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B.C. Reg. 133/2025
M221/2025
Deposited July 16, 2025
effective April 1, 2026
This consolidation is current to May 5, 2026.
Link to consolidated regulation (PDF)

Health Professions and Occupations Act

Nurses and Midwives Regulation

[Last amended April 1, 2026 by B.C. Reg. 41/2026]

Contents
Part 1 — General Matters
1Definitions
2Designation of health professions
3Regulator
4No sale of drugs
Part 2 — Practice of Nursing
Division 1 — General Practice Matters
5Exclusive titles
6Scope of practice for nursing
7Limits and conditions
8Practice standards
Division 2 — Limited Restricted Activities (Non-Nurse Practitioners)
9Application
10List of limited restricted activities
11Diagnoses
12Procedures on tissue
13Venipunctures
14Substances
15Insertions
16Labour
17Hazardous energy
18Authorizations
19Drugs
20Therapeutic diets
21Restricted activities if order or certified
22Other restricted activities if order
23Other restricted activities if certified
Division 3 — Restricted Activities (Nurse Practitioners)
24List of full restricted activities
25Limited restricted activities
Part 3 — Practice of Practical Nursing
Division 1 — General Practice Matters
26Exclusive titles
27Scope of practice for practical nursing
28Practice standards
Division 2 — Limited Restricted Activities
29List of limited restricted activities
30Diagnoses
31Procedures on tissue
32Substances
33Insertions
34Hazardous energy
35Drugs
36Restricted activities if order
37Other restricted activities if order
Part 4 — Practice of Psychiatric Nursing
Division 1 — General Practice Matters
38Exclusive titles
39Scope of practice for psychiatric nursing
40Practice standards
Division 2 — Limited Restricted Activities
41List of limited restricted activities
42Diagnoses
43Procedures on tissue
44Venipunctures
45Substances
46Insertions
47Hazardous energy
48Authorizations
49Drugs
50Therapeutic diets
51Restricted activities if order or certified
52Other restricted activities if order
53Other restricted activities if certified
Part 5 — Practice of Midwifery
Division 1 — General Practice Matters
54 Midwifery patients
55Exclusive title
56Scope of practice for midwifery
57Limits and conditions
58Exception for Indigenous midwifery
Division 2 — Full Restricted Activities
59List of full restricted activities
Division 3 — Limited Restricted Activities
60List of limited restricted activities
61Diagnoses
62Procedures on tissue
63Venipunctures
64Substances
65Insertions
66Labour and delivery
67Hazardous energy
68Drugs
69Restricted activities if order
70Restricted activities if certified
Appendix 1
Appendix 2

Part 1 — General Matters

Definitions

1   In this regulation:

"authorized health professional" means a person who is one of the following:

(a) a medical practitioner or nurse practitioner;

(b) a person who is authorized under the Act to practise the designated health profession of dentistry, midwifery, naturopathic medicine, podiatric medicine or pharmacy;

(c) a person who is authorized to practise an equivalent health profession in Alberta, Yukon or the Northwest Territories, if the person's patient

(i) has transferred from one of those jurisdictions to British Columbia and, on transfer, requires immediate health services, and

(ii) has not been assessed by a person described in paragraph (a) or (b) of this definition or by whichever of the following applies:

(A) in the case of orders issued to registered nurses or registered psychiatric nurses, by a certified registered nurse or certified registered psychiatric nurse;

(B) in the case of orders issued to licensed practical nurses, by a registered nurse or registered psychiatric nurse;

"hospital" has the same meaning as in section 1 of the Hospital Act;

"Indigenous midwifery" means midwifery practices that are based on Indigenous practices;

"licensed practical nurse" means a licensee who is authorized to practise practical nursing;

"midwife" means a licensee who is authorized to practise midwifery;

"midwifery" means the health profession in which a person provides

(a) the types of health services referred to in section 56 [scope of practice for midwifery], and

(b) Indigenous midwifery, if applicable;

"narcotic" has the same meaning as in the Narcotic Control Regulations made under the Controlled Drugs and Substances Act (Canada);

"nursing" means the health profession in which a person provides the types of health services referred to in section 6 [scope of practice for nursing];

"practical nursing" means the health profession in which a person provides the types of health services referred to in section 27 [scope of practice for practical nursing];

"psychiatric nursing" means the health profession in which a person provides the types of health services referred to in section 39 [scope of practice for psychiatric nursing];

"registered nurse" means a licensee who is authorized to practise nursing;

"registered psychiatric nurse" means a licensee who is authorized to practise psychiatric nursing.

