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.

chain of transmission

 

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:

Key points from the Public Health Ontario Technical Brief on Interim Infection Prevention and Control Measures Based on Respiratory Virus Transmission Risk in Health Care Settings (PDF, 430 KB):

  • "The time period from respiratory virus season onset until a stable sustained decline in community incidence, would be considered a high risk period for health care transmission... activity typically begins in October-November, peaking in January-February and gradually decreasing until April-May." (p. 3)
  • "Evidence suggests that universal masking for source control and personal protection in health care settings is associated with reduced transmission of COVID-195,6 and may be effective for other respiratory viruses, particularly those with presymptomatic and asymptomatic spread (e.g., Influenza)." (p. 5)
  • "During high transmission risk periods, at a minimum, masking is recommended for all direct patient care (targeted clinical masking)." (p. 6)
  • "HCW masking for direct patient care is the highest yield to protect patients and may be considered when providing care to high risk populations, especially if receiving prolonged direct close care." (p. 6)
  • "A Point of Care Risk Assessment (PCRA) is necessary prior to any encounter. The appropriate selection and use of personal protective equipment is informed by the PCRA regardless of the current epidemiology or transmission risk period." (p. 8)
  • "Active screening of patients for signs and symptoms of communicable diseases is part of best practices regardless of transmission risk period." (p. 8)

Key resource:

Public Health Ontario, Best practices for the prevention of acute respiratory infection transmission in all health care settings. October 2024 (PDF, 3.3 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