Vaccines play an important role in protecting the most vulnerable, particularly pregnant clients, who have been more impacted by COVID-19 and are in a higher risk category for severe illness. The College of Midwives of Alberta (CMA) strongly encourages all eligible midwives and clients to get vaccinated.

Alberta Health Services (AHS) has recently put into place a vaccine mandate, requiring all midwifery staff who are to continue providing AHS services to be vaccinated unless they are eligible for a medical exemption. This means that midwives who wish to continue providing services within AHS are required to be vaccinated. Midwives are required to provide proof of vaccination against COVID-19 by December 13, 2021, or take a leave of absence from AHS.

Midwives who choose not to disclose their vaccination status or to be vaccinated and who choose to take a Leave of Absence (LOA) from AHS will still be registered with the CMA, so long as they maintain Liability Insurance, and all of the Continuing Competence requirements. Midwives do not require AHS privileges as a part of their registration.

Please talk to your midwife about this situation and your ongoing care.

Clients are able to request their care be transferred due to a midwife’s vaccination status. The midwife should make an effective, courteous, and prompt referral to another midwife or physician in accordance with the CMA Standards of Practice.

Disclosing immunization status for clients and midwives is a personal decision, as it is personal health information that is covered under the Health Information Act. However, the current AHS mandate requires that all midwifery staff providing care in AHS hospitals and clinics are vaccinated. So, if your midwife is able to provide you with care in an AHS hospital or clinic then they have been fully vaccinated. If they are unable to provide care at AHS hospitals and clinics, they have declined to disclose their vaccination status with AHS or have not been vaccinated. This will be an implicit declaration of vaccination status, and one that will be finalized by the December 13, 2021.

This means that the midwife cannot admit any clients to the hospital for any reason, e.g., a client hospital appointment or hospital birth.

Your midwife has decided to stop involvement with AHS. Your midwife will not be able to work in or admit clients to any AHS hospital, but will be able to conduct community (home) births. CMA has been informed that midwives can take an LOA from AHS for up to 2 years. 

Midwives who are on an LOA from AHS are no longer considered staff members and cannot accompany you into the AHS facility. Your current midwife is obligated to discuss with you options as a result of this situation. The CMA Standards of Practice, Code of Ethics and applicable policies must be followed by all midwives choosing to take an LOA from AHS and remain registered with the CMA.

Your midwife must review and arrange designated ongoing care for you in accordance with the CMA Standards of Practice on client-centered care and the CMA Informed Choice Policy (P# 18). Your midwife should:

1) Explain their situation to you,

2) Disclose their professional plan, and

3) Conduct an informed choice discussion to review the options for care available to you, based on your choice of birthplace. An informed choice discussion should include the risks, benefits and details of the option, the risks and benefits and details of the other alternatives. You will have the opportunity to ask questions and the midwife will support your decision. You will weigh out the benefits and risks to each option, and arrive at the best decision you can make.

Options to carefully consider about your ongoing care are:

a) If you choose a community birth, you can stay with your midwife under a private pay plan (yes, private pay is covered under Policy #17 Registered Midwives Contracting Private Pay Clients).

b)  If you plan for a hospital birth, then you can consider going under the care of another midwife who has hospital privileges, either from your current clinic or another clinic.

c) You can also consider going under the care of your family doctor, low risk maternity physician or another physician who would be able to care for you during the rest of your pregnancy, birth and/or postpartum.

d) If you and your midwife cannot come to any agreement, and your midwife decides to formally terminate the relationship and discharge you from care. In this case, you would be able to seek care from any care provider on your own. Depending on your due date, you could put your name back on the client data base on the AAM website, just like you did previously.

CMA expects that this discussion should include all options. All midwives who will be taking an LOA from AHS are required to have a thorough discussion with their clients regarding their choice of birthplace and continuing midwifery care, including the limitations caused by this new AHS policy.