Designation of health professions

2   Each of the following continues to be designated as a designated health profession for the purposes of the Act:

(a) nursing;

(b) practical nursing;

(c) psychiatric nursing;

(d) midwifery.

Regulator

3   The British Columbia College of Nurses and Midwives is the regulator responsible for governing the designated health professions referred to in section 2.

No sale of drugs

4   The authority to dispense a drug under this regulation does not include the authority to sell the drug.

Part 2 — Practice of Nursing

Division 1 — General Practice Matters

Exclusive titles

5   Except as permitted under the Act,

(a) only a registered nurse who is authorized under the bylaws to do so may use the titles "nurse", "registered nurse" and "licensed graduate nurse", and

(b) only a registered nurse who is authorized under the bylaws to practise nursing as a nurse practitioner may use the titles "nurse practitioner" and "registered nurse practitioner".

Scope of practice for nursing

6   (1) The following types of health services, provided primarily for the purposes set out in subsection (2), constitute the scope of practice for nursing:

(a) assessing the health status of patients for the purpose of providing the health services referred to in paragraph (b);

(b) preventing, treating and managing physical and mental diseases, disorders and conditions, including by planning, implementing and evaluating interventions;

(c) monitoring, providing and coordinating care to patients;

(d) advising on physical and mental health.

(2) The primary purposes for providing the health services described in subsection (1) in the practice of nursing are to promote, maintain and restore physical and mental health.

(3) Without limiting subsection (1), the following types of health services are included in the scope of practice for nursing:

(a) Repealed. [B.C. Reg. 41/2026, Sch. 2, s. 1.]

(b) providing medical assistance in dying.

[am. B.C. Reg. 41/2026, Sch. 2, s. 1.]

Limits and conditions

7   A registered nurse may provide the health service of medical assistance in dying only if the registered nurse is a nurse practitioner.

Practice standards

8   The board must make bylaws establishing or adopting practice standards respecting the following:

(a) the provision, by nurse practitioners, of medical assistance in dying;

(b) the prescribing, by registered nurses, of Schedule IA drugs for the purpose of treating opioid use disorder.

Division 2 — Limited Restricted Activities (Non-Nurse Practitioners)

Application

9   This Division applies to registered nurses who are not nurse practitioners.

List of limited restricted activities

10   A registered nurse may perform the restricted activities described in the following items of the Restricted Activities Table, but only as provided for in this Division:

(a) item 1 [diagnoses];

(b) items 2 to 4 [procedures on tissue];

(c) item 6 [venipunctures];

(d) item 8 [bone fractures];

(e) items 11 to 17 [substances];

(f) items 18 to 25 [insertions];

(g) item 27 [labour];

(h) items 28, 30 to 32 and 35 [hazardous energy];

(i) items 37 and 45 [authorizations];

(j) items 46 to 49 [drugs];

(k) items 51 to 53 [therapeutic diets];

(l) items 65 and 66 [allergy testing and treatment].

Diagnoses

11   A registered nurse may diagnose a physical or mental condition that the registered nurse is authorized to treat without an assessment or diagnosis of the patient by a person who practises another designated health profession.

Procedures on tissue

12   A registered nurse may perform a procedure on tissue below the dermis or the surface of a mucous membrane for the purpose of wound care, including the suturing of skin lacerations.

Venipunctures

13   A registered nurse may perform venipuncture for the following purposes:

(a) collecting a blood sample or blood donation;

(b) establishing intravenous access.

Substances

14   A registered nurse may administer substances as follows:

(a) by injection, in the case of purified protein derivative administered for the purpose of tuberculosis screening;

(b) by inhalation, in the case of

(i) oxygen,

(ii) humidified air, or

(iii) a mixture of oxygen and nitrous oxide administered for the purpose of pain management during labour;

(c) by irrigation or enteral instillation, in the case of a solution administered for the purpose of assessment or treatment;

(d) by parenteral instillation, in the case of a solution administered for the purpose of managing hypovolemia or maintaining patency.

