Winter 2009 - Association of Ontario Midwives

Association of Ontario Midwives Winter 2009
03
Don’t miss spring
regionals
BELOW: Rebecca Rutherford makes a wish with Midwife Carol Cameron
and mom Anita. Rebecca was the first midwife-attended baby born in
an Ontario hospital after regulation in January 1994.
04
AOM at the OHA
conference
05
Midwives active on
LHIN committees
07
How to start a
new practice
09
HPRAC recommends
new drug approval
framework
Association of Ontario Midwives
Happy Birthday! Midwives celebrate
15 years of regulation in Ontario

AOM News & Updates
Graduate students and AOM Interns Nicole Versaevel
(above) and Johanna Geraci (below).
The AOM is currently facilitating student
placements for two RMs who are
working on their Master’s in Health
Policy.
Nicole Versaevel is completing a
Master’s of Science at the University
of Western Ontario in the faculty of
Health and Rehabilitation Science,
with a focus on health promotion.
Starting in the summer of 2009 Versaevel
will conduct a study to address
retention of Ontario Midwives. She is
interested in workplace wellness and
health promotion and its application
to the independent contractor model.
Johanna Geraci is working with the
AOM as part of a graduate diploma
program in Health Services and Policy
Research through the Ontario Training
Centre in Health Services and Policy
Research. Geraci is also in the Master’s
Progam in Health Research Methodology
at McMaster University. One of
the requirements is a 200-hour placement
in a policy-making environment.
At the AOM, Geraci is developing an
exit interview for midwives leaving
midwifery practice in Ontario.
The AOM is interested in working with
Master’s students whose research is
related to the work of the Association.
Interested students are welcome to
inquire with Alisa Simon, Acting Director
of Policy and Communications by
e-mail at directorpolicy@aom.on.ca
IMPP Class of 2009
Back row from left: Wenli Zhang (China), Adele Williams (USA-trained), Karline Wilson Mitchell (USA), Ingeborg
Roorda (Netherlands) and baby Yasmin (Canada), Rinat Spracklen (UK), Mandy Reid (USA), Hayley Mutch (UK)
Middle from left: Rosina Carreras-Castaneda (Cuba), Sarah Burnell (UK), Shaheeda Pierce (USA), Zinaida Bakhareva
(Russia), Mara Paredes (Guatemala)
Front row from left: Deepa Takrani (India), Shiva Saeri (Iran), Min Liu (China), Yuefang Liu (China), Betty Kagoda
(Uganda)
IMPP Midwives add
growth, experience
and diversity to AOM
membership
The International Midwifery
Preregistration Progam at Ryerson
University is now in its seventh year
and going strong. Midwives educated
in 26 countries from around the
world have completed this bridging
program which has dramatically
increased access to registration for
internationally-educated midwives.
Seventy-eight IMPP graduates are
Registered Midwives currently
practicing in Ontario - approximately
20% of total AOM membership.
Eighty-seven percent of IMPP
graduates find employment in
Ontario, with another four percent in
other provinces of Canada.
The IMPP recently held a conference
titled “International Ideas and
Experiences in Midwifery.” The
conference was a tremendous success,
with delegates over capacity.
Welcome new AOM
members!
Myriam Badger, Midwife Alliance
Lesley Janet Bonell, Birthcare
Ashley Lynn Broadbent, Community Care
Midwives
Genevieve Gagnon, Sages-Femmes de
Prescott-Russell Midwives
Fariba Gilanpour, Midwife Alliance
Corinne Hare, Kensington Midwives
Mei Rong Luo, Midwifery Collective of
Ottawa
Michele Matte, Midwives of Sudbury
Tiffany Meier, Sages-Femmes Rouge
Valley Midwives
Mojgan Nadafi, Thames Valley Midwives
Janessa Lorraine Otto, Niagara Midwifery
Practice
Soheyla Owliaei, Midwives of Windsor
Linda Rayner, Midwifery Group of
Ottawa
Julie-Lisa Toole, Riverdale Community
Midwives
(as of February 2, 2009)
02 ontario midwife • Winter 2009

Members at the fall West Regional Meeting in Stratford (left to right): Liza van de Hoef
(Stratford Midwives), Cathy Grant (Cambridge Midwives), Rebekah Bradshaw (Stratford
Midwives), Beth Lynes (Stratford Midwives) and Beth Read (Thames Valley Midwives)
Spring Regional Meetings
Regional meetings are key to information-sharing. At the fall
meetings, Board members and staff gave updates regarding
negotiations, communications, growth and new initiatives. Fall
minutes are now available for download from the members only
section of the AOM website.
Don’t miss out on this opportunity to give input into the
development of the next strategic plan. All members are invited
to attend.
Meetings will run from 1:00 to 4:30 p.m. Members are encouraged
to contact your regional representative to add items to the
agenda. Call the AOM office if you need the contact details for
your rep.
