Demonstrating leadership and collaboration
- Acting with integrity
- Being committed to self-regulation
Structure of the Professional Standards
The Professional Standards is divided into five (5) principles. Each principle includes a definition of the principle and a set of standards. The standards describe what midwives must achieve for compliance with the relevant principle. For midwives who are practice owners, there are additional standards at the end of each section that apply to you.
Italic words are defined in the Glossary.
Professional Knowledge and Practice focuses on developing and maintaining the knowledge and clinical skills necessary to provide high quality care to clients. All midwives practising in Ontario must possess the knowledge, skills, and judgment relevant to their professional practice. They must exercise good clinical and professional judgment to provide safe and effective care. Midwives must be committed to an ongoing process of learning, self-assessment, evaluation, and identifying ways to best meet client needs.
To demonstrate Professional Knowledge and Practice, you must meet the following standards:
- Work within the boundaries of the Midwifery Act related to scope of practice and the controlled acts authorized to midwives.
- Be competent in all areas of your practice.
- Know, understand, and adhere to the standards of the profession and other relevant standards that affect your practice.
- When you are also a member of another regulated profession and acting in this capacity:
- inform clients if any part of a proposed service or treatment is outside the scope of midwifery practice or will be administered outside your role as a midwife
- maintain midwifery records separate from the records for the practice of the other profession
- inform clients that they are not obligated to receive care from you in your capacity as another regulated professional.
- Maintain contemporaneous, accurate, objective, and legible records of the care that was provided during client care.
- Offer treatments based on the current and accepted evidence, and the resources available.
- Order tests or prescribe medications only when you have adequate knowledge of clients’ health and are satisfied that tests and medications are clinically indicated.
- Maintain and carry supplies and equipment necessary for safe care in home or out-of-hospital settings.
- Continuously monitor and make efforts to improve the quality of your practice using reflection, and client and peer feedback.
Midwives who are practice owners must also:
- Maintain a practice environment that supports compliance with relevant legislation, regulations, policies, and standards governing the practice of midwifery.
- Ensure essential operational and clinical supplies are available to midwives in your practice.
- Develop and maintain quality improvement systems to support the professional performance of midwives and to enhance the quality of client care.
Person-centred care is focused on the client and their life context. Person-centred care recognizes the central role the client has in their own health care, and responds to their unique needs, values, and preferences. Working with individuals in partnership, person-centred care offers high-quality care provided with compassion, respect, and trust.
To achieve Person-Centred care, you must meet the following standards:
- Ensure that every birth you attend as the most responsible provider is also attended by a second midwife or second birth attendant.
- Listen to clients and provide information in ways they can understand.
- Support clients to be active participants in managing their own health and the health of their newborns.
- Recognize clients as the primary decision-makers and provide informed choice in all aspects of care by:
- providing information so that clients are informed when making decisions about their care
- advising clients about the nature of any proposed treatment, including the expected benefits, material risks and side effects, alternative courses of action, and likely consequences of not having the treatment
- making efforts to understand and appreciate what is motivating clients’ choices
- allowing clients adequate time for decision-making
- ensuring treatment is only provided with the client’s informed and voluntary consent unless otherwise permitted by law
- supporting clients’ rights to accept or refuse treatment
- respecting the degree to which clients want to be involved in decisions about their care.
- Ensure clients have 24-hour access to midwifery care throughout pregnancy, birth, and postpartum or, where midwifery care is not available, to suitable alternate care known to each client.
- Provide clients with a choice between home and hospital births.
- Provide care during labour and birth in the setting chosen by the client.
- Take reasonable steps to provide care in the early postpartum in the setting chosen by clients.
- Ensure that your personal biases do not affect client care.
Midwives who are practice owners must also:
- Develop a reasonable and transparent client intake process.
Leadership and Collaboration requires that you work both independently and together with midwives, and other regulated and unregulated health care providers in relationships of reciprocal trust. Leadership and Collaboration demands that midwives work with clearly defined roles and responsibilities in all health care settings and when in health care teams. Communication, cooperation, and coordination are integral to the principle of Leadership and Collaboration.
To demonstrate Leadership and Collaboration, you must meet the following standards:
- Be accountable and responsible for clients in your care and for your professional decisions and actions.
- Provide continuity of care by developing an ongoing relationship of trust with your clients.
- Establish and work within systems that are clear to clients whether you are a sole practitioner, part of a primary care team of midwives, or a member of an interprofessional care team by:
- developing and following a consistent plan of care
- practising with clearly defined roles and responsibilities based on scopes of practice
- assuming responsibility for all the care you provide
- ensuring that the results from all tests, treatments, consultations, and referrals are followed-up and acted upon in a timely manner
- providing complete and accurate client information to other midwives or care providers at the time care is transferred over to them
- taking reasonable steps to ensure that a midwife or another care provider known to the client is available to attend the birth.
- Collaborate with the MRP, after a transfer of care, to provide care that is in the best interest of the client.
