Apr. 04/20

Interpretation Bulletin respecting Standards of Practice while Home Births suspended

Midwifery Regulatory Council of Nova Scotia (MRCNS)

April 4, 2020

Interpretation Bulletin respecting Standards of Practice while Home Births suspended by Health Authorities.


Due to the health risks posed by COVID-19, all midwives working as employees of the IWK or the Nova Scotia Health Authority have now been informed by their managers of the decision to prohibit midwives (and other healthcare professionals) from entering the homes of their clients.


As regulated health professionals, midwives must work within the scope of practice of their profession, (which requires them to comply with their governing legislation, Standards of Practice and Code of Ethics),  but must also work within the scope of their employment.


In order to reconcile the obligations of midwives as health professionals regulated under the Midwifery Act with the obligations of midwives as employees to abide by the directions of their employers, the MRC is providing to all midwives the following interpretation of their professional obligations.


The MRCNS has been advised by representatives of the IWK and NSHA that midwives have been informed of the following, while the direction to cease the provision of home care remains in effect:


1. Midwives are to continue to communicate with their clients with respect to their care, but must advise such clients that midwives are no longer able to see these cl ients outside the Midwifery Clinic in Dartmouth,the Midwifery Office based in St. Martha’s Hospital, the IWK, the Midwifery Office based in Fisherman’s Memorial Hospital and the South Shore Regional Hospital;


2. Where a midwife makes a determination that the client requires prenatal or post natal care that cannot be delivered remotely by the midwife, the midwife should instruct the client to attend at the hospital or clinic, as directed by the midwife, where, if possible, the midwife will provide care to the client in the clinic or hospital setting;


3. Midwives must advise clients that home births are not possible while the directive from the Health Authorities is in effect, and therefore clients will be asked to come to the hospital for delivery. Where the client is unable to attend at the hospital, as their labour has progressed rapidly, the midwife will either call EHS directly, or instruct another person to contact EHS to arrange for a paramedic to attend and to provide assistance to the client at the location of the client or through transport to the hospital;


4. Where a client refuses the services of EHS, the midwife should instruct the client of the advisability of utilizing the services of EHS, recognizing that it is ultimately the decision of the client to determine whether to utilize EHS services.  Where a client refuses the services of EHS, the responsibility of the midwife is complete at the time such services are refused,  unless and until the client (and newborn if birth has occurred) attends at the hospital or clinic and the midwife resumes the assumption of care.


5. Because the Health Authorities and the MRCNS all support good risk management, the applicable Health Authority, the midwife and the client will collaborate where possible to create an alternative care plan for clients where there is potential risk to them or their newborn were they to refuse to transfer to hospital.


Impact of these directions on compliance with governing legislation, Standards of Practice and Code of Ethics.


Where the directive from the Health Authorities remains in effect, the MRCNS will interpret its Act, regulations, Standards of Practice and Code of Ethics in the following manner:


A. The Midwifery Act defines “professional misconduct” to include “wrongfully abandoning a patient”. Midwives who follow the Health Authorities’ directions set out above will not be found to be wrongfully abandoning a patient;


B. The MRCNS’s Policy on Home Birth Transport will be interpreted in a manner that recognizes midwives will not be attending personally with clients outside of the hospital or clinic setting;


C. The Standards of Practice and the Code of Ethics approved by MRCNS, and the Midwifery Act and its Regulations will not be found to be violated where, as a result of following the Health Authorities’ directions set out above, the midwife is unable to comply with the requirements of these documents. Without limiting the generality of the preceding statement, a midwife will not be considered to be abandoning the care of a client in the course of labour if a midwife provides care according to the above directions and has been directed by her employer to cease attendance with the client outside of a hospital or clinic setting.


For further guidance on this matter, please contact Jenny Wright Registrar/Executive Director, at .(JavaScript must be enabled to view this email address) or 902 424 3218
MRCNS.ca


 

Did You know?

In order to use the title “midwife” in your professional work or activities you have to be registered with the Midwifery Regulatory Council of Nova Scotia.


PO Box 488
1894 Barrington Street
Halifax NS B3J 2A8
(902) 424 3218 (Phone)
(902) 424 0730 (Fax)
Jenny.Wright@novascotia.ca