Respecting professional-patient boundaries

Midwives are in positions of power over a client, by virtue of having professional knowledge and skill that clients rely on for their well-being. In addition, they have access to clients' personal health information.

Midwives must always maintain professional boundaries with their clients. Ethically, and further as addressed in the   Health Professions Act, they are prohibited from engaging in any form of sexual abuse or sexual misconduct with a client.  Clients can expect midwifery services will be free from conduct, behaviour or remarks of a sexual nature, and that the Registered Midwife will establish and maintain professional boundaries appropriate to the midwifery care relationship in all interactions with clients.

What is sexual abuse and sexual misconduct

Sexual abuse  “means the threatened, attempted or actual conduct of a regulated member towards a client that is of a sexual nature and includes any of the following conduct:

1. sexual intercourse between a regulated member and a client of that regulated member;
2. genital to genital, genital to anal, oral to genital or oral to anal contact between a regulated member and a client of that regulated member;
3. masturbation of a regulated member by, or in the presence of, a client of that regulated member;
4. masturbation of a regulated member’s client by that regulated member;
5. encouraging a regulated member’s client to masturbate in the presence of that regulated member; and
6. touching of a sexual nature of a client’s genitals, anus, breasts or buttocks by a regulated member.”¹

Sexual misconduct  “means any incident or repeated incidents of objectionable or unwelcome conduct, behaviour or remarks of a sexual nature by a regulated member towards a client that the regulated member knows or ought reasonably to know will or would cause offence or humiliation to the client or adversely affect the client’s health and well-being but does not include sexual abuse.”²

¹ Health Professions Act, Section 1(1), (nn.1)

² Health Professions Act, Section 1(1), (nn.2)

Are you a Client?

“ Client”: is the term typically used in midwifery practice for ‘patient’. A midwifery client is a person who contracts with the Registered Midwife or group of midwives, for the professional service of midwifery care, or has, or had received midwifery services within the last year. Client is also considered to be a newborn infant of the parent/person who holds the midwifery contract. Individuals are considered to be clients for the duration of the midwifery contract (see “Course of Midwifery Care”), as well as the duration of an episodic care situation.

Do you think your midwife may have violated a boundary or otherwise engaged in sexual misconduct or abuse?

Did your midwife do something to make you feel uncomfortable? Maybe they touched you in a way that was not medically necessary or appropriate, or perhaps they said something sexually suggestive. If this is the case, please contact the College of Midwives of Alberta (CMA) to discus your concerns.

We recognize that coming forward with a complaint about sexual abuse or sexual misconduct can be very difficult. If you believe your midwife may have committed sexual abuse or sexual misconduct, we urge you to contact us at   403-474-3999

Complaints of a sexual nature may involve the following:

• Privacy and respect:   The Registered Midwife must establish and maintain professional boundaries in any interaction with a client by way of providing private conversation space, adequate draping, privacy while client is dressing and undressing, and using appropriate examination techniques when touching sensitive or personal areas of the body.
• Inappropriate comments or gestures:  This could include saying something sexually suggestive or seductive to you, commenting or unnecessarily asking questions about sexual relationships or sexual orientation, making sexually insulting or offensive comments or jokes, or giving unwanted attention (e.g., kissing).
• Unnecessary or improper physical examinations:  This could mean touching you without permission, explanation, or consent, or performing a service such as a physical examination in a sexual rather than a medical way.
• Sexual contact or assault:  This encompasses everything from inappropriate touching to sexual assault. It also may include sexual contact between a health care professional and client that would otherwise be considered consensual.

Why report?

Coming forward about an experience that you’ve had with your Registered Midwife that may constitute sexual abuse or sexual misconduct can be incredibly difficult. There are many reasons why you may choose not to come forward. There are, however, good reasons for reporting:

• Public protection:  Incidents of sexual abuse and sexual misconduct are often not isolated. By coming forward, you could help us act to ensure that what happened to you does not happen to someone else.
• Awareness:   As CMA won’t know otherwise, we rely on individuals to make us aware when things aren’t right. We can only learn about sexual abuse and sexual misconduct from people who make complaints.
• Your own sense of closure:  If you’ve been the victim of sexual abuse or sexual misconduct by a Registered Midwife, knowing that there is an investigation and potential consequences may play a role in your healing process.