West (London): Tuesday, March 24 • Madeleine Clin
North (Sudbury): Wednesday, March 25 • Eileen Abbey
South-East (barrie): Thursday, March 26 • Sara Stainton
East (Kemptville): Monday, March 30 • Jane Somerville
South-West (Oakville): Wednesday, April 1 • Kelly Gascoigne
South-Central (Toronto): Note new date - Thursday, April 2 •
Tracy Franklin
Friends reconnect at the West Regional Meeting (left to right): Tahereh Alizadeh
Barmi (Cambridge Midwives), Nasrin Bandari Vali (Kitchener-Waterloo Midwifery
Associates), Mitra Sadeghipour (Family Midwifery Care of Guelph), Mojgan Nadafi
(Thames Valley Midwives) and Basak Ardalani (Guelph Midwives).
Membership renewal
The early bird draw winner this year is Angel Brazeau-Taylor
(Midwifery Services of Durham). Angel received a prize from
the AOM in December. Thank you to all members who have
renewed. The AOM currently has 457 members.
AOM Informed Choice eLearning Module
The Informed Choice eLearning Module is the first eLearning
product developed by the AOM. It is written for practicing
midwives, recognizing the skill and knowledge they already
have in providing informed choice.
The need for the module was first recommended by the Joint
Risk Management Working Group because of the key role
that informed choice plays in risk management.
The College of Midwives of Ontario recognizes this module
as fulfilling two Continuing Education and Professional
Development Activities for Quality Assurance Program (QAP)
reporting. Cost to AOM members is $25.
Learn more and take the course at www.aom.on.ca/
Professional/E-Learning_Opportunities/Informed_Choice_
eLearning_Module.aspx
Clinical Practice Guildelines
work underway
The AOM Clinical Practice Guidelines project
was launched last fall. The AOM will be
creating six CPGs over the next year to
provide Ontario Midwives with the most
recent evidence-based recommendations
from a uniquely midwifery- and values-based
perspective.
“This work is so valuable to members,” says
Tasha MacDonald, RM, Director of Clinical
Practice Guidelines. “To provide Association
guidelines for clinical issues is such a great
opportunity for members to both contribute
and to learn from each other. We look forward
to a lot of feedback and participation from
members once the first draft guidelines are
posted in the spring.”
The first two CPGs to be completed will be
Group B Strep and PROM.
In upcoming months information will be
posted to the AOM website to keep members
informed and elicit their feedback.
Thank you to the CPG sub-committee and
midwife researchers who have been helping
the project get off to a great start.
They are: Liz Darling (chair), Rhea Wilson,
Jenni Huntly, Ann Pennington, Cheryllee
Bourgeois, Corinne Hare, Paula Salehi, Lynlee
Spencer (student member), Lisa Weston (IRMP
Committee Rep).
For further information please contact the
Project Manager, Suzannah Bennett, at
cpgmanager@aom.on.ca.
www.aom.on.ca
03

AOM News & Updates
Staff Updates
The AOM staff continues to grow in
order to serve members. There have
also been a number of recent staff
leaves of absence. If you are not
sure who best can help you, just call
reception and you will be connected
with the staff member who can best
assist you.
A full staff directory can be found on
the AOM website at www.aom.on.ca/
AOM/Contact_Us/
Juana Berinstein, Director of Policy
and Communications, is on parental
leave, returning in September. Alisa
Simon, Senior Policy Analyst, is
currently Acting Director in Juana’s
place. Timothy Mbugua has joined the
AOM until September as a Contract
Policy Analyst.
Diana MacNab, Manager, Membership
Services, is on maternity leave until
January, 2010. Congratulations Diana
and family on the arrival of daughter
Aurora. Jill Moriarty is currently Acting
Manager in Diana’s place.
Zahara Hajiani, Program Administrator,
is on Maternity leave until
February, 2010. Congratulations
Zahara and family on the arrival of
daughter Arianna. Ferdausi Mannan
is currently Acting Program Administrator.
Deborah Schneider-Gagne, Benefits
Administrator, is on maternity leave
until January, 2010. Congratulations
Deborah and family on the arrival of
daughter Lorelye. Angela Edwards is
currently Acting Benefits Administrator
while Deborah is on leave.
The AOM has hired a new full-time
Events Coordinator. Laura Belair will
coordinate the AGM and Annual
Conference, as well as ESW events.
OHA HEalth achieve show 2008: Lisa Weston, RM, AOM Vice President, talks with two visitors at the AOM booth during
the Ontario Hospitals Association conference and trade show in November. Jasmine Ferreira, Program Assistant-Policy
and Communications, helps to staff the AOM booth and distribute brochures.
