This update follows the College advisory of 16 March 2020.

Last week, College staff researched and prepared detailed draft advice on COVID-19 issues which are relevant for midwives, including clinical care issues, home visiting, when to use PPE, and impacts on pregnancy. In order to ensure our messages were consistent with Ministry of Health advice, we sent this to the Ministry last week to ensure that community midwifery was included in planning and that clear, relevant guidance would be urgently released.  Consequently, we have been working closely with the Ministry on specific guidance and support for midwives.

We appreciate that there is an information void at present for midwifery and maternity-specific information. Please be assured that we are doing our best to fill this. In the interests of having a unified national response to COVID-19 with consistent information, to keep ourselves and our community as safe as possible, the Ministry has specifically asked the College not to circulate information without their approval. The Ministry’s guidance for midwives is currently going through its processes with public health specialists and the National Health Coordination Centre, and is expected to be released later this week.

We have been strongly advocating for increased resources to be added to our locum contract to ensure midwives can access sufficient locum cover to cover periods of self-isolation or sickness. We will update members as soon as we have confirmation from the Ministry of any changes.

In addition, we have also been systematically contacting all DHB midwifery leaders to ask how each DHB is including community midwives in DHB planning activities as part of the wider maternity team. We have clarified with them that community midwives should be able to access personal protective equipment (PPE: masks, eye protection, gowns, gloves) from their DHB as frontline community health workers if required. PPE is not required for routine care of well women who are not in self-isolation and this care should continue as per the usual pattern of appointments.

We have been in close contact with MERAS who are working at a local and national level with DHBs and other employers to support employed midwives. MERAS is putting out regular updates to members as information becomes available. We also suggest you continue to check your DHB intranet and emails for local updates from DHBs.

We acknowledge this is a stressful time. Thank you for your patience as we work closely with the Ministry to develop clear guidance. In the interim, we recommend the following:

• Before you see all women, screen women over the phone to establish whether they fit within the current Ministry of Health COVID-19 case definition.
• If the woman identifies potential risk factors for COVID-19, advise the woman to call Health Line (0800 358 5453) for personal advice on self-isolation and whether she should access testing from her GP. Ask the woman to inform you of the Health Line response and plan.
• If no recent travel or symptoms, continue to provide usual care.
• If a woman is unwell but does not require self-isolation, it is reasonable to talk by phone and defer the appointment until she has recovered if it is clinically safe to do so, according to your midwifery judgement.
• If a woman is in self-isolation, use your clinical judgement to determine whether care can safely be deferred until the period of self-isolation is completed. The Ministry has advised us that for women who require visits while in self-isolation at home:
  • It is an expectation that the woman wears a standard surgical mask throughout the visit.
  • The visit is kept as short as possible. Maintain social distancing (remain at least 1m away from the woman) except as required for physical assessment. Clinical assessment takes place in person but the majority of the discussion can take place by phone or video call.
  • PPE is not required for the midwife unless the woman is symptomatic.
  • If care is clinically indicated during the period of self-isolation, call the College or your DHB for practice advice until more definitive Ministry advice is available.
• Self-isolation information can be found on the Ministry’s website.
• In all cases, if you have a client who is required to be in self-isolation, notify your DHB’s maternity department.

Minimising risk for all midwives and women:

Personal

• Practise frequent hand hygiene, particularly at the beginning of a visit, after physical contact, at the end of the visit, between clients
• Social distancing
• Cough and sneeze etiquette
• If the midwife is unwell, avoid providing care and contact the College for locum support.

Equipment

• Clean equipment with alcohol cleaning wipes between all uses. Contact DHBs if unable to source these from usual suppliers
• Take your own soap and towel for hand washing at home visits

Clinic

• Remove magazines and toys
• Clean clinic surfaces and toilets regularly
• Minimise waiting in clinic waiting area: consider asking women to wait in their car if possible and text when you are ready to see them
• Request minimal attendance of additional people to the appointment where possible 

Work pattern

• Organise work pattern where possible to minimise risk of midwife being a source of cross-infection to the most vulnerable women and babies. For example, see these women early in the day

Written communication to clients

• Consider providing written information to all clients about new ways of working to minimise transmission of COVID-19. We have included below an example of a letter to clients, which has been adapted from a letter kindly shared with the College by one midwifery practice.
• Include Ministry of Health hygiene recommendations.

Example letter to clients