STATEMENT
This communication is in follow-up to the approval of an Order in Council April 10, 2024, bringing The Midwifery Amendment Regulations, 2024 into force. What follows is a summary of the legislative framework that defines the authorized practices of midwifery, a description of the changes to scope of midwifery practice as they pertain to the amended regulations and information on the requirements that must be met as a result of the amendments.
OBJECTIVE
To ensure that registered midwives, employers and stakeholders have a clear understanding of the implications and changes to midwifery practice based on The Midwifery Amendment Regulations, 2024.
The Authorized Practices of midwifery are outlined in The Midwifery Act as follows:
EXCERPT FROM THE MIDWIFERY ACT
Further requirements related to the practice of midwifery are outlined in The Midwifery Regulatory Bylaws as follows:
EXCERPT FROM MIDWIFERY REGULATORY BYLAWS, 2023
With respect to The Midwifery Amendment Regulations, 2024:
- No amendments in the Regulations require amendment to the The Midwifery Act in order for midwives to prescribe, dispense or administer drugs; order, perform or interpret diagnostic tests; or perform invasive procedures.
- Existing items and all amendments/additions (other than Controlled Drugs and Substances) contained in Tables 1, 2 and 3 of the Appendix in The Midwifery Amendment Regulations, 2024, are considered as entry level competencies of midwifery practice. Advanced practices are not identified in SCM legislation and bylaws.
- Practices listed in Tables 1, 2 and 3 of the Appendix in The Midwifery Amendment Regulations, 2024 may be performed provided the midwife is competent to do so. This may include training courses to acquire competence, but the courses (other than the course for Controlled Drugs and Substances) need not be approved by the council.
- Table 1 in the previous version of The Midwifery Regulations listed authorized drugs and was repealed and replaced with a list of “Categories of Drugs” in The Midwifery Amendment Regulations, 2024.
Appendix of The Midwifery Amendment Regulations, 2024
Table 1
Authorized Categories of Drugs
| Abortifacient agents Antibiotics Antiemetics Antifibrinolytic Antifungals Antihaemorrhoidal agents Antihemorrhagics Antireflux Antivirals Benzodiazepines Benzodiazepine Receptor Antagonists Cervical Ripening/Induction Agents Contraceptives Corticosteroids (Topical) Galactogogues/Lactation Aid Histamine antagonists Immune globulins Inhalants Intravenous fluids Laxatives Local anaesthetics Narcotic and non-narcotic analgesics Narcotic antagonists Nitrates Non-prescription drugs Sympathomimetics Uterotonic agents Vaccines Vitamin and mineral prophylaxis and therapy |
Midwives are required by section 20 of The Midwifery Regulatory Bylaws, to comply with the Midwifery Standards of Practice. Standard 13 pertains specifically to Table 1 contained in the appendix of The Midwifery Amendment Regulations, 2024
TRAINING COURSE REQUIREMENTS – Controlled Drugs and Substances
- Prescribing, administering and possessing two of the categories, Benzodiazepines and Narcotic Analgesics, will require additional training for registered midwives.
- The Midwifery Regulatory Bylaws require that members complete a training course approved by the council in order to prescribe, administer and/or possess controlled drugs and substances. This is the only amendment/addition that requires completion of a “council approved” course.
- In anticipation of Regulation amendments, the Transitional Council (September 13, 2022 meeting) approved training courses offered through the University of British Columbia (UBC), Continuing Education/Professional Development as a resource for Saskatchewan Midwives to obtain the necessary assessment and skills training to enhance their knowledge to competently perform the authorized practices of midwifery as they are now described in The Midwifery Amendment Regulations, 2024.
- Specifically, the UBC course currently entitled “Opioids and Benzodiazepines: Safe Prescribing for Midwives” with respect to prescribing, administering and possessing controlled drugs and substances. The course brochure has been attached to this email message and the link for registration is https://ubccpd.ca/learn/learning-activities/course?eventtemplate=36-opioids-and-benzodiazepines-safe-prescribing-for-midwives
- The deadline for completion for registered midwives in Saskatchewan is December 31, 2024. A request for information about successful course completion will be included on the 2025 Licence Renewal Application Form.
- Evidence of course completion must be submitted to the College for the Controlled Drugs and Substances course only.
- Completion of the Controlled Drugs and Substances course is not a requirement for the purpose of licence renewal, rather, it is required in order to prescribe, administer and/or possess Controlled Drugs and Substances.
- Provisions for midwives’ participation in the provincial Prescription Review Program (PRP) are in place. Once a registered midwife has completed the approved training course, they are required to submit a copy of the certificate/document of successful completion to the College. Once receipt of the required evidence of completion is received by the College, the PRP will be notified and an email will be sent to the midwife confirming the date they are authorized to prescribe, administer and/or possess Controlled Drugs and Substances.
