Covid-19

Dear Clients of The Midwives Clinic of East York–Don Mills,

We are writing to give you an update and outline changes we have made at our clinic in response to COVID-19 Pandemic. The health of everyone is our top priority at this time. The midwives and students will follow all Public Health guidelines regarding self-isolation if they are at risk of COVID-19 or screen positive. This means that your prenatal visits, birth, postpartum visits may be attended by a midwife that is not part of your team.

Worrying if you have CoVID-19?
Have you developed the common symptoms of COVID-19 such as fever (over 37.8C), new or worsening cough, and/or difficulty breathing? Do you have any of these other symptoms; sore throat, difficulty swallowing, new olfactory or taste disorders and upset stomach: with new or worsening nausea, vomiting, diarrhea and stomach pain? Do you have any of these atypical symptoms such as red eyes, chills, headache, unexplained fatigue? Do have sneezing, a runny or a stuffed nose for no clear reason (such as seasonal allergies)?

You can read the Ministry of Health CoVID-19 Reference Document for Symptoms here. Please reach out to your midwife and/or call the testing centre at Michael Garron Hospital at 416-469-6858 to see if you qualify for testing. Don’t attend your clinic appointment but keep us updated by calling the clinic. In urgent situations, please page us.

COVID-19 Provincial Testing Guidance  has been updated with new information if you want to learn more about testing.

MGH has two satellite locations: 

  1. Thorncliffe Park by visiting the TNO Youth Centre at 45 Overlea Blvd., Unit 108A. Please make an appointment by calling the MGH testing centre at 416-469-6858 or 647-477-1640.
  2. Crescent Town Health Centre, 4 The Market Place.This walk-in facility, which serves patients of all ages, will be open Monday to Saturday from noon to 7 p.m. Testing may finish earlier depending on client volumes.

In-person clinic visits and OTN/Internet visits:
Your midwives will be wearing masks to reduce the spread of COVID-19 for all your in-person visits. As of April 20th we will be starting Ontario Telemedicine Network (OTN) visits which will mean you can meet with your midwife in a secure way over the internet. Your midwife will let you know before your visit if it will be in-person visit or by using this platform. We can achieve a lot over the phone including answering your questions, discussing relevant topics related to pregnancy and birth, arranging ultrasounds and other testing and sending prescriptions and reviewing completed lab work. If there are other appointments that you would like to do by phone or OTN, please let us know.

We are asking that all of our clients who come to our office follow the Ontario Provincial legislation ensuring that everyone in the business/ organization wear face coverings/ masks. The provincial requirement includes the following exceptions, among others:

  • children younger than two years of age;
  • a person with a medical condition that inhibits their ability to wear a mask or face covering;
  • a person that is unable to put on or remove their mask or face covering without the assistance of another person;
  • when a person needs to temporarily remove their mask or face covering to receive services that require the removal of their mask or face covering, to consume food or drink, or as needed for health and safety;
  • as is needed for reasonable accommodation under the the Human Rights Code; or
  • works for the business or organization, is in an area that is not accessible to members of the public, and is able to maintain a physical distance of at least two metres from every other person.

See the questions in the AOM’s COVID-19 Clinical FAQ on clients wearing masks for more information and suggestions on how to respond to clients that may refuse to wear a mask. 

We are continuing to use the World Health Organization (WHO) guidelines on the number of prenatal appointments for a positive outcome. We will offer a virtual appointment for initial visits at 8-10 weeks, clinic appointments at 12-14 weeks, 20, 26 30, 34, 36, 38, 40 and 41 weeks. The visits on weeks 37 and 39 will be determined with your midwife if they will be in person or by phone. If your initial visit is greater than 12 weeks, it will take place in the clinic. The in-person portion of your visit will be 10-15 minutes and then the remainder of your appointment will be done by phone. 

The postpartum visit schedule includes a home or hospital visit between day 1 and day 2. You midwife will call on day 3 and see you again on day 4/5. If everything is well, you will return to the clinic on day 10. There will be one or two additional clinic visits, if needed, between weeks 3 and 6.

Cancer Care Ontario is recommending the gradual resumption of cervical cancer screening for those who are due or overdue. Talk to your midwife if you due or overdue for your Pap test so that we can make arrangements for this to be done. 

We are continuing with these schedules, even though we are in “Stage Three”, because of the volume of people that our midwives interact with. Our goal is to keep our pregnant clients and midwives as physically distanced as possible to decrease the chances of anyone getting COVID-19.

Our clinic space:
We have removed all the toys and we ask you not to touch the lending library books in the waiting room to reduce the number of objects that are touched and to make cleaning easier.

