Ontario to expand list of tests midwives can order; midwives say it's a first step

Ontario is set to expand the list of tests midwives can order and perform, as part of the government's push to increase community care options and ease health system pressures.

However, midwives say that while the step is welcome, government regulations are still preventing them from practising within their full scope.

They have been pushing for the government to remove those lists entirely, as well as the list of drugs they can prescribe, and just allow midwives to order the full range of tests and medications used in pregnancy and post-partum care.

"The big problem with lists is that they quickly become out of date when there is new evidence or when there are shifting standards of practice," said Jasmin Tecson, president of the Association of Ontario Midwives.

Further expansions would help clients receive care even more quickly and would eliminate unnecessary doctor and hospital visits, the midwives say.

"We are definitely in line with the provincial government's priorities around serving client needs like convenient accessible care for health-care consumers in the community, where they're at, and where and when they have that need," Tecson said.

Midwives should have equal access to drugs, tests: college

Part of the government's plan for giving people more convenient health-care options closer to home involves "maximizing the expertise of our health care workforce by expanding scopes of practice," Health Minister Sylvia Jones said in a recent letter to the chair of the College of Midwives of Ontario.

"To that end, I am delighted to inform you that the ministry has begun the work to advance a proposal to expand midwives' authority to order additional laboratory tests as well as to allow midwives to perform certain point of care tests," Jones wrote.

Claire Ramlogan-Salanga, the chair of the college, said the college is still in talks with the government on expanding the drugs midwives can prescribe, though the ultimate goal is doing away with the lists.

"The aim is to get us to that place to have clients have ... equal access to drugs and tests in the pregnancy and postpartum that they would get with any other health-care provider providing the same care," she said in an interview.

"It just feels like that (lab test) piece, we're having actual traction and we're able to move forward and that we're really pleased about. We just have the other component that still needs pushing."

Goal to ease pressures on health-care system

The college on March 27 sent the government a list of tests it wants to see added for now and isn't sharing that list while it waits to hear back. But one example cited by Tecson is non-invasive prenatal testing, which is genetic testing if an initial screen finds an increased likelihood of Down Syndrome.

When it comes to medications, older versions of a drug to manage post-partum hemorrhaging are on the list, but not better and newer ones, Tecson said. They are also unable to prescribe medications for severe nausea and vomiting in pregnancy.

It has been frustrating to see how quickly the government has expanded the scope for pharmacists, Tecson said. Ontario announced in its budget last month that pharmacists would be able to prescribe for six more common ailments, in addition to the 13 added to their powers earlier this year, and is considering further expansions.

"We know that an expeditious process and creativity from the government is possible and that's very heartening, and so our ask for the government is that that same creative thinking, that same commitment to facilitating a change for the sake of improved health care happen for midwives and their clients," Tecson said.

The government has said it is considering other scope expansions for health professionals, including allowing registered nurses to prescribe, allowing nurse practitioners to order and apply defibrillators and ECGs, and allowing chiropodists/podiatrists, optometrists and naturopaths to prescribe more drugs.

Jessica Carfagnini, a board member of the Ontario Association of Naturopathic Doctor, said their hopes are similar to the midwives' – to be able to prescribe whatever they deem medically necessary. Leaning more on naturopaths would ease pressures on family doctors as well as lower health system costs, since naturopath services are not covered by the Ontario Health Insurance Plan, she said.

"I really think that they have a huge opportunity here," she said. "If they turn their analysis towards naturopathic medicine, they can see that there are really highly educated qualified primary health-care practitioners in the province of Ontario who are willing to help, but just right now, our hands are tied."

The Ontario Society of Chiropodists has also been asking for the province to do away with a list of drugs they can prescribe, because it becomes so out of date in between updates. They also want the province to allow their members to order lab tests such as X-rays, CT scans, MRIs and ultrasounds, and communicate a diagnosis to a patient.