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The Ministry of Health has now published guidance for community midwifery care on its website in its section on Resources for Health Professionals under the heading Maternity.

The three documents for midwives are also attached here:

• Information for community based midwives
• Table 1: Advice for community-based midwives caring for women who are in self-isolation after potential COVID-19 exposure
• Table 2: Advice for community-based midwives caring for women who have confirmed or suspected COVID-19

Please read these documents carefully as they contain the official recommendations from the Ministry of Health for midwifery care in the community and they supersede any other documents that may have previously been produced by other organisations.

While these documents and associated Ministry information will answer a number of questions that midwives have been asking the College during the last fortnight, there are some areas which are not fully covered and which require more detail. Last week the College drafted supplementary documents to support midwives in anticipation of the Ministry’s guidance being published. Now that we have the final Ministry guidance, we will finalise these supporting recommendations in order to provide midwives with as much clarity as possible, given the rapidly changing circumstances.

The government’s announcement on Saturday 21 March of a 4-level alert system for COVID-19 will also provide some clarity about how we as midwives respond to the situation. As the Prime Minister announced yesterday, at the time of writing we are currently at alert level 2 nationwide, which means that cases of COVID-19 are still contained but the risk of community transmission is increasing. At alert level 2, the Ministry has encouraged ‘alternative ways of working’, with examples such as ‘remote working, shift-based working, physical distancing within the workplace, staggered meal breaks and flexible leave arrangements’. In addition, ‘Those at high-risk, are advised to stay at home regardless. This includes those over 70, those with a compromised immune system or those with underlying health conditions.’

The Ministry has specified the following: Pregnant women: Health experts do not yet know if pregnant women are impacted by COVID-19 in the same way as other people. However, pregnant women experience changes in their bodies that may increase their risk from some infections. It would therefore be appropriate to recommend to your clients that they should stay at home where possible. If they need to go out for work, they should discuss COVID-19 prevention measures with their employers.

Midwifery care is an essential, frontline health service and as such needs to continue, with safety measures put in place.

• MERAS is working closely with DHBs and other maternity facilities to look at how to facilitate physical distancing and other ways of keeping all midwives who work in and access the facilities safe. MERAS is sending regular updates to members.
• Community midwives are guided by the Ministry documents (links above). Community midwifery care is a primary, preventative health care service. As such, it is important to find ways to continue providing necessary care to ensure that women receive the assessments and information they need to maintain health during pregnancy, birth and postpartum. Midwives are encouraged to use their professional judgement on how visits and care are conducted. The College will be sending out additional guidance in the near future on providing routine care for well women who are not in self-isolation.

Community midwives who are immune-compromised, have underlying health conditions, are pregnant or are over 70 years old, need to discuss their situation with their practice partners to consider how the practice could arrange workloads so that those who may be more susceptible to complications from the virus minimise personal risk.

At alert level 2, the College is developing alternative arrangements for Midwifery Standards Review and guidance on mentoring which will be released this week.

Please do not hesitate to contact the College on its dedicated email address for questions relating to COVID-19: covid-19@nzcom.org.nz