By: Vincia Herbert, RM, Policy Analyst, Association of Ontario Midwives
As the first COVID-19 waves spread across the province, midwives continued to do what they do best—provide excellent primary care to their pregnant, birthing and postpartum clients. Outfitted in personal protective equipment (PPE), midwives continued to attend clients in their homes, at clinics and at hospitals. However, at Oak Valley Health's Markham Stouffville Hospital (MSH), some GTA midwives found themselves adapting their clinical skillset to a new and unexpected environment: the Intensive Care Unit (ICU).
Early in the pandemic, ICUs across the province struggled to respond to the influx of patients with serious illness requiring critical inpatient care. Within a year, MSH increased their ICU bed capacity from 15 to 34 beds. To offset the pressure on the ICU team, a plan emerged that would integrate non-ICU clinicians to work alongside the specialized team in a supportive role.
When the unit “doubled in size overnight… you needed the resources of other disciplines to come in and help members of the team," says Sandeep Yakub, ICU Patient Care Manager. Part of this response was a call to recruit healthcare providers in the Oak Valley Health community. Says Yakub, “integrating more members onto the team allowed the ICU nurses to focus more on the ICU aspects of care—the things that only an ICU nurse can do. “
Midwives were among those who responded to the call and came to the ICU with clinical skills that were directly transferable from their work. Midwives are accustomed to long hours closely attending to and monitoring clients for subtle changes; mixing and administering medications through IVs; taking blood samples; inserting and removing catheters; repositioning clients; using medication pumps; tracking their supplies; and restocking their own birth kits and carts. With some ICU-specific training, midwives quickly adapted their existing skills to the new environment, and integrated new skills such as enteral feeding and vent suctioning. Some of the direct-care nursing components of the work were easier to take on “because midwives have that nursing/MRP dual role, and we had been closer to it for longer," hospitalist midwife Andrea Mills reflects. The seamless integration of midwives' primary care clinical skills and decision making did not go unnoticed. According to Yakub, “The midwives were so respected while they were in the ICU, the team trusted them. I saw it right off the bat… they came in and they just did."
Midwives also played an important emotional support role at a time when patient families were unable to be in the ICU due to Covid restrictions. “Just the fact that they were there and offering comfort—for the families to know someone was with that loved one while they're in the hospital. I think that was huge for them, that they were not just in that bed alone. I think that was one of the biggest contributions from the midwives," says Yakub. For Mills, the interprofessional environment lent itself to continuous learning: “When we get so siloed—any of us, nurses, OBs—it doesn't serve us, it doesn't serve clients (or) patients, and we have so much to learn from each other if we allow it."
Oak Valley Health's MSH has long had a reputation for championing midwifery contributions to patient care in the hospital ecosystem, due in no small part to the efforts of Carol Cameron, an Ontario midwife whose leadership and vision led to the development of the Alongside Midwifery Unit, the first of its kind in Canada. The midwife-led unit has recently been rebranded as a Centre of Excellence.
“Most hospitals would not think of including midwives in being a part of the solution to an emerging crisis such as the one all of us faced in staffing ICUs earlier in the pandemic," says Cameron. “It just would not have occurred to them. But that is exactly what makes Markham Stouffville Hospital unique, and what is possible when leaders from the midwifery profession are included and respected at the leadership table. Leaders who started their careers as midwives form part of the Director and Manager team here, and there is an awareness and appreciation of the role of midwives in the organization. This allowed for leaders in medicine and in particular the ICU to see all the possibilities and ask the most important question of all: Why not [include midwives]?"