Insertions

15   (1) A registered nurse may do any of the following for the purpose of assessment or treatment:

(a) perform the restricted activities described in items 18 to 24 [insertions] of the Restricted Activities Table;

(b) insert the following into the external ear canal:

(i) air that is under pressure no greater than the pressure created by the use of an otoscope;

(ii) water that is under pressure no greater than the pressure created by the use of an ear bulb syringe.

(2) For certainty, the performance of the restricted activity of inserting a device into the external ear canal includes the insertion of a wearable hearing instrument, or a part of or an accessory for it.

Labour

16   A registered nurse may manage labour in a hospital if the primary maternal care provider is absent.

Hazardous energy

17   (1) A registered nurse may apply ultrasound for the following purposes:

(a) bladder volume measurement;

(b) blood flow monitoring;

(c) fetal heart monitoring.

(2) A registered nurse may apply electricity for the purpose of defibrillation in the course of emergency cardiac care.

Authorizations

18   A registered nurse may, in the course of assessment, issue an authorization to do the following:

(a) apply ultrasound for diagnostic or imaging purposes;

(b) apply X-rays for diagnostic or imaging purposes, except for the purpose of a computed tomography scan.

Drugs

19   (1) A registered nurse may prescribe, compound, dispense or administer a Schedule I drug for any of the following purposes:

(a) treating anaphylaxis, cardiac dysrhythmia, hypoglycemia, opiate overdose, post-partum hemorrhage or respiratory distress in a known asthmatic;

(b) treating conditions that are symptomatic of influenza-like illness;

(c) preventing disease using immunoprophylactic agents or post-exposure chemoprophylactic agents.

(2) A registered nurse may prescribe, compound, dispense or administer a Schedule II drug.

Therapeutic diets

20   (1) A registered nurse may compound or administer a therapeutic diet if nutrition is to be administered by enteral instillation.

(2) A registered nurse may dispense a therapeutic diet if nutrition is to be administered orally or by enteral instillation.

Restricted activities if order or certified

21   (1) Subject to subsection (2), a registered nurse may do the following:

(a) perform the restricted activities described in the following items of the Restricted Activities Table:

(i) items 2 to 4 [procedures on tissue];

(ii) items 11 to 17 [substances];

(iii) items 18 to 25 [insertions];

(iv) items 28, 30 to 32 and 35 [hazardous energy];

(v) items 65 and 66 [allergy testing and treatment];

(b) issue an authorization to apply X-rays for diagnostic or imaging purposes, except for the purpose of a computed tomography scan;

(c) compound, dispense or administer Schedule I or IA drugs.

(2) A registered nurse may perform a restricted activity under subsection (1) only if one of the following applies:

(a) the registered nurse is acting under an order issued by

(i) an authorized health professional,

(ii) a certified registered nurse or a certified registered psychiatric nurse, or

(iii) a person who is authorized in Alberta, Yukon or the Northwest Territories to

(A) practise a health profession that is equivalent to that of nursing or psychiatric nursing, and

(B) to perform restricted activities that a certified registered nurse or a certified registered psychiatric nurse is authorized to provide;

(b) the registered nurse is a certified registered nurse.

Other restricted activities if order

22   (1) A registered nurse may cast a fracture of a bone if acting under an order issued by a medical practitioner or nurse practitioner.

(2) A registered nurse may administer a therapeutic diet by parenteral instillation if acting under an order issued by an authorized health professional.

Other restricted activities if certified

23   (1) A certified registered nurse may diagnose a disease, disorder or condition for which they have received certification.

(2) A certified registered nurse may prescribe the following for the purposes of treating or managing a disease, disorder or condition that they may diagnose under subsection (1):

(a) a Schedule I drug;

(b) a Schedule IA drug, for the purpose of treating opioid use disorder.