- Coordinate client care with other providers when an alternative to midwifery care is requested.
- Consult with or transfer care to another care provider when the care a client requires is beyond the midwifery scope of practice or exceeds your competence, unless not providing care could result in imminent harm.
- Provide complete and accurate client information to the consultant at the time of consultation or transfer of care.
- Ensure that clients and health care providers know who the most responsible provider throughout the client’s care is, including when there are delegations, consultations, and transfers of care.
- Be accountable for your decisions to delegate and accept delegations of controlled acts by:
- delegating acts only to individuals whom you know to be competent to carry out the delegated act, and who are authorized to accept the delegation
- delegating only those acts you are authorized and competent to perform
- never delegating a controlled act delegated to you by another health care provider (sub-delegation) and never accepting delegation from an individual who has been delegated to perform a controlled act themselves
- accepting only delegated acts that you are competent to perform.
- ensuring the client has provided informed consent to the performance of the delegated act
- documenting in the client record who you received the delegation from or to whom you delegated and the controlled acts that have been delegated.
Integrity is a fundamental quality of any member of the midwifery profession. Every midwife has a duty to practise truthfully and honestly, with the best interest of their clients as paramount. Integrity demands that midwives consistently model appropriate behaviour, recognize the power imbalance inherent in the midwife-client relationship, and maintain the reputation and values of the profession.
To demonstrate Integrity, you must meet the following standards:
- Conduct yourself in a way that promotes clients’ trust in you and the public’s trust in the midwifery profession.
- Never abandon a client in labour.
- Be honest in all professional dealings with clients, midwives, other health care providers, and the College.
- If a client experienced any harm or injury during your care that is related to your care, disclose the following information promptly and accurately:
- the facts of the incident
- anticipated short-term and long-term effects
- recommended actions to address the consequences.
- Avoid caring for clients while in a conflict of interest, unless all the following circumstances apply:
- you have explained the conflict to clients and have advised clients of their right to seek care from another provider
- you have a reasonable belief that clients understand the conflict and their right to seek care elsewhere
- you and the clients are satisfied that it is in the clients’ best interest for you to provide care
- you have documented the clients’ choice to you providing care despite the conflict.
- Take every reasonable precaution to protect the confidentiality and privacy of your clients’ personal health information, unless release of information is required or permitted by law.
- Recommend the use of products or services based on evidence and clinical judgment, and not commercial gain.
- Make referrals to other health care providers only based on the client’s best interest and not financial gain.
- Appropriately use the healthcare resources available to you for client care.
- Establish and maintain clear and appropriate professional boundaries always.
- Never pursue or engage in a sexual relationship with a client.
- Ensure that any physical or mental health condition does not affect your ability to provide safe and effective care.
- Recognize the limits imposed by fatigue, stress, or illness, and adjust your practice to the extent that is necessary to provide safe and effective care.
Midwives who are practice owners must also:
- Manage practice in a way that supports the physical and mental well-being of all individuals involved in client care.
- Ensure that information you publicize about your practice or any other practice is accurate and verifiable.
Self-regulation is the authority, delegated from the government to the members of the profession, to govern their profession. Commitment to self-regulation demands that midwives demonstrate personal responsibility by diligently fulfilling their duties owed to others, including their clients and the public, other midwives, midwifery students, and the College. As self-regulated professionals, midwives must uphold the standards and reputation of the profession, protect and promote the best interests of clients and the public, and collectively act in a manner that reflects well on the profession.
To demonstrate Commitment to Self-Regulation, you must meet the following standards:
- Appropriately supervise students and peers whom you have a duty to supervise by:
- role modelling integrity and leadership
- facilitating their learning and providing opportunities for consolidating knowledge
- providing honest and objective assessments of their competence.
- Co-operate fully with all College procedures. This duty applies to:
- investigations of your practice and the practice of others
- peer and practice assessments and audits
- referrals to a committee panel
- any other proceedings before the College.
- Know, understand, and comply with mandatory reporting obligations and notification requirements.
- Respond promptly to College correspondence that requires a response.
- Do not discourage or prevent anyone from filing a complaint or raising a concern against you.
- Provide appropriate information to your clients about how the midwifery profession is regulated in Ontario, including how the College’s complaints process works.
Midwives who are practice owners must also:
- Establish a system to deal with clients’ expressed concerns promptly, fairly, and openly.
The Glossary comprises a set of defined terms which are used in the Professional Standards. Defined terms are highlighted in grey within the individual standards under each principle. The Glossary may also contain commentary and interpretation.
means a clear separation between professional conduct aimed at meeting the needs of a client and the midwife’s personal views, feelings, and relationships which are not relevant to a client-midwife relationship.
means the College of Midwives of Ontario established under the Midwifery Act, 1991.
Conflict of interest
means a situation that arises when a midwife, entrusted with acting in the best interests of a client, also has professional, personal, financial or other interests, or relationships with third parties which may undermine the midwife’s professional judgment and affect their care of the client.
