Winter 2009 - Association of Ontario Midwives

Association of Ontario Midwives Winter 200903Don’t miss springregionalsBELOW: Rebecca Rutherford makes a wish with Midwife Carol Cameronand mom Anita. Rebecca was the first midwife-attended baby born inan Ontario hospital after regulation in January 1994.04AOM at the OHAconference05Midwives active onLHIN committees07How to start anew practice09HPRAC recommendsnew drug approvalframeworkAssociation of Ontario MidwivesHappy Birthday! Midwives celebrate15 years of regulation in Ontario

AOM News & UpdatesGraduate students and AOM Interns Nicole Versaevel(above) and Johanna Geraci (below).The AOM is currently facilitating studentplacements for two RMs who areworking on their Master’s in HealthPolicy.Nicole Versaevel is completing aMaster’s of Science at the Universityof Western Ontario in the faculty ofHealth and Rehabilitation Science,with a focus on health promotion.Starting in the summer of 2009 Versaevelwill conduct a study to addressretention of Ontario Midwives. She isinterested in workplace wellness andhealth promotion and its applicationto the independent contractor model.Johanna Geraci is working with theAOM as part of a graduate diplomaprogram in Health Services and PolicyResearch through the Ontario TrainingCentre in Health Services and PolicyResearch. Geraci is also in the Master’sProgam in Health Research Methodologyat McMaster University. One ofthe requirements is a 200-hour placementin a policy-making environment.At the AOM, Geraci is developing anexit interview for midwives leavingmidwifery practice in Ontario.The AOM is interested in working withMaster’s students whose research isrelated to the work of the Association.Interested students are welcome toinquire with Alisa Simon, Acting Directorof Policy and Communications bye-mail at directorpolicy@aom.on.caIMPP Class of 2009Back row from left: Wenli Zhang (China), Adele Williams (USA-trained), Karline Wilson Mitchell (USA), IngeborgRoorda (Netherlands) and baby Yasmin (Canada), Rinat Spracklen (UK), Mandy Reid (USA), Hayley Mutch (UK)Middle from left: Rosina Carreras-Castaneda (Cuba), Sarah Burnell (UK), Shaheeda Pierce (USA), Zinaida Bakhareva(Russia), Mara Paredes (Guatemala)Front row from left: Deepa Takrani (India), Shiva Saeri (Iran), Min Liu (China), Yuefang Liu (China), Betty Kagoda(Uganda)IMPP Midwives addgrowth, experienceand diversity to AOMmembershipThe International MidwiferyPreregistration Progam at RyersonUniversity is now in its seventh yearand going strong. Midwives educatedin 26 countries from around theworld have completed this bridgingprogram which has dramaticallyincreased access to registration forinternationally-educated midwives.Seventy-eight IMPP graduates areRegistered Midwives currentlypracticing in Ontario - approximately20% of total AOM membership.Eighty-seven percent of IMPPgraduates find employment inOntario, with another four percent inother provinces of Canada.The IMPP recently held a conferencetitled “International Ideas andExperiences in Midwifery.” Theconference was a tremendous success,with delegates over capacity.Welcome new AOMmembers!Myriam Badger, Midwife AllianceLesley Janet Bonell, BirthcareAshley Lynn Broadbent, Community CareMidwivesGenevieve Gagnon, Sages-Femmes dePrescott-Russell MidwivesFariba Gilanpour, Midwife AllianceCorinne Hare, Kensington MidwivesMei Rong Luo, Midwifery Collective ofOttawaMichele Matte, Midwives of SudburyTiffany Meier, Sages-Femmes RougeValley MidwivesMojgan Nadafi, Thames Valley MidwivesJanessa Lorraine Otto, Niagara MidwiferyPracticeSoheyla Owliaei, Midwives of WindsorLinda Rayner, Midwifery Group ofOttawaJulie-Lisa Toole, Riverdale CommunityMidwives(as of February 2, 2009)02 ontario midwife • Winter 2009

Members at the fall West Regional Meeting in Stratford (left to right): Liza van de Hoef(Stratford Midwives), Cathy Grant (Cambridge Midwives), Rebekah Bradshaw (StratfordMidwives), Beth Lynes (Stratford Midwives) and Beth Read (Thames Valley Midwives)Spring Regional MeetingsRegional meetings are key to information-sharing. At the fallmeetings, Board members and staff gave updates regardingnegotiations, communications, growth and new initiatives. Fallminutes are now available for download from the members onlysection of the AOM website.Don’t miss out on this opportunity to give input into thedevelopment of the next strategic plan. All members are invitedto attend.Meetings will run from 1:00 to 4:30 p.m. Members are encouragedto contact your regional representative to add items to theagenda. Call the AOM office if you need the contact details foryour rep.West (London): Tuesday, March 24 • Madeleine ClinNorth (Sudbury): Wednesday, March 25 • Eileen AbbeySouth-East (barrie): Thursday, March 26 • Sara StaintonEast (Kemptville): Monday, March 30 • Jane SomervilleSouth-West (Oakville): Wednesday, April 1 • Kelly GascoigneSouth-Central (Toronto): Note new date - Thursday, April 2 •Tracy FranklinFriends reconnect at the West Regional Meeting (left to right): Tahereh