COVID-19: Frequently Asked Questions for Midwives
The COVID-19 pandemic has changed the way that 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.
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?
Midwives changing class from Inactive to General must submit the Inactive to General Class Change Application Form. The $50 class change fee is currently being waived. The application will guide you through the requirements for re-issuance of a General certificate of registration as outlined in the Registration Regulation. The process and possible outcomes are as follows:
- Applicant meets all requirements. They are re-issued a general certificate of registration upon confirmation of professional liability insurance and payment of membership fees for the General Class.
- Applicant does not meet the current clinical experience and active practice requirements. The application is then reviewed in accordance with the Requalification Program Approval and Registrar Authorization Policy. Where the applicant meets the low-risk criteria, the applicant will be asked to complete a standard re-qualification program which includes review of relevant documents. This streamlined approach allows applicants to complete the requirements without referral to a panel of the Registration Committee.
- Applicant does not meet the current clinical experience and active practice requirements, nor the low-risk criteria. A referral to a panel of the Registration Committee is made in order for the panel to approve an appropriate re-qualification program. Panels currently meet once per month, however, during this time, panels will be struck as needed and where possible to facilitate a faster approval of a re-qualification program as required by the Registration Regulation.
In all cases, the College will work to meet the applicant’s time frame for return to practice. If the applicant does not meet the requirements for re-issuance of a General certificate, and needs to complete a re-qualification program, the College will work with registrants to facilitate completion of the requirements as quickly as possible.
Midwives needing to return to practice to assist with the pressures created by the pandemic should notify the College when applying for a class change.
Any questions about class change can be directed to the Registration Department at firstname.lastname@example.org or (416) 640 2252 ext. 208.
What care can midwives provide during the COVID-19 pandemic?
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 practising 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 if a midwife 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.
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?
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:
- When determining mask requirements for clients, midwives must make recommendations based on best practice and current recommendations and directives from reputable sources such as Public Health Ontario (PHO) and the Provincial Council of Maternal for Maternal Child Health (PCMCH).
- 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.
- As always, the College requires that midwives provide care in accordance with the Professional Standards for Midwives and all relevant regulations and legislation.
How should midwives communicate 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.
What COVID-19 tests are midwives authorized to perform?
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 administer the COVID-19 vaccination?
A change to the Controlled Acts Regulation (O. Reg. 107/96) permits midwives to administer the COVID-19 vaccine without delegation or an order, as long as they do so in a facility that has an agreement the Minister of Health related to the administration of the COVID-19 vaccine AND a regulated health care provider from the following Colleges is on the premises and available to them:
- College of Physicians and Surgeons of Ontario
- College of Nurses of Ontario
- Ontario College of Pharmacists (and provider is a Part A pharmacist).
In all other situations, a midwife may only administer the COVID-19 vaccine under delegation for a client that is not in the midwifery scope of practice, or on the order of a health care provider authorized to administer it (e.g., nurse or physician). This is because the vaccine for COVID-19 is not a substance designated in the Designated Drugs Regulation (O. Reg. 884/93).
Note: An order under the Emergency Management and Civil Protection Act, 1990 (EMCPA) authorizes health care professionals including midwives to provide patient care services outside their [JG1] 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?
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 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 members of the public, including health care providers who are inactive or retired, to assist with provincial efforts to stop the spread of COVID-19. If you are interested in submitting your application, please click here.
Are vaccines mandatory for midwives?
Vaccines play an important role in protecting the most vulnerable—particularly those from communities who have been disproportionately impacted by COVID-19. The College strongly encourages all eligible midwives to get vaccinated unless contraindicated.
The province is not currently mandating that healthcare providers be required to receive a COVID-19 vaccine. However, hospitals are mandated to implement vaccine policies where staff are required to be vaccinated, provide proof of medical exemption, or complete an educational module and receive frequent COVID-19 testing if they choose to not be vaccinated.
Hospitals may choose to adopt their own vaccine policies that go beyond those mandated by the government. Under these policies, disciplinary action may be taken by the hospital, up to and including loss of hospital privileges or termination, for midwives who do not show proof of vaccination without a valid medical exemption.
Midwives who lose their hospital privileges as a result of these vaccine policies will have a difficult time meeting the College’s Professional Standards 18 and 19, which require midwives to offer and provide clients with their choice of birthplace.
A midwife who is unable to provide hospital births must promptly inform their clients of this fact. If the client chooses a hospital birth at any time during their care, the midwife must transfer them to another midwife for care in the hospital setting. If there are no other midwives to provide this care to their client, the midwife is not able to meet the College’s Professional Standards. Failing to maintain a standard of the profession is an act of professional misconduct under the Professional Misconduct Regulation.
If a midwife is asked about their vaccination status as it relates to their work role, are they required to disclose?
Disclosing your immunization status for COVID-19 is a personal decision, as it is personal health information that is covered under the Personal Health Information Protection Act. However, certain situations may arise where a midwife has a professional obligation to make a disclosure in the interest of client and public safety.
If there is a realistic possibility of COVID-19 transmission to a client that would be mitigated if the midwife were vaccinated, there may be a duty for the midwife to proactively notify the client of their immunization status.
Regarding mandatory disclosure to an employer or workplace, the College cannot offer legal advice. That is an employment law issue, for which a midwife should obtain advice from their lawyer. The College can only provide information related to the legislative framework and professional standards midwives must consider when maintaining their professional obligations.
The College of Midwives is not currently requesting or expecting disclosure of a registered midwife’s COVID-19 status or immunization status to the College. This would likely only change if directed by the Government or the Chief Medical Officer of Health.
Can a client refuse to see a midwife because they will not disclose personal vaccination information?
Yes. If a client wishes to have their care transferred either because a midwife declines to disclose their immunization status, or because they disclose that they have not received a vaccination for COVID, the midwife should make an effective, courteous, and prompt referral to another midwife or physician in accordance with the Professional Standards for Midwives.
All information from the College relating to the COVID-19 pandemic can be found here.