Documentation of the concrete plan of care and designated care provider must appear on your chart with acknowledgement of agreement from you; these are requirements of the CMA.

As per CMA Standards of Practice, midwives whose clients choose not to continue with their midwifery care are required to find an alternative care provider for their clients. If you choose to go with another care provider, your midwife is required to find you one. Please be aware that the care provider may be a physician, as another midwife may not be available to provide ongoing care.

Please review the options for ongoing care listed above.

Clients are able to request their care be transferred due to a midwife’s vaccination status. The midwife should make an effective, courteous, and prompt referral to another midwife or physician in accordance with the CMA Standards of Practice.

Yes, it is. Midwives are eligible for private pay. This option will be discussed with you fully by your current midwife, as there are a number of different payment plans here as well. For information regarding private pay, please see the CMA Policy#17 Registered Midwives Contracting Private Pay Clients.  

Masks are required for all indoor sites per Alberta government requirements. For some midwifery visits, care may be provided virtually, or visits may occur on a slightly different schedule depending upon current recommendations for preventing spread of COVID 19. Communication may occur virtually, over the phone, via email, or in person. All support people are requested to wear masks during births in an out-of-hospital setting. Labouring women are not expected to wear masks. Midwives are required to wear masks during all visits.

If your midwife does not have admitting privileges with AHS, but has maintained CMA registration, they will be able to provide care in a community setting that is not an AHS site. This may be community birth if you choose. They will not be able to accompany you into the hospital as your care provider should you require a hospital visit or require hospital birth. Care will be transferred to a physician if you are transferred into hospital. Midwives who are on an LOA from AHS are no longer considered staff members and cannot accompany you into the AHS facility. If you require a hospital delivery, only one designated support person is allowed at the delivery; who that is, is up to you.

For the purposes of providing care, any currently established midwifery practice is considered an AHS site. Alternative clinical arrangements should be made by your midwife if care outside of the AHS framework continues to be provided. Birth suites in clinics will also be considered AHS sites. The CMA encourages all clients who have questions to have a thorough discussion about choice of birthplace and private pay with their midwives.

The CMA maintains a database of all practicing midwives in the province, clients are encouraged to go on the CMA’s website and search their midwife’s name to ensure up-to-date registration. The CMA website: www.albertamidwives.org. Go to “Find a Midwife” tab at the left hand top of the page. After you click on that tab, type in the midwife’s name. When the name comes up, it will tell you the midwife’s status. For further assistance please contact the CMA at info@albertamidwives.org or call (403) 474-3999.

Midwives are required by the CMA to provide evidence-based recommendations regarding all vaccinations, in line with the midwifery standards of practice, provincial, and federal public health guidance. Information will be given to you regarding protection and prevention measures, including vaccinations, masking, hand-washing, and social distancing, and that information will be grounded in science and best practice.

CMA expects that your midwife will conduct an informed choice discussion with you around getting the vaccine. They may ask you what you already know, to be able to provide factual evidence and dispel some concerns and myths surrounding the COVID 19 vaccine, and then go through what, when, where, how and why the vaccine may be recommended for you. An informed choice discussion should include the risks and benefits of the option, the risks and benefits of the alternatives, including to do nothing or wait. You will have the opportunity to ask questions and the midwife will support your decision. The discussion and decision you have made will be documented in your chart. See the CMA Informed Choice policy for more information.

Information will be given to you from the midwifery scope of practice, in line with provincial public health guidance regarding protection and prevention measures, including vaccinations, making, handwashing and social distancing, and finally, that information will be grounded in science and best practice.

CMA also expects that your midwife will:

Conduct an Informed decision-making process with you around getting the vaccine. Firstly, it would help to know what you know already (myths and evidence) and then go through, the What, When, Where, How and walk through the WHY:

Benefits, risks of the vaccine, and the benefits and risks of alternatives, including to do nothing and the option to wait.

You will make your choice. The midwife will document the conversation and the decision that you made.