AlizadehBarmi (Cambridge Midwives), Nasrin Bandari Vali (Kitchener-Waterloo MidwiferyAssociates), Mitra Sadeghipour (Family Midwifery Care of Guelph), Mojgan Nadafi(Thames Valley Midwives) and Basak Ardalani (Guelph Midwives).Membership renewalThe early bird draw winner this year is Angel Brazeau-Taylor(Midwifery Services of Durham). Angel received a prize fromthe AOM in December. Thank you to all members who haverenewed. The AOM currently has 457 members.AOM Informed Choice eLearning ModuleThe Informed Choice eLearning Module is the first eLearningproduct developed by the AOM. It is written for practicingmidwives, recognizing the skill and knowledge they alreadyhave in providing informed choice.The need for the module was first recommended by the JointRisk Management Working Group because of the key rolethat informed choice plays in risk management.The College of Midwives of Ontario recognizes this moduleas fulfilling two Continuing Education and ProfessionalDevelopment Activities for Quality Assurance Program (QAP)reporting. Cost to AOM members is $25.Learn more and take the course at www.aom.on.ca/Professional/E-Learning_Opportunities/Informed_Choice_eLearning_Module.aspxClinical Practice Guildelineswork underwayThe AOM Clinical Practice Guidelines projectwas launched last fall. The AOM will becreating six CPGs over the next year toprovide Ontario Midwives with the mostrecent evidence-based recommendationsfrom a uniquely midwifery- and values-basedperspective.“This work is so valuable to members,” saysTasha MacDonald, RM, Director of ClinicalPractice Guidelines. “To provide Associationguidelines for clinical issues is such a greatopportunity for members to both contributeand to learn from each other. We look forwardto a lot of feedback and participation frommembers once the first draft guidelines areposted in the spring.”The first two CPGs to be completed will beGroup B Strep and PROM.In upcoming months information will beposted to the AOM website to keep membersinformed and elicit their feedback.Thank you to the CPG sub-committee andmidwife researchers who have been helpingthe project get off to a great start.They are: Liz Darling (chair), Rhea Wilson,Jenni Huntly, Ann Pennington, CherylleeBourgeois, Corinne Hare, Paula Salehi, LynleeSpencer (student member), Lisa Weston (IRMPCommittee Rep).For further information please contact theProject Manager, Suzannah Bennett, atcpgmanager@aom.on.ca.www.aom.on.ca03

AOM News & UpdatesStaff UpdatesThe AOM staff continues to grow inorder to serve members. There havealso been a number of recent staffleaves of absence. If you are notsure who best can help you, just callreception and you will be connectedwith the staff member who can bestassist you.A full staff directory can be found onthe AOM website at www.aom.on.ca/AOM/Contact_Us/Juana Berinstein, Director of Policyand Communications, is on parentalleave, returning in September. AlisaSimon, Senior Policy Analyst, iscurrently Acting Director in Juana’splace. Timothy Mbugua has joined theAOM until September as a ContractPolicy Analyst.Diana MacNab, Manager, MembershipServices, is on maternity leave untilJanuary, 2010. Congratulations Dianaand family on the arrival of daughterAurora. Jill Moriarty is currently ActingManager in Diana’s place.Zahara Hajiani, Program Administrator,is on Maternity leave untilFebruary, 2010. CongratulationsZahara and family on the arrival ofdaughter Arianna. Ferdausi Mannanis currently Acting Program Administrator.Deborah Schneider-Gagne, BenefitsAdministrator, is on maternity leaveuntil January, 2010. CongratulationsDeborah and family on the arrival ofdaughter Lorelye. Angela Edwards iscurrently Acting Benefits Administratorwhile Deborah is on leave.The AOM has hired a new full-timeEvents Coordinator. Laura Belair willcoordinate the AGM and AnnualConference, as well as ESW events.OHA HEalth achieve show 2008: Lisa Weston, RM, AOM Vice President, talks with two visitors at the AOM booth duringthe Ontario Hospitals Association conference and trade show in November. Jasmine Ferreira, Program Assistant-Policyand Communications, helps to staff the AOM booth and distribute brochures.Building relationships with Ontario HospitalsIn November, the AOM participated in “OHA Health Achieve”, the Ontario HospitalAssociation trade show and conference. The AOM booth saw hundreds of visitors overthree days. Staff handed out newsletters, posters and informational brochures aboutmidwifery, increasing the visibility of the profession within a targeted health careaudience of hospital CEOs, senior hospital administrators, hospital board members,senior nursing staff and others. Feedback from delegates was very positive.AOM board members and staff also attended many of the seminars and networkingsessions focussed on maternity care in Ontario.The AOM anticipates being involved with Health Achieve annually to continue topromote the integration of midwives into the health care system.Midwifery Education Program activitiesAOM representatives recently attended several Midwifery Education Program eventsincluding a screening of Orgasmic Birth and panel discussion at Ryerson, a guestlecture regarding Cultural Politics and Traditional Birth Attendants also at Ryersonand an information session and reception at McMaster.Many members also attended the annual MEP Preceptor Conference. This conferenceis available at no cost to all midwives.Sessions included:• New approaches and developments in the MEP• Meaningful feedback between students and teachers in the MEP• Planning clinical experiences in a variety of on-call models• Changing trends in midwife-attended homebirth and implications04 ontario midwife • Winter 2009