Building relationships with Ontario Hospitals
In November, the AOM participated in “OHA Health Achieve”, the Ontario Hospital
Association trade show and conference. The AOM booth saw hundreds of visitors over
three days. Staff handed out newsletters, posters and informational brochures about
midwifery, increasing the visibility of the profession within a targeted health care
audience of hospital CEOs, senior hospital administrators, hospital board members,
senior nursing staff and others. Feedback from delegates was very positive.
AOM board members and staff also attended many of the seminars and networking
sessions focussed on maternity care in Ontario.
The AOM anticipates being involved with Health Achieve annually to continue to
promote the integration of midwives into the health care system.
Midwifery Education Program activities
AOM representatives recently attended several Midwifery Education Program events
including a screening of Orgasmic Birth and panel discussion at Ryerson, a guest
lecture regarding Cultural Politics and Traditional Birth Attendants also at Ryerson
and an information session and reception at McMaster.
Many members also attended the annual MEP Preceptor Conference. This conference
is available at no cost to all midwives.
Sessions included:
• New approaches and developments in the MEP
• Meaningful feedback between students and teachers in the MEP
• Planning clinical experiences in a variety of on-call models
• Changing trends in midwife-attended homebirth and implications
04 ontario midwife • Winter 2009

The Association of Ontario Midwives presents the College of Midwives of Ontario with a set of promotional posters during a CMO/AOM Liaison meeting at the new AOM office.
ABOVE (left to right): Deborah Adams (CMO Registrar); Diane Parkin, RM (CMO Midwife Member); Kelly Stadelbauer (AOM Executive Director); Mary Ann Leslie, RM (AOM
Secretary); Katrina Kilroy, RM (AOM President); Mylene Shields, RM (CMO President); Barbara Herron (CMO Public Member, Vice President); Eleni Palantzas (CMO Public
Member); Andrea Lennox, RM (CMO Vice President)
Midwives active with
Ontario LHINs
The AOM is pleased to announce that
midwives from every region in Ontario
applied to serve on their Local Health
Integration Network (LHIN) Health Care
Professionals Advisory Committees
(HPAC) and that four midwives were
appointed.
The four midwives serving on HPACs
are: Sandy Knight in the Hamilton
Niagara Haldimand Brant LHIN, Sara
Stainton in the North Simcoe Muskoka
LHIN, Remi Ejiwunmi in the Mississauga
Halton LHIN and Deborah Bonser in the
Toronto Central LHIN.
As members of the HPAC, these
midwives have a unique opportunity to
help inform health care policy in their
regions and to ensure the voices of
midwifery are heard in the health care
planning process.
“There have been a number of ways
that I have been able to give input
to my LHIN,” says Sara Stainton.
“First is through HPAC, and this is an
ongoing and developing relationship.
Also, I have met LHIN representatives
through various committees that are
community-based and run through the
local health unit, community health
centre and the hospital.
“My LHIN went out looking for
representatives of the local maternity
health care community and
consumers,” she says. “Whenever I have
seen or heard for calls for consumers
through the health care community
or through local media I am quick to
contact some of the consumers from my
own practice and I also contact other
midwifery practices in the LHIN so that
they can alert other consumers. I think
that this contact with consumers will
really help to make the LHIN aware of
what a great resource midwives are.”
Many more midwives throughout the
province are working hard to help with
maternity care planning by serving on
important committees in their LHIN
such as Liz Darling, Leslie Viets and
Céline D’Arcy in the Champlain LHIN,
Shirley Meltzer with Central West LHIN
and Allyson Booth in the Central East
LHIN. If you are working with your
regional LHIN, please contact the AOM
office so that there is knowledge of the
work being done by members.
As more LHINs engage in maternity care
planning, it is becoming increasingly
important for midwives to engage in
work with LHINs - and there are many
ways to be involved:
• Sign up to be on the AOM LHIN
listserve for your region
• Go to your local LHIN webpage
which can be found at www.lhins.
on.ca and sign up for updates
about health care planning
occurring in your LHIN
• Attend open LHIN board meetings
• To find out if your LHIN is working
on maternity care planning and
how you can get involved with
LHIN committees, contact
Tim Mbugua at the AOM:
policy@aom.on.ca
www.aom.on.ca
05

AOM News & Updates
Celebrating 15 years of regulated midwifery in Ontario
Anita Rutherford was the first midwifery
client to give birth in an Ontario hospital
attended by midwives instead of a doctor
after regulation came into place in
January 1994. Baby Rebecca arrived just
one day after Registered Midwife Carol
Cameron and six other midwives were
granted privileges at the hospital.
“There was a lot of excitement going
on behind the scenes,” says Cameron.
“All these people were waiting outside
the room and we weren’t even aware
of it until after the birth. There was a
news camera, the Hospital Chief of Staff,
and Anita was so gracious and spoke to
everyone. I’m glad it was her fourth baby
and everything was straightforward.”