We will continue to wipe off surfaces in our clinic rooms and wash our hands or use hand sanitizer in between clients. We ask that you also use hand sanitizer when you arrive for your appointment that is available at the front desk. For the time being we will be restricting other family members from coming into clinic visits. All pregnant clients will have a 15 minute in person appointment followed by a phone appointment with family members as needed.

Toronto Birth Centre:

  • Effective Oct 14th, 2020, TBC is increasing restrictions on support people accompanying people in labour at TBC. 
  • Clients in labour are limited to one support person from their family. If they have planned the participation of a trained doula and/or Indigenous knowledge keeper, we have asked them to discuss it their midwives so that exceptions to the one-person limit can be made.
  • Clients with children should make plans for them to be cared for elsewhere.
  • We expect everyone to participate in the following measures while at TBC. Those who do not will be asked to leave.
    • Answer screening questions before entering the space. Midwives will first screen their clients by phone or in person, before arriving at the TBC. Staff continue to do active screening on site.
    • Wear a mask, and clean your hands frequently. Support people must keep their mask on at all times, covering both nose and mouth. Clients in advanced stages of labour can negotiate with their midwives about removing their mask in birth room spaces in advanced stages of labour. TBC provides level 1 masks for midwives and students doing client care with low risk of splash, and level 2 or 3 for higher risk of splash. 
    • Maintain distance of 2 metres (six feet) from others wherever possible.

Michael Garron Hospital:
The birthing unit is equipped with items (PPE) required to care for pregnant people with COVID-19. All people entering the hospital will be screened for CoVID-19. You can only enter the Coxwell Ave entrance when going to Labour and Delivery regardless of time of day. If you are less than 20 weeks gestation and require emergency services you will go to the emergency entrance and seek care there. Labouring clients can have 1 support person for the duration of their stay, this person is not interchangeable with another.  All other appointments at the hospital can have one person accompanying you. Children under the age of 16 will not be able to visit the hospital at this time.

It’s currently recommended that people who are CoVID-19 positive or People Under Investigation (PUI) for CoVID-19 should have external fetal monitoring and epidural for their labours. This is due to the many uncertainties during the labouring process with people who are ill. Your midwife will discuss these recommendations with you if you become positive or have symptoms of CoVID-19. All people who are either CoVID-19 positive or a PUI will be placed in a single room for the entirety of their stay. 

Due to the growing number of CoVID-19 cases in the Toronto shelter system our hospital will be initially isolating clients who live in a shelter. What does that look like? When you talk to your midwife on the phone they will screen you for symptoms of CoVID-19. When you arrive at the hospital you will be admitted directly into a room instead of being assessed in triage. 

All of our clients are asked to register at the hospital, regardless of planned place of birth. You can register by faxing your registration forms before 30 weeks, the forms can be retrieved here. If you do not have access to a fax machine bring your forms to your next in-person visit and we will fax them for you. 

Michael Garron Hospital Breastfeeding Clinic 416-469-6580, extension 6667 to book an appointment. Due to Covid-19 your first visit will be a virtual appointment with a Lactation Consultant. They will then book you an in-person visit after this based on need. Currently there is no drop-in option due to the requirement to socially distance and the cleaning requirements of Covid-19. As of Aug 17th, 2020 the clinic will be open 5 days a week being closed on Wednesday and Sunday.  

Visitors Policy as of Oct 9, 2020 for Michael Garron Hospital (MGH):

All Units:

  • Masks must be worn in public spaces (hallways) and at all times in shared rooms and spaces.
  • Visitors must wash their hands regularly and maintain physical distance with other patients and visitors.
  • No visitor should be under the age of 16.
  • The visitor is determined by the patient or the patient’s guardian.
  • Exceptions can be made via management or in consultation with charge nurse ie. in person interpreters, additional supports for bereavement, family meetings or parent education. 

Family Birthing Centre (FBC):

  • Only 1 designated visitor a day.
  • A maximum of 2 different visitors for the entire patient stay. 
  • No in-and-out privileges:
    • Exceptions can be made for getting care seat, food or supporting discharge.
    • Exceptions can be allowing for flexibility during a prolonged labour if necessary in consultation with management or charge nurse. 

Special Care Nursery (SCN):

  • 1 parents/guardians at a time.
  • A maximum of two different visitors for the entire patient stay. 

G7- Paediatrics:

  • 1 parent/guardian at a time for Inpatient Paediatrics. 
  • A maximum of 2 different visitors for the entire patient stay. 
  • 1 parent/guardian at a time for Day Surgery, Blood work or Pre-Operative visits. 

Home Births and Postpartum Home Visits:
Your midwife will be wearing the appropriate PPE when in your home.  When we visit we ask that you provide paper towel in the bathroom or kitchen so we can dry our hands off after hand washing. When we visit we hope that family members who are in contact with our midwives will be wearing masks and keep social distancing measures whenever possible.

