P-16.1 - Act respecting the practice of midwifery within the framework of pilot projects

Updated to 1 April 1999

This document has official status.

chapter P-16.1

Act respecting the practice of midwifery within the framework of pilot projects

DIVISION I APPLICATION

1. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 1, s. 45.

2. Within the framework of the pilot projects, any act the object of which is to provide the required care and services to a woman during pregnancy, labour, delivery and the postnatal period constitutes the practice of midwifery. The practice of midwifery includes, without being limited to, prenatal and postnatal counselling of parents, preventive care, the detection of abnormal conditions in the woman or newborn child, the delivery, the provision of care to the woman and newborn child and family planning.

A midwife may also, within the scope of her practice, make a vaginal examination using a speculum, perform an amniotomy, perform and repair an episiotomy and repair a minor perineal laceration.

1990, c. 12, s. 2.

DIVISION II PILOT PROJECTS

3. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 3, s. 45.

4. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 4, s. 45; 1992, c. 21, s. 201; 1994, c. 23, s. 23.

5. Every pilot project must include the following elements:

(1)  where the project is devised jointly by two institutions, the name of the institution responsible for the project;

(2)  the administrative and professional organization enabling midwives to practise;

(3)  the opinion, if any, of the council of physicians, dentists and pharmacists of the institution responsible for the pilot project, where there is such a council;

(4)  the terms of the agreement whereby medical support, when needed, is to be provided to a midwife within the scope of her practice;

(5)  the number of midwives taking part in the pilot project;

(6)  a list of the medical or nursing acts a midwife will be authorized to perform in addition to the acts listed in section 2;

(7)  the expected number of deliveries;

(8)  the description of the group of clients for whom the project is intended, if any;

(9)  the budget for the first year of operation of the pilot project;

(10)  the mechanisms for the assessment of the pilot project in accordance with the assessment procedure established under section 36.

Every pilot project must provide that deliveries will take place in a facility maintained by an institution operating a hospital centre or in a facility specially equipped for the conduct of deliveries, maintained by the institution responsible for the pilot project. In the latter case, the agreement referred to in subparagraph 4 of the first paragraph shall provide not only for medical support but also for safety measures to ensure that, in an emergency, the parturient woman and the newborn child will be given the care and services required by their condition.

1990, c. 12, s. 5; 1992, c. 21, s. 202, s. 375.

6. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 6, s. 45.

7. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 7, s. 45.

8. Except in an emergency, no midwife may provide care or services to a woman if the pregnancy, labour, delivery or postnatal period involves a particular risk or presents signs of complications, according to the criteria established under the second paragraph of section 23. The same applies with respect to a newborn child whose condition does not satisfy the criteria established under the said section.

A midwife may, however, provide or continue to provide care or services to the woman or newborn child where the physician in charge of the woman or child consents thereto.

1990, c. 12, s. 8.

9. Every person employed for the sole purpose of taking part in a pilot project, including a midwife, must be hired under a contract by the institution responsible for the pilot project.

The contract may provide for a period of probation which shall not exceed three months. At the end of the probation period, the executive director of the institution shall inform the person as to the maintenance or termination of his or her participation in the pilot project.

1990, c. 12, s. 9; 1992, c. 21, s. 375.

10. The Government shall determine the remuneration of any person to whom section 9 applies.

1990, c. 12, s. 10.

DIVISION III MULTIDISCIPLINARY MIDWIFERY BOARD

1992, c. 21, s. 203.

11. Every institution responsible for an approved pilot project shall establish a multidisciplinary midwifery board composed of seven persons as follows, who become members of the board upon being appointed:

(1)  three midwives appointed by and from among the midwives practising within the framework of the pilot project;

(2)  two physicians, including an obstetrician and gynecologist, appointed by the council of physicians, dentists and pharmacists or, where there is no such council in the institution, by the board of directors;

(3)  a nurse in perinatal care appointed by the council of nurses or the clinical staff advisory council, as the case may be;

(4)  a person chosen after consultation with groups fostering the practice of midwifery, appointed by the board of directors.