Division 3 — Restricted Activities (Nurse Practitioners)

List of full restricted activities

24   A nurse practitioner may perform the following restricted activities:

(a) item 1 [diagnosis];

(b) items 2 to 4 [procedures on tissue];

(c) item 6 [venipunctures];

(d) items 8 and 9 [fractures and dislocations];

(e) items 11 to 17 [substances];

(f) items 18 to 25 [insertions];

(g) items 28, 30 to 32 and 35 [hazardous energy];

(h) items 37, 42, 44 and 45 [authorizations];

(i) items 46 to 49 [drugs];

(j) items 50 to 53 [therapeutic diets];

(k) items 65 and 66 [allergy testing and treatment].

Limited restricted activities

25   (1) A nurse practitioner may perform the restricted activities described in the following items of the Restricted Activities Table, but only as provided for in this section:

(a) item 7 [setting fractures];

(b) item 27 [labour];

(c) item 36 [X-rays].

(2) A nurse practitioner may set a simple closed fracture of a bone.

(3) A nurse practitioner may manage labour in a hospital if the primary maternal care provider is absent.

(4) A nurse practitioner may apply X-rays for diagnostic or imaging purposes, except for the purpose of a computed tomography scan.

Part 3 — Practice of Practical Nursing

Division 1 — General Practice Matters

Exclusive titles

26   Except as permitted under the Act, only a licensed practical nurse may use the titles "nurse", "licensed practical nurse" and "practical nurse".

Scope of practice for practical nursing

27   (1) The following types of health services, provided primarily for the purposes set out in subsection (2), constitute the scope of practice for practical nursing:

(a) assessing the health status of patients for the purpose of providing the health services referred to in paragraph (b);

(b) preventing, managing and treating physical and mental diseases, disorders and conditions, including by planning, implementing and evaluating interventions;

(c) monitoring, providing and coordinating care to patients;

(d) advising on physical and mental health.

(2) The primary purposes for providing the health services described in subsection (1) in the practice of practical nursing are to promote, maintain and restore physical and mental health, with a focus on stable or predictable states of health.

Practice standards

28   The board must make bylaws establishing or adopting practice standards for the performance, by licensed practical nurses, of the restricted activities described in items 47 to 49 [drugs] of the Restricted Activities Table.

Division 2 — Limited Restricted Activities

List of limited restricted activities

29   A licensed practical nurse may perform the restricted activities described in the following items of the Restricted Activities Table, but only as provided for in this Division:

(a) item 1 [diagnoses];

(b) items 2 and 3 [procedures on tissue];

(c) item 6 [venipunctures];

(d) item 8 [bone fractures]:

(e) items 11 to 16 [substances];

(f) items 18 to 25 [insertions];

(g) items 28 and 31 [ultrasounds and electricity];

(h) items 47 to 49 [drugs];

(i) items 51 to 53 [therapeutic diets].

Diagnoses

30   A licensed practical nurse may, if the patient is in a stable or predictable state of health, diagnose a physical or mental condition that the licensed practical nurse is authorized to treat without an assessment or diagnosis of the patient by a person who practises another designated health profession.

Procedures on tissue

31   A licensed practical nurse may perform a procedure on tissue below the dermis or the surface of a mucous membrane for the purpose of wound care, other than the suturing of skin lacerations.

Substances

32   A licensed practical nurse may administer substances as follows:

(a) by injection, in the case of purified protein derivative administered for the purpose of tuberculosis screening;

(b) by inhalation, in the case of oxygen or humidified air.

Insertions

33   (1) A licensed practical nurse may insert the following into the external ear canal:

(a) an instrument, device or finger, for the purpose of assessment;

(b) a wearable hearing instrument, or a part of or an accessory for it;

(c) air that is under pressure no greater than the pressure created by the use of an otoscope, for the purpose of assessment.

(2) A licensed practical nurse may insert an instrument, device, finger or hand beyond the labia majora, up to the cervix, for the purpose of providing personal hygiene care.

(3) A licensed practical nurse may insert an instrument, device or finger beyond the anal verge for the purpose of assessment or treatment.

Hazardous energy

34   (1) A licensed practical nurse may apply ultrasound for the following purposes:

(a) bladder volume measurement;

(b) blood flow monitoring.

(2) A licensed practical nurse may apply electricity, using an automatic external defibrillator, for the purpose of defibrillation in the course of emergency cardiac care.

Drugs

35   (1) A licensed practical nurse may compound, dispense or administer a Schedule I drug for any of the following purposes:

(a) treating anaphylaxis, hypoglycemia or respiratory distress in a known asthmatic;

(b) preventing disease using immunoprophylactic agents.