The Association of Ontario Midwives presents the College of Midwives of Ontario with a set of promotional posters during a CMO/AOM Liaison meeting at the new AOM office.ABOVE (left to right): Deborah Adams (CMO Registrar); Diane Parkin, RM (CMO Midwife Member); Kelly Stadelbauer (AOM Executive Director); Mary Ann Leslie, RM (AOMSecretary); Katrina Kilroy, RM (AOM President); Mylene Shields, RM (CMO President); Barbara Herron (CMO Public Member, Vice President); Eleni Palantzas (CMO PublicMember); Andrea Lennox, RM (CMO Vice President)Midwives active withOntario LHINsThe AOM is pleased to announce thatmidwives from every region in Ontarioapplied to serve on their Local HealthIntegration Network (LHIN) Health CareProfessionals Advisory Committees(HPAC) and that four midwives wereappointed.The four midwives serving on HPACsare: Sandy Knight in the HamiltonNiagara Haldimand Brant LHIN, SaraStainton in the North Simcoe MuskokaLHIN, Remi Ejiwunmi in the MississaugaHalton LHIN and Deborah Bonser in theToronto Central LHIN.As members of the HPAC, thesemidwives have a unique opportunity tohelp inform health care policy in theirregions and to ensure the voices ofmidwifery are heard in the health careplanning process.“There have been a number of waysthat I have been able to give inputto my LHIN,” says Sara Stainton.“First is through HPAC, and this is anongoing and developing relationship.Also, I have met LHIN representativesthrough various committees that arecommunity-based and run through thelocal health unit, community healthcentre and the hospital.“My LHIN went out looking forrepresentatives of the local maternityhealth care community andconsumers,” she says. “Whenever I haveseen or heard for calls for consumersthrough the health care communityor through local media I am quick tocontact some of the consumers from myown practice and I also contact othermidwifery practices in the LHIN so thatthey can alert other consumers. I thinkthat this contact with consumers willreally help to make the LHIN aware ofwhat a great resource midwives are.”Many more midwives throughout theprovince are working hard to help withmaternity care planning by serving onimportant committees in their LHINsuch as Liz Darling, Leslie Viets andCéline D’Arcy in the Champlain LHIN,Shirley Meltzer with Central West LHINand Allyson Booth in the Central EastLHIN. If you are working with yourregional LHIN, please contact the AOMoffice so that there is knowledge of thework being done by members.As more LHINs engage in maternity careplanning, it is becoming increasinglyimportant for midwives to engage inwork with LHINs - and there are manyways to be involved:• Sign up to be on the AOM LHINlistserve for your region• Go to your local LHIN webpagewhich can be found at www.lhins.on.ca and sign up for updatesabout health care planningoccurring in your LHIN• Attend open LHIN board meetings• To find out if your LHIN is workingon maternity care planning andhow you can get involved withLHIN committees, contactTim Mbugua at the AOM:policy@aom.on.cawww.aom.on.ca05

AOM News & UpdatesCelebrating 15 years of regulated midwifery in OntarioAnita Rutherford was the first midwiferyclient to give birth in an Ontario hospitalattended by midwives instead of a doctorafter regulation came into place inJanuary 1994. Baby Rebecca arrived justone day after Registered Midwife CarolCameron and six other midwives weregranted privileges at the hospital.“There was a lot of excitement goingon behind the scenes,” says Cameron.“All these people were waiting outsidethe room and we weren’t even awareof it until after the birth. There was anews camera, the Hospital Chief of Staff,and Anita was so gracious and spoke toeveryone. I’m glad it was her fourth babyand everything was straightforward.”“Baby” Rebecca is now a teenagercelebrating her fifteenth birthday rightalong with midwifery in Ontario.Provincial midwifery legislation waspassed in 1991, but didn’t take effect untilthe first day of 1994.At that time, 60 midwives were registeredto practice in Ontario. Today, there areover 400 and that number is expected todouble in the next four years.Of the “original sixty” midwives whoqualified to practice through theMichener Program, thirty-five arecurrently registered with the AOM.Today, there are 66 practices operating 73sites across the province.Cameron, a former AOM President, saysregulation changed how midwives areviewed in the health care system.