Winter 2009 - Association of Ontario Midwives

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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
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Winter 2009 - Association of Ontario Midwives

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