“Baby” Rebecca is now a teenager
celebrating her fifteenth birthday right
along with midwifery in Ontario.
Provincial midwifery legislation was
passed in 1991, but didn’t take effect until
the first day of 1994.
At that time, 60 midwives were registered
to practice in Ontario. Today, there are
over 400 and that number is expected to
double in the next four years.
Of the “original sixty” midwives who
qualified to practice through the
Michener Program, thirty-five are
currently registered with the AOM.
Today, there are 66 practices operating 73
sites across the province.
Cameron, a former AOM President, says
regulation changed how midwives are
viewed in the health care system.
“It sounds cliché, but it’s huge. When
you’re outside the system, you can
influence individuals, but now in terms
of hospitals, I sit on multidisciplinary
committees, I’m the head midwife at the
hospital and maternity policy decisions
have to include midwives. People look
to me for my expertise and experience.
It’s counted and valued. Now we have
influence for women in the community
and the profession.”
But she recognizes that regulation didn’t
fix everything overnight.
“Change is hard for anybody,” says
Cameron. “People are vulnerable about
their roles. It can be difficult to negotiate
the role definitions – we’re always
working on that with doctors and nurses
and midwives. It takes goodwill on all
sides and really working together for a
while at any site.”
Besides professional changes, regulation
gave Cameron personal rewards as well.
“Now I can truly provide the kind of care
that in the past I was just advocating for,”
Top: Rebecca Rutherford, Carol Cameron, RM, and Anita
Rutherford hold clippings from the January 29, 1994
Toronto Star. Rebecca’s birth at Markham-Stouffville
Hospital was front page news.
Bottom: Anita, Rebecca and Carol enjoy birthday cake
and a reunion at the photo shoot.
Photos by Ian Goodall
she says. “Being a primary care provider
means the client and the professional
come up with a care plan and see it right
through. Even if other care providers are
involved, you’re orchestrating it. That’s a
source of personal satisfaction and pride.”
“At this point in my career, it’s also so
satisfying that I’m helping the future
generations. I love working with MEP
students and IMPP midwives and
mentoring them,” she says. “Being
able to see the future is personally very
rewarding.”
06
ontario midwife • Winter 2009

Key Maternity Care Issues
Passion and hard work key to starting a new practice
Establishing a new practice takes a lot
of hard work and organization, but the
rewards are enormous both to practice
partners and families in the community.
Midwifery continues to grow at a
tremendous rate in Ontario. Consumer
demand is high, and more midwives enter
the profession every year than retire. This
means that individual midwives have to be
leaders in expanding
opportunities to
practice.
One way to start a
new practice is by
a satellite location
“splitting” off and
dividing a catchment
area. Midwives of
Grey Bruce have
done this a few times.
“In the late ‘90s we had huge catchment
area and we had grown to have eleven
midwives,” says Heather Keffer, a founder
of Grey Bruce (previously Grey Simcoe).
“So it made sense that in 2001, once we
had enough midwives living near the
Barrie area, we had our amicable divide
and the satellite clinic there became a
separate practice. Recently, the same
thing happened again and the clinic in
Collingwood became a new practice and
the Grey Bruce practice set up in Owen
Sound, which used to be a satellite office.”
The original practice, Grey Bruce, continues
to provide support for the new practice.
“Unofficially, we provide backup for the
new Nottawasaga practice because there
are only two midwives,” says Keffer. “We
retain hospital privileges in Collingwood,
but haven’t had to use them yet.”
Lynne- Marie Culliton is a partner at
Nottawasaga. “Two major advantages of
starting a new practice in an established
clinic are that you already have a built-in
caseload and location. We also already
had hospital privileges, so that made the
transition in the community quite smooth.”
Internally, though, starting a new practice
means a lot of changes. “One of the
biggest disadvantages was going from a
big practice with eight full time midwives
and an administrator to a small one with
only two midwives and no administrator.
All of the systems – charts, call schedule,
clinic schedule, office procedures and such
worked well for a big group, but not for a
small group. It has meant a lot of reworking
things to fit better with the resources we
have,” says Culliton.
Some midwives start new practices in areas
previously underserviced by midwifery
care, or where they have their own roots in
the community, but where no clinic current
exists. Starting from scratch offers its own
challenges and its own
rewards.
“My intention right
out of school was to
open a practice in my
home community,” says
Lisa Weston of Sages-
Femmes Rouge Valley
Midwives. “We were
working on it during our
new registrant year.”
There was a strong group of about 15
consumers working with the future Rouge
Valley Midwives during the proposal stage
and beyond.