“It sounds cliché, but it’s huge. Whenyou’re outside the system, you caninfluence individuals, but now in termsof hospitals, I sit on multidisciplinarycommittees, I’m the head midwife at thehospital and maternity policy decisionshave to include midwives. People lookto me for my expertise and experience.It’s counted and valued. Now we haveinfluence for women in the communityand the profession.”But she recognizes that regulation didn’tfix everything overnight.“Change is hard for anybody,” saysCameron. “People are vulnerable abouttheir roles. It can be difficult to negotiatethe role definitions – we’re alwaysworking on that with doctors and nursesand midwives. It takes goodwill on allsides and really working together for awhile at any site.”Besides professional changes, regulationgave Cameron personal rewards as well.“Now I can truly provide the kind of carethat in the past I was just advocating for,”Top: Rebecca Rutherford, Carol Cameron, RM, and AnitaRutherford hold clippings from the January 29, 1994Toronto Star. Rebecca’s birth at Markham-StouffvilleHospital was front page news.Bottom: Anita, Rebecca and Carol enjoy birthday cakeand a reunion at the photo shoot.Photos by Ian Goodallshe says. “Being a primary care providermeans the client and the professionalcome up with a care plan and see it rightthrough. Even if other care providers areinvolved, you’re orchestrating it. That’s asource of personal satisfaction and pride.”“At this point in my career, it’s also sosatisfying that I’m helping the futuregenerations. I love working with MEPstudents and IMPP midwives andmentoring them,” she says. “Beingable to see the future is personally veryrewarding.”06ontario midwife • Winter 2009

Key Maternity Care IssuesPassion and hard work key to starting a new practiceEstablishing a new practice takes a lotof hard work and organization, but therewards are enormous both to practicepartners and families in the community.Midwifery continues to grow at atremendous rate in Ontario. Consumerdemand is high, and more midwives enterthe profession every year than retire. Thismeans that individual midwives have to beleaders in expandingopportunities topractice.One way to start anew practice is bya satellite location“splitting” off anddividing a catchmentarea. Midwives ofGrey Bruce havedone this a few times.“In the late ‘90s we had huge catchmentarea and we had grown to have elevenmidwives,” says Heather Keffer, a founderof Grey Bruce (previously Grey Simcoe).“So it made sense that in 2001, once wehad enough midwives living near theBarrie area, we had our amicable divideand the satellite clinic there became aseparate practice. Recently, the samething happened again and the clinic inCollingwood became a new practice andthe Grey Bruce practice set up in OwenSound, which used to be a satellite office.”The original practice, Grey Bruce, continuesto provide support for the new practice.“Unofficially, we provide backup for thenew Nottawasaga practice because thereare only two midwives,” says Keffer. “Weretain hospital privileges in Collingwood,but haven’t had to use them yet.”Lynne- Marie Culliton is a partner atNottawasaga. “Two major advantages ofstarting a new practice in an establishedclinic are that you already have a built-incaseload and location. We also alreadyhad hospital privileges, so that made thetransition in the community quite smooth.”Internally, though, starting a new practicemeans a lot of changes. “One of thebiggest disadvantages was going from abig practice with eight full time midwivesand an administrator to a small one withonly two midwives and no administrator.All of the systems – charts, call schedule,clinic schedule, office procedures and suchworked well for a big group, but not for asmall group. It has meant a lot of reworkingthings to fit better with the resources wehave,” says Culliton.Some midwives start new practices in areaspreviously underserviced by midwiferycare, or where they have their own roots inthe community, but where no clinic currentexists. Starting from scratch offers its ownchallenges and its ownrewards.“My intention rightout of school was toopen a practice in myhome community,” saysLisa Weston of Sages-Femmes Rouge ValleyMidwives. “We wereworking on it during ournew registrant year.”There was a strong group of about 15consumers working with the future RougeValley Midwives during the proposal stageand beyond.“Three of us worked out of our homes andcars for about a year in 2004, but nowwe’ve grown to have eight midwives and apermanent clinic space,” says Weston. “I’mgrateful to those midwives who gave us somuch support and mentoring during ourfirst years. It was a steep learning curve,so it was important to have their help andhave different viewpoints from a few otherpractices, and from the Association. Thesedays, there are even more resources inplace for midwives interested in starting anew practice.”