Confidentiality and Privacy
means complying with the legal and professional duty to maintain the confidentiality of clients’ personal health information and protecting that information from inappropriate access. The Personal Health Information Protection Act, 2004 (PHIPA) governs midwives’ use of personal health information, including its collection, use, permitted disclosure, and access. For more guidance, refer to the Personal Health Information Protection Act, 2004 (PHIPA) and the College’s Guide on Compliance with the Personal Health Information Protection Act.
means consent to treatment as defined in the Health Care Consent Act, 1996, SO 1996, c 2, Sched A. According to section 11(1) of the Health Care Consent Act, 1996, the following are the required elements for consent to treatment:
- The consent must relate to the treatment.
- The consent must be informed.
- The consent must be given voluntarily.
The consent must not be obtained through misrepresentation or fraud
means a discussion with another professional (e.g., a midwife or physician) who has a particular area of expertise for the purpose of seeking clinical advice or treatment.
Controlled acts authorized to midwives
means the list of controlled acts provided to midwives pursuant to section 4 of the Midwifery Act, 1991.
means a process where a regulated health professional (the delegator) who is authorized to perform a controlled act, as defined under the Regulated Health Professions Act, 1991, designates that authority to someone else (delegatee) who is not authorized to perform that controlled act. When an act is delegated, both the delegator and the delegate are accountable. Delegation is carried out by either a direct order or a medical directive.
A direct order provides the delegatee with authority to carry out a medical procedure on one specific client and occurs after the client has been assessed by the delegator. A direct order can be written or verbal and provides the details required for the delegatee to carry out the procedure.
A medical directive provides authority to carry out a medical procedure or series of procedures for any client as long as clinical conditions set out in the directive exist and are met. Medical directives are written in advance.
means the time period from birth to 7 days after birth.
Mandatory reporting obligations
means a statutory responsibility to report relevant matters to the College or other authorities. The Regulated Health Professions Act, 1991 (RHPA) governs midwives’ use of personal health information, including its collection, use, permitted disclosure, and access. For more guidance, refer to the Regulated Health Professions Act, 1991 Health Professions Procedural Code Section 85.1, and the College’s Guide on Mandatory and Permissive Reporting.
means the legislation that sets out the midwifery scope of practice and controlled acts that are authorized to midwives, as well as provisions on title protection and Council composition.
Most responsible provider (MRP)
means a midwife or another health care provider who holds overall responsibility for leading and coordinating the delivery and organization of a client’s care at a specific moment in time.
means a requirement to provide information to the College in accordance with the Registration Regulation, made under the Midwifery Act, 1991 and Article 14 of the General by-law.
means a midwife who owns a midwifery practice as a sole proprietor, partner in a partnership as defined in the Partnerships Act, 1990 (Ontario), or shareholder of a corporation.
Quality improvement systems
means developing and maintaining an approach for evaluating and improving client outcomes. Quality improvement is a team process and includes monitoring and data collection, including client feedback, implementation of quality improvement measures, and evaluation.
Scope of Practice
has the same meaning as in section 3 of the Midwifery Act, 1991.
Second birth attendant
has the same meaning as in the Second Birth Attendant Standard.
means the transfer of responsibility from a midwife to another midwife or a physician for some, or all, of the duration of the client’s care.
The College of Midwives of Ontario was established with the proclamation of the Regulated Health Professions Act, 1991 (RHPA) and the Midwifery Act, 1991 on December 31, 1993 to govern midwifery. The mandate of the College is to regulate the profession of midwifery in accordance with the RHPA. The College’s primary obligation to the public is to ensure that members of the profession are qualified, skilled, and competent in the area in which they practise.
Professional Standards for Midwives
Approved by the College of Midwives of Ontario Council
Approval Date: March 21, 2018
Implementation Date: June 1, 2018
Practice Management Standards
The midwifery record serves as a factual account of the client’s care and is a key form of communication between midwives and between midwives and other healthcare providers. The midwifery record provides evidence to support the quality of the care and clinical decision-making, facilitates continuity of care and reflects the client’s values and preferences. To support this the midwifery record must identify what care was provided and why, who provided the care, when the care was provided and recommended follow-up. In telling the story of a client’s care, the midwifery record must be chronological, legible, and accurate. Clients have the right to records that are complete and understandable. Those records must remain private and secure.
The purpose of this standard is to set out the College’s requirements for documentation in, and management of, records related to the practice of midwifery. 1 All institutions and locations where midwives practice will have their own requirements regarding record keeping midwives must follow.
Midwifery record – a paper or electronic record specific to the care of a midwifery client. Practice owners are custodians2The custodian of the midwifery record is the partnership that operates a midwifery practice group or a sole practitioner (Guide on Personal Health Information Protection Act, October 2020) of the midwifery record.
