Human Resources Shortages

Over the past several years, we have seen devastating impacts on health human resources and the availability of services (critical numbers of midwives unable to work due to illness or isolation, labour and delivery units closed, no availability for EMS services, etc.). 

The College of Midwives of Ontario released a Practice Advice article on Managing Caseloads During Staffing Shortages which reviews all applicable professional standards.

Considerations for human resources planning 

Midwifery practice groups should review their practice group's leave protocols, outbreak and pandemic protocols (templates available to members) to update contingency plans as necessary with the increasing risk of having a reduced workforce.

Labour and delivery (L&D) departments may be impacted. If a hospital closes the L&D unit and is redirecting patients, CritiCall should provide direction as to where clients should go. If this situation arises, midwives should attempt to manage client expectations and explain to clients that their midwife most likely cannot accompany them to a hospital where the midwife does not have privileges.

Midwives will need to recognize that there are limits to the provision of safe care and unfortunately, at times when there are not enough midwives available, care needs to be transferred to physician colleagues. It may be appropriate to proactively discuss contingency planning with interprofessional colleagues in the hospital and community to assess who may have capacity to take over or provide care if midwives cannot.

Whenever care significantly differs from the usual practice, midwives should document in greater detail, including:

  • what the plan would be under normal circumstances ("plan A")
  • the extenuating circumstances (e.g. closed L&D, no ultrasound capacity for anatomy scan)
  • the current plan, taking into consideration the evolving situation ("plan B")
  • the discussion with the client

Considerations for choice of birthplace

During midwife shortages, there may be circumstances where midwives cannot safely offer out of hospital birth to clients. Midwives must draw upon their clinical skills and judgement to keep birth as safe as possible for both their clients and themselves, taking into account local context, resources and rapidly evolving circumstances.

Choice of birthplace may be limited by:

  • the unavailability of midwives or second attendants to attend a birth at home
  • the availability and capacity of timely EMS services
  • access to sufficient and adequate PPE supplies and the ability to maintain the integrity of PPE during the labour and birth to keep midwives and second attendants safe

Midwives should endeavor to discuss any conditions that may impact choice of birthplace with clients in a timely manner and document those discussions.

The CMO has provided midwives with practice advice for times of staffing shortages, with specific requirements of all midwives involved as well as responsibilities of practice owners. 

Our hospital has requested midwifery support to cover nursing shifts. What can we do?

Please see the following information regarding midwives working to address hospital human resources shortages.

What HR solutions can our MPG consider to manage if a midwife cannot work?

Typically, MPGs will ask midwives at the practice to fill this gap or contract with another midwife temporarily. If hiring a midwife longer-term or in the usual course (e.g. to cover a parental leave), the MPG will need to have professional liability insurance funding from the OMP. If the MPG chooses to contract with a midwife on a temporary basis to provide relief due to COVID, know that HIROC has waived professional liability insurance premiums. In this situation, there is no need for the MPG to request professional liability insurance funding from the OMP, but the midwife must Contact AOM Membership Manager Diana MacNab prior to the start date to ensure the midwife has professional liability insurance coverage.

If redistributing income between midwives is necessary to reflect changing responsibilities and workload, consider allocating BCCs in such a way that the midwife who cannot work receives a portion of the BCC to reflect the work they have already done, and the midwife stepping in is compensated with the remainder portion of the BCC. Consult the Interpractice Care Agreement for a formula that may help. There are a number of other considerations when attempting to redistribute income as equitably as possible.

Depending on what care is provided by the midwife taking over, it may also be possible to compensate them with approved CVs. The MPG may also have a contingency fund that can be drawn on for this purpose.

For the midwife who has had to go on leave, there are government supports and elements of midwives’ benefits plan that can be accessed.

Our MPG would like to hire Second Birth Attendants to respond to human resources challenges. Can we?

Second Birth Attendants (SBAs) cannot be midwives, as per the CMO Second Birth Attendant Standard and the Funding Agreement. In short — a midwife acting as a second will always be a midwife practicing midwifery. SBAs must have completed a CMO-approved course or program in neonatal resuscitation, emergency obstetric skills, and cardiopulmonary resuscitation as per the schedule laid out in the CMO Second Birth Attendant Standard.

The CMO does not need to approve SBAs as long as they meet the certification requirements outlined in the SBA Standard. If they do not meet these standards, but the MPG feels they can demonstrate that exceptional circumstances exist, the MPG can apply for a waiver of those requirements.

The SBA Supplement provides some funding for MPGs using Second Birth Attendants or midwives who are only acting as seconds. SBAs are insured through midwives’ policies however it is recommended that nurses acting as SBAs get additional professional liability insurance. Midwives need full professional liability insurance.

Our MPG would like to hire a midwife who would strictly be attending births as backups. Can we?

Even when a midwife’s work strictly involves attending births as backups, they will require full professional liability insurance coverage and will need to be ‘active’ with the CMO. For midwives returning to work on a temporary basis to provide relief due to COVID-19 related shortages, HIROC has waived professional liability insurance premiums.

In this situation, there is no need for the MPG to request insurance funding from the OMP, but the midwife must contact AOM Membership Manager Diana MacNab prior to working to ensure they have professional liability insurance coverage.

What can practice partners and head midwives do to support the mental health of their MPG during this time?

Midwives and health care workers are likely to feel less resourced than usual, and this environment can contribute to conflict, stress and burnout.  As best they can, practice partners and head midwives should attempt to:

  • Ensure good quality communication and accurate information updates are provided to all staff/colleagues.
  • Monitor stress levels of staff/colleagues and reinforce safety procedures.
  • Build time for colleagues to provide social support to each other.
  • Consider caseload plans – some midwives may prefer to reduce caseload during this time, to provide themselves with more time off or to provide a buffer in case a midwife becomes unexpectedly unable to work.
  • Facilitate access to and ensure staff are aware of resources to support mental health, such as the employee assistance program offered to AOM midwife members.