“Starting from zero meant a huge amountof work and responsibility, but there’salso joy in making our own vision andour model a reality,” she says. “It mightbe easier to start from a satellite in someways but there may be limitations interms of how you want to organize andpractice. We created the identity andflavor of our practice and set things upthe way we wanted right from the start,rather than having to un-do any previousarrangements.”Whether starting from an establishedsatellite site or a brand new practice, everynew practice must go through regularapplication channels with the Ministry ofHealth and Long-Term Care.New practices based ondemand, existing service,practice group strategyThe first step in starting a new practiceis to contact the Ontario MidwiferyProgram (OMP) at the Ministry ofHealth. The OMP holds an annual informationsession each fall (November),but your work can and should beginbefore then. Proposals are usually duein January. The AOM can provide ideasand advice about the process.Steps in Proposal Development1. Establish a location and assessstakeholder support2. Review proposal guidelines,conduct research and assemblenecessary resources3. Develop and draft proposalincluding a proposed budget4. Submit proposal to the TransferPayment Agency (TPA)5. Refine proposal with TPA6. TPA approves proposal andsubmits to OMP with TPA AnnualBudget RequestExpansion CriteriaThe OMP uses the following criteriato determine whether to expand orestablish midwifery services:• Under-served community –Priority given to communities withobstetrical provider shortages• Strong unmet demand formidwifery services in thecommunity• Practice group efficiency –strategy ensures that practicegroups function at adequate sizeto provide on-call coverage.Resources:• AOM• OMP• TPAs• Hospitals• Current practice• Neighbouring practices• Community Health Centres• Consumer Advocacy Groupswww.aom.on.ca07

National NewsBritish ColumbiaB.C. Women’s Hospital and Health Centre, the busiest maternityhospital in Canada, has been recognized as a breast-feedingand “baby-friendly” hospital by the World Health Organization(WHO) and UNICEF. Hospital president Dr. Elizabeth Whynotsaid it took four years of preparation to attain the highly desiredstatus, which was awarded after a 72-hour inspection andassessment by the designating organizations. The current tally ofBaby-Friendly facilities in Canada has also reached a milestone. Atotal of 25 facilities have now been designated – nine hospitals,two birthing centres and 14 community health facilities.Alberta / SaskatchewanMount Royal College in Calgary and the University of BritishColumbia have partnered to pilot the Multi-jurisdictionalMidwifery Bridging Project (MMBP) set to start in March 2009.This seven-month pilot, if successful, will become the mechanismfor internationally-educated midwives to be assessed andintegrated into Western Canadian midwifery practice. Midwiferystudents in Alberta are still left with finding their own educationalroutes mostly outside of the province. This is becauseAlberta Advanced Learning will not establish an educationprogram for midwifery until Alberta Health and Wellness designatesmidwifery as a priority profession in the province.Saskatchewan will participate in the pilot phase of the MMBP, byproviding preceptor support to limited number of internationallytrained midwives. The MMBP is seen as a way to encourage moreforeign trained midwives residing in Saskatchewan the opportunityto challenge Canadian midwifery exams without having toleave the province. Saskatchewan has been allocated two seatsin the MMBP which may be a limiting factor to expansion of themidwifery program to other areas of the province when jurisdictionsdiscontinue the PLEA assessment.The MMBP will assist internationally-trained midwives to prepareto meet the requirements for registering and practising as amidwife in British Columbia, Alberta, Saskatchewan, Manitoba orthe Northwest Territories.Northwest TerritoriesNWT Midwife Gisela Becker is the new President of the CanadianAssociation of Midwives. Becker, a registered midwife working inFort Smith, has been Vice President of CAM for three years. Oneother midwife works with Becker in Fort Smith and together theyprovide maternity care for all childbearing families in that areathrough a program with the Fort Smith Health and Social ServicesAuthority. A midwifery program has been established in Yellowknifewith the recent certification and hiring of a midwife there.This is currently a solo practice through the Yellowknife Healthand Social Services Authority. The program has been well receivedby the community and the demand for midwifery servicesoutnumbers the program’s capacity.The 2009 CAM conference will take place November 4, 5, and6 in Winnipeg, MB. Visit www.canadianmidwives.org for moreinformation.ONTARIOThe long wait is over for four midwives who are now able todeliver babies at Belleville hospital. Approval, which was firstgiven in principle in May 2007 by the Quinte Health Care Board ofDirectors, was announced February 2.