Midwives are autonomous practitioners who have the education and training to meet the competencies for prescribing, ordering, dispensing, compounding, and administering medications and substances. Midwives practice within the Midwifery Regulation, BCCNM standards, limits and conditions, workplace policies, and individual competence (referred to as the controls on practice) when performing any activities with medications and substances.
Registered Midwives Medications and Substances: Standards, Limits and Conditions that came into effect
March 1, 2023 outlines midwives' scope of practice, accountabilities, and responsibilities when performing activities involving medications and substances. Midwives use critical thinking, knowledge, and clinical and professional judgment when making decisions about prescribing, ordering, dispensing, compounding, and administering medication and substances.
It is the midwife's responsibility to act according to current evidence and to ensure they have access to the most current resources when performing activities and providing services related to medications and substances for clients.
Prescribing controlled drugs and substances (CDS) is within the scope of practice for registered midwives.
The drugs listed in the B.C.
Controlled Prescription Program require the use of a duplicate prescription pad. BCCNM oversees the provision of duplicate controlled prescription pads to midwives who are practising in B.C.
Dispensing medications and substances involves preparing and giving medications to a client to take later or when necessary. Dispensing includes ensuring the pharmaceutical and therapeutic suitability of the medication for its intended use and taking steps to ensure its proper use. Midwives can dispense with the involvement of a pharmacist or without their involvement when pharmacy services are unavailable.
When a pharmacist has already reviewed a medication's suitability and dispensed it for the client, midwives ensure its proper use.
Medications and Substances: Standards, Limits and Conditions states:
Record dispensing information in the client's record.
When a pharmacist has not reviewed a medication's suitability (or it's unclear whether this was done), it is recommended midwives consider the medication's pharmaceutical and therapeutic suitability for the client and its proper use by:
Checking that the medication is appropriate for the client, and the dose and frequency are within usual range
Verifying the information with client when possible
Reviewing the client's best available medication history and other personal health information
Assessing the client's known allergies and ensuring medication allergy information is documented
Considering potential medication interactions, contraindications, therapeutic duplications, side effects, adverse effects, and any other potential problems
Considering the client's ability to follow the medication regimen
Explaining what is ordered and confirming the client is able to take the medication as prescribe
Handing the medication directly to the client or the client's substitute decision-maker or other authorized delegate.
Midwives document the dispensed medication and substances in the client's medical record following the
Policy on Medical Records and the
Standards of Practice. It is recommended to include:
Often just called an "order," a client-specific order is an instruction or authorization given by an authorized health professional to another health professional to carry out a treatment, medication, intervention, or procedure for a specific client. A consultation, referral or professional recommendation is not an order.
A client-specific order must:
Midwives give client-specific orders for clients. Midwives may also act on client-specific orders given by physicians and nurse practitioners for activities outside the midwifery autonomous scope of practice.
For example, midwives may compound, dispense, or administer other Schedule I or IA medications not included in the drug categories and for purposes as set out in Tables 1, 2, and 3 within the standard
only if they have consulted with and received an order from a physician or nurse practitioner (Midwives Regulation, 6(3) & 5(1) (k)).
Midwives are autonomous practitioners who have the education and training to meet the competencies for prescribing, ordering, dispensing, compounding and administering medications and substances. Midwives are responsible for providing medications and substances to clients using current medical resources. This may include consulting:
Midwives in all midwifery practices need to enrol in PRIME to gain access to PharmaNet. You can read more about the PRIME initiative
in this announcement.
All PharmaNet users must enrol in PRIME during specified time periods in 2022 or 2023. Registered Midwives have until April 30, 2023 to enrol in PRIME. Additional resources can be found at
British Columbia PRIME.
Please direct all questions to:
PrimeSupport@gov.bc.ca or 1-844-397-7463.
The four existing prescribing standards have been revised and combined into one new medications and substances practice standard. The changes clarify midwifery scope related to medications and substances, as the new standard sets out the expectations, limits and conditions for all potential medication activities a midwife may perform (i.e., prescribing, ordering, compounding, dispensing, administering), both within autonomous scope of practice and with a client-specific order.
Another change is how the standard looks. The long lists of drugs and the accompanying information have been removed and replaced with tables that outline drug categories, drug purposes, and any BCCNM limits or conditions that apply.
Also, two new drug categories beyond those listed in Schedules A and B of the Midwives Regulation have been added to allow for the two emergency medications already named within the inclusive list.
As well, we have clarified the expectations when midwives act on a client-specific order.
Other changes include:
Removing the limit around anticoagulants for the prophylaxis of VTE. The new standard allows midwives in hospital settings to prescribe or administer anticoagulants for the prophylaxis of VTE in accordance with hospital protocol/ guidelines.
Yes, ordering packed red blood cells for the purpose of preventing or treating dehydration or blood loss, resuscitation or other emergency measures is within the scope of midwifery practice. See
Table 4: Substances in Schedule A Limits and Conditions.
For further guidance on understanding and applying the standards of practice, contact our team by completing the Standards Support intake form.
For questions specifically about the Controlled Prescription Program, email firstname.lastname@example.org.
BCCNM recommends speaking directly to the midwife and/or their supervisor, if applicable. Most midwives, however, are independent practitioners, meaning they do not have an employer or supervisor/manager.
When you have a concern about a midwife's practice in this situation, we recommend:
if possible, discuss the problem directly with the midwife.
If the problem occurred
within a hospital setting, you consider pursuing the matter with the Patient Care Quality Office and/or health care agency where the problem occurred.
Regardless of how (or whether) you attempt to address your concern directly with the midwife, or relevant health care agency, you can always submit a written complaint to BCCNM.