Hospital record – a paper or electronic record that includes documentation specific to client care occurring in the hospital. Hospitals are custodians of the hospital record. Requirements for hospital records are the jurisdiction of the hospital.3 See section 19 of the Public Hospitals Act for the requirements for record keeping in hospital records
Client – an individual who is receiving midwifery care (i.e., pregnant, intrapartum, postpartum, or newborn).
Standards for the Midwifery Record
- The midwifery record must include the client’s relevant identifiers such as name, date of birth, OHIP number and their contact information (i.e., telephone number and address).
- Every page of the midwifery record must have a client identifier.
- The midwifery record must identify the midwife designated as responsible for the overall management of the client’s care.
- The midwifery record must reference care provided to the client outside of the midwifery practice group and update care plans as appropriate.
Standards for Documentation
A midwife is responsible for documenting all care they provide to a client according to the following:
5. Documentation must be chronological and completed at the time, or as soon as possible after an event. When a contemporaneous record of the care cannot be made, a late entry must be documented as soon as possible including the date and approximate time the care was provided and the date and time of, and rationale for, the late entry note.
6. Any corrections that must be made to an incomplete or inaccurate record must be clearly identified as incorrect and kept in the Corrections must be dated and signed.
7. Every entry must be legible and written in English or French, and only use terms and abbreviations that are understandable to all health care providers who may provide care.
8. Every entry must be identifiable, containing a signature or initial, or an audit trail that identifies the author and their professional designation.
9. When checklists and fields are part of the record, all relevant checkboxes and fields must be completed.
10. Any care provided under supervision (e.g., by a student) must be identified as such.4The midwifery record and the midwifery practice group’s documentation policy should describe how care provided under supervision is identified in the client record.
11. When documentation has been assigned to a recorder during an emergency, the midwife must review the accuracy of the record and sign off on it as soon as possible after the event.
12. Documentation of the clinical encounter must be accurate and objective and include:
a. the reason for the clinical encounter and information that conveys the client’s health status and any concerns
b. every assessment, clinical finding, treatment, discussion, or other provision of care provided by the midwife to the client
c. the rationale for providing any procedures or treatments
d. the client’s response and outcomes to the interventions or care provided
e. the client’s care management plans and updates to the management plan
f. all communication with the client that is relevant to their care whether in- person, virtual or through electronic communication such as email or text
g. important communication with other care providers, family members, and substitute decision-makers
h. every recommendation or order made by the midwife for examinations, tests, and consultations, and all associated reports received by the midwife or attempts made to acquire such reports
i. every controlled act that the midwife has delegated to another care provider or that the midwife has performed under delegation
j. all relevant information contained in a prescription by the midwife or a copy of the prescription
k. every informed choice discussion, including risk, benefits, alternatives, any recommendations made and the client’s consent or refusal
l. every transfer of, and discharge from care as well as the reason for the transfer or discharge.
Access and Retention of the Midwifery Record
Midwives must be aware of who is the custodian of the midwifery record and the rules and accountabilities with respect to the use, management, and storage5Please refer to the Personal Health Information Protection Act, 2004 (s. 14). Available Online.of the midwifery record.
Midwives must be aware of how to access past client records after they have left the midwifery practice group in the event the records must be accessed for a review of the care.
Every client midwifery record shall be retained by the custodian for the following time periods:6Custodians should note that the limitations period for some legal proceedings might be 15 years after an event and should consider retaining records for longer than the 10 year minimum requirement.
a) For a client who is 18 years or older, the record must be retained for 10 years from the date of the last entry
b) For a client who is younger than 18 years, the record must be retained for 10 years after the day on which the client reached, or would have reached, 18 years of age.
Storage, transfer, and disposal of midwifery records must be in a manner that complies with the provisions of the Personal Health Information Protection Act, 2004.7Please refer to the College’s Guide on Compliance with Personal Health Information Protection Act for obligations under privacy law (2020). Available online.
References (legislative and other)
Regulated Health Professions Act, 1991
Personal Health Information Protection Act, 2004.
Guide on Compliance with Personal Health Information Protection Act, October 2020 Strategies for Improving Documentation – Lessons from Medical-Legal Claims, HIROC
Approved by: Executive
Approval Date: January 11, 2013
Implementation Date: January 11, 2013
Last reviewed and revised by Council: December 7, 2022
The purpose of this Standard is to set out the College’s requirements for midwives working with a second birth attendant.
Second Birth Attendant means an individual, other than a midwife registered with the College of Midwives of Ontario, who works with a midwife to provide care during labour, birth and the immediate postpartum, not in a subsequent postpartum visit. A second birth attendant may be a care provider who is regulated as a member of a health regulatory College in Ontario or who is an unregulated care provider.
Unregulated care provider means a care provider who is neither registered nor licensed by a regulatory body and who has no legally defined scope of practice.
- A midwife working with a second birth attendant must be registered in the general class without new registrant conditions.
- A midwife must be confident that the second birth attendant they are working with has the knowledge, skill, and judgment to provide competent, respectful, and ethical care.
