Prescribing Medications New to Midwives

Are midwives required to offer all of medications in the Designated Drugs and Substances Regulation?

Many new medications were added to the legal midwifery scope of practice in 2024, and the College of Midwives of Ontario (CMO) is recommending further expansion to the Ministry of Health. Midwives are not required to prescribe or administer every drug listed in the regulation. This is explained in Section 3.3 of the CMO’s Scope of Practice document.

Before administering any drug or substance authorized to midwives in legislation, each midwife must ensure that they have the knowledge, skill and judgement to do so safely.

See Designated Drugs and Substances Regulation

What does the CMO require before midwives can add new drugs to their scope of practice?

The CMO provides resources describing the drug regulation and what is required of midwives. The CMO does not specify the training required, with the exception of the regulatory training required for controlled substances (opioids). On their resources page, the CMO states:

Midwives must be competent in all areas of their practice including prescribing and administering drugs and substances.

As such, prior to initiating any drug therapy, midwives must have sufficient knowledge, skill, and judgment to use the drug or substance safely and effectively.  Anything less may constitute professional misconduct. Midwives are expected to seek out the resources, courses, and training they need to be competent at prescribing or administering drugs and substances.

The CMO recognizes that midwives have different educational backgrounds and experience and different learning needs.

What should midwives read before prescribing every medication new to their scope of practice?

1.      The Health Canada Drug Product Data Base online query provides approved product monograms for health care providers. Drugs with lengthy market histories and established safety profiles may not have a product monograph in the data base. If this is the case, read the package labels and inserts, which are also approved by Health Canada.

2.      The AOM RM RX pharmacology app is a convenient and curated educational guide. It provides prescribing information and links to trusted sources for further information.

3.      Clinical Practice Guidelines and recommendations from sources like the AOM, the Society of Obstetricians and Gynecologists of Canada (SOGC), local/provincial/national Public Health organizations, the Provincial Council for Maternal and Child Health (PCMCH) and the National Advisory Committee on Immunizations (NACI) should be consulted for information about protocols and best practices for using specific medications and vaccines.

4.      Institutional policies and protocols should be reviewed for medications used in hospitals or birth centres.

These four sources may provide enough information for a midwife to begin prescribing or administering some medications. The midwife may already have considerable knowledge and experience managing a specific condition and the new drug is an additional option in a clinical treatment algorithm. For example, if the midwife has experience diagnosing and treating urinary tract infections (UTIs) in pregnancy and a new antibiotic is added to the list that can treat UTIs, the midwife may be able to easily incorporate the new drug into care management by reading product monographs and consulting guidelines and protocols.

When is a more extensive learning plan recommended?

Offering new types of care or using classes of drugs that are unfamiliar may require more comprehensive learning plans. Before midwives start prescribing contraceptives, or inserting IUDs, or administering narcotics or any other new care process made possible by the changes to the regulations, they must ensure that they have the necessary knowledge and skill.

Midwives should consider taking courses (in person or on-line), attending webinars or conference sessions, and/or receive mentorship or instruction from an experienced practitioner. For examples of courses to consider, see the Education section on the Safe Medication Practice web page.

Is specific training required to administer or prescribe opioids (controlled substances)?

The Controlled Drugs and Substances Education and Training or Course Requirement policy explains CMO requirements. For midwives who have not yet met the requirements, the CMO offers a free on-line training webinar. Some hospitals may also have required training for administering opioids.

It is important to note that the CMO training focuses on laws, regulations and standards midwives must follow. It also provides information about the opioid crisis. The training does not provide the clinical knowledge required to add the medications to the midwife’s scope of practice.

Should midwives keep a record of their learning activities?

Keeping a record of learning activities may be helpful if the midwife’s competency to provide the care is ever questioned in a legal, regulatory or hospital proceeding. This is particularly important if the necessary skills and knowledge are new to the midwife’s scope of practice and if the training required is more than reading monograms and clinical practice guidelines. The record can be kept in any format, in a personal file. The record may also be a helpful reference when the midwife is required to submit a Professional Development Portfolio to the CMO.

Should midwives attend sessions provided by pharmaceutical companies?

Pharmaceutical companies sometimes invite midwives to training sessions or “discussion groups” about their products.  Choose wisely how to use drug company training. Where special skills or knowledge are needed for administration, it may make sense to attend a product demonstration or training session hosted by the manufacturer. This may be one of the PD opportunities midwives undertake to ensure they are ready to provide the new care.

Midwives should be aware that, despite Canadian laws prohibiting advertising or promotion of prescription drugs and devices, some sessions provided by pharmaceutical companies may include incomplete, inaccurate and biased information to promote their products. Health Canada provides guidance on the difference between promotion or advertising of drugs and dissemination of non-promotional information.