Transforming and Supporting Patient Care - Health Professions ...

229Chapter 10 – Profession of MidwiferyHPRAC Scope of Practice ReviewHPRAC has recently completed a review of the scope of practice ofmidwives in Ontario. The review concluded that Ontario’s midwives have asignificant role to play in primary maternity care during normal, healthypregnancies. HPRAC recommends that midwives acquire additional tools tostrengthen their role as primary, low-risk maternity care providers, asregulatory and structural barriers to their practice are removed.HPRAC did not find that the expansion of the scope of midwifery practiceinto high-risk, complex care is supported by their current training andclinical experience. HPRAC did not recommend expanding the scope ofpractice for midwives in Ontario, nor recommend the creation of anextended class of midwives in Ontario.HPRAC has recommended that midwives be given access to a number oftools to strengthen their role as primary, low-risk maternity care providers.Changes recommended include that midwives be authorized to:• Communicate a diagnosis of a disease, disorder or dysfunctionthat can be identified through a midwifery assessment;• Take blood samples from fathers and donors from veins or byskin pricking;• Put an instrument, hand or finger beyond the anal verge for thepurpose of administering suppository medications; and• Order additional laboratory tests and diagnostics, consistentwith their scope of practice, except for orders for maternalpostpartum ultrasounds and newborn follow-up ultrasounds.HPRAC also recommended that the CMO develop comprehensive standardsof practice, with terms, limitations and conditions for emergencies and thatthese standards be incorporated into the CMO’s Indications document andindicate the education and clinical training required to maintaincompetency for emergency procedures. This recommendation is intendedto address requests for a number of authorities that midwives may need inemergency situations.In the scope of practice review, midwives requested access to a number ofdrugs that they have not previously been authorized to prescribe oradminister. These include prescribing and administering oxytocin,prescribing and administering antibiotics for Group B streptococcus,mastitis, bacterial vaginosis, urinary tract infections and sexuallytransmitted infections. They also requested the authority to order andadminister mumps, measles and rubella vaccine (MMR) and to order andadminister varicella. These requests have been referred to this review forconsideration.HPRAC Critical Links January 2009