Midwives infuriated: Health Minister’s recent announcement about prescribing restricts midwives
October 30, 2023
Toronto, October 30, 2023: Midwives across the province are infuriated over the Ministry of Health's announcement that outdated rules regarding prescribing powers will not be updated. The rules hinder midwives from providing optimal care. The Ministry of Health is giving Ontarians until November 13 to provide feedback and midwives are asking Ontarians to speak out.
A recent announcement by Health Minister Sylvia Jones promises to expand the list of medications midwives can prescribe. But midwives are outraged because it continues an outdated practice of restricting the overall prescribing powers of midwives. The outdated approach, which relies on a list of Ministry approved medications, is fundamentally flawed. Midwives have been trying to address this flaw with government for over a decade. The promise of adding medications to a list is a band-aid solution because lists quickly become outdated. A forward-thinking solution proposed by the College of Midwives of Ontario (CMO), the authority responsible for ensuring public safety in midwifery practice, continues to be dismissed by government. The proposed solution calls for the removal of a list, and for letting midwives prescribe according to the standards set out by the CMO.
Binding midwives to a pre-set list of medications often causes delays for patients and increases risk. It leaves midwives with their hands tied when new and improved medications become available.
“Ontario’s current approach of restricting midwives to a list of drugs stifles our ability to provide care. It creates red tape for patients. It means patients must obtain additional appointments elsewhere simply to access a medication - creating barriers to timely access to care, and increasing cost and risk. Midwives have tried - for over a decade - to urge government to lift restrictions on the prescribing powers of midwives. Midwives, like physicians, should be able to provide medications that are within our education, knowledge, and skill to prescribe. I am hearing from midwives across the province who are infuriated with government and Minister Jones’ decision to continue restricting our ability to provide care,” Jasmin Tecson, midwife, and president of the Association of Ontario Midwives.
“The government’s restrictions on midwives hurt patients. The restrictions limit, for example access to vaccinations. Routine vaccines like flu, Tdap, and COVID-19 are recommended by the National Advisory Committee on Immunizations (NACI) for pregnant people. Even though government is adding these specific vaccines to the proposed list, there are still inherent barriers in relying on a list-based approach. Rapid advancements in medicine mean lists can’t keep up. For example, Health Canada recently approved a single-dose immunization designed to prevent RSV disease in newborns. As a midwife, I should be able to provide this antibody to my clients, but this specific drug isn't included on the proposed list. It can take the ministry years to update a list. Years. Restricting midwives to lists is bad health care. The fixed-list approach is flawed. Simply adding medications to a list will not fix the problem,” Anna Meuser, midwife, and chair of the AOM’s clinical practice guidelines committee.
Midwives want to follow guidelines and provide evidence-informed care. The fixed-list approach impacts care beyond vaccines. It impacts the care midwives can provide during early pregnancy loss, genetic testing, thyroid screening, nausea and vomiting, STI treatment, UTI treatment, heartburn management, pre-term labour, and contraception. The AOM has developed an infographic (PDF, 182 KB) to explain how restrictions impact the close to 30 000 pregnant people who access midwifery care each year in Ontario.
Restrictions burden the health system and cost taxpayers. A fixed list means those in midwifery care must access additional appointments with another health provider, often a doctor, simply to access a prescription, even when it is well within the expertise of a midwife to provide the medication and care needed.
“If the Ford government is interested in reducing red tape, this is a good place to do it. Midwives are professionals with in-depth knowledge of reproductive health. Ending unnecessary restrictions on our ability to prescribe means patients receive timely, appropriate medications without delays or unnecessary visits to other providers. Ontario's health system is stretched to its limits, especially in rural and underserved areas. By allowing midwives to prescribe according to our skills and knowledge, we reduce the need for appointments simply to access a prescription. We alleviate pressures on family doctors and obstetricians, ensuring faster and better care for everyone, time savings for patients, and cost savings for the system. The time for Minister Jones to expand prescribing powers for midwives is long overdue,” Manavi Handa, midwife, and professor at TMU.
Midwives are urging Minister Jones to do away with lists and support an approach that enables midwives to prescribe within their authority and standards set out by the CMO. It is not just preferable but imperative for the health of Ontarians. The current restrictions hinder midwives from providing comprehensive care, raise potential risks and escalate costs.
AOM will arrange interviews on request. Contact Anna Ianovskaia, A/Manager, Policy and Communications, at firstname.lastname@example.org or (647) 865-0711.
About the Association of Ontario Midwives:
The AOM advances the clinical and professional practice of Indigenous and registered midwives in Ontario with a vision of midwives leading decolonized and anti-racist reproductive, pregnancy, birth, and newborn care. There are over one thousand midwives in Ontario, serving more than 250 communities across the province, funded by the Ministry of Health. Since midwifery became a regulated health profession in 1994, more than 250 000 babies have been born under midwifery care. For more information, visit: https://www.ontariomidwives.ca/midwifery-numbers
Add your voice today! Tell the Ministry of Health to do away with the outdated drug list.