(2) A licensed practical nurse may

(a) compound or dispense a Schedule II drug, or

(b) administer a Schedule II drug as follows:

(i) by any method, if administered for a purpose described in subsection (1);

(ii) orally, intranasally or by intradermal, intramuscular or subcutaneous injection, if administered for any other purpose.

Restricted activities if order

36   (1) Subject to subsection (2), a licensed practical nurse may do the following:

(a) perform the restricted activities described in the following items of the Restricted Activities Table:

(i) items 2 and 3 [procedures on tissue];

(ii) items 11 to 16 [substances];

(iii) items 18 to 25 [insertions];

(iv) items 47 to 49 [drugs];

(b) perform venipuncture for the following purposes:

(i) collecting a blood sample or blood donation;

(ii) establishing intravenous access;

(c) apply ultrasound, except to a fetus, for diagnostic or imaging purposes;

(d) apply ultrasound to a fetus for the purpose of fetal heart monitoring;

(e) compound a therapeutic diet in which nutrition is to be administered by enteral instillation;

(f) dispense a therapeutic diet in which nutrition is to be administered orally or by enteral instillation;

(g) administer a therapeutic diet by enteral instillation or parenteral instillation.

(2) A licensed practical nurse may perform a restricted activity under subsection (1) only if the licensed practical nurse is acting under an order issued by

(a) an authorized health professional,

(b) a registered nurse or registered psychiatric nurse,

(c) a person who is authorized in Alberta, Yukon or the Northwest Territories to practise a health profession that is equivalent to that of nursing or psychiatric nursing, or

(d) a dietitian.

Other restricted activities if order

37   A licensed practical nurse may cast a fracture of a bone if acting under an order issued by a medical practitioner or nurse practitioner.

Part 4 — Practice of Psychiatric Nursing

Division 1 — General Practice Matters

Exclusive titles

38   Except as permitted under the Act, only a registered psychiatric nurse may use the titles "nurse", "psychiatric nurse" and "registered psychiatric nurse".

Scope of practice for psychiatric nursing

39   (1) The following types of health services, provided primarily for the purposes set out in subsection (2), constitute the scope of practice for psychiatric nursing:

(a) assessing the health status of patients for the purpose of providing the health services referred to in paragraph (b);

(b) preventing, treating and managing physical and mental diseases, disorders and conditions, including by planning, implementing and evaluating interventions;

(c) monitoring, providing and coordinating care to patients;

(d) advising on physical and mental health.

(2) The primary purposes for providing the health services described in subsection (1) in the practice of psychiatric nursing are to promote, maintain and restore physical and mental health, with a focus on

(a) mental, psychosocial and emotional conditions, and

(b) associated or comorbid physiological conditions.

Practice standards

40   The board must make bylaws establishing or adopting practice standards respecting the prescribing, by registered psychiatric nurses, of Schedule IA drugs for the purpose of treating opioid use disorder.

Division 2 — Limited Restricted Activities

List of limited restricted activities

41   A registered psychiatric nurse may perform the restricted activities described in the following items of the Restricted Activities Table, but only as provided for in this Division:

(a) item 1 [diagnoses];

(b) items 2 and 3 [procedures on tissue];

(c) item 6 [venipunctures];

(d) items 11 to 16 [substances];

(e) items 18 to 25 [insertions];

(f) items 28, 31 and 32 [hazardous energy];

(g) item 45 [authorizations to apply X-rays];

(h) items 46 to 49 [drugs];

(i) items 51 to 53 [therapeutic diets].

Diagnoses

42   A registered psychiatric nurse may diagnose a physical or mental condition that the registered psychiatric nurse is authorized to treat without an assessment or diagnosis of the patient by a person who practises another designated health profession.

Procedures on tissue

43   A registered psychiatric nurse may perform a procedure on tissue below the dermis or the surface of a mucous membrane for the purpose of wound care, other than the suturing of skin lacerations.

Venipunctures

44   A registered psychiatric nurse may perform venipuncture for the following purposes:

(a) collecting a blood sample;

(b) establishing intravenous access.

