Ontario Regulation 188/24, established under the Midwifery Act, 1991, governs the prescribing and administering of drugs and substances by registered midwives in Ontario. It outlines the specific drugs and substances that midwives are authorized to prescribe and administer, along with the conditions that must be met for these actions to take place.

The regulation specifies that midwives may prescribe drugs listed in Schedule 1 on their own responsibility, which includes a variety of vaccines, antibacterials, antifungals, antivirals, hormonal contraceptives, and analgesics. However, for drugs classified under Schedule 4, which includes controlled substances, midwives must demonstrate sufficient knowledge and skills or complete an approved course before prescribing.

Additionally, midwives are granted the authority to administer substances by inhalation and injection. Under Schedule 2, substances such as oxygen and nitrous oxide can be administered via inhalation. For injections, Schedule 3 outlines various vaccines and drugs, including morphine and epinephrine, that can be administered.

The regulation also allows midwives to use any drug based on orders from physicians or registered nurses with an extended certificate of registration. This provision highlights the collaborative nature of healthcare in Ontario, facilitating the integration of midwives’ practices with those of other healthcare professionals.

Moreover, midwives are permitted to administer, prescribe, or order any non-prescription drugs or substances that are legally obtainable without a prescription. This provision further improves their ability to provide care without additional barriers.

The regulation includes detailed schedules specifying the types of drugs and substances midwives can prescribe and administer. Schedule 1 encompasses vaccines (including COVID-19 and influenza), anti-infectives, hormonal contraceptives, and analgesics, focusing primarily on preventative care and common therapeutic drugs. Schedule 2 details substances for inhalation, such as oxygen and nitrous oxide, while Schedule 3 lists injectable substances, including various vaccines, antibacterials, and anesthetics. Schedule 4 specifically addresses controlled drugs and substances, primarily opioid analgesics like fentanyl and morphine, which are subject to stricter regulations due to their potential for misuse.

By clearly delineating the drugs and substances that midwives are authorized to prescribe and administer, the regulation promotes safe and effective midwifery care. It reinforces the role of midwives within the healthcare system, ensuring they possess the necessary competencies to effectively manage various medical situations.

Ontario (188/24) May 18, 2024