- A midwife is accountable for the care provided by a second birth attendant who is unregulated and is responsible for ensuring that a second birth attendant provides care in accordance with relevant practice standards, community standards and clinical practice guidelines.
- A Midwife working with a second birth attendant must:
- be in attendance during the provision of care by the second birth attendant
- ensure the second birth attendant documents in the client record in accordance with the College’s standards of practice
- delegate controlled acts in accordance with the College’s standards of practice
- ensure the client understands the role of the second birth attendant during the client’s care
- ensure the second birth attendant is competent to assist in the provision of care during neonatal resuscitation
- When working with a second birth attendant who is not practicing in their capacity as an employee or privileged staff of a hospital or birthing centre, a midwife must:
- ensure the second birth attendant has attended and successfully completed a college approved course or program in obstetrical emergency skills in the past 24 months (every 2 years); and cardiopulmonary resuscitation (CPR) in the past 24 months (every 2 years).
- ensure the midwife’s professional liability insurance extends to cover the care provided by the second birth attendant
- obtain informed consent from the client to the participation of a second birth attendant
References (legislative and other)
Regulated Health Professions Act, 1991, S.O. 1991, c. 18
Professional Standards for Midwives (June 2018)
Record Keeping Standard for Midwives (January 2013)
Continuing competency requirements and approved courses (September 2018)
Approved by: College of Midwives of Ontario Council
Approval Date: March 21, 2018
Implementation Date: September 1, 2022
Last reviewed and revised: June 22, 2022
Clinical Practice Standards
The purpose of this standard is to set out the College’s requirements for midwives to protect their clients from midwife to client transmission of a blood borne virus during the provision of care.
Blood borne virus means hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV).
Exposure-prone procedure (EPP) means an invasive procedure where there is a higher-than-average risk that injury to the midwife may result in the exposure of the client’s open tissues to the blood of the midwife. These procedures include those where the midwife’s hands (gloved or not gloved) may come in contact with sharp instruments, needle tips or sharp tissues (e.g., bone spur) inside a client’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times. Exposure prone procedures in the midwifery scope of practice include infiltration of the perineum with local anesthetic, episiotomy, repair of an episiotomy or perineal/vagina tear and application of fetal scalp electrodes8 Communicable Diseases Network Australia. Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses. Canberra: Australian Department of Health; 2018.
Treating primary care provider means a physician or nurse practitioner with expertise in blood borne viruses who is managing the care related to the blood borne virus of the seropositive midwife in accordance with national guidelines.
- Midwives must take all reasonable steps to protect the health and safety of their clients which includes preventing the transmission of blood borne viruses from themselves to their clients.
- Midwives must comply with institutional, provincial, and national recommendations regarding preventing the transmission of blood borne viruses to their clients9Public Health Agency of Canada. Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings. 2019..
Midwives who perform exposure prone procedures
- Midwives who perform exposure prone procedures must know their blood borne virus status and be tested for HIV and HCV at least once every three years
- Midwives who perform exposure prone procedures must be tested for HBV every year if immunity has not been demonstrated. Midwives with demonstrated immunity to HBV through vaccination or resolved infection, do not require HBV testing unless certain health conditions exist10 Individuals requiring regular HBV testing are those who are immunocompromised, because of waning immunity, and individuals with chronic renal disease or on dialysis. Frequency of testing should be based on the recommendations of their primary care provider and the PHAC guidelines.
- Midwives who are exposed to risks for acquiring a blood borne virus in non-occupational settings should be aware of testing frequencies based on those risks and must follow any relevant guidelines recommending testing that may be sooner than those in this standard
- Midwives must adhere to relevant public health authorities and guidelines regarding reporting accidentally exposing a client to their blood
- Midwives must be tested for blood borne viruses following an exposure to a client’s blood or body fluid or a client’s exposure to the midwifes’ blood
- Midwives must be tested for blood borne viruses following an exposure to a client’s blood or body fluid or a client’s exposure to the midwifes’ blood
Midwives who are seropositive for HIV, HCV or HBV
- When initially diagnosed with a blood borne virus, midwives must cease performing EPPs immediately and seek appropriate medical care under the guidance of a treating primary care provider
- Midwives living with a blood borne virus who perform EPPs can continue to practise if they comply with the PHAC Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings guidelines, and the recommendations of their treating primary care provider related to testing frequencies and acceptable viral loads for the provision of care.
References (legislative and other)
Public Health Agency of Canada. Guideline on the Prevention of Transmission of Blood borne Viruses from Infected Healthcare Workers in Healthcare Settings. 2019.
Approved by Council
Approval Date: December 8, 2021
Implementation Date: June 1, 2022
Last reviewed and revised:
The purpose of this standard is to describe CMO expectations regarding the prescribing and administering of drugs.
Midwifery standards of practice refer to the minimum standard of professional behaviour and clinical practice expected of midwives in Ontario.
Midwives have the requisite knowledge, skills, and judgment to prescribe drugs from the list of Designated Drugs. Any drug that can be administered by a midwife according to the Ontario Regulation 884/93 Designated Drugs can be prescribed by the midwife.
