900 – 200 Granville St
Vancouver, BCCanada V6C 1S4

T: 604.742.6200
Toll-free: 1.866.880.7101
bccnm.ca

FOR BCCNM REGISTERED MIDWIVES

Midwifery scope andmodel of practicePreamble
The midwifery scope and model of practice as defined in this document provides the broadboundaries of midwifery practice in British Columbia (BC). The British Columbia College of Nurses andMidwives (BCCNM)’s Standards of Practice and associated policies detail the minimum requirements
for safe practice of midwifery within the midwifery scope and model. The Competencies ofRegistered Midwives provide details of the skills and knowledge expected of a midwife in BC.

Midwifery scope of practice
According to the International Confederation of Midwives (ICM), a midwife is:“a responsible and accountable professional who works in partnership with women to givethe necessary support, care and advice to during pregnancy, labour and the postpartum
period, to conduct births on the midwife’s own responsibility and to provide care for thenewborn and the infant. This care includes preventative measures, the promotion of normal
birth, the detection of complications in the mother and child, the accessing of medical careor other appropriate assistance when necessary and the carrying out of emergency
measures when necessary.
The midwife has an important task in health counselling and education, not only for thewoman but also within the family and the community. The work should involve antenatal
education and preparation for parenthood and may extend to women’s health, sexual orreproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics, orhealth units.”
The ICM definition of a midwife (last updated in 2005) has been consistently supported by theInternational Federation of Gynaecologists and Obstetricians (FIGO), and the World HealthOrganization (WHO) since 1972.

Last Updated: March 2021

SCOPE AND MODEL OF PRA CTICE

FOR REGISTERED MIDWIVESIn BC, the Midwives Regulation limits the midwifery scope of practice as the practice of midwifery.
Midwifery is defined as “the health profession in which a person provides the following services
during normal pregnancy, labour, delivery and the postpartum period:•assessment, monitoring and care for patients, newborns and infants, including carrying outappropriate emergency measures when necessary;•counselling, supporting and advising persons, including providing advice and information
regarding care for newborns and infants;•

conducting internal examinations of patients, performing episiotomies and amniotomies andrepairing episiotomies and simple lacerations;•contraceptive services for patients during the 3 months following a birth.”

Midwifery model of practice
The midwifery model of practice in British Columbia is autonomous, community-based primary care,and incorporates the principles of continuity of care, informed choice, choice of birth setting,collaboration, accountability, ethics and evidence-based practice.
AUTONOMOUS, COMMUNITY-BASED PRIMARY CARE

Midwives are primary care providers in autonomous practice, with hospital privileges, within theircommunities. For each client, under their own responsibility, the midwife provides a continuum ofmidwifery services throughout pregnancy, labour and the postpartum period.
Midwives practice in a range of settings, including clinics, clients’ homes, hospitals, and othercommunity-based settings. Midwifery care for labour, birth and early postpartum is provided in asetting chosen by the client and appropriate to their level of risk. In all settings, midwives remain
responsible and accountable for the care they provide.
CONTINUITY OF CARE

Midwives provide continuity of care. Continuity of care is delivered through the provision of midwiferycare during pregnancy, labour, birth and the postpartum period, on a 24-hour on-call basis by aregistrant or small group of registrants known to the client. Continuity of care is both a philosophy
and a process that is facilitated through a partnership; ideally each client will meet and develop a
relationship of trust with the midwife or midwives in the group before labour. A group practice must
share a common philosophy and a consistent and coordinated approach to practice.
INFORMED CHOICE

Midwives respect the rights of clients to make informed choices and facilitate this process byproviding complete, relevant, objective information and their professional recommendations in a
non-authoritarian, supportive manner. Having adequate time for discussion in the prenatal period isnecessary to the successful facilitation of informed choice.

BC COLLEGE OF NURSES AND MIDWIVES / 2

SCOPE AND MODEL OF PRA CTICE

FOR REGISTERED MIDWIVESCHOICE OF BIRTH SETTING

Midwives provide care in a variety of settings, including homes, hospitals and birth centres, whereavailable. The birth setting is chosen by the client in consultation with the midwife. Midwives must
acquire admitting and discharge midwifery hospital privileges in their local maternity units and, whereavailable, privileges for birth centers. Midwives function within their scope of practice in both thehome and hospital setting.
COLLABORATION

Midwives consult and collaborate with other health care professionals to work safely within theirscope of practice. In situations where transfer of care to a physician is required, the midwife may
provide supportive care after transfer and may resume primary care if appropriate.
ETHICS, ACCOUNTABILITY AND EVIDENCE-BASED PRACTICE

Midwives’ fundamental accountability is to the clients in their care. They are also accountable to theirpeers, their regulatory body, the health agencies where they practice and the public to for theprovision of safe, competent, ethical practice informed by the BCCNM Philosophy of Care and current
evidence in perinatal care. Midwives develop and share midwifery knowledge, promoting andparticipating in research.

BC COLLEGE OF NURSES AND MIDWIVES / 3

SCOPE AND MODEL OF PRA CTICE

FOR REGISTERED MIDWIVES

References
Ministry of Health (2008). Health Professions Act: Midwives Regulation. Retrieved from:http://www.bclaws.ca/civix/document/id/lc/statreg/281_2008
International Confederation of Midwives (2018). ICM Definitions. Retrieved from:https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html
Kilthei, Jane. (2017). The Safety of the BC Midwifery Model of Practice: A Literature Review.
Unpublished paper.

Copyright © British Columbia College of Nurses and Midwives/March 2021
Effective date: December 10, 2018
900 – 200 Granville St
Vancouver, BC V6C 1S4
Canadawww.bccnm.ca
Pub. No. 831

BC COLLEGE OF NURSES AND MIDWIVES / 4