TORONTO — Ontario is planning to expand the list of drugs that midwives can prescribe and administer, including allowing them to prescribe birth control.
But while midwives say the updates are good and will help them more effectively serve their clients, not being limited to a list of medications would be even better.
The College of Midwives of Ontario has been working with the province for years to expand the list, but the registrar and CEO said that due to advances in medicine, a list can be out of date almost as soon as it is published.
"We're really happy that the (proposed new) list better reflects the care that midwives currently provide, and will reduce fragmented care that clients now experience," Kelly Dobbin said.
"(But) the best drug to use in a certain situation today may no longer be the best drug to use tomorrow. So when a list is prescriptive, like this, it does pose challenges in the future."
A spokesperson for Health Minister Sylvia Jones said the ministry is reviewing further scope of practice changes and is rolling them out based on advice from health-care partners.
Jasmin Tecson, president of the Association of Ontario Midwives, said it would be more beneficial if they were allowed to order the full range of tests and medications used in pregnancy and post-partum care. There are currently many issues midwives can diagnose, but they then have to get a doctor to write a prescription, she noted.
"It makes sense to receive care at the point of the care provider, at the point of getting screening, getting diagnosis, getting the recommendation for care, so to then be sent to somebody else to actually receive treatment isn't making sense," Tecson said.
"The list is only a stopgap, and given how slow legislative changes are we're looking at another five to 10 years and midwifery care will still be behind."
One of the bigger changes to the list is that midwives will be able to prescribe hormonal contraceptives, including intra-uterine devices, in the immediate post-partum period, Dobbin said.
"It's something that many midwives across Canada can already prescribe, but in Ontario, we've been waiting for this for some time," she said.
There are also additional pain medications on the list that midwives would be able to administer in hospital under their own authority under the new regulation, instead of needing a physician.
"What that means is that at 3 o'clock in the morning, when a midwife knows that this medication is needed, they will no longer have to call in an obstetrician in the middle of the night," she said.
"Who wants to wait for that, right? Every minute does count ... I think that this will be well received by midwifery clients as well."
A number of vaccines have also been added to the proposed list of substances midwives could inject, including flu shots, COVID-19 vaccines and the Tdap vaccine, which protects against whooping cough and has been recommended in the third trimester for about five years.
Midwives should be allowed to administer categories of vaccines rather than wait for a regulatory change years after a certain new vaccine becomes important, such as the one for COVID-19, said midwife Jenna Bly.
"It's just a very inefficient, illogical way to practice medicine," they said.
"Many, many people will avoid seeking medical care until a pregnancy and so pregnancy is a really key time. So midwives are getting people in the room and have this opportunity for all these public health interventions, but they can't actually do all the things that they should be able to do, and that they're trained and have the knowledge and skills and expertise to be able to offer."
The government's latest proposal is open to public comment on the province's regulatory registry until Nov. 13.
This report by The Canadian Press was first published Oct. 27, 2023.
Allison Jones, The Canadian Press
