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The Member Communiqué is the College's digital newsletter offering quick and easy-to-read information about midwifery standards and regulation in Ontario, including updates to practice standards, changes to regulation and legislation, and other news affecting midwifery practice.
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  MEMBER COMMUNIQUÉ

Special Regional Member Forums across Ontario this November and December
Join us at our upcoming CMO regional member forums to connect with College Council and staff and to learn about important College initiatives. We will also be offering live streaming from our Sudbury Forum (more details to follow at a later date.)
 
We are seeking your feedback on proposed transparency-related and general by-law amendments. The College has examined which categories of information should be posted on our public register as part of our 
ongoing work on Transparency and there is a current public consultation process until December 31, 2015.
 
Welcoming members in the Kitchener, Toronto, Ottawa and Sudbury areas, these half-day Forums are designed to be interactive and informative. Each regional forum has a flexible agenda to ensure that together we engage in the topics that are most relevant to you. Come prepared to share and learn along with your colleagues so that together, we can make information more accessible and more valuable to our collective communities. 

 
*Save the Date!
 
Toronto - November 20
Hart House: 9:30am coffee catch-up, 10am-1pm
 
Kitchener Waterloo - November 27,
Grebel College: 9:30am coffee catch-up, 10am-1pm
 
Sudbury - December 4
Laurentian University: 1pm coffee catch-up, 1:30pm-4:30pm
 
Ottawa - December 11
Ottawa Birth and Wellness Centre: 9:30am coffee catch-up, 10am-1pm
Revised Standards
As part of the ongoing review cycle of College Standards, Council approved on September 30th, 2015 a revised Code of Ethics and Laboratory Testing Standard.
 
Code of Ethics
The CMO’s Code of Ethics establishes the core values and principles that guide midwives in their work. Council approved revisions to the Code of Ethics, resulting from member feedback during the 60-day consultation period, as well as a jurisdictional scan of other midwifery and health care colleges, and changes proposed by our legal counsel. Revisions to the Code of Ethics also were made to reflect inclusive language in regard to the gender expression of midwives and their clients.
 
Laboratory Testing
 
The College is currently pursuing amendments to the list of laboratory tests that midwives are authorized to order, in recognition that the current list has significant limitations for the delivery of optimal maternity care services to clients. Midwives will be invited to comment on the proposed revisions to lab testing authority in the coming months.
 
In the meantime, Council has revised the Standard on Laboratory Testing to replace the list of tests they can order (which was based on Appendix B of the Laboratories Regulation under the Laboratory and Specimen Collection Centre Licensing Act) with a link to
Appendix B of the Laboratories Regulation itself.
 
The laboratory tests midwives are currently authorized to order are outlined in a regulation that is managed by the Labs Branch of the Ministry of Health and Long Term Care (MOHLTC).  These tests, and their associated codes, are listed in Appendix B of the
Laboratory and Specimen Collection Centre Licensing Act, R.S.O. 1990, c. L.1. The CMO developed its Standard, Laboratory Testing, by repeating this list but categorizing each test according to the client it applies to (i.e., mother, baby, father/donor) in order to provide additional guidance and direction to midwives. A recent inquiry by the MOHLTC about which tests midwives are authorized to order suggested that our Laboratory Testing Standard lacked clarity. By removing the categorized list, the Standard is clearer and midwives can exercise their own clinical judgement when ordering the laboratory tests in Appendix B. CMO staff will regularly review the MOHLTC laboratory regulation providing guidance to members if changes to the list are made.
 
NEW Mandatory Reporting Obligations: Notice to Members 
Changes have been made to the Health Professions Procedural Code of the RHPA regarding mandatory reporting obligations for health professionals. There are now more circumstances where a registered midwife is required to report to the College regarding the competency, conduct or capacity of a partner or associate midwife.
 
Every employer, partner or associate of a registered midwife or a facility offering privileges to them has a duty to make reports to the College.

What are the criteria for making a report?
 