The authority of midwives, according to the Ontario Regulation 884/93 Designated Drugs, to initiate a prescription for a drug, is limited to treating conditions that they can diagnose and for which they can provide the necessary counseling, informed choice decision making and ongoing management of care.
In the course of engaging in the practice of midwifery, midwives may use any drug and may administer any substance by injection or inhalation on the order of a member of the College of Physicians and Surgeons of Ontario. Midwives may also administer, prescribe or order any drug or substance that may lawfully be purchased or acquired without a prescription.
To Ensure Safety
- Assess the client, conducting laboratory and diagnostic investigations as appropriate Comply with relevant federal and provincial legislation
- Adhere to all relevant standards, guidelines or policies established by agencies or organizations (e.g., public health unit or blood banks) involved in the provision or control of any of the authorized drugs or substances
- Provide either a written, or when necessary, a telephone prescription or verbal order
- Consider whether the drug is a safe and effective treatment for the specific client circumstances
- Provide the client and/or client representative with the necessary information about the drug prescribed including expected therapeutic effect, potential side effects, contraindications and precautions
- Consider drug resistance, medication errors, infection control and safety, when they prescribe and/or administer any substance from the regulation
- Ensure there are adequate systems in place to prevent prescription fraud
- Ensure proper reporting of drug reactions and medication errors (Appendix 1, Reporting Adverse Drug Reactions and Medication Errors)
- Monitor the client’s response to the drug therapy after prescribing, and continue, adjust dosage or discontinue the drug therapy as appropriate.
- Conduct a medical history and document the symptoms and/or conditions being treated
- Obtain a full understanding of the drugs the client is taking using the “Best Possible Medication History” (see Appendix 2 for an example of what can be included)
- Document in the client’s record, in a timely manner, all telephone prescriptions or verbal orders
- Provide a follow-up care plan as appropriate and document in the client’s record
- Document the client’s response to the drug therapy
- Ensure proper recognition and management of medication errors including documentation and reporting as outlined by Association of Ontario Midwives (Appendix 1, Reporting Adverse Drug Reactions and Medication Errors)
- Ensure proper risk management reporting when drug reactions or medication errors occur in a hospital (Appendix 1)
- Midwives may only prescribe drugs for the intended purpose as described in the Guideline to Prescribing and Administering Designated Drugs (below) and the amended Ontario Regulation 884/93 Designated Drugs.
- Midwives may not self-prescribe a drug, or prescribe a drug for a family member outside the provision of midwifery care, or when there is a conflict of interest.
- Midwives will document the drug prescribed in the client’s record.
A legal prescription prepared by a midwife must include:
- Full date (day, month and year)
- Client’s name
- Client’s address (if available)
- Name of drug, drug strength (where applicable), dose and the quantity of the prescribed drug
- Full instructions/directions for use of the prescribed drug
- Refill instructions, if any
- Printed name of the midwife prescriber with telephone number and address
- College registration number and the professional designation
Midwives Obtaining Consults and Providing Inter-professional Care, Relating to Prescriptions:
- May not delegate the act of prescribing a drug
- Notify any relevant health care provider involved in the client’s care when clinically appropriate and document that this notification has been given
- Consult with appropriate health care professional if the client’s response to the drug therapy is other than anticipated
When midwives continue drug therapy initiated by another health care professional they must:
- Provide and document ongoing assessments
- Monitor and document the client’s response to the drug therapy
- Communicate the client’s response and change to or discontinuation of drug therapy to the initiating health care provider as appropriate
- Consult with appropriate health care professional at any point in the continuing drug therapy as appropriate
Ensuring Appropriate Storage
- Ensure recommendations for storage and handling issued by the medication/ vaccine’s manufacturer are followed
- Dispose unused and expired medications/vaccines/blood products in accordance to the guidelines set forth by public health and blood bank
Reporting Adverse Drug Reactions and Medication Errors
Reporting Adverse Drug Reactions
You can report any suspected adverse drug reactions to drugs and other health products to the Canada Vigilance Program by visiting the Reporting Adverse Reactions to Drugs and Other Health Products page at: http://hc-sc.gc.ca/dhpmps/medeff/report-declaration/reporting-declaration-eng.php
The site offers the Canada Vigilance Reporting Form for use in the reporting by health care professionals and clients via fax, mail, online or phone.
Canada Vigilance Regional Office phone 1 866-234-2345 and fax 1 866-234-678-6789
Reporting Medication Errors
Consider reporting any medication errors confidentially to The Institute for Safe Medication Practices Canada, an independent national non-profit agency. Contributing to this database provides information for the purpose of developing policies to prevent future adverse events. For information about this non-profit organization, go to their home page at http://www.ismp-canada.org, or their page with information about reporting medication incidents at Canadian Medication Incident Reporting and Prevention System (CMIRPS) http://www.ismp-canada.org/cmirps.htm. For further information about incident reporting, refer to the AOM (www.aom.on.ca) and HIROC (www.hiroc.com) websites.
