By Her Own Authority: The Scope of Midwifery Practice under the Ontario Midwifery Act, 1991

Abstract

Midwifery is recognized as an autonomous, self-governing profession under Ontario's Midwifery Act, 1991 and Regulated Health Professions Act, 1991. The author discusses the implications of this new legislation and addresses how the Acts define the nature and scope of midwifery practice. Although the new regulatory model grants midwives legal and professional status, their statutory scope of practice is limited to "normal" pregnancy, labour and delivery. Within the new regulatory framework, the authority to define the meaning of "normal" remains with physicians. Therefore, the capacity to control the scope and availability of midwifery services lies in the hands of the medical profession, which has historically been opposed lo the autonomous practice of midwifery. The author explores the other elements of the Midwifery Act, 1991, such as matters of assessment and diagnosis, and issues of potential liability, and whether or not these could hind midwifery practice by established medicine within the Ontario health care system. In implementing the Acts, much consultation remains to be done among members of the relevant professional bodies and the public to balance competing interests and views, while ensuring quality health care and consumer choice.