Pandemic drives up home birth numbers, highlights sacrifices made by Ontario midwives

The stress of having a baby has increased significantly due to the COVID-19 pandemic, with concerns about being in a hospital setting and potential exposure to the virus resulting in a marked increase in the number of people delivering at home.

Meagan Furnivall, a London-based registered midwife and adjunct professor at McMaster University, said her practice — Talbot Creek Midwives — has seen home births increased by more than 50 per cent.

The Association of Ontario Midwives (AOM) said while the home birth rate for midwives across the province is roughly 15 per cent, midwifery practices have "reported a significant increase" in the number of people who have been switching into midwifery care. Without providing exact numbers, the AOM said the rate has roughly doubled.

"In our practice specifically, we are at about 50 to 60 per cent home birth rate, up from  five to 10 per cent pre-pandemic for our low-risk pregnant clients," Furnivall said. 

"The higher risk clients still deliver in hospitals."

When coronavirus cases first began to spike in Ontario, Madeleine Spencer and her husband Jonathon decided to have their third baby at home. She felt it was safer in the pandemic to do so without being exposed to the hospital.

Furnivall said when she and her colleagues showed up at their home at 3 a.m., Spencer was exhausted but she wanted to prevent her from having to transfer to the hospital for an unnecessary reason — exhaustion. 

"I tucked her into bed and I said, why don't I give you some IV fluid and see if that gives you a bit of energy and sort of wake your uterus up so that you can have your baby instead of putting you in an ambulance or a car and transferring you to the hospital," Furnivall said. 

"So, I stood there with the bag hanging because we don't have IV poles at home, so I just stood there for 25 minutes and waited for the fluid to run through the IV and then she had her baby [Knox] shortly afterwards."

Pandemic highlights sacrifices midwives make

Furnivall said midwives have been providing exceptional care, as they try to make sure their clients still get a nice, straightforward, healthy and safe birth "amidst all of the chaos in the pandemic."

"I think the pandemic is highlighting the kinds of sacrifices that we make, and I'm not saying that we're unique [because] I think every health-care provider is doing that," she said. 

"But I feel like there is this sort of special thing happening with home births because we just simply cannot be afforded the same protection at home that you can be in a room at a hospital with all of the PPE and all of the access to sanitation and all that stuff."

Midwifery by the Numbers

According to AOM, midwifery has been a regulated health profession for 26 years.

There are currently 963 midwives in the province and the number of clients who gave birth in midwifery care between April 1, 2017 and March 31, 2018 stands at 25,283.

Among the other data provided by the AOM are:

• Number of midwifery practices in the province: 105.
• Number of communities where midwives provide care: 239.
• Number of hospitals where midwives have privileges: 122.
• Number of new midwives who graduate from the Midwifery Education program each year: approximately 80.

'Kind of a crazy year'

Furnivall said midwives continue to keep clients safe even with the increased number of home births during the pandemic.

"It's been kind of a crazy year. We've been really trying to negotiate our fear of being in someone's home for 24 hours in an environment where we can't even go to the bathroom without having to take off some form of PPEs," she said.

"I think we're the only care provider that probably spends that much time in someone's house full of PPEs while trying to drink and have time to eat. 

So, it's been a crazy year trying to figure out how to support clients but also how to stay safe," she said.

AOM president Jasmin Tecson said 2020 has been extremely challenging for midwives, as it has been for everybody else in health care and particularly people who are on the front lines.

She said while an integral part of the care midwives provide is based in the community, and even though they are a ministry funded program, there are elements that are essential for providing safe care such as infection prevention and control supplies, and personal protective equipment that practices need to source themselves.

"What made 2020 really difficult for midwives is needing to pivot to maintain those same elements of quality and safety options for their clients but on a health-care landscape that is constantly shifting, very uncertain and feels very high risk," Tecson said. 

"And on top of that, not being recognized as the essential health-care workers that they are — front-line primary care providers — by the ministry of health and sometimes by their local hospital, that just exacerbates the challenges and stress that midwives are already under in pandemic conditions."

The issue of pandemic pay for midwives arose in the early stages of the pandemic and Tecson said despite the AOM's strong, articulate advocacy, the ministry of health just wasn't able or willing to recognize midwives as essential workers that fit into the definition of pandemic pay.

"It's really unfortunate and disheartening for midwives, especially in light of the very significant finding of the human right tribunal case," she said.

"But we have to go on. Not that we've given up on that, we are continuing to work on different fronts to advocate for midwives to be paid fairly and to receive the PPE that they need in a timely way and to strategically receive funding support in their communities.

"But ultimately for us as midwives the priority is to be there for our clients. It's not as if we can stop providing care when pregnancies continue, people go into labour, babies decide to come when they are going to come at any time of day or night," Tecson said.