- In order to maintain minimum standards, consistency, and fair and transparent processes, the College is developing policy that will identify course criteria and suitable outcomes, to enable the approval process of courses similar to the UBC course. The tentatively titled Professional Practice Policy, “Controlled Drugs and Substances Training Course Requirement”, will be further developed by the Professional Practice Policy Committee. It is anticipated that this policy will be reviewed by the Transitional Council in September 2024.
SCOPE OF PRACTICE
- By virtue of the authorization to prescribe and administer abortifacients, midwives are authorized to perform medical abortions. No amendments to the The Midwifery Act will be necessary for this to take place as this is not well-client care. Well-client care refers to care outside the pregnancy, labour and post-partum periods. It is possible and reasonable that a client may enter midwifery care suspecting pregnancy, which is within the midwifery scope of practice, and choose to terminate via medical abortion. The care provided by a midwife thereafter would also be within the midwifery scope of practice.
- A pregnant person who is seeking termination of a pregnancy and discloses this information would need to be taken into care by the midwife in order for the midwife to offer a medical abortion. There might need to be processes put in place by the employer in order to provide for this type of midwifery care. This is not well-client care. This is a pregnant person seeking midwifery care, as midwives are authorized to prescribe abortifacients. It is reasonable that the person remains in care until such time as all pregnancy matters/conditions are resolved. So, the population remains the same, “pregnant people”.
- It is reasonable to assume that a midwife could practice in an “early pregnancy loss” care clinic or a “termination” clinic and this would be within midwifery scope of practice. This conclusion follows if termination falls within the scope of midwifery practice as described in s. 23. The inclusion of abortifacients in Table 1 of the Regulations supports that interpretation, because the only basis for including them is because they can be prescribed for the purposes of clauses 23(1)(a) to (c).
- A client who requests midwifery care after having experienced early pregnancy loss or termination could be admitted into midwifery care as the authorized practices also allow midwives to provide care to a woman postpartum.
- In cases where a client enters midwifery care while pregnant and experiences an early pregnancy loss or terminates the pregnancy while in care, it is reasonable that the client remains in care until all pregnancy matters/conditions are resolved.
Table 2 listing authorized diagnostic tests was amended to include the item in bold red below:
Table 2
Authorized Diagnostic Tests
| Biochemistry Cytology Haematology Immunology Microbiology Newborn screening Non-stress test Ultrasound imaging X-ray |
Midwives are required by section 20 of The Midwifery Regulatory Bylaws, to comply with the Midwifery Standards of Practice. Standard 14 pertains specifically to Table 2 in the Appendix of The Midwifery Amendment Regulations, 2024.
Table 3 listing authorized invasive procedures was amended to include items in bold red below:
Table 3
| Authorized Invasive Procedures Amniotomy Applying fetal scalp electrode Bladder catheterization Conducting internal examinations of women during pregnancy, labour, delivery and the post-partum period Episiotomy Fitting cervical caps and diaphragms for contraceptive purposes Heel puncture of the newborn Injections: subcutaneous, intramuscular and intradermal only Inserting cervical ripening device Inserting intrauterine contraceptive devices Inserting nasogastric tube Inserting rectal thermometer Intravenous cannulation Intubation Manual removal of the placenta Nasopharyngeal suctioning Newborn frenectomy Newborn hearing screening Placing umbilical venous catheters in the newborn Repairing episiotomy Repairing tears, not including fourth degree tears or repairs to the urethra Taking cytological smears from the cervix Taking vaginal and rectal specimens Vacuum extraction Venipuncture |
Midwives are required by section 20 of The Midwifery Regulatory Bylaws, to comply with the Midwifery Standards of Practice. Standard 15 pertains specifically to Table 3 in the Appendix of The Midwifery Amendment Regulations, 2024.
SCOPE OF PRACTICE
- As previously stated, existing items and all amendments (other than Controlled Drugs and Substances) are considered as entry level competencies of midwifery practice. Practices listed in Tables 1, 2 and 3 of the Appendix in The Midwifery Amendment Regulations, 2024 may be performed provided the midwife is competent to do so. Advanced practices are not identified in SCM legislation and bylaws.
TRAINING COURSE REQUIREMENTS – General
- In order to maintain minimum standards, consistency, and fair and transparent processes, the College is developing policy that will identify course requirement criteria. The tentatively titled Professional Practice Policy, “Clinical Training Course Requirement”, will be further developed by the Professional Practice Policy Committee. It is anticipated that this policy will be reviewed by the Transitional Council in September 2024.
Please contact the College with any questions or concerns.
Sincerely,
Cheryl Deschene
Executive Director/Registrar
For further information please contact Cheryl Deschene, Executive Director/Registrar at the Saskatchewan College of Midwives.
Phone: (306) 781-1356
Email: registrar@saskmidwives.ca