Best Possible Medication History (BPMH)
Best Possible Medication History (BPMH) is a medication history obtained by a healthcare provider which includes a thorough history of all regular medication use (prescribed and non-prescribed), using a number of different sources of information. The BPMH is different and more comprehensive than a routine primary medication history (which is often a quick patient medication history).
- Patient medication interview where possible.
- Verification of medication information with more than one source as appropriate including:
- family or caregiver
- community pharmacists and physicians
- inspection of medication vials
- patient medication lists
- medication profile from other facilities
- prescription drug claim histories of Ontario Drug Benefit (ODB) recipients (Drug Profile Viewer)
- previous patient health records
The BPMH includes drug name, dose, frequency and route of medications a patient is currently taking, even though it may be different from what was actually prescribed. Using tools such as a guide to gather the BPMH may be helpful for accuracy and efficiency. (A BPMH Interview Guide is available here).
If a patient is unable to participate in a medication interview, other sources may be utilized to obtain medication histories or clarify conflicting information. Other sources should never be a substitute for a thorough patient and/or family medication interview. For patients who present prescription bottles and/or a medication list, each individual medication and corresponding dosing instruction should be verified, if possible. Frequently, patients take medications differently than what is reflected on the prescription label. Also, patients may not have updated their personal list with newly prescribed medications.11Queen’s University, Office of Interprofessional Education and Practice. Medication Reconciliation: A Learning Guide. Web page retrieved August 19, 2010 on the World Wide Web at: http://meds.queensu.ca/courses/assets/modules/mr/4.html
Midwives should ensure that client’s reporting drug allergies are asked the extent and type of allergy, sensitivity or reaction they have had and this should be documented in the client’s record.
Standard: Prescribing and Administering Drugs
Reference #: STCMO_C09252013
Approved by: Council
Date Approved: September 25, 2013
Date to be Reviewed: April 2016
Revision date(s): June 1, 2018; October 9, 2019
Effective date: January 1, 2014
Appropriate clinical supervision enables students to learn and achieve professional competence, confidence, and autonomy, ultimately ensuring safe and appropriate client care. The student’s ability to develop the appropriate professional values, knowledge, skills, and behaviours is largely influenced by their supervisors and the learning environment in which they are supervised and mentored. Similarly, client safety that is at the core of quality midwifery care, is inseparable from a good learning environment and culture that values and supports students. Midwives supervising students are accountable and responsible for clients in their care and for their professional decisions and actions.12The term professional encompasses the role and duties of a midwife as set out in the Professional Standards for Midwives.
The purpose of this standard is to define the professional responsibilities of midwives who supervise students.
Supervisor means a midwife who supervises a student in a clinical environment. This can include:
- a midwife who is the preceptor and is responsible for overseeing a specific student’s clinical work through a placement in a clinical environment. They lead the evaluation and assessment of the student’s practice throughout a placement and contribute to the report on whether the student should progress to the next stage of their training.
- a midwife who is the most responsible provider and holds overall responsibility for leading and coordinating the delivery and organization of a client’s care and supervises a student at a specific moment in time.
Student means a person enrolled in an education or bridging program to become a regulated health professional.
Conflict of interest means a situation where a supervisor’s personal relationship with a student improperly influences the supervisor’s judgment, which may compromise the quality of the student’s learning or client care and safety.
Clinical supervision and involvement in client care
- Supervisors must ensure appropriate supervision when a student is involved in client care by:
- Ensuring that a student’s supervision is proportionate to the student’s abilities, performance, confidence, and clinical experience and reflects their learning needs and stage of learning.
- Determining and adjusting the level of supervision as needed, including determining when a student has the knowledge and skills to provide client care without the supervisor being physically present or to independently attend a birth as the second midwife.
- Being immediately available to the student when not physically present during the clinical encounter or if unavailable, ensuring that an appropriate alternative supervisor is immediately available and has agreed to provide supervision.
- Supervisors must ensure that a midwifery student only works within the boundaries of the midwifery scope of practice and the controlled acts authorized to midwives and adheres to the standards of the profession and other relevant standards. When supervising a non-midwifery student, all controlled acts must be delegated in accordance with the midwifery standards of practice.
- Supervisors must have current knowledge and experience in the area in which they are providing supervision and feedback to a student.
- Supervisors must ensure that a discussion occurs with the client regarding the role of the student and client consent is obtained when a student is involved in their care.
- Supervisors must continuously monitor and identify concerns about a student’s performance or conduct that may affect client safety. Once identified, concerns affecting the safety of clients must be addressed immediately and effectively.
- Supervisors must have the capacity and resources to provide appropriate clinical supervision and practical experiences for a student.
- Supervisors must ensure that a student receives sufficient orientation to the practice and clear guidance about their clinical role before they get involved in direct client care.