Substances

45   A registered psychiatric nurse may administer substances as follows:

(a) by injection, in the case of purified protein derivative administered for the purpose of tuberculosis screening;

(b) by inhalation, in the case of oxygen or humidified air;

(c) by irrigation or enteral instillation, in the case of a solution administered for the purpose of assessment or treatment;

(d) by parenteral instillation, in the case of a solution administered for the purpose of managing hypovolemia or maintaining patency.

Insertions

46   (1) A registered psychiatric nurse may do any of the following for the purpose of assessment or treatment:

(a) perform the restricted activities described in items 18 to 24 [insertions] of the Restricted Activities Table;

(b) insert the following into the external ear canal:

(i) air that is under pressure no greater than the pressure created by the use of an otoscope;

(ii) water that is under pressure no greater than the pressure created by the use of an ear bulb syringe.

(2) For certainty, the performance of the restricted activity of inserting a device into the external ear canal includes the insertion of a wearable hearing instrument, or a part of or an accessory for it.

Hazardous energy

47   (1) A registered psychiatric nurse may apply ultrasound for the following purposes:

(a) bladder volume measurement;

(b) blood flow monitoring.

(2) A registered psychiatric nurse may apply electricity for the purpose of defibrillation in the course of emergency cardiac care.

Authorizations

48   A registered psychiatric nurse may issue an authorization to apply X-rays for the purpose of tuberculosis screening, except for the purpose of a computed tomography scan.

Drugs

49   (1) A registered psychiatric nurse may prescribe, compound, dispense or administer a Schedule I drug for any of the following purposes:

(a) treating anaphylaxis, hypoglycemia, opiate overdose or respiratory distress in a known asthmatic;

(b) treating conditions that are symptomatic of influenza-like illness;

(c) preventing disease using immunoprophylactic agents or post-exposure chemoprophylactic agents.

(2) A registered psychiatric nurse may prescribe, compound, dispense or administer a Schedule II drug.

Therapeutic diets

50   (1) A registered psychiatric nurse may compound or administer a therapeutic diet if nutrition is to be administered by enteral instillation.

(2) A registered psychiatric nurse may dispense a therapeutic diet if nutrition is to be administered orally or by enteral instillation.

Restricted activities if order or certified

51   (1) Subject to subsection (2), a registered psychiatric nurse may do the following:

(a) perform the restricted activities described in the following items of the Restricted Activities Table:

(i) items 2 and 3 [procedures on tissue];

(ii) items 11 to 16 [substances];

(iii) items 18 to 25 [insertions];

(iv) item 32 [electricity];

(b) compound, dispense or administer Schedule I or IA drugs.

(2) A registered psychiatric nurse may perform a restricted activity under subsection (1) only if one of the following applies:

(a) the registered psychiatric nurse is acting under an order issued by

(i) an authorized health professional,

(ii) a certified registered nurse or a certified registered psychiatric nurse, or

(iii) a person who is authorized in Alberta, Yukon or the Northwest Territories to

(A) practise a health profession that is equivalent to that of nursing or psychiatric nursing, and

(B) to perform restricted activities that a certified registered nurse or a certified registered psychiatric nurse is authorized to provide;

(b) the registered psychiatric nurse is a certified registered psychiatric nurse.

Other restricted activities if order

52   A registered psychiatric nurse may administer a therapeutic diet by parenteral instillation if acting under an order issued by an authorized health professional.

Other restricted activities if certified

53   A certified registered psychiatric nurse may do all of the following:

(a) diagnose opioid use disorder;

(b) for the purpose of treating opioid use disorder, prescribe, compound, dispense or administer a Schedule I or IA drug.

Part 5 — Practice of Midwifery

Division 1 — General Practice Matters

Midwifery patients

54   In this Part, "midwifery patient" means a patient who

(a) is pregnant,

(b) is in labour or is delivering a baby, or

(c) is in the postpartum period.

Exclusive title

55   Except as permitted under the Act, only a midwife may use the title "midwife".

Scope of practice for midwifery

56   (1) The following types of health services, provided primarily for the purposes set out in subsection (2), constitute the scope of practice for midwifery:

(a) assessing the health status of midwifery patients and their newborns and infants for the purpose of providing the health services referred to in paragraph (b);

(b) preventing, treating and managing physical and mental diseases, disorders and conditions of midwifery patients and their newborns and infants, including carrying out appropriate emergency measures when necessary;

(c) monitoring and providing care to midwifery patients and their newborns and infants;

(d) supporting and advising persons with respect to the provision of care to newborns and infants;

(e) providing contraceptive services for midwifery patients.