We continue to offer out-of-hospital births both at the TBC and home. This is a great way to keep clients and babies out of the hospital. As always, we need to be certain that every person requesting an out-of-hospital birth is a good candidate. If any household members are sick or have screened positive for COVID-19, midwives will not be able to attend you at home and will request that the birth occurs in the hospital where there is a supply of masks and gowns. 

As of July 2nd, 2020 clients can have two support people present at their home birth. This includes other family members or a doula. We request that the birth guests wear masks and socially distance as necessary. 

Getting Information that’s relevant to you!
We are committed to giving you the best possible update information. We will change this page when new information becomes available. There are also these links to read: 

Association of Ontario Midwives Clinical FAQ page can be found here.
 
Clients with confirmed or suspected COVID-19 should be encouraged to continue chest/breastfeeding their infants. Breast/Chest feeding information from the Association of Ontario Midwives can be found here
 
Public Health Agency of Canada has created a Fact Sheet on COVID-19 for pregnant people.
 
The Canadian Paediatric Society and Society of Obstetricians and Gynaecologists of Canada have published a joint practice point article on breastfeeding: Breastfeeding when mothers have suspected or proven COVID-19.
 
The Canadian Paediatric Society has two updated two Practice Points:
 
The Society of Obstetricians and Gynaecologists of Canada has released this Committee Opinion regarding CoVID-19 here.
 
The (Ontario) Provincial Council for Maternal and Child Health (PCMCH) has released The Maternal-Neonatal General Guidelines for CoVID-19 and they can be found here.
 
The Joint Statement of the Issue of Support Persons in Labour in Canada can be found here. This is statement that was released on April 24th, 2020 from the Society of Gynaecologist of Canada, The College of Family Physicians of Canada, The National Aboriginal Council of Midwives, The Canadian Association of Perinatal and Women’s Health Nurses and The Canadian Association of Midwives. 
 

Thinking of travelling? Here are some links to help you make your decision.

  • The US-Canada land border remains closed to non-essential travel. Canadian citizens, permanent residents and visitors are mandated by law to quarantine for 14 days upon return to Canada from any international destination.
  • Non-essential travel throughout Canada is generally advised against. Travel restrictions, including mandatory periods of self-isolation, vary between provinces. Before travelling, visit the intended province’s public health website to learn about current restrictions.
  • Visit local public health websites to learn about any potential restrictions for travel within Ontario, particularly if you plan to travel to a ‘hot spot.’
 
Resources for pregnant people and new parents in the postpartum:
 
Walk in clinics for all. If you don’t have OHIP this spread sheet will help you to find a doctor here.
 
HealthcareAccess Ontario will  help you to find a walk-in clinic for clients without OHIP. 
 
Barbra Schlifer Commemorative Clinic resources for Non- Status Women can be found here.  
 
You can find the Ontario government CoVID-19 support website here which includes information and resources about financial support, supports for child and youth, emergency shelters and mental health services. 
 
The Barbra Schlifer Commemorative Clinic has put together this handout Resources for Non-Status Women During Covid-19 for people who currently don’t have status in Ontario. 
 
First Nations Health Managers Association updates can be found here regarding resources and announcements relating to CoVID-19.
 
Best Start resources for families on having a baby during the COVID-19 pandemic. Check out Health Nexus Website under the COVID-19 Section. 
 
Toronto Public Health Online Self-Referrals

Clients can self-refer to receive telephone support with breastfeeding and or postpartum coping from a Public Health Nurse by completing an online form on the TPH website:

Michael Garron Hospital Breastfeeding Clinic 416-469-6580, extension 6667 to book an appointment. Due to Covid-19 your first visit will be a virtual appointment with a Lactation Consultant. They will then book you an in-person visit after this based on need. Currently there is no drop-in option due to the requirement to socially distance and the cleaning requirements of Covid-19. As of Aug 17th, 2020 the clinic will be open 5 days a week being closed on Wednesday and Sunday. 

The Midwives’ Clinic’s next zoom prenatal classes will be held in the fall but you can find online resources here

*Updated information*Recalls:

Health Canada is advising Canadians that hand sanitizers containing technical-grade ethanol are being recalled from the Canadian market because they are not compliant with federal regulations and may pose a risk to your health. You can find the updated list from July 3rd here

Continuing Updates:
We will send regular emails as things change, update our website: themidwivesclinic.ca, and have regular postings on our social media platforms. You can follow @themidwivesclinic on Instagram, Twitter and The Midwives Clinic of East York-Don Mills on Facebook for updates.

We know these are stressful times. We hope you all are able to feel our continued support and reach out if you have concerns. Most of all we hope that you and your families remain healthy in the coming weeks.

Sincerely,

Your Midwives at The Midwives’ Clinic of East York-Don Mills