Scope of practice

​​This page introd​​uces the scope of midwifery practice in B.C., highlighting how legislation, standards, and individual competence work together to ensure safe, ethical, and appropriate​ care.

What will I learn?​

• About the midwifery scope of practice
• The difference between midwifery profession's scope of practice vs.  individual midwife's scope of practice
• About the "controls on practice" framework and how it helps midwives to practice within scope

Standards

• Standards of Practice

• Indications for Discussion, Consultation and Transfer of Care​

The midwifery model in B.C. is grounded in a holistic and evidence-informed approach that views pregnancy and childbirth as normal physiologic processes. Central to this model are the principles of continuity of care, informed choice, collaborative practice, and respect for clients as primary decision-makers.

You can find detailed information about the Midwifery Model of Practice and Philosophy of Care on the Midwives Association of British Columbia (MABC) website.

Midwives in B.C. practise autonomously across a range of settings and in partnership with clients, supporting families throughout the reproductive journey with dignity and respect.

BCCNM's standards detail the minimum requirements for safe practice of midwifery. The Entry-level Competencies for Registered Midwives provide details of the skills and knowledge expected of a midwife in B.C.

What is Scope of practice?​​

​Understanding scope of practice

In B.C., the Midwives Regulation sets out midwives' scope of practice. The Midwifery Regulation defines midwifery as the health profession in which a person provides midwifery services during normal pregnancy, labour, delivery,​ and the postpartum period.

Scope of practice refers to the activities that registered midwives are educated, competent, and authorized to perform.

There are two aspects of midwifery scope:

1. Midwifery profession's scope of practice​​

This includes:

• Midwives Regulation and other relevant federal and provincial legislation

• BCCNM bylaws, standards of p​ractice, and other regulatory documents

2. Individual midwife's scope of practice​​

A midwife's individual scope of practice is shaped by their unique background and practice setting. Each midwife's individual practice will look different. Midwives individual scope of practice within their practice settings is influenced by:

• Their education
• Authority to perform activities
• Their individual competence, i.e., the ability to integrate and apply knowledge, skills, attitudes, and judgment for safe and appropriate performance in practice
• Policies that may restrict a midwife's practice in a practice setting (e.g., clinic, hospital, or home)

Staying within scope: Controls on practice

Controls on practice is a framework that helps define a midwife's scope of practice. It can be used as a decision support tool to help you understand what activities are in scope, when you can perform them, what limits or conditions must be met, and what competencies are required.

There are four levels of regulatory control on a midwife's practice. Each level, from the top to the bottom, works to narrow and define a midwife's scope of practice.

​

1. Legislation & regula​tion

The Health Professions Act and the Midwives Regulation broadly outline the activities midwives are authorized to perform.

For example, the Midwives Regulation sets out that midwives provide health-care services to clients during “normal pregnancy, labour, delivery and the postpartum period." Therefore, under the Regulation, a midwife is not authorized to provide care to clients who fall outside this requirement (e.g., treating a client's non-pregnant partner).

2. BCCNM​​

BCCNM bylaws, standards, limits, and conditions further define the scope of practice set out in the Regulation.

For example, before prescribing narcotics, a midwife must complete the BCCNM-approved course as set out in the Medications and Substances: Standard, Limits, Conditions. A midwife is not authorized to prescribe narcotics if the course is not successfully completed.

3. Place of practice

"Place of practice" can be defined as the location in which midwives provide care to clients (e.g., a clinic, hospital in which you have privileges, or independent practice setting). Practising midwives are required to know which activities they are authorized to perform in their place of practice as these policies may restrict or define the practice of midwives in a particular location.

For example, some hospital policies may restrict midwives from performing an activity like water births, even if midwives have the skills and knowledge to perform it or have performed it at another place of practice.

4. Individual competence

Competence is the integration and application of the professional attributes (knowledge, skills, attitudes, and judgment) required to perform in a given role, situation, or practice setting. An individual midwife's competence to carry out a particular activity may further define a midwife's scope.

An individual midwife determines whether they have the necessary competence to safely perform an activity for their client and whether they can appropriately manage the outcomes of care in their practice setting. If a midwife has not acquired the competence to perform an activity, they have a duty not to perform it. For example, if a midwife is not sure they can safely perform an amniotomy because they haven't recently performed this procedure, they should not proceed with it even though amniotomy falls within midwives' legal scope of practice.​​​