Doulton Prudil, Comm ’10, is expecting to give birth any day now. 

While the COVID-19 pandemic has postponed elective surgeries and medical appointments, childbirths have continued, no matter the inconvenience. For Prudil, who lives just outside of Kingston, her midwives have been a lifeline in these uncertain times.

“If I could pay my midwives a million dollars, I would,” Prudil said in a phone interview with The Journal. “I don’t think I’ve ever had a healthcare professional care so much about my wellbeing.”

A first-time parent, Prudil has had the stress of a global pandemic added to the already heightened anxieties that come with pregnancy. She’s also been cut off from the support systems that were helping her prepare for parenthood.

“There are no prenatal classes. There are no lactation classes,” she said. “The things that help first-time parents get comfortable, the groups and the camaraderie, have all gone away.”

As a result, Prudil’s only professional guidance has come from her midwives. Not only have they continued to provide the same standard of prenatal care, but Prudil says her midwives have actually been more available than ever during COVID-19.

“My midwife will text back and forth with me if I have questions, just to make sure I feel reassured throughout this entire process, which has been a real wonderful support measure,” she said. “They have spent so much time talking things through with me over the phone every time there’s a change in a hospital procedure.”

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Midwives, who act as primary care providers during childbirth as well as pre and postnatal care, attend approximately 18 per cent of Ontario’s births annually. These births can take place in the client’s home, a birth clinic, or the hospital. Like other healthcare professionals, midwives have taken on new challenges during the COVID-19 pandemic.

Jasmin Tecson, president of the Association of Ontario Midwives (AOM), is proud of the work Ontario’s midwives have done to ensure client safety in the past few months. In an interview with The Journal, she said reducing the risk of infection has been the Association’s first priority while continuing to provide care for pregnant clients.

“In our midwifery clinics, we know that one of the first and most effective ways to reduce the risk of infection is through screening and distancing,” Tecson said. “It’s that collective responsibility. We take that very seriously for ourselves and for our clients.”

Alongside all other maternal care providers, midwives have been following The Provincial Council for Maternal and Child Health’s Maternal-Neonatal COVID-19 General Guideline since its release on April 30. This protocol means screening clients and workers for signs and symptoms of COVID-19, using Personal Protective Equipment (PPE) to reduce the risk of transmission, and limiting in-person care visits.

“The average midwifery visit used to be 30 minutes, and now the visits are 10 to 15 minutes,” Tecson said. “The talking, teaching, and answering questions piece of visits now happens virtually.”

These virtual visits are intended to replace half of the visits that would have been conducted in-person before the spread of COVID-19. By spacing out check-ups, the hope is that the risk of transmission is halved as well. Clients can use virtual visits to ask questions about their pregnancy, birth plan, and postnatal care, while in-person visits are used to check blood pressure, draw blood, and perform physical tests.

Tecson said clients have responded positively to these measures, and that the level of prenatal care clients receive has not been compromised significantly by the pandemic. However, she added the reduced frequency of postpartum care appointments has proved a challenge.

“In that first week [after childbirth] alone, we’re used to doing an average of three visits with the new parent and the baby. What we’ve had to do is reduce those visits and space them out so that there are two in that first week,” Tecson said. “As midwives, we know that so much happens over those [first] two or three days. There are more situations where we’d like to do closer visits, or extra visits.”

Additionally, guidelines limiting the number of people at a birth or clinical visit means midwives are now only interacting with the pregnant parent and new baby, while other family members must distance themselves.

“It’s sad to have even a clinic visit with just the new parent and the baby and not have the partner or support people involved, when we worked with the whole family so intensely over [the] birth,” Tecson said.

Another source of stress for midwives in Ontario has been accessing Personal Protective Equipment (PPE). Tecson said, while the level of access varies from practice to practice, midwives are having a difficult time sourcing equipment.

“[Midwives are] having to purchase personal equipment, hand sanitizer, and disinfectants themselves,” she said. “The AOM has been helpful in centralizing that [process] and flagging sources, but those [items] are in high demand and prices are inflated.”

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Essential health workers have taken on the increasing burden of care during COVID-19. In Ontario, the provincial government has acknowledged this by providing temporary pandemic pay— an extra four dollars per hour —to frontline workers including nurses, correctional officers, and personal care workers. 

Midwives are not considered eligible for temporary pandemic pay.

“Frankly, it doesn’t make sense to us. It’s baffling,” Tecson said. 

She maintains that midwives fulfill all of the provincially-mandated requirements for the temporary pandemic pay. She said it’s disheartening to see midwives go unrecognized for their contributions to COVID-19 prevention in maternal health.

“Our work combines essential healthcare elements, and elements of social services. When we look at the list of job categories that qualify, midwifery definitely fits into that,” Tecson said. “To be told that [your] work is not essential is a slap in the face.”

This isn’t the first time Ontario midwives have been discouraged by the provincial government’s decisions about their pay. 

Since 2013, the AOM has been working to secure pay equity for midwives based on allegations— ruled legitimate by the Human Rights Tribunal of Ontario —that the Ontario government financially undervalues midwifery on the basis of gender. 

“Of course, we do have in the back of our minds that midwives still don’t have pay equity,” Tecson said. “They still don’t have recognition from the government of the discrimination that has taken place and has been confirmed by the Human Rights Tribunal.”

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Now days away from her due date, Prudil said midwives have played a crucial role in her prenatal care.

“The fact that they can be undercompensated, take their jobs so seriously, and provide such a high level of care, goes to the heart of the quality of midwives in general,” Prudil said. “They’re not after the paycheck. They’re after the work itself.”

As Prudil waits out the last few days before her baby’s arrival, she said she’s reflecting on how much her midwives have helped her prepare and stay calm despite the fear permeating healthcare during these times. 

“I think the grace in which my midwives have handled the changing requirements has been amazing,” she said. “Their calmness has resonated with me. They’ve done a great job.”