(2) The primary purposes for providing the health services described in subsection (1) in the practice of midwifery are to promote, maintain and restore the physical and mental health of midwifery patients and their newborns and infants.

[am. B.C. Reg. 41/2026, Sch. 2, s. 2.]

Limits and conditions

57   (1) Subject to subsection (2), the health services described in section 56 [scope of practice for midwifery] may be provided only during

(a) normal pregnancy, labour and delivery, and

(b) the postpartum period, if the condition of the midwifery patient and the patient's newborn or infant is normal.

(2) If there is a deviation from the normal course of a midwifery patient's pregnancy, labour, delivery or postpartum period, a midwife

(a) must consult with a medical practitioner or nurse practitioner, and

(b) must, if necessary or appropriate, transfer responsibility for the midwifery patient's care to another suitable health professional.

(3) A midwife who is not an Indigenous person must not practise Indigenous midwifery.

Exception for Indigenous midwifery

58   Despite any prohibition, limit or condition imposed under the Act, an Indigenous person may perform the restricted activities described in Divisions 2 and 3 of this Part if both of the following conditions are met:

(a) the person practised Indigenous midwifery, before March 15, 1995, on a reserve within the meaning of the Indian Act (Canada);

(b) the person performs the restricted activities on a reserve.

Division 2 — Full Restricted Activities

List of full restricted activities

59   A midwife may perform the restricted activities described in item 37 [authorizations to apply ultrasound] of the Restricted Activities Table.

Division 3 — Limited Restricted Activities

List of limited restricted activities

60   A midwife may perform the restricted activities described in the following items of the Restricted Activities Table, but only as provided for in this Division:

(a) item 1 [diagnoses];

(b) items 2 and 3 [procedures on tissue];

(c) item 6 [venipunctures];

(d) items 11, 12, 14 and 16 [substances];

(e) items 19 to 24 [insertions];

(f) item 27 [labour and delivery];

(g) item 28 [ultrasounds];

(h) items 46 to 49 [drugs].

Diagnoses

61   A midwife may diagnose a disease, disorder or condition that the midwife is authorized under section 56 (1) (b) [scope of practice for midwifery] to prevent, treat and manage.

Procedures on tissue

62   A midwife may perform a procedure on tissue below the dermis or the surface of a mucous membrane for any of the following purposes:

(a) performing episiotomies or amniotomies;

(b) repairing episiotomies or simple lacerations;

(c) taking a swab or specimen required for a screening or diagnostic test.

Venipunctures

63   A midwife may perform venipuncture for the following purposes:

(a) collecting a blood sample;

(b) establishing intravenous access.

Substances

64   (1) A midwife may administer a substance or Schedule III drug by inhalation, injection or parenteral instillation for any of the following purposes:

(a) relieving pain;

(b) preventing or treating dehydration or blood loss;

(c) resuscitation or other emergency measures;

(d) other purposes as required for the practice of midwifery.

(2) A midwife may administer a solution by irrigation for the purpose of wound care during the postpartum period.

Insertions

65   A midwife may insert an instrument, finger or hand beyond the following:

(a) the point in the nasal passages where they normally narrow, for the purpose of suctioning a newborn;

(b) the pharynx, for the purpose of intubating a newborn;

(c) the opening of the urethra, for the purpose of catheterizing a midwifery patient during labour or the postpartum period;

(d) the labia majora, for the purpose of

(i) conducting internal examinations of midwifery patients,

(ii) performing episiotomies or amniotomies, or

(iii) repairing episiotomies or simple lacerations;

(e) the anal verge, for the purpose of

(i) assessing perineal repairs,

(ii) administering a substance, or

(iii) assisting in the emergency delivery of a baby.

Labour and delivery

66   A midwife may manage labour or the normal, spontaneous vaginal delivery of a baby.

Hazardous energy

67   A midwife may apply ultrasound for the following purposes:

(a) fetal heart monitoring;

(b) determining fetal position and presentation.