“The most difficult task involved meeting with the departmentsof obstetrics, pediatrics and anesthesia to develop policiesoutlining our interactions together,” says Stephanie McDonnell,RM at Quinte Midwives. “We faced a great deal of resistance andmany delays in scheduling these critical meetings. With the assistanceof the hospital administration, the AOM, strong communitysupport and changes in departmental leadership, we eventuallymet all criteria and were approved to deliver babies at the Pictonsite in September 2008. As the Picton hospital is a level 1 facilitywith limited resources and many of our clients wish to deliverat their local hospital in Belleville, we continued to advocate forhospital privileges at the Belleville site as well. We are thrilledto finally have privileges at both Belleville and Picton sites as ofFebruary 2009 and we feel we can now truly offer choice of birthplace to our clients.”2008 Coroner’s report onlineThe Fourth Annual Report of the Maternal and PerinatalDeath Review Committee to the Chief Coroner for theProvince of Ontario (September 2008) is on the AOMwebsite. It can be downloaded from Members/ ReferenceDocuments/ 2008 Coroner’s Report.Clinical Resources onlineThe Clinical Bibliography has been updated online as ofFebruary 2, 2009. Visit Members/ Reference Documents/Selected Clinical References to access a list of relevantarticles. Compiled by Director of Insurance & RiskManagement Bobbi Soderstrom.08 ontario midwife • Winter 2009

Government InitiativesMidwifery scope ofpractice reviewIn September 2008, the Health ProfessionsRegulatory Advisory Council(HPRAC) submitted its proposalregarding the scope of practice ofmidwives, as well as three otherprofessions, to the Minister of Healthand Long-Term Care. This scope reviewwas viewed as a significant step as itwas the first systemic review of thescope of practice of midwives sincethe Midwifery Act of 1994. The AOMcollaborated closely with the Collegeof Midwives of Ontario on the originalsubmission to HPRAC regardingexpanding midwives scope of practice.HPRAC recommended a few keyexpansions for midwives, namely: theability to communicate a diagnosis;the authority to order additional labtests and diagnostics; the authority toplace a finger or instrument beyond theanal verge to allow for the administrationof suppository medications; and, theauthority to take blood samples fromfathers and donors from veins or by skinpricking.Unfortunately, some recommendationsmade by the CMO and AOM wererejected by HPRAC. In particular, the AOMwas disappointed that midwives didnot receive the authorization to directambulances to the most appropriatecare facility; the authorization to putan instrument, hand or finger beyondthe anal verge for routine perinealassessment and repair; or the abilityto facilitate midwives to certify foradditional procedures in order to facilitateIPC, particularly in rural and remote areas.AOM has submitted a response whichargues that these recommendations arecritical to midwives’ ability to provide carefor low-risk women in a safe, collaborativemanner, to facilitate midwiferyparticipation in IPC, to provide efficiencyin the use of highly skilled obstetricianresources, to support maternity care closeto home, and to bring midwifery scopeof practice into line with Canadian andcommunity practice standards.The Ministry has stated that it plans toannounce legislative changes in responseto the scope of practice review as early asspring 2009. The AOM will be advocatingfor Ministry support for the midwiferyprofession’s efforts to participate in IPC.Prescribing and use of drugsby non-physiciansIn December 2008, the College ofMidwives of Ontario, in consultation theAOM, submitted to HPRAC its proposalto replace the current list of drugs thatmidwives can prescribe with therapeuticcategories of medications, specific toclinical indications that fall under low-riskmaternity care. Allowing midwives toprescribe from within drug classes ratherthan being restricted to a specific drug listis critical to public safety, to excellence inprofessional practice, and to interprofessionalcollaboration.On February 2, 2009, HPRAC publishedits recommendations to the Minister ofHealth and Long-Term Care regardingmidwives ability to prescribe and usemedications. The AOM submitted aresponse to the Minister of Healthproviding support for:• Replacing the current drug approvalsprocess as it is too lengthy andcompromises patient safety;• Replacing drug lists with therapeuticdrug classes in the legislation forindividual health professions;• Adding technical expertiseof pharmacologists andpharmacotherapists as an integralpart of a new approvals frameworkfor determination of specific drugswithin a drug category; and• Including antibiotics in the midwiferypharmacopoeia.HealthForceOntariogrant project underwayAs discussed at the fall regionalmeetings, the AOM has beenawarded a HealthForceOntario (HFO)grant to:• examine relationships betweenmaternity care providers;• ensure