Philosophy and standards of practice
The practice of midwifery is based on the respect of pregnancy and birth as normal physiological processes having an important significance in a woman’s life. Midwives acknowledge that delivery and birth are moments that belong to the women and their families. The responsibility of healthcare professionals is to offer women the respect and support they need to give birth with their own capacities, safely and with dignity. Midwives respect the diversity of women’s needs as well as the numerous personal and cultural significations that the women, their family and their community associate with pregnancy, birth and the experience of being a new parent.
Midwifery is to be practised within the context of a personal and egalitarian relationship, open to social, cultural and emotional needs, as well as the physical needs of women. This relationship is established with continuity of care and services during pregnancy, birth and the postnatal period.
Midwives encourage women to make choices regarding the care and services they receive and the way they are given. They view decisions as the result of a process in which the responsibilities are shared between the woman, her family (as defined by the woman) and health professionals.
Midwives acknowledge that the final decision belongs to the woman. They respect women’s right to choose their health professional and where they want to give birth, in accordance with OSFQ standards of practice. Midwives are willing to assist women in the birthplace of their choice, including their home.
Midwives consider that promoting health is essential in the pregnancy cycle. Their practice is based on prevention and includes wise use of technology. Midwives consider that the mother and the child’s interests are close and compatible. They believe that the best way to ensure the mother and baby’s well-being is to focus their care on the mother.
Midwives encourage the support of families and the community as a privileged way to facilitate the adaptation of new families.
Standards of Practice
The following standards of practice related to the practice of midwifery in Quebec are based on the definition of the practice of the profession in the Midwives Act and are presented as a logical outcome of the Professional Code of Ethics of the OSFQ, as well as the Philosophy of practice of midwifery adopted by the members of the OSFQ in March 2002. They are also formulated in conformity with these documents and, consequently, they show that the professional practice of midwifery includes the following characteristics:
- The practice is based on the principle that pregnancy and birth are normal physiological phenomena.
- The practice focuses on preventing and promoting health.
- The practice supports continuity of care and the recognition of women’s right to choose their birthplace (home, birth centre or elsewhere).
- The practice is based on respect, mutual trust and collaboration between the woman and the midwife, during their supportive relationship, in other words, during pregnancy follow-up, at the time of giving birth and during postnatal follow-up.
- The practice recommends the collaboration of three midwives for a same practice place and the presence of two midwives during birth.
The standards of practice of midwives in Quebec are designed to support midwives in pursuing their profession. They are also designed to be a reference document for the professional inspection committee of the OSFQ regarding the essential elements of a quality professional practice. The standards of practice are set forth to suggest visible measures of performance related to the execution of tasks specific to the professional practice of midwifery.
There are 24 standards of professional midwifery practice in Quebec:
- The midwife takes the time needed to establish a relationship of trust with the woman by the first meeting and she maintains this relationship throughout the pregnancy follow-up, birth and postnatal follow-up.
- The midwife encourages the involvement of every person of significance to the woman (father, children, etc.) according to her wishes.
- The midwife exchanges with the woman to learn about her real-life experience and her needs throughout the pregnancy, birth and postnatal follow-up.
- The midwife brings up subjects to discuss at the right moment, in order to respect the woman’s pace and reality, and encourages her to express herself and to share any questions, concerns or wishes, etc., throughout the pregnancy follow-up, birth and postnatal follow-up.
- The midwife takes clinical measures appropriate to the situation, and she makes wise use of technology, in conformity with the professional practice of midwives and related directives of the OSFQ.
- When necessary, the midwife guides the woman towards local community resources and other health professional resources.
- The midwife has the duty to give the woman available information regarding issues related to different choices she must make during the pregnancy; she also takes the necessary time and exchanges with the woman to allow her to make decisions throughout the prenatal follow-up, birth and postnatal follow-up.
- The midwife respects the decisions the woman makes and, at the same time, she reminds her of the limits she must respect regarding her professional scope of practice as well as her competence throughout the prenatal follow-up, birth and postnatal follow-up.
- The midwife agrees to assist the woman in the birthplace of her choice (home, birth centre or elsewhere) and ensures that she is able to do so in conformity with the midwives’ professional scope of practice and the Midwives Act.
- The midwife promotes breast-feeding and encourages and supports the woman’s desire to breast-feed.
- The midwife reinforces the woman’s competence and autonomy and encourages her to trust herself throughout her pregnancy, birth and the postnatal follow-up.
- The midwife communicates with the woman and with any other person of significance to her (father, children, etc.) using appropriate language; she ensures that she is properly understood throughout pregnancy follow-up, birth and postnatal follow-up.
- The midwife encourages bonding between the parents, including the other children and the newborn.
- Ideally, the midwife works in a team of maximum two to three midwives for a pregnancy follow-up in order to ensure continuity of the relationship during pregnancy follow-up, birth and postnatal follow-up.
- The midwife applies rules related to the confidentiality and preservation of information on private life effective in Quebec, at the OSFQ and in her working environment.
- The midwife has the woman sign every appropriate document in conformity with the standards established in this matter by the OSFQ and in her working environment.
- The midwife ensures record keeping in conformity with the OSFQ Regulation on record keeping and enters all useful information legibly and concisely.
- In the case where a woman were to refuse an emergency transfer, the midwife must provide a competent presence, call emergency services and document the woman’s refusal to follow the midwife’s recommendations or her advice.
- The midwife participates in training activities in conformity with rules established at the OSFQ regarding continuing education.
- The midwife makes sure to remain abreast of changes in knowledge regarding her professional practice.
- The midwife participates in knowledge sharing, the exchange of views and peer review activities regarding her professional practice.
- The midwife collects all important information in order to evaluate her professional practice in conformity with directives established by the OSFQ.
- The midwife participates in the evaluation and continuous improvement of the quality of the professional practice of the midwives in her working environment.
- The midwife contributes to training midwives, promoting the professional practice of midwifery and to midwives’ evolution of knowledge.