The following are the standards for midwives to independently prescribe, order and administer hormonal contraceptives in the community, hospital or other sites of midwifery practice for clients in care, as designated under specialized practice certification. Midwives without Specialized Practice Certification in Hormonal Contraceptive Therapy are required to refer their clients to an appropriate health care practitioner for treatment.
Systemic hormonal contraceptives are available in two basic preparations: 1) combined estrogen and progesterone and 2) progestin only. Condoms continue to be additionally recommended where protection against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is required. The SOGC makes the following recommendations in their consensus document:
Combined Hormonal Contraception
- A range of hormonal contraceptives should be available to ensure that the individual receives the preparation most suited for their needs. (Grade C)
- Information that antibiotic use does not appear to affect combined OC efficacy (except for griseofulvin and rifampicin). (Grade B) should be provided.
Progestin-Only Hormonal Contraception
- Progestin-only methods should be considered as contraceptive options during the postpartum period, regardless of breastfeeding status, and may be introduced immediately after birth. (Grade B)
- Progestin-only methods should be considered as contraceptive options if there is a history of venous thromboembolism (VTE), or if at a higher risk of myocardial infarction or stroke. If there is a proven thrombophilia, progestin-only preparations should be used with caution. (Grade B)
- If using depot medroxyprogesterone acetate (DMPA) counselling should be provided about dietary and lifestyle factors that will affect peak bone mass, such as smoking, exercise, and calcium intake. (Grade A)
Special Considerations for Hormonal Contraception
If smoking, cessation counselling should be provided. If over 35 and smoking, advice not to use combined oral contraceptives (OCs) should be provided. (Grade A)