Drugs

68   (1) A midwife may prescribe, compound, dispense or administer a Schedule I or IA drug for midwifery patients and their newborns if both of the following conditions are met:

(a) the drug is included in a category set out in Column 1 of the table to Appendix 1;

(b) the activity is performed for a purpose shown opposite in Column 2.

(2) A midwife may prescribe, compound, dispense or administer a Schedule II drug for midwifery patients or their newborns.

Restricted activities if order

69   A midwife may compound, dispense or administer a Schedule I or IA drug if acting under an order issued by a medical practitioner or nurse practitioner.

Restricted activities if certified

70   A certified midwife may do all of the following:

(a) insert acupuncture needles under the skin for the purpose of relieving pain during labour or the postpartum period;

(b) insert an instrument, device, finger or hand beyond the labia majora, for the purpose of administering a contraception or inducing labour;

(c) insert an instrument, finger or hand

(i) beyond the labia majora for the purpose of conducting the vacuum-assisted emergency delivery of a baby, or

(ii) into an artificial opening into the body for the purpose of assisting in the surgical delivery of a baby;

(d) prescribe, compound, dispense or administer Schedule I or IA drugs for midwifery patients and their newborns, if

(i) the drug is included in a category set out in Column 1 of the table to Appendix 2, and

(ii) the activity is performed for a purpose shown opposite in Column 2.

Appendix 1

(section 68 (1) [drugs])

Midwives (Schedule I and IA Drugs — Certification Not Required)

ItemColumn 1
Drug Category
Column 2
Purpose
1AntibioticsIntra-partum chemoprophylaxis for Group B strep Treatment of topical infection, breast infection or urinary tract infection
Prophylaxis of ophthalmia neonatorum
2AnaestheticsPerformance and repair of episiotomies
Repair of lacerations
Treatment of topical inflammation
Localized pain prophylaxis
3Anti-coagulantsProphylaxis of venous thromboembolism
4AntifibrinolyticsTreatment of postpartum hemorrhage
5Anti-fungalsTreatment of candidiasis
6Anti-nauseants/Anti-emeticsTreatment of nausea and vomiting
7Anti-viralsSuppression of viral infections during pregnancy and the postpartum period, except HIV/AIDS management
8BenzodiazepinesTherapeutic rest in prodromal labour
Short term management of excessive anxiety in the postpartum period
9Benzodiazepine receptor antagonistsTreatment of benzodiazepine overdose
10CorticosteroidsTreatment of skin inflammation and haemorrhoids
11GalactagoguesEnhancement of breast milk production
12Histamine antagonistsManage symptoms associated with allergic reactions
Treat signs and symptoms of gastrointestinal discomfort
13Immune globulinsProphylaxis in the neonate
Prophylaxis or treatment of the patient in pregnancy or the postpartum period
14InhalantsPain relief in labour or the immediate postpartum period
15Narcotic antagonistsReversal of narcotic-induced depression
16NarcoticsPain relief in labour or the postpartum period
17NitratesTreatment of hypertonic uterine contractions with non-reassuring fetal status
18Non-steroidal anti-inflammatoriesRelief of inflammation and pain
19SympathomimeticsTreatment of anaphylaxis or allergic reaction following the administration of drugs, vaccines or sera
Neonatal resuscitation
20Uterotonic agentsProphylaxis and treatment of uterine atony and postpartum haemorrhage
21VaccinesEstablishing an immune response
22Vitamin and mineral supplementsNutritional therapy and support

Appendix 2

(section 70 (d) [restricted activities if certified])

Midwives (Schedule I and IA Drugs if Certified)

ItemColumn 1
Drug Category
Column 2
Purpose
1AntibioticsTreatment of infection other than topical, breast or urinary tract infections
2Anti-viralsHIV/AIDS management
3Cervical ripening agentsPreparation of the cervix for labour
4ContraceptivesPrevention of conception
5Epidural analgesia (continuous infusion maintenance)Pain relief during labour and delivery, in a hospital only
6Uterotonic agentsInduction or augmentation of labour

[Provisions relevant to the enactment of this regulation: Health Professions and Occupations Act, S.B.C. 2022, c. 43, ss. 25 and 27.]