Despite not being declared front-line workers, midwives in Ontario, Canada, did not stop working as the COVID-19 pandemic presented serious risks. Adapting their workflow to comply with safety standards, midwives continued providing care as experts in low-risk pregnancy and birth across the province, as they have been doing since being regulated and incorporated into the provincial healthcare system in 1995. In Ontario, midwives conduct roughly 18% of deliveries. Association of Ontario Midwives president Jasmin Tecson attributes the lack of classification to the government’s need for expediency, and a misunderstanding of midwifery work and skills rooted in a devaluation of women’s work in society. “We’re constantly having to educate people about the breadth of midwives’ knowledge and skills, and we’re constantly needing to justify that,” she said. 

The lack of classification as an essential service comes on the heels of the Human Rights Tribunal of Ontario having ruled in 2018 that the work of midwives has been chronically undervalued and underpaid because it’s a female-dominated profession. The process was put on hold in February, 2019, when the government filed to appeal the ruling.

“It really depends on how much sleep that particular midwife has had,” said Tecson when asked how not being deemed essential impacts midwives. “At best it's discouraging to have not been designated as an essential service. When you are working on the front lines, and making sacrifices, and constantly making adjustments in your work, and when added to your standard level of clinical consciousness, professional awareness and responsibility is the potential ramifications of a lapse in your practice, or a lapse in caution, that's stressful. And then to have that be disrespected by not being designated an essential service, to be left out of pandemic pay, to be struggling for personal protective equipment at the height of the pandemic, that’s all very discouraging,” Tecson said. “Then if you've had to work with COVID-19-positive patients, or have had to go out, as we often do, on a limb for a client, and have not had much sleep, not had much food, not seen your family for prolonged periods, then it goes from intensely frustrating to demoralizing,” she said.

Since COVID-19 hit, midwifery clinics across the province have seen a rise in clients’ interest in birthing outside of hospitals, said Tecson. “People are coming to midwives for home birth because they are concerned about potential exposure to COVID-19 in hospitals,” she said. “Hospitals have very strict protocols in place to protect people using the hospital from picking up other infections, but we do know that the greatest cause for infection is actually nosocomial,” she said. “Situations like this highlight that the hospital is not a dedicated birthing place.”

Midwives’ ability to care for clients outside of hospitals helps alleviate the healthcare system, and midwives are expanding their care beyond midwifery clinics. Programs at Trillium Health Partners in Mississauga and Markham Stouffville Hospital have incorporated postpartum home visits with midwives for patients who are eligible for early discharge, instead of an obstetrician or public health nurse, said Tecson. “The idea there is to reduce the amount of time that people are in the hospital, and then address the preventable reasons that would lead people to be readmitted to hospital,” she said.