Notwithstanding the foregoing, the institution responsible for an approved pilot project may designate the council of physicians, dentists and pharmacists to exercise the functions of the multidisciplinary board. Where the council of physicians, dentists and pharmacists exercises the functions of the multidisciplinary board, the midwives taking part in the pilot project shall form part of the council and three of them, appointed under subparagraph 1 of the first paragraph, shall sit on the executive committee of the council, if any. The midwives shall take part in the deliberations of the council of physicians, dentists and pharmacists or of the executive committee, as the case may be, and shall have the right to vote on any matter relating to the said functions.

1990, c. 12, s. 11; 1992, c. 21, s. 204, s. 375.

12. The members of the multidisciplinary board shall elect a chairman and a vice-chairman from among the midwives on the board.

If the chairman is absent or unable to act, the vice-chairman shall act as chairman.

1990, c. 12, s. 12.

13. Every decision of the multidisciplinary board must be approved by the vote of the majority of the members present. In the case of a tie, the chairman has a casting vote.

1990, c. 12, s. 13.

14. One-half of the members in office, including the chairman, constitute a quorum at meetings of the multidisciplinary board.

1990, c. 12, s. 14.

15. The multidisciplinary board shall adopt internal management by-laws, which shall be effective from the date of their approval by the board of directors.

1990, c. 12, s. 15.

16. The functions of the multidisciplinary board, under the authority of the board of directors, are

(1)  to devise rules of care applicable to midwives within the scope of their practice;

(2)  to supervise and assess the acts performed by midwives within the scope of their practice;

(3)  to examine any complaint concerning the practice or conduct of a midwife and make the recommendations it deems appropriate to the executive director of the institution responsible for the pilot project.

The rules established under subparagraph 1 of the first paragraph shall be effective from the date of their approval by the board of directors.

1990, c. 12, s. 16; 1992, c. 21, s. 375.

17. Any complaint concerning a pilot project must be addressed to the executive director of the institution responsible for the project. In the case of a joint pilot project, the executive director of the institution shall inform the executive director of the other institution.

1990, c. 12, s. 17; 1992, c. 21, s. 375.

18. Where a complaint is made concerning the practice or conduct of a midwife, the executive director of the institution responsible for the project shall refer the complaint to the multidisciplinary board.

1990, c. 12, s. 18; 1992, c. 21, s. 375.

19. Where a complaint is referred to the multidisciplinary board, the board, after allowing the midwife concerned to be heard, shall address its recommendations to the executive director of the institution responsible for the project, who shall report thereon to the board of directors.

The board of directors shall take any necessary administrative or disciplinary measure, including termination of the midwife’s employment by the institution.

The board of directors shall hear the midwife if it intends to take any administrative or disciplinary measure other than the measure recommended by the multidisciplinary board.

In an urgent situation, the executive director may forthwith take any necessary administrative or disciplinary measure. He shall, however, inform the multidisciplinary board immediately and send a report of the situation to the board within 48 hours. The decision of the executive director shall remain effective until the board of directors of the institution, after receiving the recommendations of the multidisciplinary board, has made its own decision.

1990, c. 12, s. 19; 1992, c. 21, s. 375.

20. Where the executive director of an institution responsible for a project receives a complaint other than a complaint under section 18, he shall inform the midwives taking part in the pilot project.

The executive director of the institution responsible for the project shall address his recommendations to the board of directors, which shall take any necessary measure.

1990, c. 12, s. 20; 1992, c. 21, s. 375.

21. The board of directors of an institution responsible for a project shall transmit a copy of every decision made under section 19 or 20 to the Minister of Health and Social Services and to the Minister responsible for the administration of legislation respecting the professions.

In the case of a joint pilot project, the board of directors of the institution responsible for the project shall also transmit a copy to the board of directors of the other institution.

1990, c. 12, s. 21; 1992, c. 21, s. 375.

DIVISION IV COMMITTEE ON ADMISSION TO THE PRACTICE OF MIDWIFERY

22. A committee on admission to the practice of midwifery is hereby established. The committee is composed of eight persons, who become members of the committee upon being appointed, appointed by the Government as follows:

(1)  three midwives appointed after consultation with organizations representing midwives in the province, and chosen from among midwives who are certified for practice pursuant to subparagraph 2 of the first paragraph of section 23;

(2)  a nurse with experience in perinatal care, appointed after consultation with the Ordre des infirmières et infirmiers du Québec;

(3)  an obstetrician and gynecologist appointed after consultation with the Ordre professionnel des médecins du Québec;

(4)  two persons representing the college sector and the university sector, respectively, appointed on the recommendation of the Minister of Education;

(5)  a woman having received the care and services of a midwife and chosen after consultation with groups fostering the practice of midwifery.