that all health careproviders understand eachothers’ College-defined scope ofpractice and expertise;• ensure that all health careproviders are able to work totheir College-defined scope ofpractice; and• support patient safety and leadto more efficiencies for thehealth care system.The response to the HFO grantfrom midwifery practices has beentremendous, with 20 practices representing20 hospitals applying toparticipate. Eight sites were chosenthat represent all geographic regionsof the province as well as a mix oflevel 1, 2 and 3 hospitals.More activity will be rolled out overthe spring and summer as participatingpractices and hospitals areconfirmed.The AOM showcased this projectat an interprofessional educationconference in January. The posterpresentation, titled “Optimizing Useof Midwifery Competencies in theProvision of Primary Care for Womenand Newborns” explained theproject’s history, process and goals.However, the response also outlines theAOM’s serious concern with HPRAC’sproposed drug approvals framework. Inparticular, that it will undermine theprinciples of self-regulation and be asonerous as the current system, therebycompromising client safety.Members can read the full AOM responseto the HPRAC recommendations inthe members only section of the AOMwebsite, under “Government Relations.”www.aom.on.ca09

Consumer ResourcesHealth Canada to ban BPAThe Government of Canadaannounced it will immediatelyproceed with drafting regulations toprohibit the importation, sale andadvertising of polycarbonate babybottles that contain bisphenol A (BPA).The Government will also take actionto limit the amount of bisphenolA that is being released into theenvironment.“In 2007, we issued a challengeto industry under our ChemicalsManagement Plan to provideinformation on how they managebisphenol A,” said the HonourableTony Clement, Minister of Health.“Today’s announcement is a milestonefor our government and for Canada asthe first country in the world to takeregulatory action.”It was determined that the mainsources of exposure for newborns andinfants are through the use of polycarbonatebaby bottles when they areexposed to high temperatures and themigration of bisphenol A from cansinto infant formula.The scientists concluded in thisassessment that bisphenol A exposureto newborns and infants is belowlevels that cause effects; however,due to the uncertainty raised in somestudies relating to the potentialeffects of low levels of bisphenol A,the Government of Canada is takingaction to enhance the protection ofinfants and young children.The Government has allocated anadditional $1.7 million over the nextthree years to fund research projectson bisphenol A. This research, inaddition to major studies currentlyunderway at Health Canada andEnvironment Canada, will help toaddress key knowledge gaps andinform Government decision-makingshould further actions be required.The proposed risk managementapproach will be followed by a 60-dayconsultation period. Regulations areexpected to come into effect in 2009.For more information, visit theChemicals Management website atwww.chemicalsubstanceschimiques.gc.ca/challenge-defi/bisphenol-a_e.html or call the information line at1-866-891-4542.Cough and cold medicine not for children under sixHealth Canada is requiring manufacturersto relabel over-the-counter cough and coldmedicines with certain active ingredientsto indicate that they should not be used inchildren under 6.Although cough and cold medicines havebeen used by children for many years,there is limited evidence supporting theireffectiveness in this group. In addition,reports of misuse, overdose and very rareserious side-effects have raised concernsabout the use of these medicines inchildren under 6.The risk to children is only at the time ofuse; in other words, children who usedthese products in the past are not at riskfrom having taken them.Check PregVit vitamins, says Health CanadaHealth Canada is informing expectantmothers and women who are planningpregnancy taking the product PregVitFolic 5 and/or PregVit distributed byDuchesnay Inc. to check the product’s individualsealed packages. Reports relatedto incorrect packaging of some blisterpacks have been received by HealthCanada; however no concerns have beenraised regarding the tablets themselves.Individual sealed packages of PregVitFolic 5 and PregVit should contain apink blister pack of pink tablets to betaken in the morning, and a blue blisterpack of blue tablets, to be taken in theevening. The pink and the blue tablets donot contain the same active ingredientsand their daily intake is complementary.Some of the individual sealed packages,which should contain both a pink and ablue blister pack, contained only pink orThe relabelling of over-the-counter coughand cold medicines will be completed byfall 2009, in time for the next cough andcold season. Until then, these medicineswill remain on store shelves and in homeswith the current labelling. Labels couldinclude dosing information for childrenunder 6, because