- Supervisors must create and foster a learning environment that:
- Provides learning opportunities for consolidating skills and developing the professional knowledge, skills and behaviours required of midwives practising in Ontario.
- Supports compliance with relevant legislation, regulations, policies, and standards governing the practice of midwifery.
- Ensures students have an appropriate workload that minimizes the adverse effects of fatigue on the provision of client care.
Professional conduct and boundaries
- Supervisors must model integrity and leadership and act when a student is subjected to, or subjects others to, behaviours that undermine their professional confidence, performance, or self-esteem.
- Supervisors must take reasonable steps to avoid supervising a student while in a conflict of interest, which includes supervising a relative or a person with whom they have a close or intimate relationship.13It may not be possible in certain practice settings to avoid supervising a student with whom a midwife has a personal relationship, but it must never put a student at risk of harm.
- Supervisors must provide honest and objective assessments of student performance and competence.
- Supervisors must not engage in inappropriate sexual conduct or sexually abuse a student while mentoring, teaching, supervising, or evaluating the student.14Sexual abuse and inappropriate sexual conduct include a sexual physical relationship with a student, touching a student in a sexual manner, or behaviour or remarks of a sexual nature by the midwife towards the student.
- Supervisors must not engage in discrimination, violence, or harassment (including intimidation) against students.
- Supervisors must assist and provide direction to students encountering disruptive behaviour (including discrimination, violence, and harassment) in the learning environment.15 Assistance and direction include, but are not limited to, taking action as required in accordance with applicable institutional policies, policies, and codes of conduct.
References (legislative and other)
Professional Standards for Midwives (June 2021)
Regulated Health Professions Act, 1991
Approved by College of Midwives of Ontario Council
Approval Date: June 22, 2022
Implementation Date: September 1, 2022
Last reviewed and revised: June 22, 2022
Archived Standards of Practice from the College
If you are looking for historic information on College standards or for a copy of any of the College’s archived standards, you can contact the College’s Professional Practice Advisor by phone: 416.640.2252 or by email: email@example.com
- Ambulance Transport (January 2014)
- Blood Borne Pathogens (January 2014)
- Pathogènes transmissibles par le sang (January 2014)
- Caring for Related Persons (January 2014)
- Clinical Education and Student Supervision (July 2014)
- Code of Ethics (September 2015)
- Complementary and Alternative Medicine (January 2014)
- Continuity of Care (January 2014)
- Consultation and Transfer of Care (November 2015)
- Diagnostic Imaging (January 2014)
- Delegation, Orders and Directives (January 2014)
- Epidural Monitoring and Management (July 2014)
- Essential Equipment, Supplies and Medications (June 2015)
- External Cephalic Version (July 2014)
- Home and Out of Hospital Births (January 2014)
- Induction and Augmentation of Labour (July 2014)
- Informed Choice (January 2014)
- Interprofessional Collaboration (January 2014)
- Laboratory Testing (September 2015)
- Neonatal-Resuscitation (June 2015)
- Newborn Eye Prophylaxis (January 2014)
- Nitrous Oxide-Oxygen Blends (January 2014)
- Postpartum/Newborn Visits (June 2015)
- Practice Communication (June 2014)
- Practice Protocols (November 2015)
- Prescribing and Administering (October 2019)
- Record Keeping Standard (January 2013)
- Routine Childhood Vaccinations (January 2014)
- Surgical Assistant in Obstetrics (July 2014)
- The Ontario Midwifery Model of Care (September 2013)
- Twin and Breech Birth (July 2014)
- VBAC and Choice of Birthplace (January 2014)
- When a Client Chooses Care Outside Midwifery Standards of Practice (January 2014)
Waiver Policy – Standards
College standards set minimum expectations that must be met by any midwife in any setting or role. Standards guide the professional knowledge, skills and judgment needed to practise midwifery safely.
In exceptional circumstances, midwives may not be able to meet certain College standards. In these rare cases, standards may be waived.
“Exceptional circumstances” is defined as conditions beyond one’s control that justify waiving College standards. A midwife applying for a waiver will need to show that the circumstances of the application are both in the public interest and are sufficiently exceptional to justify a departure from the relevant standards. It is for the applicant to demonstrate that exceptional circumstances exist.
Every application will be considered on its individual merits. In all cases an applicant must satisfy the College that the following apply:
- The waiver will support the public interest which the standards are designed to safeguard
- A public benefit will be gained by a departure from the standards, and
Please note that the College does not have the power to waive or permit practice outside of statutory provisions such as the midwifery scope of practice or the controlled acts authorized to midwives. Midwives can only perform acts outside of statutory provisions through delegation.
Submit your application only if you are confident that you will be able to demonstrate to the College that exceptional circumstances exist and that granting you a waiver is in the public interest. Processing times for the waiver are between two and three weeks.
If you have an active practice shortfall or seek an exemption from the quality assurance program requirements, you are not required to fill out this application. Please contact the College at firstname.lastname@example.org for further information.