The members of the admission committee shall receive no remuneration except in the cases, on the conditions and to the extent that may be determined by the Government. They are, however, entitled to the reimbursement of expenses they incur in the performance of their duties, on the conditions and to the extent determined by the Government.

1990, c. 12, s. 22; 1993, c. 51, s. 72; 1994, c. 16, s. 50; 1994, c. 40, s. 457.

23. The functions of the admission committee are

(1)  to define general standards of competence and training for midwives;

(2)  to evaluate every midwife who applies for admission, determine whether she is qualified to practise within the framework of a pilot project governed by this Act and, if so, issue a qualification certificate to that effect.

Moreover, the admission committee shall define criteria permitting to determine whether the pregnancy, labour, delivery or the postnatal period involves a particular risk or presents signs of complications. It shall also define criteria permitting to determine whether a newborn child may receive the care of a midwife.

The criteria defined under this section shall be established by regulation of the admission committee, which shall be submitted to the Government for approval on the recommendation of the Minister of Health and Social Services and the Minister responsible for the administration of legislation respecting the professions.

1990, c. 12, s. 23.

24. The members of the admission committee shall elect a chairman and a vice-chairman from among the midwives on the committee.

If the chairman is absent or unable to act, the vice-chairman shall act as chairman.

1990, c. 12, s. 24.

25. Every decision of the committee must be approved by the vote of the majority of the members present. In the case of a tie, the chairman has a casting vote.

1990, c. 12, s. 25.

26. One-half of the members in office, including the chairman, constitute a quorum at meetings of the admission committee.

1990, c. 12, s. 26.

27. The admission committee shall adopt internal management by-laws, which shall be effective from the date of their approval by the Government.

1990, c. 12, s. 27.

28. Only a midwife certified for practice pursuant to subparagraph 2 of the first paragraph of section 23 may be admitted by and according to the needs of an institution to take part in a pilot project.

1990, c. 12, s. 28; 1992, c. 21, s. 375.

29. A midwife taking part in a pilot project may admit a woman who requires her care and services to give birth in a facility maintained by an institution referred to in section 4 and authorize her discharge and that of her child.

1990, c. 12, s. 29; 1992, c. 21, s. 205, s. 375.

DIVISION V PILOT PROJECT ASSESSMENT BOARD

30. A pilot project assessment board is hereby established. The board is composed of 11 persons including three physicians, who become members of the board upon being appointed, appointed by the Government as follows:

(1)  two midwives appointed after consultation with and chosen from among midwives certified for practice pursuant to subparagraph 2 of the first paragraph of section 23;

(2)  a physician appointed after consultation with the Ordre professionnel des médecins du Québec;

(3)  a nurse appointed after cnsultation with the Ordre des infirmières et infirmiers du Québec;

(4)  a person appointed after consultation with the Association des hôpitaux du Québec;

(5)  a person appointed after consultation with the Fédération des centres locaux de services communautaires du Québec;

(6)  two women having received the care and services of a midwife and chosen after consultation with groups fostering the practice of midwifery;

(7)  three persons appointed on the recommendation of the Minister of Health and Social Services, the Minister responsible for the administration of legislation respecting the professions and the Minister of Education, respectively.

The members of the assessment board receive no remuneration except in the cases, on the conditions and to the extent that may be determined by the Government. They are, however, entitled to the reimbursement of expenses they incur in the performance of their duties, on the conditions and to the extent determined by the Government.

1990, c. 12, s. 30; 1993, c. 51, s. 72; 1994, c. 16, s. 50; 1994, c. 40, s. 457.

31. The members of the assessment board shall elect a chairman and a vice-chairman from among themselves.

If the chairman is absent or unable to act, the vice-chairman shall act as chairman.

1990, c. 12, s. 31.

32. Every decision of the assessment board must be approved by the vote of the majority of the members present. In the case of a tie, the chairman has a casting vote.

1990, c. 12, s. 32.

33. One-half of the members in office, including the chairman, constitute a quorum at meetings of the assessment board.

1990, c. 12, s. 33.

34. The assessment board shall adopt internal management by-laws, which shall be effective from the date of their approval by the Government.

1990, c. 12, s. 34.