“Three of us worked out of our homes and
cars for about a year in 2004, but now
we’ve grown to have eight midwives and a
permanent clinic space,” says Weston. “I’m
grateful to those midwives who gave us so
much support and mentoring during our
first years. It was a steep learning curve,
so it was important to have their help and
have different viewpoints from a few other
practices, and from the Association. These
days, there are even more resources in
place for midwives interested in starting a
new practice.”
“Starting from zero meant a huge amount
of work and responsibility, but there’s
also joy in making our own vision and
our model a reality,” she says. “It might
be easier to start from a satellite in some
ways but there may be limitations in
terms of how you want to organize and
practice. We created the identity and
flavor of our practice and set things up
the way we wanted right from the start,
rather than having to un-do any previous
arrangements.”
Whether starting from an established
satellite site or a brand new practice, every
new practice must go through regular
application channels with the Ministry of
Health and Long-Term Care.
New practices based on
demand, existing service,
practice group strategy
The first step in starting a new practice
is to contact the Ontario Midwifery
Program (OMP) at the Ministry of
Health. The OMP holds an annual information
session each fall (November),
but your work can and should begin
before then. Proposals are usually due
in January. The AOM can provide ideas
and advice about the process.
Steps in Proposal Development
1. Establish a location and assess
stakeholder support
2. Review proposal guidelines,
conduct research and assemble
necessary resources
3. Develop and draft proposal
including a proposed budget
4. Submit proposal to the Transfer
Payment Agency (TPA)
5. Refine proposal with TPA
6. TPA approves proposal and
submits to OMP with TPA Annual
Budget Request
Expansion Criteria
The OMP uses the following criteria
to determine whether to expand or
establish midwifery services:
• Under-served community –
Priority given to communities with
obstetrical provider shortages
• Strong unmet demand for
midwifery services in the
community
• Practice group efficiency –
strategy ensures that practice
groups function at adequate size
to provide on-call coverage.
Resources:
• AOM
• OMP
• TPAs
• Hospitals
• Current practice
• Neighbouring practices
• Community Health Centres
• Consumer Advocacy Groups
www.aom.on.ca
07

National News
British Columbia
B.C. Women’s Hospital and Health Centre, the busiest maternity
hospital in Canada, has been recognized as a breast-feeding
and “baby-friendly” hospital by the World Health Organization
(WHO) and UNICEF. Hospital president Dr. Elizabeth Whynot
said it took four years of preparation to attain the highly desired
status, which was awarded after a 72-hour inspection and
assessment by the designating organizations. The current tally of
Baby-Friendly facilities in Canada has also reached a milestone. A
total of 25 facilities have now been designated – nine hospitals,
two birthing centres and 14 community health facilities.
Alberta / Saskatchewan
Mount Royal College in Calgary and the University of British
Columbia have partnered to pilot the Multi-jurisdictional
Midwifery Bridging Project (MMBP) set to start in March 2009.
This seven-month pilot, if successful, will become the mechanism
for internationally-educated midwives to be assessed and
integrated into Western Canadian midwifery practice. Midwifery
students in Alberta are still left with finding their own educational
routes mostly outside of the province. This is because
Alberta Advanced Learning will not establish an education
program for midwifery until Alberta Health and Wellness designates
midwifery as a priority profession in the province.
Saskatchewan will participate in the pilot phase of the MMBP, by
providing preceptor support to limited number of internationally
trained midwives. The MMBP is seen as a way to encourage more
foreign trained midwives residing in Saskatchewan the opportunity
to challenge Canadian midwifery exams without having to
leave the province. Saskatchewan has been allocated two seats
in the MMBP which may be a limiting factor to expansion of the
midwifery program to other areas of the province when jurisdictions
discontinue the PLEA assessment.
The MMBP will assist internationally-trained midwives to prepare
to meet the requirements for registering and practising as a
midwife in British Columbia, Alberta, Saskatchewan, Manitoba or
the Northwest Territories.
Northwest Territories
NWT Midwife Gisela Becker is the new President of the Canadian
Association of Midwives. Becker, a registered midwife working in
Fort Smith, has been Vice President of CAM for three years. One
other midwife works with Becker in Fort Smith and together they
provide maternity care for all childbearing families in that area
through a program with the Fort Smith Health and Social Services
Authority. A midwifery program has been established in Yellowknife
with the recent certification and hiring of a midwife there.
This is currently a solo practice through the Yellowknife Health
and Social Services Authority. The program has been well received
by the community and the demand for midwifery services
outnumbers the program’s capacity.
The 2009 CAM conference will take place November 4, 5, and
6 in Winnipeg, MB. Visit www.canadianmidwives.org for more
information.
ONTARIO
The long wait is over for four midwives who are now able to
deliver babies at Belleville hospital. Approval, which was first
given in principle in May 2007 by the Quinte Health Care Board of
Directors, was announced February 2.
