Respiratory Illness

Midwives care for clients at all stages of pregnancy and postpartum. While these clients are no more likely than the general population to become ill, pregnant and recently postpartum individuals, along with their newborns, are more susceptible to serious illness (1, 2, 3, 4). Infection prevention and control practices, including masking, are integral to breaking the chain of transmission and keeping this population safe.

Covid-19   |   Influenza   |   RSV

Public Health Ontario currently advises both a proactive and responsive approach to community transmission rates of respiratory viruses:

As the community incidence of circulating respiratory viruses changes, it is important to revisit and adjust the additional IPAC measures in health care settings with the primary goal of preventing harm to vulnerable patients and reducing transmission within the health care setting, in addition to preserving operational capacity of the health care system. 
(5, p. 3)

A multi-modal, year round approach to reducing risk for clients is recommended. This includes:

• routine practices (PDF, 349 KB), including point of care risk assessments (PCRAs) (PDF, 336 KB) & personal protective equipment (PPE) (PDF, 3.3 MB);
• active and passive screening for illness (screening signage — found in Infection Prevention & Control section);
• vaccination;
• air filtration and quality monitoring (See: IPAC Checklist for Clinical Office Practice: Core Elements, Air Quality; PDF, 859 KB);
• thoughtful office flow; and
• frequent cleaning.

Key points from the Public Health Ontario Best Practices for the Prevention of Acute Respiratory Infection Transmission in All Health Care Settings (PDF, 2.3 MB):

• "The risk of transmission of acute respiratory infections (ARIs) in health care settings is largely dependent on community incidence of respiratory viruses... While the peaks of the different viral pathogens vary, in general, ARI activity starts to increase in late September, peaks in December-February and gradually decreases until April-May." (p. 16)
• "Using the transmission framework, 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)
  
  Table 1, Framework for Transmission Risk Periods (p. 16)

  Indicator	High Risk Period	Non-high Risk Period
  Respiratory virus outbreaks in healthcare facilities	Frequent and ongoing	Infrequent or baseline
  Hospitalizations and intensive care unit admissions	High, or moderate and increasing	Low, or stable and not increasing
  Community transmission	High, or moderate and increasing	Low, or stable and not increasing

• "Targeted continuous masking should be considered during high transmission risk periods for close and prolonged direct patient/resident/client contact due to the resulting risk of transmission and risk of outbreaks, while also considering the vulnerability of a certain patient/resident/client population." (p. 51)
• "A PCRA is to be conducted prior to any encounter to support appropriate selection of PPE regardless of the current epidemiology." (p. 42)

Key resource:

Public Health Ontario, Best practices for the prevention of acute respiratory infection transmission in all health care settings. 2nd Rev. April 2025 (PDF, 2.3 MB)

Planning & Communication

Due to the uncertainty of the seasonality of Covid-19, respiratory virus transmission rates in your region should be monitored regularly. Midwives in all practice settings should develop a plan to respond appropriately to any increase outside of seasonal trends. Clients should be made aware of midwives ethical obligation to adopt proactive protective measures for a client population at increased risk of severe complications from disease. Seasonal, and any other responsive changes to midwifery practice group policies regarding masking should be communicated in advance to clients.

Covid-19   |   Influenza   |   RSV

See also:

Vaccinations in Pregnancy

1. Use of antiviral drugs for seasonal influenza: Foundation document for practitioners—Update 2019. Fred Y Aoki, Upton D Allen, Samira Mubareka, Jesse Papenburg, H Grant Stiver, and Gerald A Evans. Journal of the Association of Medical Microbiology and Infectious Disease Canada 2019 4:2, 60-82. Accessed at: https://jammi.utpjournals.press/doi/full/10.3138/jammi.2019.02.08?role=tab

2. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. Smith ER, Oakley E, Grandner GW Perinatal COVID PMA Study Collaborators, et al. BMJ Global Health 2023;8:e009495.

3. Respiratory syncytial virus (RSV) vaccines: Canadian Immunization Guide, For health professionals. Health Canada. 2024. Accessed at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/respiratory-syncytial-virus.html#a1

4. Pregnant patients with respiratory syncytial virus infection: assessment of characteristics and maternal morbidity at delivery. Cox, K. R., Mandelbaum, R. S., Brueggmann, D., Ouzounian, J. G., & Matsuo, K. AJOG global reports, 2023 4(1), 100289. https://doi.org/10.1016/j.xagr.2023.100289

5. Interim Infection Prevention and Control Measures Based on Respiratory Virus Transmission Risk in Health Care Settings. Public Health Ontario. November 2023. Accessed at: https://www.publichealthontario.ca/-/media/Documents/I/2023/ipac-measures-transmission-risks-technical-brief.pdf