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Ryerson alumna says response is unprecedented as regulator changes requirements to get more midwives back in practice
For Elaina Ferrari and her fellow midwives, “flattening the curve” is what happens to a mother’s belly after childbirth. Now, in the midst of a global pandemic, it means something else entirely. Ferrari is one of several midwives who has been called to help fight COVID-19.
“I’d booked three weeks off to spend time with my kids for March break,” said Ferrari. “I had about a week left when I got the notice that our roles would be changing.”
The abrupt notice that cancelled Ferrari’s plans and called her back to work came from Markham Stouffville Hospital, where she works in the midwifery unit when she isn’t running her own community-based practice. The callback was just one of several initiatives undertaken as part of the hospital’s contingency plan to deal with emergency situations.
Ferrari said the hospital sent emails surveying midwives about their skills at the time the virus was first detected in January and again when it was declared a pandemic last month. The hospital administration was trying to figure out where to place the midwives on staff to increase the hospital’s capacity.
“We might be doing assessments, screening patients that come in, those sorts of things,” said Ferrari. “I can do some things that nurses do, like start IV drips.”
Ferrari said she’s never seen anything like COVID-19 before. “I wasn’t practising during SARS,” she said. Ferrari graduated from Ryerson’s midwifery education program in 2003, the same year SARS hit.
Jasmin Tecson, a midwife in Toronto and the president-elect of the Association of Ontario Midwives, said the response is unprecedented, even compared to SARS. “Taking on this increased workload to decrease the load on the hospital system and in-hospital professionals [is] a new thing,” she said.
Tecson reiterated Ferrari’s thoughts on midwives having skills that “straddle a number of different professions,” listing nursing, obstetrics and counselling as examples. “There are different ways we can be plugged into the system to fill gaps,” said Tecson.
Tecson also said the association has heard of obstetricians (doctors who specialize in pregnancy, childbirth and reproduction) who handle hospital births approaching midwives to take over the care of mothers and newborns so that the doctors could discharge the person early. That means passing off the 24-hour newborn health screening that follows every childbirth to the midwives, who conduct those health checks in their own practices.
That frees up hospital beds and equipment like masks and respirators that are in short supply. It also gets the mothers and newborns back to practising social distancing as soon as possible.
While Tecson understands the necessity, she has concerns with midwives being tapped to raise hospitals’ capacities. “Given our relatively small workforce, how is that going to increase the workload on the remaining midwives?” said Tecson.
There are just over 950 registered midwives in Ontario, who handle 17 per cent of all births, according to the Association of Ontario Midwives. The province averages about 1,000 births per day according to Statistics Canada, and pregnancies and deliveries aren’t stopping on account of the pandemic.
However, the College of Midwives of Ontario may have the answer. The regulatory body announced that it is waiving the fee and some other requirements, like CPR and neonatal resuscitation, to have non-practising midwives return to active practice in response to the pandemic.
Ontario’s Ministry of Health put out a similar call, looking for anybody with health-care experience, even if they weren’t practising anymore.
That means those midwives re-entering active practice or just lending a hand might be put to work where skills like CPR aren’t needed, such as teleconferencing.
Teleconferencing technology is proving to be an asset to midwives’ normal duties as well. Ferrari provides care for mothers during pregnancy up until six months after giving birth. In the community-based portion of her practice that would mean home visits. In a time where social distancing is strongly encouraged, Ferrari has switched to a webcam and microphone to help talk mothers through post-childbirth needs or to keep them from bunching together. “If a mother’s having trouble breastfeeding, normally she’d go to a breastfeeding clinic,” said Ferrari. “That’s a lot of people in one place.”
It also eases the burden on the province’s stressed telehealth services. Even if mothers wanted to access breastfeeding clinics or other public health services, many of them are closed. York region, where Ferrari practises, has seen groups that offer infant feeding and pregnancy support shutter their doors. On the City of Toronto’s website, five of the nine breastfeeding clinics have closure notices.
Telehealth Ontario offers 24/7 breastfeeding and other infant support lines but the service is stretched thin, with hours-long wait times reported. The province announced a five-fold increase in phone lines, to 2,000 from 400, but every new mother Ferrari, Tecson and their fellow midwives can talk to through a laptop is one more that won’t clog up the lines looking for alternatives to services that have shut their doors.
Tecson said teleconferencing doesn’t stop at counselling supports. Some practices, including her own, have prepared home kits with thermometers, scales and other medical equipment like stethoscopes to send out to new mothers. Midwives can talk them through weighing their baby, taking their temperature and checking their heartbeat without having to be present.
With the situation evolving, all midwives can do is adapt. After a few days of uncertainty, Ferrari found out what her new role at the hospital would be. Another midwife would be moved into the hospital’s pandemic response staff and Ferrari would take over that midwife’s duties in the midwifery unit.
It’s just another change and it appears that Ferrari is unfazed by it. “Midwifery’s not a job,” she said. “It’s a lifestyle.”