THERAPY & COUNSELLING FUNDING

There are a variety of situations in which you may be eligible for funding for counselling or therapy. In fact, filing a complaint with the CMA alleging sexual abuse/sexual misconduct by a health care professional while you were a client is one of the eligibility criteria for receiving funding. For more information, please contact the College of Midwifes of Alberta at 1-403-474-3999.

ADDITIONAL RESOURCES
The Association of Alberta Sexual Assault Services offers numerous resources and information about sexual assault services in Alberta.

Complaint Process

When you call for assistance or to make a complaint, you will speak to a member of CMA staff. They have specific training in the area of sexual abuse and sexual misconduct, are very familiar with the college’s complaint process, and can give you an idea of what to expect. They will record that a concern of sexual abuse or sexual misconduct was received and discussed. Our office can be reached by calling 403-474-3999. You can remain anonymous, use an alias, or arrange to meet a staff member in person. If you then decide to make a formal complaint, it must be submitted in writing and signed.

When your formal written complaint is received, the complaints director may conduct, or may appoint an investigator to conduct, an investigation. The investigator will contact you to discuss your concerns and obtain additional information. If you prefer, you can meet in person. The investigator will ask you to explain what happened as clearly and in as much detail as you can possibly provide. During an investigation, the investigator may obtain copies of your midwifery records relevant to the concerns raised.  Legislation requires that we notify the midwife about your complaint. They will be given opportunity to respond to it. Your complaint is handled with the utmost seriousness and privacy, and all written complaints will be fully investigated. When the investigation is complete, all the materials gathered by the investigator will be forwarded to CMA’s complaints director, who will review the information and determine what should happen next. The complaints director may decide to refer the concerns about the midwife to a Hearing Tribunal or may determine that no further action is needed if the conduct or care was appropriate.

What happens if the complaints director dismisses my complaint?

You will be provided with the complaints director’s written decision, including reasons why your complaint was dismissed. Should you be dissatisfied with the decision to dismiss your complaint, you may request that the decision be reviewed. You will be provided with instructions on how to make this request.

What happens if my complaint is referred to a Hearing Tribunal?

Your complaint may be referred to a Hearing Tribunal for hearing. Hearings at CMA are much like proceedings in a court of law. At a hearing, the college will present evidence before a panel consisting of Registered Midwives and a member of the public. The Hearing Tribunal’s role is much like that of a jury. They will hear evidence presented by the college and the Registered Midwife whose professional conduct is being investigated. Upon considering all of the information, they must determine whether the complaint is well-founded or not.   You may be asked to testify at the hearing. If so, you are encouraged to bring someone with you for support. You may be questioned by the legal representatives for the college and the investigated Midwife.

If the Hearing Tribunal finds the allegations of sexual abuse are proven, the midwife's registration will be permanently cancelled. If the Hearing Tribunal finds allegations of sexual misconduct proven, the midwife will be suspended for a period of time determined appropriate by the Tribunal depending on the circumstances of the case. The decisions of the Hearing Tribunal are subject to an appeal process whereby the investigated person or the complaints director, on behalf of CMA, may appeal the Hearing Tribunal’s decision to CMA Council. Hearings are open to the public and the media may attend unless the Hearing Tribunal orders or accepts an application from one of the parties to hold the hearing in private. The media can publish the name of the midwife, but in cases involving unprofessional conduct of a sexual nature, the Hearing Tribunal is required, by law, to order a publication ban on information that could identify you if you request such an order.


Who to contact

If you think you have experienced sexual abuse as the result of an interaction with a midwife, we urge you to contact CMA at 403-474-3999