Last week on the morning of the biggest snowstorm Toronto has seen in years, midwife Kyla Austin was on call.

Austin, who works at Kensington Midwives downtown, got a phone call in the early hours of Jan. 17 to head to St. Joseph’s Health Centre for a birth. When she saw the blizzard outside her window, she realized her usual 20-to-30-minute drive was going to take much longer.

“While I was there for the shift change, there were nurses who couldn't actually get into the hospital to work that morning… it was just like stress everywhere, all over the place,” she said.

When Austin went to leave the hospital later that morning, her car was buried in snow and a Good Samaritan helped her dig it out.

“This guy in snowshoes was going up and down the street looking for people in scrubs and helping to push their cars out,” she said. “It took me two hours to drive home.”

She said the following day she attended a home birth in an area of the city where streets had not yet been plowed.

“I was really surprised at my anxiety levels, trying to manage. I'm on call. What if something happens? What do I do,” Austin said.

“You can potentially have accidental home births with nobody there with them.”

For some midwives, Monday’s once-in-a-decade snowstorm exacerbated what has already been an incredibly challenging situation as the Omicron wave of the pandemic leaves many clinics without enough staff.

"I have a friend who... she works in a rural community and her clinic had to shut down because five of the seven midwives were either sick or had symptoms," Austin said.

"There was a couple of weeks there that the clinic just couldn't even function and people in labour had to just be transferred to (an obstetrician), into hospital care."


'She was the last midwife standing'

Jasmin Tecson, the president of the Association of Ontario Midwives, told that some clinics in the province have felt the impact of Omicron in very significant ways.

“I've talked to midwives across the province. There is somebody where she was the last midwife standing and she works in an area that's rural and remote. So she's driving around these vast areas that are very snowy, doing newborn testing, dropping off those samples, checking if babies are well, and of course, wouldn't you know at that time a bunch of babies decided that they were going to come,” she said.

“She was the last midwife who was not sick with COVID or isolating because of COVID. We have some practices where the entire practice is out.”

She said that the scope of care that is offered by midwives and the close relationship they have with the people they care for means that the impact of staffing shortages is deeply felt by their clients.

“Our work bridges from throughout pregnancy into labor and birth and that postpartum follow up that's so important, that's really crucial for strengthening new families, helping people recover from the birth process and continue on in a healthy way as a family, growing the baby, feeding the baby,” she said.

“So in those small teams that we have, we have much less resources if there is a COVID exposure, if there's a COVID illness. So that impact is much more direct. We have less ability to absorb it.”

Tecson said while there have been many challenges throughout the pandemic, in the last couple of months, Omicron has forced clinics to put emergency measures in place to cope with the staffing shortages.

“All across the health-care system, all across Canada, we're hearing growing concern, screaming concern about the health-care human resources crisis that's happening and we're definitely feeling that within midwifery,” she said.

"We hold on with our fingernails and we keep going until it's better." 

In areas where staffing is limited, some clinics have had to seek assistance from health-care partners in their respective communities.

“They might rely on support in the hospital, in the health-care system in their region, so they might have good relationships with family docs who will cover the in-person primary care temporarily,” Tecson said.

“Or they might have a partnership that they've had to strike up necessarily with another local practice… So we always have to be creative as midwives in so many ways and the pandemic is forcing us to be creative in these newer ways.”

She said anxiety over COVID-19 has also led to an uptick in calls from clients who are seeing stress levels that are “through the roof.”

“Being ill… or even if they're not ill, that they're positive and asymptomatic, they worry about how that will affect their babies or their pregnancy,” Tecson said.

“And through all of that, they worry about their pregnancy or birthing or afterward, not having people in their lives that they're used to having in their lives to be with them for key moments to stand by, then to bear witness.”

She added that at the start of the pandemic, she noticed more and more people transferring into midwifery care late into their pregnancy in order to have the option for a home birth and avoid being in the hospital.

Current hospital restrictions have made out-of-hospital births a more attractive option for those who have pregnancies deemed to be low risk.

At hospitals around the GTA, visitor access has been significantly restricted due to the high levels of community transmission of COVID-19. In order to protect hospital staff and vulnerable patients, the list of hospital visitors has been dramatically scaled back.

At some hospitals, if a patient who is admitted for labour and delivery tests positive for COVID-19, anyone considered to be a close contact of that patient must immediately self-isolate at home. This means that some partners and support people who attended the hospital for the delivery may be asked to leave. Other facilities permit high-risk close contacts to stay but note that they cannot leave the delivery room. Practically every hospital allows no more than one support person to be present during delivery.

Tecson said these tight restrictions at hospitals can potentially cause trauma for pregnant people who are forced to deliver without a support person present.

“It's an unfortunate policy for families. It's a difficult policy because what we do know is that pregnant people need that support, especially in people who come from communities that are very vulnerable, Indigenous communities, Black communities, (communities where) those supports are key for experiences of health or for minimizing a repeat of trauma that people might re-experience from engagement in the health-care system,” she said.

“So those supports are more significant than just having somebody nearby or having somebody to hold their hand.”

For some pregnant people, the risk of a possible exposure at the hospital has also played a role in the decision about whether they want to give birth in a hospital or at home.

“I've definitely had a lot of conversations with people who are nervous about the hospital,” Kearston Bergeron, another registered midwife at Kensington Midwives, told “It definitely increases anxiety for people.”

She said while she hasn’t personally seen an increase in people planning for home births due to the pandemic, it is concerning that it is factoring into the decision.

“If you're making a choice for where you want to have your baby and the choice is based on fear of the hospital, that's not a good choice. That's not true choice.”


'The anxiety is so high right now'

Austin said over the past few months, she feels like her conversations with clients have been dominated by concern over COVID-19.

"I feel like in the clinic, all I talk about is is COVID with people. One of my clients, it was just like every appointment was, 'What are we going to do if I get COVID? What if I test positive?' 

"I do have clients who are like 30 weeks, 33 weeks... who have COVID now and are isolating at home and have a lot of questions about what does this mean, like, 'If I actually have COVID when I go into labour, how am I going to be treated? Can my partner come in with me? Are you guys going to be in the room?' The anxiety is so high right now."

She said the pandemic-related stress pregnant people face does not end after a successful labour.

Austin said she has seen higher levels of postpartum anxiety and depression due to isolation brought on by the pandemic.

“They're scared of having their parents come over to see the baby and so they don't have someone to come over and help with the dishes and like drop off a lasagna," she said.

"They're having their babies in this really weird isolation.”

Tecson noted that many who work in midwifery are also feeling high levels of stress as the pandemic wears on and the profession is not immune to the widespread health-care worker burnout being reported across the country. She said she has seen a notable rise in the number of midwives on leave due to the pandemic.

“We're concerned about those leaves. We're concerned about those midwives. We're concerned about the midwives who are still here. We want midwives to be able to have lifelong, fulfilling careers and professions,” she said.

“We worry about our students because they're starting the profession burnt out. We have definitely seen more attrition and we expect more if things don't change for us.”

She added that finding a placement for midwifery students has become more difficult during the pandemic.

Austin, who just began working in midwifery eight months ago, said she is already feeling the effects of burnout.

“I was talking to my colleague…. feeling very sad and grumpy and saying, ‘Why am I burnt out? I just got here,’” she said.

“Even the new people are really starting to feel it.”