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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 April 23, 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.  

Note: A new order under the Emergency Management and Civil Protection Act, 1990 (EMCPA) authorizes health care professionals including midwives to provide patient care services outside their regular scope of practice. The College interprets this new order to apply only to practising midwives providing care within a hospital (who are either employees of or hold privileges in that hospital).  It does not permit midwives to practise outside of scope while they are working in a clinic or home setting. Read more about the new order under the EMCPA here.

What care can I provide during the COVID-19 pandemic? [Updated May 19, 2021]

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 April 23, 2021]

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.
  • Midwives are permitted to perform point-of-care tests to diagnose COVID-19 because of revisions made to the Laboratories Regulation on March 3, 2021. Point-of-care testing is defined in the regulation as testing performed outside a clinical laboratory at or near where a patient is receiving care. To be considered point-of-care testing, the specimen being tested must be taken from the human body such as blood, urine or amniotic fluid.

While performing an NP swab 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. 

Note: A new order under the Emergency Management and Civil Protection Act, 1990 (EMCPA) authorizes health care professionals including midwives to provide patient care services outside their regular scope of practice. The College interprets this new order to apply only to practising midwives providing care within a hospital (who are either employees of or hold privileges in that hospital).  It does not permit midwives to practise outside of scope while they are working in a clinic or home setting. Read more about the new order under the EMCPA here.

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.

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 practiceadvice@cmo.on.ca.

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.

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

I am an Inactive midwife who would like to become registered in the General Class to work during the COVID-19 pandemic. What do I need to do?

On April 1, 2021, a new class change policy came into effect. The Requalification Program Approval and Registrar Authorization Policy establishes a streamlined process for inactive certificate holders applying for re-issuance of a General certificate of registration, in accordance with section 15(4)(b) of the Registration Regulation, where a requalification program is required. Where an applicant meets the low risk criteria outlined in Schedule A of the Policy (Assessment Tool), the applicant may complete the established standard requalification program without being referred to a panel of the Registration Committee.

The new Policy and updated Inactive to General Class Change Application Form are available on the College’s website.

Any questions related to class change may be directed to the Registration Department at regsupport@cmo.on.ca or 416-640-2252 ext. 208.

What is the availability of continuing competency courses for practising midwives [Updated May 10, 2021]

For 2021, the College has outlined two options for meeting the continuing competency requirements in neonatal resuscitation (NRP), cardiopulmonary resuscitation (CPR) and Emergency Skills (ES) for 2021.

• Option 1: Complete an approved continuing competency course(s) including the in-person component.

• Option 2: Complete the online components of an approved continuing competency course(s) and skills review/practice.

To review the options and requirements for 2021, click here.

What are the requirements around mask-wearing for midwifery clients during the COVID-19 pandemic? What do I need to consider if a client does not wish to wear a mask? [Added June 2, 2021]

The College of Midwives of Ontario as a health care regulator does not have a policy regarding mask wearing for midwifery clients, however, the Ontario government requires that everyone in the province wear a mask in public indoor places. You can read more about the current public health guidelines around masking below. The College does require midwives to follow current best practice for infection prevention and control which includes wearing masks during all client interactions during the COVID-19 pandemic.

As a regulatory body, the College does not provide clinical practice guidance, but it does provide midwives and the public with information about practice as it relates to its mandate and College standards. Here are a few key considerations:

  • Midwives must work in accordance with the rules set by each of the locations where they practise, including institutional policies (e.g. hospitals), and community standards. Some of these locations may have rules regarding mask wearing for clients.
  • If recommendations or directives are that a client wear a mask during labour, midwives should ensure the client understands the rationale behind the decision. This can include providing clients with or referring them to the current guidelines and institutional policies that require it. As with all care, midwives should be documenting these discussions in the client record and noting whether the client agrees or disagrees with the recommendations. 

All information from the College relating to the COVID-19 pandemic can be found here.