“The most difficult task involved meeting with the departments
of obstetrics, pediatrics and anesthesia to develop policies
outlining our interactions together,” says Stephanie McDonnell,
RM at Quinte Midwives. “We faced a great deal of resistance and
many delays in scheduling these critical meetings. With the assistance
of the hospital administration, the AOM, strong community
support and changes in departmental leadership, we eventually
met all criteria and were approved to deliver babies at the Picton
site in September 2008. As the Picton hospital is a level 1 facility
with limited resources and many of our clients wish to deliver
at their local hospital in Belleville, we continued to advocate for
hospital privileges at the Belleville site as well. We are thrilled
to finally have privileges at both Belleville and Picton sites as of
February 2009 and we feel we can now truly offer choice of birth
place to our clients.”
2008 Coroner’s report online
The Fourth Annual Report of the Maternal and Perinatal
Death Review Committee to the Chief Coroner for the
Province of Ontario (September 2008) is on the AOM
website. It can be downloaded from Members/ Reference
Documents/ 2008 Coroner’s Report.
Clinical Resources online
The Clinical Bibliography has been updated online as of
February 2, 2009. Visit Members/ Reference Documents/
Selected Clinical References to access a list of relevant
articles. Compiled by Director of Insurance & Risk
Management Bobbi Soderstrom.
08 ontario midwife • Winter 2009

Government Initiatives
Midwifery scope of
practice review
In September 2008, the Health Professions
Regulatory Advisory Council
(HPRAC) submitted its proposal
regarding the scope of practice of
midwives, as well as three other
professions, to the Minister of Health
and Long-Term Care. This scope review
was viewed as a significant step as it
was the first systemic review of the
scope of practice of midwives since
the Midwifery Act of 1994. The AOM
collaborated closely with the College
of Midwives of Ontario on the original
submission to HPRAC regarding
expanding midwives scope of practice.
HPRAC recommended a few key
expansions for midwives, namely: the
ability to communicate a diagnosis;
the authority to order additional lab
tests and diagnostics; the authority to
place a finger or instrument beyond the
anal verge to allow for the administration
of suppository medications; and, the
authority to take blood samples from
fathers and donors from veins or by skin
pricking.
Unfortunately, some recommendations
made by the CMO and AOM were
rejected by HPRAC. In particular, the AOM
was disappointed that midwives did
not receive the authorization to direct
ambulances to the most appropriate
care facility; the authorization to put
an instrument, hand or finger beyond
the anal verge for routine perineal
assessment and repair; or the ability
to facilitate midwives to certify for
additional procedures in order to facilitate
IPC, particularly in rural and remote areas.
AOM has submitted a response which
argues that these recommendations are
critical to midwives’ ability to provide care
for low-risk women in a safe, collaborative
manner, to facilitate midwifery
participation in IPC, to provide efficiency
in the use of highly skilled obstetrician
resources, to support maternity care close
to home, and to bring midwifery scope
of practice into line with Canadian and
community practice standards.
The Ministry has stated that it plans to
announce legislative changes in response
to the scope of practice review as early as
spring 2009. The AOM will be advocating
for Ministry support for the midwifery
profession’s efforts to participate in IPC.
Prescribing and use of drugs
by non-physicians
In December 2008, the College of
Midwives of Ontario, in consultation the
AOM, submitted to HPRAC its proposal
to replace the current list of drugs that
midwives can prescribe with therapeutic
categories of medications, specific to
clinical indications that fall under low-risk
maternity care. Allowing midwives to
prescribe from within drug classes rather
than being restricted to a specific drug list
is critical to public safety, to excellence in
professional practice, and to interprofessional
collaboration.
On February 2, 2009, HPRAC published
its recommendations to the Minister of
Health and Long-Term Care regarding
midwives ability to prescribe and use
medications. The AOM submitted a
response to the Minister of Health
providing support for:
• Replacing the current drug approvals
process as it is too lengthy and
compromises patient safety;
• Replacing drug lists with therapeutic
drug classes in the legislation for
individual health professions;
• Adding technical expertise
of pharmacologists and
pharmacotherapists as an integral
part of a new approvals framework
for determination of specific drugs
within a drug category; and
• Including antibiotics in the midwifery
pharmacopoeia.
HealthForceOntario
grant project underway
As discussed at the fall regional
meetings, the AOM has been
awarded a HealthForceOntario (HFO)
grant to:
• examine relationships between
maternity care providers;
• ensure that all health care
providers understand each
others’ College-defined scope of
practice and expertise;
• ensure that all health care
providers are able to work to
their College-defined scope of
practice; and
• support patient safety and lead
to more efficiencies for the
health care system.
The response to the HFO grant
from midwifery practices has been
tremendous, with 20 practices representing
20 hospitals applying to
participate. Eight sites were chosen
that represent all geographic regions
of the province as well as a mix of
level 1, 2 and 3 hospitals.
