COVID-19: Frequently Asked Questions for Midwives
The COVID-19 pandemic has changed the way midwifery care is currently being provided. The College understands that midwives have questions related to their professional obligations in light of the pandemic and the directives that have been issued by the Province, the Chief Medical Officer of Health, and their local communities and hospitals. We will work to provide you with appropriate guidance to help you navigate these changes.
These frequently asked questions will be updated when the College has new information to share.
Can I administer the COVID-19 vaccination? [Updated January 20, 2021]
Midwives may not administer the COVID-19 vaccine on their own authority because they may only administer by injection a substance designated in the Designated Drugs Regulation (O. Reg. 884/93) and the vaccine for COVID-19 is not a substance designated in this regulation.
For individuals who are in the scope of practice (e.g., pregnant or postpartum) midwives may administer the COVID-19 vaccine on the order of a physician.
For individuals who are outside of the scope of practice (e.g., non-pregnant) midwives must be delegated the controlled act of administering a substance by injection in order to administer the COVID-19 vaccine.
What care can I provide during the COVID-19 pandemic? [Updated December 21, 2020]
The College expects midwives to use their knowledge, skills, and judgment, and follow the Ministry of Health’s Directives to determine what care they can provide during the COVID-19 pandemic. If providing care remotely, midwives should continue to document their findings and recommendations in the midwifery record. Health Quality Ontario has developed draft clinical guidance for health care professionals providing care remotely.
When practicing remotely, midwives should continue to document their findings in accordance with College standards and take every reasonable precaution to protect the confidentiality and privacy of their clients’ personal health information in accordance with the Personal Health Information Protection Act (PHIPA).
For more guidance on PHIPA, please see the College’s Guide on Compliance with the Personal Health Information Protection Act.
What COVID-19 tests are midwives authorized to perform? [Updated December 21, 2020]
Midwives are permitted to perform some, but not all, tests for COVID-19.
- Midwives are not permitted to perform nasopharyngeal (NP) swabs and deep nasal swabs on their own authority as they require the performance of the controlled act of “putting an instrument, hand or finger beyond the point in the nasal passages where they normally narrow.” Under the Midwifery Act, 1991, midwives do not have the authority to perform this controlled act. Midwives are only permitted to perform these tests under delegation if they have the knowledge, skills, and judgment to safely do so.
- Midwives are permitted to perform anterior nasal swabs and throat swabs, as they do not require the performance of a controlled act. Midwives must only perform these tests if they have the appropriate training to do so and must follow Public Health recommendations for testing.
While NP swabs is the optimal specimen collection method for COVID-19 testing, as per the current Public Health Ontario guidance, when NP swabbing cannot be performed, including in remote and low resource communities where there is not a health professional with the requisite or delegated authority, combined swabbing of the throat AND both nostrils (anterior nares) is a preferred alternative method.
Can midwives order COVID-19 testing? [Updated December 21, 2020]
Midwives are authorized to order, for midwifery clients and their newborns, laboratory testing for COVID-19, as it is considered “virus isolation” in Appendix B of the Laboratories Regulation (O. Reg. 682) under the Laboratories and Specimen Collection Centre Licensing Act.
I am currently Inactive but would like to transfer to the General class to help my practice [Updated December 22, 2020]
In March, in an effort to enhance midwifery resources in Ontario, the College temporarily revised its class change processes to expedite registration for midwives who were in the Inactive class but wished to return to the General class.
As we continue into 2021, we recognize that there may be continued challenges in meeting all registration requirements for the class change process (e.g., limited access to continuing competency courses). The College will continue to monitor the situation and provide members with an update in early 2021. In the meantime, members who wish to transfer from the Inactive to the General class must meet the following class change requirements:
2. Demonstrate current clinical experience as required by s. 15(4)(a) and 8(1)2i of the Registration Regulation, which includes active practice for at least two years out of the four years immediately before the date of application (i.e., must have attended a minimum total of 40 births, including 10 out-of-hospital births as primary, and 10 hospital births as primary in two out of the four years prior to re-applying for a General certificate of registration).
As part of the temporary revisions to the class change process, a member may meet this requirement by counting births attended as a primary and second midwife in the required timeframe.