There are two conditions that have to be met before a report must be made:
 
1. Termination / Restriction. There must be a termination of the relationship, the relinquishment of privileges or a restriction in the midwife’s practice or privileges. This termination, relinquishment or restriction can either have been imposed on the midwife, he or she could have agreed to it, or he or she could unilaterally do it. The source of the termination, relinquishment or restriction does not matter.
 
2. Conduct / Competence / Capacity. The termination / restriction must be related to the professional misconduct, competence or incapacity of the midwife. For example, where there are reasonable grounds to believe that the midwife voluntarily terminated / restricted his or her practice or privileges because of conduct / competence / capacity concerns, the report has to be made. Similarly, if the midwife voluntarily terminated / restricted his or her practice or privileges during the course of or as a result of an investigation into his or her conduct / competence / capacity, a report must be made.
 
Where those two conditions are met, a mandatory report must be made.
 
Please read the College’s full notice to members on the new mandatory reporting obligations
here.
 
CMO Request to Hon. Minister Hoskins Ontario’s to Rescind Mandatory Ocular Prophylaxis
In support of clear research evidence and community led petitions to rescind Ontario’s mandatory ocular prophylaxis law, the CMO recently sent a letter to the Honourable Dr. Hoskins, Ontario Minister of Health and Long-Term Care requesting that this out-dated law be rescinded.
 
In this letter, the College clarified that, as a standard of practice, midwives in Ontario offer informed choice, providing their clients with research evidence regarding the potential benefits and risks of the various components of care. Due to the mandatory ocular prophylaxis law and despite strong evidence that the administration of ocular prophylaxis is ineffective, midwives are not able to provide informed choice about its potential benefits and harms. In fact, when a client refuses this mandatory treatment, the midwife can incur large fines and the practice becomes at risk of closure. 
 
As part of the larger health care system, enforcing this law limits the ability of midwives, together with all health care providers, to deliver the highest quality care.
Rescinding this law is supported and promoted by the Canadian Paediatric Society (CPS). The CPS’s position statement from March 2015 uses current research evidence to show that the routine application of erythromycin to a newborn’s eyes, for preventing neonatal ophthalmia caused by N gonorrhoea and C trachomatis, is ineffective and can interfere with the early bonding between a mother and newborn.  As a result of this evidence, the CPS has asked that organizations petition the government to repeal this out-dated law. 
 
Belleville midwife Liza van de Hoef has spearheaded the recent campaign “Eye Protest” to petition the government to rescind the law.  Liza is attending Queen's Park on November 30, 2015 at 10am for a media briefing and presentation of the petition to the legislative assembly.  Congratulations to Liza for raising awareness of this important issue on behalf of all newborns and their families in Ontario.
 
To read the College’s full letter, please click
here.
 
CLARIFICATION: Uterine Balloon Tamponade (UBT) for Postpartum Haemorrhage (PPH)  
The College Council has agreed that midwives have the legal authority to use uterine balloon tamponade (UBT) in emergency postpartum haemorrhage situations, when they have the knowledge and skill to do so. Midwives are not required to carry this tool as a part of their essential equipment for out-of-hospital births, nor are they required to have the knowledge and skill to appropriately use the device; however, there is nothing in law or College Standards preventing midwives from doing so.
 
In the event that midwives and midwifery practices choose to carry UBT in their out-of-hospital equipment they must be able to demonstrate that they have the necessary training, which would be achieved through regular participation in a CMO-approved emergency skills in obstetrics course that includes appropriate training in the use of UBT. The CMO’s Policy on
Continuing Competency in Emergency Skills requires midwives recertify in Emergency Skills (ES) every 2 years as a condition of registration. The College approves each ES program and recognizes that ES programs in Canada are appropriately teaching and training midwives using the best available evidence and community standards.
 
It should be noted that the College maintains concerns about the use of UBT and its potential risks and benefits in clinical practice. There is insufficient evidence regarding the appropriateness of the use of UBT for management of PPH in low-risk populations and insertion of UBT in out-of-hospital settings without access to ultrasound.
 