More activity will be rolled out over
the spring and summer as participating
practices and hospitals are
confirmed.
The AOM showcased this project
at an interprofessional education
conference in January. The poster
presentation, titled “Optimizing Use
of Midwifery Competencies in the
Provision of Primary Care for Women
and Newborns” explained the
project’s history, process and goals.
However, the response also outlines the
AOM’s serious concern with HPRAC’s
proposed drug approvals framework. In
particular, that it will undermine the
principles of self-regulation and be as
onerous as the current system, thereby
compromising client safety.
Members can read the full AOM response
to the HPRAC recommendations in
the members only section of the AOM
website, under “Government Relations.”
www.aom.on.ca
09

Consumer Resources
Health Canada to ban BPA
The Government of Canada
announced it will immediately
proceed with drafting regulations to
prohibit the importation, sale and
advertising of polycarbonate baby
bottles that contain bisphenol A (BPA).
The Government will also take action
to limit the amount of bisphenol
A that is being released into the
environment.
“In 2007, we issued a challenge
to industry under our Chemicals
Management Plan to provide
information on how they manage
bisphenol A,” said the Honourable
Tony Clement, Minister of Health.
“Today’s announcement is a milestone
for our government and for Canada as
the first country in the world to take
regulatory action.”
It was determined that the main
sources of exposure for newborns and
infants are through the use of polycarbonate
baby bottles when they are
exposed to high temperatures and the
migration of bisphenol A from cans
into infant formula.
The scientists concluded in this
assessment that bisphenol A exposure
to newborns and infants is below
levels that cause effects; however,
due to the uncertainty raised in some
studies relating to the potential
effects of low levels of bisphenol A,
the Government of Canada is taking
action to enhance the protection of
infants and young children.
The Government has allocated an
additional $1.7 million over the next
three years to fund research projects
on bisphenol A. This research, in
addition to major studies currently
underway at Health Canada and
Environment Canada, will help to
address key knowledge gaps and
inform Government decision-making
should further actions be required.
The proposed risk management
approach will be followed by a 60-day
consultation period. Regulations are
expected to come into effect in 2009.
For more information, visit the
Chemicals Management website at
www.chemicalsubstanceschimiques.
gc.ca/challenge-defi/bisphenol-a_e.
html or call the information line at
1-866-891-4542.
Cough and cold medicine not for children under six
Health Canada is requiring manufacturers
to relabel over-the-counter cough and cold
medicines with certain active ingredients
to indicate that they should not be used in
children under 6.
Although cough and cold medicines have
been used by children for many years,
there is limited evidence supporting their
effectiveness in this group. In addition,
reports of misuse, overdose and very rare
serious side-effects have raised concerns
about the use of these medicines in
children under 6.
The risk to children is only at the time of
use; in other words, children who used
these products in the past are not at risk
from having taken them.
Check PregVit vitamins, says Health Canada
Health Canada is informing expectant
mothers and women who are planning
pregnancy taking the product PregVit
Folic 5 and/or PregVit distributed by
Duchesnay Inc. to check the product’s individual
sealed packages. Reports related
to incorrect packaging of some blister
packs have been received by Health
Canada; however no concerns have been
raised regarding the tablets themselves.
Individual sealed packages of PregVit
Folic 5 and PregVit should contain a
pink blister pack of pink tablets to be
taken in the morning, and a blue blister
pack of blue tablets, to be taken in the
evening. The pink and the blue tablets do
not contain the same active ingredients
and their daily intake is complementary.
Some of the individual sealed packages,
which should contain both a pink and a
blue blister pack, contained only pink or
The relabelling of over-the-counter cough
and cold medicines will be completed by
fall 2009, in time for the next cough and
cold season. Until then, these medicines
will remain on store shelves and in homes
with the current labelling. Labels could
include dosing information for children
under 6, because many of these products
also have dosing information for adults
and older children on the same label. For
this cough and cold season, parents or
caregivers should consult a pharmacist or
a health care practitioner when buying or
using these products. These medicines can
still be used in children 6 and older, and
adults.
only blue blister packs. Consumers are
advised to check the individual, sealed
packages to ensure they contain both a
pink and a blue blister pack so that they
receive the optimal amount of vitamin
and mineral supplements.
Consumers with the incorrectly packaged
products are advised to consult their
pharmacist to get a new package.
Health Canada has not received any
adverse reaction reports related to the
mis-packaging of these products in
Canada. Preventive benefits, as well as
vitamin and mineral supplementation
will be optimized by using correctly packaged
products.
Consumers requiring more information
about this advisory can contact Health
Canada’s public enquiries line at (613)
957-2991, or toll free at 1-866-225-0709.