many of these productsalso have dosing information for adultsand older children on the same label. Forthis cough and cold season, parents orcaregivers should consult a pharmacist ora health care practitioner when buying orusing these products. These medicines canstill be used in children 6 and older, andadults.only blue blister packs. Consumers areadvised to check the individual, sealedpackages to ensure they contain both apink and a blue blister pack so that theyreceive the optimal amount of vitaminand mineral supplements.Consumers with the incorrectly packagedproducts are advised to consult theirpharmacist to get a new package.Health Canada has not received anyadverse reaction reports related to themis-packaging of these products inCanada. Preventive benefits, as well asvitamin and mineral supplementationwill be optimized by using correctly packagedproducts.Consumers requiring more informationabout this advisory can contact HealthCanada’s public enquiries line at (613)957-2991, or toll free at 1-866-225-0709.10ontario midwife • Winter 2009

AOM ProgramsAOM Emergency Skills Workshop Instructor TrainingMay 11, 2009 in Mississauga, ONVenue: AOM Conference, Renaissance Toronto Airport HotelType: New Instructor WorkshopAOM Emergency Skills WorkshopMay 12, 2009 in Mississauga, ONVenue: AOM Conference, Renaissance Toronto Airport HotelType: Recertification2009 AOM Emergency Skills Recertification Workshops:Date: September 2009City: Sudbury, ONDate: October 2009City: Toronto, ONDate: December 2009City: Ottawa, ONTo register for ESW courses, visit the AOM website or contactevents@aom.on.ca, 416-425-9974 x2255Announcements - more at www.aom.on.ca “Professional Development”Examining Controversies, Promoting SuccessDurham Region Breastfeeding Coalition Second Annual BreastfeedingSeminar (with Jack Newman)April 16, 2009 in Oshawawww.durhambreastfeeding.ca, 905-493-2645Day in PerinatologyMcMaster Children’s Hospital & St. Joseph’s HealthcareFriday, April 17, 2009, Hamilton Convention CenterContact: Nancy Bonney 905-522-1155 #34161nbonney@stjoes.caHIROC Annual General MeetingApril 27, 2009 in Toronto, ONwww.hiroc.com/22nd_AGM_7th_RMC.aspCanada’s Forum on Patient Safety and Quality ImprovementCanada Patient Safety InstituteApril 28-30, 2009 in Toronto, ONContact: 613-882-6697 sally@f2fe.comwww.f2fe.com/documents/CPSI_Program_2008_E15.pdf“Resolve Through Sharing” Perinatal Bereavement Training2-day WorkshopThe Child Health Network in partnership with the PerinatalBereavement Services OntarioApril 29-30 2009 in Toronto, ON (North York General Hospital)Contact Moya Johnson: 416-813-6507moya.johnson@sickkids.caOVLC 2009 Annual Conference: The Wonder of Human MilkApril 30 and May 1, 2009 in Ottawa, ONContact Sheryl Hamilton: Sheryl@hamiltoncrew.comwww.ovlc.netMedications in Mothers’ Milk with Dr. Thomas W. HaleMay 8, 2009 in North Bay, ONContact: Anne Marie Westenenk 705-474-1400 x2285amw@nbdhu.on.ca7th Annual Refresher in Primary Maternity CareMay 22, 2009, Dept. of Ob/Gyn, U of T and Mount Sinai HospitalContact Elizabeth Gan: egan@mtsinai.on.cawww.mtsinai.on.ca/seminars/ceAmerican College of Nurse-Midwives Annual Meeting & ExpoMay 22-27, 2009 in Seattle, Washington, USAwww.midwife.org/amQuebec IBCLC conference - Breastfeeding Practice based onScienceJune 1 & 2, 2009 in Montreal, PQ (takes place in English withFrench translation)www.ibclc.qc.caNormal Labour and Birth: 4th Research ConferenceJune 10-12, 2009 in Lancashire, EnglandContact: healthconferences@uclan.ac.ukwww.uclan.ac.uk/health/about_health/health_bdu/conferences.phpSOGC 65th Annual Clinical MeetingJune 17- 21, 2009 in Halifax, Nova Scotiawww.sogc.orgAWHONN Canada 20th National ConferenceOctober 15-17, 2009 in Winnipeg, MBwww.awhonncanada.orgOntario Midwife is a quarterly publication of the Association of Ontario Midwives. This publication isavailable online at www.aom.on.ca, or you may request a printed copy. All websites listed are “hotlinked”in the digital copy. Scroll over the website address and click to launch the site.Association of Ontario MidwivesAll feedback welcome. Please contact Joanna Zuk, Senior Communications Officer:comms@aom.on.ca, or by phone: 416-425-9974 x2261 or 1-866-418-3773 x2261.Association of Ontario Midwives, 365 Bloor St. East, Suite 301, Toronto, ON M4W 3L4www.aom.on.ca11

Featured speakers:•Minister of Health and Long-Term Care• Jane Sandall, RN, RM, MSc, Ph.D• Pat Armstrong, Ph.DHonourable David Caplan, &• Bridget Lynch, RM• Dr. Ivor MargolisFeatured sessions:• Emergency Skills Workshops• Epidural management• The late pre-term infant• Home birth• Marketing your practice• Breastfeeding management• Career planning• Artwork by midwives and more!Conference Location:Renaissance Toronto Airport Hotel801 Dixon Road, Toronto, ON M9W 1J5416-675-6100 or 1-800-630-2590www.marriott.comAOM Conference delegates should identify themselves toreceive the special guestroom rate unil April 11, 2009.For more conference information, visit www.aom.on.caAssociation of Ontario Midwives