In COVID-19, many of us are choosing to avoid the hospital in order to ease the burden on frontline healthcare workers and limit our exposure to the virus. But life does not stop, and births continue to happen. Midwives are highly skilled primary health care providers who provide sexual and reproductive healthcare in the community and in hospitals. This week, we spoke with Seventh Generations Midwives Toronto, a group of midwives who offer primary reproductive and pregnancy care to families in Toronto with a focus on Indigenous families on how they are adapting to COVID-19.
1. How has your organization had to adapt its services and programs amid COVID-19?
We have seen a lot of changes in how we provide perinatal care over the past couple of months. We are constantly writing and updating plans in order to provide the best care possible to our clients and their families. Some of our biggest changes are in how, when and where we provide care. To limit our clients' interactions with other people we have revised our visit schedule to be in line with the World Health Organization's recommendations for prenatal visits, a portion of our visits are now conducted over the phone, and we have made changes at our clinic to increase people’s ability to physically distance.
As midwives, we are highly skilled in providing care in a community setting, whether that be providing care over the phone, in people’s homes, at the Toronto Birth Centre, or in our clinic. During the pandemic, this skill is in even higher demand. Many of our clients are wanting to stay out of the hospital, limit their visits to our clinic and other health care settings. As midwives, we are trained to provide care in this way, to be able to do risk assessments, to talk with our clients about the risks and benefits of interventions and going into the clinic or hospital and help them to make a decision that is best for them and their family. This has been extremely important during the pandemic.
2. What role does community and culture play in your programs and services? Can you tell us a bit about how COVID-19 is impacting this?
Community and culture are an important part of pregnancy and birth for many people, but especially for the Indigenous community. Pregnancy, birth and postpartum are community events. This is a time where we take care of the pregnant person, their family and the new life we are welcoming into this world. It is a difficult time to be separated from family, friends and community support.
Some birth spaces allow for more flexibility and physical distancing, meaning more people there to support the birth. However, we are trying to limit our interaction with others, and this makes the family and community aspects of pregnancy, birth and postpartum difficult. As Indigenous and allied midwives, we know the importance of more than one support person in labour - having to choose between your partner and your parent or sibling as support in labour is a choice we do not want our clients to make. However, we also know the importance of protecting our families and communities by limiting our exposure to the coronavirus. Our families, our Elders, our communities are extremely important to us and we need to think about how we can best support everyone during this time.
At times what this means for us is an increase in our role as support people, or our role as Aunties. Providing that additional support role when other family members can’t be present in the hospital, whether that be before, during or after the birth. Our role as emotional support to our clients, and the importance that can have on their health and well-being, has never been more clear.
3. Are there certain vulnerable groups who are underserved and/or who you worry about?
As midwives who approach our care through the lens of social justice, we are increasingly aware of the inequitable burden of COVID-19 on marginalized populations. We see first hand how some of our community members experience a higher burden of ill-health. The pandemic is amplifying the already inequitable access to safe sexual and reproductive care that exists not just across the country, but here in our city. For those in our families and communities who already live with illnesses and compromised immunity, live in overcrowded homes, with mental illness, substance use and trauma, COVID-19 is a new and added layer to their lives and to accessing healthcare. As healthcare providers for the Indigeous community, we see how racism contributes to ill health and lack of access to healthcare.
We are trying to address the multiple layers of inequity that contribute to poor health. We need to examine how this pandemic is affecting people differently, what people’s access to care is, and how we approach care during a pandemic differently to ensure we are meeting our clients' needs. We need to examine how the advice given to pregnant people around COVID-19 is applicable to our families, for example: how do you self-isolate before your birth if you live in an overcrowded house and you still need to go to work? How do you decide between having a support person in labour and keeping your family safe? How do you access birth control when your walk-in clinic is overcrowded with sick people? We are working to address these needs through continuing to provide care both in the community and in hospitals, by working with other health care providers to meet the expanded needs of our clients, and by going out into our communities when others won’t, we are reaching out to those people who are continuing to need care.
4. What are your greatest challenges in supporting your clients right now? What have been the greatest successes?
One of the greatest challenges for midwifery practices across Ontario, is accessing personal protective equipment (PPE) for the midwives. When the COVID-19 recommendations first came out for health care providers, PPE stock instantaneously vanished, everything was out of stock. Without PPE, it would have been extremely difficult to keep our clients, staff and midwives safe. PPE is essential to reducing the spread of transmission.
We have also seen challenges for our clients, such as needing to use public transportation to get to the clinic, lack of child care, and the recommendation to come alone to the clinic for their prenatal appointments. To keep family members involved in prenatal care, clients have been connecting with their support people virtually at appointments.
We have increased our opportunity to provide excellent, safe, community-based care. We are providing care for people where they are located, thus reducing their need to travel to us. We are also able to provide care to people who otherwise are unable to access care. This has reduced the burden on hospital resources and increased the number of people who are accessing safe health care.
5. As governments start talking about easing restrictions, what support will you be aiming to provide your clients?
We will continue to provide a clinic schedule that allows for physical distancing for our clients. As health care providers, we have an important opportunity to provide education for proper hand hygiene, how to use masks in public and how to practice good physical distancing. We will continue to provide community-based care and early discharge from the clinic and hospital to allow for a shorter stay and thus limiting the possible exposure to the coronavirus. Our clients may leave the hospital within three hours after giving birth because they have access to their midwife 24 hours a day and receive the rest of their care at home.
6. Are there any silver linings for long term and systemic change that you can see? What do we need to do to ensure we make an “equitable recovery”?
A few opportunities for change that we hope will continue are the recognition of the importance of preventative care for all our clients and access to hospital-based care for people without OHIP. We have also noticed that phone appointments can work; our clients are happy with them and they can provide increased access to health care for some who have difficulty attending appointments in person. There has also been some opportunity to see how expanding the scope of midwives can improve access to safe sexual and reproductive healthcare.
For more information on the roles of midwives during the pandemic check-out the National Aboriginal Council of Midwives and the Canadian Association of Midwives websites: www.indigenousmidwifery.ca and www.canadianmidwives.org.