10
ontario midwife • Winter 2009

AOM Programs
AOM Emergency Skills Workshop Instructor Training
May 11, 2009 in Mississauga, ON
Venue: AOM Conference, Renaissance Toronto Airport Hotel
Type: New Instructor Workshop
AOM Emergency Skills Workshop
May 12, 2009 in Mississauga, ON
Venue: AOM Conference, Renaissance Toronto Airport Hotel
Type: Recertification
2009 AOM Emergency Skills Recertification Workshops:
Date: September 2009
City: Sudbury, ON
Date: October 2009
City: Toronto, ON
Date: December 2009
City: Ottawa, ON
To register for ESW courses, visit the AOM website or contact
events@aom.on.ca, 416-425-9974 x2255
Announcements - more at www.aom.on.ca “Professional Development”
Examining Controversies, Promoting Success
Durham Region Breastfeeding Coalition Second Annual Breastfeeding
Seminar (with Jack Newman)
April 16, 2009 in Oshawa
www.durhambreastfeeding.ca, 905-493-2645
Day in Perinatology
McMaster Children’s Hospital & St. Joseph’s Healthcare
Friday, April 17, 2009, Hamilton Convention Center
Contact: Nancy Bonney 905-522-1155 #34161
nbonney@stjoes.ca
HIROC Annual General Meeting
April 27, 2009 in Toronto, ON
www.hiroc.com/22nd_AGM_7th_RMC.asp
Canada’s Forum on Patient Safety and Quality Improvement
Canada Patient Safety Institute
April 28-30, 2009 in Toronto, ON
Contact: 613-882-6697 sally@f2fe.com
www.f2fe.com/documents/CPSI_Program_2008_E15.pdf
“Resolve Through Sharing” Perinatal Bereavement Training
2-day Workshop
The Child Health Network in partnership with the Perinatal
Bereavement Services Ontario
April 29-30 2009 in Toronto, ON (North York General Hospital)
Contact Moya Johnson: 416-813-6507
moya.johnson@sickkids.ca
OVLC 2009 Annual Conference: The Wonder of Human Milk
April 30 and May 1, 2009 in Ottawa, ON
Contact Sheryl Hamilton: Sheryl@hamiltoncrew.com
www.ovlc.net
Medications in Mothers’ Milk with Dr. Thomas W. Hale
May 8, 2009 in North Bay, ON
Contact: Anne Marie Westenenk 705-474-1400 x2285
amw@nbdhu.on.ca
7th Annual Refresher in Primary Maternity Care
May 22, 2009, Dept. of Ob/Gyn, U of T and Mount Sinai Hospital
Contact Elizabeth Gan: egan@mtsinai.on.ca
www.mtsinai.on.ca/seminars/ce
American College of Nurse-Midwives Annual Meeting & Expo
May 22-27, 2009 in Seattle, Washington, USA
www.midwife.org/am
Quebec IBCLC conference - Breastfeeding Practice based on
Science
June 1 & 2, 2009 in Montreal, PQ (takes place in English with
French translation)
www.ibclc.qc.ca
Normal Labour and Birth: 4th Research Conference
June 10-12, 2009 in Lancashire, England
Contact: healthconferences@uclan.ac.uk
www.uclan.ac.uk/health/about_health/health_bdu/conferences.php
SOGC 65th Annual Clinical Meeting
June 17- 21, 2009 in Halifax, Nova Scotia
www.sogc.org
AWHONN Canada 20th National Conference
October 15-17, 2009 in Winnipeg, MB
www.awhonncanada.org
Ontario Midwife is a quarterly publication of the Association of Ontario Midwives. This publication is
available online at www.aom.on.ca, or you may request a printed copy. All websites listed are “hotlinked”
in the digital copy. Scroll over the website address and click to launch the site.
Association of Ontario Midwives
All feedback welcome. Please contact Joanna Zuk, Senior Communications Officer:
comms@aom.on.ca, or by phone: 416-425-9974 x2261 or 1-866-418-3773 x2261.
Association of Ontario Midwives, 365 Bloor St. East, Suite 301, Toronto, ON M4W 3L4
www.aom.on.ca
11

Featured speakers:
•
Minister of Health and Long-Term Care
• Jane Sandall, RN, RM, MSc, Ph.D
• Pat Armstrong, Ph.D
Honourable David Caplan,
&
• Bridget Lynch, RM
• Dr. Ivor Margolis
Featured sessions:
• Emergency Skills Workshops
• Epidural management
• The late pre-term infant
• Home birth
• Marketing your practice
• Breastfeeding management
• Career planning
• Artwork by midwives and more!
Conference Location:
Renaissance Toronto Airport Hotel
801 Dixon Road, Toronto, ON M9W 1J5
416-675-6100 or 1-800-630-2590
www.marriott.com
AOM Conference delegates should identify themselves to
receive the special guestroom rate unil April 11, 2009.
For more conference information, visit www.aom.on.ca
Association of Ontario Midwives