35. Every institution conducting a pilot project shall prepare an assessment report, in the form and tenor determined by the assessment board, covering the period extending from the date of approval of the project to 31 March following the first anniversary of the approval. The assessment report must be submitted to the assessment board on or before 30 June following that anniversary. Subsequently and in the same manner, the institution shall transmit an assessment report, on or before 30 June, for each project year ending on 31 March.

Where a pilot project is conducted by two institutions, they shall transmit the assessment reports jointly.

The assessment of a pilot project shall be made on a continuous basis throughout the duration of the project.

1990, c. 12, s. 35; 1992, c. 21, s. 206, s. 375.

36. The functions of the assessment board are

(1)  (this subparagraph ceased to have effect on 24 September 1998);

(2)  (this subparagraph ceased to have effect on 24 September 1998);

(3)  to examine every assessment report transmitted to it under section 35 and submit to the Minister of Health and Social Services, on the date he determines, a report on the results obtained within the framework of the pilot projects in progress, sending a copy to the Minister responsible for the administration of legislation respecting the professions;

(4)  to make, if expedient, any recommendation it deems appropriate concerning the conduct of a pilot project to the Minister of Health and Social Services and to the institution concerned, sending a copy to the Minister responsible for the administration of legislation respecting the professions;

(5)  (this subparagraph ceased to have effect on 24 September 1998).

Subparagraph 3 of the first paragraph does not, however, apply in respect of the last year in which this Act has effect (*).

1990, c. 12, s. 36, s. 45; 1992, c. 21, s. 375.

(*) The second paragraph of this section ceased to have effect on 24 September 1998 (1990, c. 12, s. 45).

37. On the recommendation of the assessment board, the Minister of Health and Social Services may, at any time, modify or terminate a pilot project, after consultation with the institution concerned or with both institutions in the case of a joint pilot project.

1990, c. 12, s. 37; 1992, c. 21, s. 207, s. 375.

DIVISION VI MISCELLANEOUS AND FINAL PROVISIONS

38. This Act applies notwithstanding any inconsistent provision of the Act respecting health services and social services (chapter S-4.2) or the Act respecting health services and social services for Cree Native persons (chapter S-5).

1990, c. 12, s. 38; 1992, c. 21, s. 208; 1994, c. 23, s. 23.

39. Notwithstanding any inconsistent provision of the Nurses Act (chapter I-8) and of the Medical Act (chapter M-9), a midwife may, within the framework of a pilot project, perform the medical or nursing acts listed in section 2 as well as those authorized by the pilot project itself, if any.

1990, c. 12, s. 39.

40. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 40, s. 45.

41. The perinatal care project under the responsibility of the Centre hospitalier de la Baie d’Hudson in progress on 22 June 1990 is deemed to be an approved pilot project and the midwives taking part in the project are deemed to be certified for practice within the framework of the project, within the meaning of this Act.

For the purposes of section 35, the project referred to in the first paragraph is deemed to be approved only from the date of the approval of the first pilot project by the Minister of Health and Social Services under section 7.

1990, c. 12, s. 41.

42. (This Act ceased to have effect on 24 September 1998).

1990, c. 12, s. 42, s. 45.

43. (This section ceased to have effect on 24 September 1998).

1990, c. 12, s. 43, s. 45.

44. The Minister of Health and Social Services is responsible for the administration of this Act, except sections 22 to 27 and 40 which are under the administration of the Minister responsible for the administration of legislation respecting the professions.

1990, c. 12, s. 44.

45. This Act shall cease to have effect on 24 September 1998.

1990, c. 12, s. 45.

For the purpose of authorizing the continuation of the practice of midwifery within the framework of pilot projects already approved by the Minister of Health and Social Services, the provisions of sections 2, 5, 8 to 35, subparagraphs 3 and 4 of the first paragraph of section 36 and sections 37 to 39, 41 and 44 of this Act continue to be effective until 24 September 1999 or any date to be fixed by government order, which shall not be later than 24 December 1999. (1998, c. 26, s. 1).

46. (Omitted).

1990, c. 12, s. 46.

REPEAL SCHEDULE

In accordance with section 9 of the Act respecting the consolidation of the statutes and regulations (chapter R-3), chapter 12 of the statutes of 1990, in force on 1 September 1990, is repealed, except section 46, effective from the coming into force of chapter P-16.1 of the Revised Statutes.