Standards Review: Important changes in effect as of June 1, 2021

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of the standards review involved developing a document describing the midwifery scope of practice so the CTCS could be rescinded, and revising the Professional Standards for Midwives and the Guideline on Ending the Midwife Client Relationship to allow for the rescinding of the standards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.

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.

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.

We held two webinars this past spring to answer any outstanding questions midwives had about the legislative scope of practice. If you were not able to join one of the webinars, we are always happy to answer questions by phone and by email. You can contact us for practice advice at practiceadvice@cmo.on.ca