What should midwives do regarding mask policies now that the provincial mask mandate in health care spaces has been lifted?

COVID-19 continues to circulate in communities and the effectiveness of masking to reduce transmission has not changed. 

Health care settings such as midwifery clinics, birth centres, hospitals, community labs and diagnostic imaging facilities are responsible for deciding whether to maintain current masking policies or amend them. Public Health Ontario cautions that “due to changes in the Ministry of Health’s updated guidance on testing and case, contact and outbreak management, counts are an underestimate of the true number of cases and outbreaks with COVID-19 in Ontario”. Decisions about maintaining masking policies will be influenced by transmission risks in different communities, risks of severe COVID-19 illness in the population served, and the toll already taken and on health human resources which may be further impacted by relaxing of IPAC measures. To track prevalence in your region, see the Ontario Respiratory Virus Data Tool and the Health Canada Wastewater Monitoring. To monitor the impact of respiratory virus load on your hospital system, see the Acute Care Enhanced Surveillance system dashboards.

Many organizations are moving to adopt seasonal protocols that increase infection and prevention controls during higher risk periods, such as Fall and Winter. To reduce the risk that midwives and midwifery clients will be negatively impacted by seasonal changes like these, consider the following strategies:

• Everyone in the workplace, including owners, partners, associates, new registrants, locums, student midwives and staff should be engaged in the discussion and have input into the decision about maintaining or amending masking policies.
• Ensure that policy decisions address all locations of work including clients’ homes.
• Midwives should check if hospitals and birth centres where they have privileges and community labs and diagnostic imaging facilities used by clients have maintained or amended their policies.
• Consider the benefits of making midwifery workplace masking policies align with hospital policies. Clients and the public may be better able to understand and more likely to comply with a community standard for health care organizations.
• Communicate the policies of the clinic, the hospital and community facilities attended by clients on the clinic’s website, on social media, when appointments are booked and with office signage.
• If the midwifery group decides to continue to require clients and support people to mask in the clinic and at visits in the community, provide a rationale based on:

1. Public Health data that shows that the virus is still circulating.
2. A reminder that pregnancy is a risk factor for more severe disease requiring hospitalization and midwives need to promote policies to keep all clients safe.
3. Midwives need to be protected from infection risk so that they can continue to work and provide safe care to clients.
4. Evidence that face mask use results in a large reduction in risk of infection, with greater protection associated with N95 or similar respirators compared with disposable surgical masks or similar (e.g., reusable 12–16-layer cotton). Infographics can be shared on social media or posted in the clinic to explain how various IPAC measures reduce transmission and more specifically the significance of masking in reducing transmission.

• Providing a rationale for continuing masking requirements may help to reduce resistance from clients.

Midwives should continue to perform a point-of-care risk assessment (PCRA) for every clinical encounter and use their knowledge, skill, and judgement to recommend higher levels of infection prevention and control measures in higher risk situations.

MPGs can still access PPE from the Ministry of Health. Practice groups must create an account to access the PPE Supply portal. 

[September 9, 2025] 
 

Should clients wear masks or face coverings for their appointments with their midwives or during labour?

Public Health Ontario's Best practices for the prevention of acute respiratory infection transmission in all health care settings (April 2025, PDF, 3.3 MB) notes that "health care settings can adjust components of expanding Routine Practices with the primary goal of preventing harm to vulnerable patients/resident/clients and reducing transmission within the health care facility, in addition to preserving operational capacity" (p 36). One possible expansion of Routine Practices is universal continuous masking: "In general, the higher the transmission risk (i.e., the absolute risk), the more likely there is a sizeable benefit (i.e., absolute risk reduction) of continuous masking policies" (p 37). There are various considerations when deciding whether to require or request that clients wear masks during their appointments. See the FAQ above "What should midwives do regarding mask policies now that the provincial mask mandate in health care spaces has been lifted?" for more details.

During respiratory illness season if your practice settings require universal continuous masking, clients may be confused and question having to wear a mask for their midwifery care; midwives may need to explain how there are different measures for higher risk settings like health care. You can refer to the AOM's COVID-19 Bulletin: Issue #149 - April 14, 2023 (PDF, 162 KB) for talking points for conversations with client. To support these discussions, Public Health Ontario's  Best practices for the prevention of acute respiratory infection transmission in all health care settings (April 2025, PDF, 3.3 MB) Table 2. Scenarios and Considerations for Masking – Ranked in Order of Perceived Highest Impact on Protecting Patients/Residents/Clients and Preventing Outbreaks (p. 39) may also be helpful.

[September 9, 2025]

What if clients refuse to wear a mask?

Midwives may encounter clients (or their support person) who refuse to wear a mask. These are very complex issues, midwives can call the AOM On Call to access advice and support regarding their particular situation.

Before considering how and if to provide care to such a client, explore the client’s rationale. It may be based on past trauma, a health condition, or a perception of health risk from wearing a mask. Personal circumstances warrant special consideration, and misunderstandings of risk can be addressed by reviewing the evidence.

Violence and harassment around mask refusal should not be tolerated. Under the Occupational Health and Safety Act, midwifery practice groups are required to have an Anti-Harassment and Anti-Violence policy; the AOM has produced a template (under "Midwives Safety and Wellbeing"). 

In January 2022, the Criminal Code of Canada was amended to enhance protections for healthcare workers. The newly enacted section 423.2 makes it an offence to intimidate a health professional or a person who assists a health professional, in order to impede them in the performance of their duties. Midwives should not hesitate to contact hospital security or the police with any threat of violence

Similarly, midwives need to carefully consider their professional and ethical obligations to this client, to themselves and to other clients and staff. Consider:

• Having a practice protocol/policy about masking that is shared with all clients on intake
• A client's decisions and understanding may change over time; a client that refuses to wear a mask at one appointment may choose to wear a mask in the future or wear one in certain circumstances (i.e. only when the midwives are within 2 metres distance)
• The safety of midwives (e.g. can the midwives wear full PPE during visits with the unmasked client, just as health-care providers caring for patients with COVID-19 do, including gowns and face shields/goggles?)
• The safety of other clients, virtual care and visit scheduling to avoid contact with other clients.
• The occupational health and safety of clinic staff, avoiding or reducing contact
• Thinking ahead to birth plans: 
  • if the client is symptomatic for COVID-19 or any other respiratory illness and refusing to mask, in areas of high community spread, or in other higher risk situations, consider the use of N95 respirator upon completion of a point-of-care risk assessment
  • consider policies, equipment and testing protocols in all birth settings in collaboration with clients.
• What can be done to enhance the safety of the space for home visits or home births, such as ventilation, designating a separate disinfected bathroom for the midwives, etc. (see the AOM's guidance on home birth during COVID-19 [PDF, 768 KB] for further suggestions)
• Making a decision about whether to continue to provide care before the client is term, to ensure adequate time to transfer care if needed
• Documenting all discussions and the plan of care thoroughly

There may be circumstances where interactions about this issue contribute to a breakdown in the trust relationship between client and midwife. If this occurs, the midwife should consult CMO standards and guidance documents about loss of trust and ending the client/midwife relationship and contact  AOM On Call. 

[September 9, 2025]