According to the CMO’s Standard on Consultation and Transfer of Care, a PPH unresponsive to therapy requires a transfer of care to a physician. In emergency situations, however, when a transfer of care is not immediately possible (e.g., home birth), midwives are expected and required to manage situations that are not normal before and during transport to hospital. Pursuant to the Midwifery Act, midwives have the authority to use UBTs with the authorized act of “putting an instrument, hand or finger beyond the labia majora or anal verge during pregnancy, labour and the post-partum period”. The authorized act is to be carried out only within the scope of midwifery practice that, according to the Midwifery Act is “…the assessment and monitoring of women during pregnancy, labour and the post-partum period and … the provision of care during normal pregnancy, labour and post-partum period.”
 
Providing or attempting to provide services the member knows are beyond their knowledge, skills or judgement is considered an act of professional misconduct under the Health Professions Procedural Code and the CMO’s Professional Misconduct Regulation.
 
Has your information changed? 
As a registered midwife, you have a professional obligation to notify the College within 30 days of any change to:
  • your name that differs from the College’s Public Register;
  • your residential address, telephone number and personal email address;
  • the name, business address and business telephone number of every practice with which you are affiliated, whether as a sole proprietor, a partner, an associate or in some other capacity as a Midwife;
  • the name of each hospital, birth centre and health facility in Ontario where you have privileges, as well as the date that each privilege was granted and terminated
This is set out in article 15.06 of the College’s General By-Law.
 
The College relies on having accurate information about its members so that it can communicate with them effectively and regulate the profession in the public interest. The failure to provide accurate information to the College in a timely fashion may constitute professional misconduct under Ontario Regulation 388/09, made under the Midwifery Act, 1991. For further details about the information that members are required to provide to the College, please refer to Article 15 of the College’s General By-law. You can make all information changes through the
Member Portal.
 
Quality Assurance Program Update
The Quality Assurance Committee will be dedicating time over the next year to reviewing and revising the components of the QA Program including Self-Assessments Peer and Practice Assessments, and Quality of Care Evaluations. Community input will be needed to help identify best practices and develop an innovative and meaningful QA Program as the profession grows.  So please stay tuned to learn more about how to get involved.
 
***Thank you to all new registrants who completed their QAP reporting. This is the first year where all General Registrants had to complete their QAP reporting and despite this program requirement being new, completion rates were higher than expected!
 
Registration and Renewal
Thank you to everyone for their feedback on the registration renewal process using the new online registrant self service – the College’s Member Portal’. Your feedback is being incorporated into the next phase of development.
 
The College now has 810 Registered Midwives consisting of:
 
594 – General
71 – General with new registrant conditions
14 – Supervised Practice
131 – Inactive

 
 
2014-15 Annual Report
We are pleased to provide the 2014-2015 Annual Report of the College of Midwives of Ontario. In 2014-2015, strong emphasis was placed on enhancing our processes to ensure a governance model in which our members and public can have confidence. Throughout the year we worked to ensure a governance framework of the highest quality, increase member consultation in policy development, enhance the professionalism of our members, and provide Council and staff with the necessary knowledge and resources to continue promoting the public interest.
 
The year 2014-15 was a great “step forward” for the College and our members and we look with great optimism and excitement to continued challenge and change in the year to come. Please read the 2104-15 Annual Report
here.

 
 
2015-16 Council Elections & Meeting Dates 
The Council is the governing body of the College. The College’s Council sets the direction for the regulation of the midwifery profession in Ontario, and establishes the strategic goals, objectives and policies of the College. Council is made up of:
 
•       Eight Registered Midwives elected by their peers
•       Up to seven public members appointed by the provincial government
 
College members recently voted in the 2015-16 Council election and the results are in. The 2015-16 College Council members can be viewed
here.
 
All Council meetings are public and members are encouraged to attend. Council meets in Toronto at the College office. In 2016 Council will meet:
 
  • November 19, 2015
  • March 2, 2016
  • June 22, 2016
  • October 26, 2016
  • December 7, 2016
 
Copyright © 2015 The College of Midwives of Ontario All rights reserved.


Our mailing address is:
303-21 St. Clair Ave East, Toronto, ON M4T 1 L9
1-416-640-2252

cmo@cmo.on.ca

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