Protocols vs. Guidelines
by Suzanne Hope Suarez

[Editor's note: This article first appeared in Midwifery Today Issue 73, Spring 2005.]

The term protocols is confusing sometimes because it is used differently from location to location, state to state. In general, protocols have to be very carefully written, or midwives damage themselves legally. The midwife should be certain that the way she practices and interacts with clients fits within her protocols. For example, a protocol in Florida is usually between a CNM and a physician and serves as a contract to limit the midwife's practice. Should she deviate from working within the protocol (in this case as determined by the agreement she has with the physician), she could be liable for damages in a malpractice claim and may be unable to get insurance coverage for her defense. The same is true for any midwife whose practice uses written protocols. Most of the time protocols are a group decision by a group of practitioners and serve to insulate the group from legal action should one of the members deviate from them.

Midwives need to understand the terms standards, clinical guidelines and protocols so that they can utilize them in the same way that others in the medical and legal fields do. This is a mechanism by which to protect the midwife, her practice and the midwifery profession.

The terms guidelines and standards should NOT be interchanged. Standards provide the midwife with process. Clinical guidelines provide research-based information. Standards are rigid. Clinical guidelines may be flexible to meet client needs and the particular circumstances. Clinical guidelines do not take the place of standards, but rather provide research-based options for decisions.

Clinical guidelines are:

  • Operational tools to assist in clinical decisions
  • Detailed and client-focused
  • Based on procedures or clinical conditions
  • Recommended courses of action and/or practices for meeting standards of care
  • Sources of continuity, quality of care and a range of acceptable practices and options that can be adapted to specific needs

For guidelines utilized by other professionals, see www.guideline.gov.

Suzanne Hope Suarez, RN, BSN, is an attorney who has created a legal program for practicing professional midwives that includes standards, guidelines and protocols. She lives in Tampa, Florida, and offers consultation services to midwives across the country. She is a board member of the Midwives Education Accreditation Council and previously served on the NARM board. She is the author of Midwifery Is Not the Practice of Medicine (1993).


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