3. Demonstrate satisfactory evidence of competency in Neonatal Resuscitation (NRP), Emergency Skills (ES), and Cardiopulmonary Resuscitation (CPR) by meeting the following:
- Provision of valid card(s) showing current training in NRP, ES, and/or CPR in accordance with the College’s Continuing Competency Requirements and Approved Courses. Valid means certification has not expired, or
- Provision of cards showing certifications in NRP, ES, and CPR which expired a year or less than one year prior to the date of application for a General certificate of registration.
4. Completion of the College’s Jurisprudence Course.
When a member cannot meet all the requirements, they are asked to enter into an Acknowledgement and Undertaking to address any combination of an active practice shortfall, lack of satisfactory evidence of competency in NRP, ES or CPR, and/or an incomplete Jurisprudence Course.
The Acknowledgement and Undertaking outlines the requalification program required for re-issuance of a General certificate of registration (as required in s. 15(4)(b) of the Registration Regulation) and any practice limitations. Where a member does not meet the current clinical experience and active practice requirements, the member will be referred to a panel of the Registration Committee to approve an Acknowledgement and Undertaking, including a requalification program for re-issuance of a General certificate of registration.
The College has waived the class change application fee.
What if I can’t meet a standard of practice during the pandemic?
Midwives remain accountable and responsible for clients in their care and their professional decisions and actions must be justifiable at all times. The College recognizes that in these challenging times midwives may not be able to meet all College standards and that there may be a need to adjust their practice to be able to provide appropriate care to their clients and newborns.
It is therefore important that if midwives cannot meet a standard of the profession, they must ensure that their clients receive the best care possible in the current circumstances and document the rationale for any decisions they make.
In some cases, midwives will know in advance that they cannot meet a particular standard. One example of this is when midwives cannot meet the Second Birth Attendant Standard because they plan to work with second birth attendants who do not have a current certificate in Neonatal Resuscitation or an obstetrical emergency skills program. In this example, midwives may apply for a waiver from these requirements of the Second Birth Attendant Standard because of extenuating circumstances (e.g., if courses in NRP or obstetrical emergency skills are not being offered). More information on the waiver policy, including the Application for a Waiver of Standards, is available on the College’s website. Any questions about waivers can be directed to email@example.com.
Midwives should exercise professional judgment, in every situation, to provide care that is in their clients’ best interest within the limits of their competence and the midwifery scope of practice that is in line with any directive or current guidance available from Public Health, the Ministry of Health, and the hospitals of which they hold privileges at.
Communicating information to clients about the pandemic
Midwives are reminded to rely on verifiable evidence-based information from reliable sources when communicating with their clients in person and/or on social media platforms about issues related to the pandemic. The public must receive a consistent and clear message.
If you are providing advice that does not align with best evidence or information being provided by public health officials and all levels of government, your comments or actions can lead to harm and make you vulnerable to be the subject of a complaint or a Registrar’s investigation.
The College’s Professional Standards for Midwives provides a framework for decision-making in a wide range of situations. This includes offering treatments based on the current and accepted evidence and resources available. Midwives must practice with integrity and recognize that the inherent power imbalance in the midwife-client relationship may be magnified by the current pandemic, as such any messaging should be clear and correct.
Do I need to report my Personal Protective Equipment (PPE) inventory on a daily basis?
On June 8, 2020, the Minister of Health issued an updated order (initially sent March 27, 2020) that changed the frequency in which health professionals must report their PPE inventory. Instead of reporting daily, midwives are required to report their PPE inventory twice a week, on Mondays and Thursdays. To read the updated order from the Minister, please click here. To read more about the frequency in which you should report, please click here.
I am a retired midwife, but I’d like to help out during this pandemic, what are my options?
The Ministry of Health issued a call out seeking experienced health care providers who are inactive or retired to consider being deployed within the health sector to assist with provincial efforts to stop the spread of COVID-19. If you are interested in submitting your application, please click here.
Availability of continuing competency courses for practising midwives [Added December 22, 2020]
The College is aware that there is currently reduced or no access to in-person Neonatal Resuscitation, Cardiopulmonary Resuscitation, and Emergency Skills workshops across the province that may affect midwives’ ability to successfully renew their training in these areas. The College is closely monitoring the situation and will update members in early 2021 with respect to any changes to continuing competency requirements for renewal 2021 and other College processes such as registration and class change.
All information from the College relating to the COVID-19 pandemic can be found here.