By removing pregnant women from their communities, the birth ceremony that traditionally fostered connections between families and nations was lost, negatively impacting the health of Aboriginal women and their communities. In addition to the psychosocial costs incurred by the pregnant woman leaving the community for her birth, feelings of competency and self-sufficiency were erased among the women who were once respected for their role as the community midwife (Inuit Women's Association of Canada, 1995). For many Aboriginal communities, the answer to these injustices has been to return birth to Aboriginal communities through the revitalization of the role of a community midwife.

 

A universal definition of  an Aboriginal midwife is challenging given the heterogeneity of Aboriginal populations found within Canada; however, a commonality identified by Carol Couchie, an Aboriginal midwife in Ontario, is that "if Aboriginal midwifery is anything it is community driven" (as cited in National Aboriginal Health Organization, 2008, p. 10). The National Aboriginal Council of Midwives, established in 2008 to promote excellence in the reproductive health of Canadian Aboriginal women through midwifery care, created a video describing the multidimensional role of an Aboriginal midwife. In the video, the Aboriginal midwife is also described as someone who comes from within the community; furthermore, she is one who blends the traditional practices and ceremonies of the community with modern medicine as a way that honours and strengthens the connections between Aboriginal people and their nation. These relationships are integral to the early childhood development of the children born herein, and arguably contribute to the overall sense of well-being and belonging experienced by women and children, an essential component of good health.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Welcoming the newborn. Retrieved from http://www.aboriginalmidwives.ca/about

 

 

Unsurprisingly, the path to returning Aboriginal midwives to their communities has been obfuscated by Settlers. The mainstream movement to legalize midwifery in Canada in the 1980s and 1990s was primarily driven by a group of white, privileged women who argued that midwifery was a means shirk the patriarchal, medicalized view of pregnancy and birth as a pathological event requiring technological intervention and management. Midwifery was seen as the antithesis to the medical model of birth, wherein negative gender stereotypes of women as passive and powerless were perpetuated. Midwifery activists argued that women were strong and competent birthers and attendants, capable of making intelligent, informed decisions about reproductive health. As a result, the birth process became identified as a site of women’s oppression and therefore a focus for emancipation (MacDonald, 1999).

 

When the midwifery movement became a gender inequality issue, it largely ignoring the heterogeneity of oppressive forces experienced by Canadian women. For Aboriginal women, it can be argued that an equally, if not more significant oppression, is colonialism. When the midwifery legislation was pending in Ontario, the first province to legalize the profession, Aboriginal communities rallied to oppose the inclusion of traditional Aboriginal midwives in the Midwifery Act. The Ontario Native Women’s Association (1991) released the following statement on the impact of midwifery legislation on Aboriginal communities:

 

It is obviously evident the social issues and conditions of Native Communities…are the result of Natives not being in the control of their affairs…Again it seems the same mistakes are reoccurring with the midwifery issue…it is clear that once again, government agencies are assuming control of issues that clearly affect Native people and Native communities…Native people ultimately have to be in control of their own affairs to impose the social issues…It would be counterproductive to continue with any strategies which involve Natives and Native communities without the involvement of Native people. (as cited in Nestel, 2006, pp. 45-46)

 

As a result of pressure from Aboriginal communities in Ontario, when the first midwifery legislation was enacted in Canada in the Province of Ontario in 1991, traditional Aboriginal midwives were exempted (and remain exempt) from the Act’s regulations. British Columbia, on the other hand, has taken a different approach; when midwifery legislation was enacted in 1995, the regulations did not apply on a reserve to an aboriginal person who practised aboriginal midwifery prior to legislation. However, all Aboriginal midwives practicing in British Columbia after enactment of the Midwives Regulation must register with the College of Midwives of British Columbia and are governed by the Midwives Regulation of the Health Professions Act and the College of Midwives of British Columbia bylaws. While there are College bylaw provisions for developing an Aboriginal category of registration, no such category is currently in place (National Aboriginal Council of Midwives, 2012).

 

Contemporary Aboriginal midwifery care is a blend of traditional Aboriginal teachings around pregnancy and birth with modern midwifery techniques and knowledge. However, given the long history of settlers' attempts to erase Indigenous knowledge systems, a difficulty for many Aboriginal communities lies in resurrecting the ancient knowledge once held by their community midwives and healers. Bedard (2006) writes,

 

Anishinaabe women have passed down many traditions and knowledge about mother practices and the actions that lead to motherhood...Colonization did much to destroy, damage, and send into hiding those women's ways of knowing about motherhood. (p.70)

 

While midwifery-led practices in the far North have been successful in reclaiming their traditions around pregnancy and birth, it is possible that their geographic isolation has acted as a shield against the Canadian government's colonizing eye, and thus has been an important factor in the survival of these teachings. It remains to be seen what will emerge in British Columbia as the First Nations Health Authority moves forward in their initiatives to return birth and pregnancy to Aboriginal women.

 

Another barrier lies in the necessity of midwives, physicians, and nurses working collaboratively in low resource settings. Historically, physicians providing obstetrical care and midwives were at odds with one another, and remnants of this dissonance remains in rural British Columbia creating barriers to collaboration between midwives and other health care providers (Munro, Kornelsen, & Grzybowski, 2013). However, in 2010 the Society of Obstetricians and Gynaecologists of Canada (SOGC) released a policy statement supporting of the return of birth to rural and remote Aboriginal communities that do not have access to emergency surgical back-up. The SOGC is the national voice for Canadian obstetricians, and is responsible for setting clinical practice guidelines related to obstetrical care in Canada. In their policy statement, the SOCG recommended the implementation of local midwifery and collaborative care practices to allow low-risk Aboriginal women a choice in place of birth. The support of this national professional body is essential to changing negative attitudes toward midwifery led care, laying the foundation for the development of Aboriginal midwifery practices throughout British Columbia.

 

The development of a rural maternity care service is also complicated by government bureaucracy. For example, in the community of Norway House, Manitoba, approximately 150-200 women are medevaced to a tertiary care centre each year for parturition. While a midwifery practice has been established in this community, women continue to be evacuated as a result of confusion about who is responsible for the provision of Aboriginal health services between the federal and provincial governments (Olson & Couchie, 2013). As the First Nations Health Authority has recently assumed governance over health services, one hopes that for First Nations living in British Columbia, issues of jurisdiction will not arise in the event of the implementation of midwifery services in Aboriginal communities. However, as the mandate of the First Nations Health Authority is to provide health care services to status First Nations, the development of a midwifery service for Metis or non-status individuals may encounter a similar scenario as found in Norway House.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2. Mother and her newborn. Retrieved from http://www.healthcouncilcanada.ca/rpt_det.php?id=123

 

Perhaps the most significant obstacle to returning birth to Aboriginal communities is a dearth of Aboriginal midwives. Aboriginal midwifery advocates stress the importance of having their own community members fulfill the role of the midwife, so that the midwife fully appreciates her clients' lived experience. While the National Aboriginal Council of Midwives (2012) has the ambitious vision of "Aboriginal midwives working in every Aboriginal community", across Canada there are currently only about 70 aboriginal midwives, elders, and student midwives. One solution to the paucity of appropriate care providers has been the creation of three community-based midwifery training programs that allows Aboriginal women to live and learn in their own community. No such program exists in British Columbia; the only midwifery training program is located in Vancouver at the University of British Columbia, far removed from many of the Aboriginal communities most in need of a local maternity care service. Furthermore, despite the reservation of seats for Aboriginal candidates who meet the requirements of the program, very few Aboriginals have been admitted; in the 2015 intake year, no one was admitted who identified as having Aboriginal ancestry (writer is a member of this class).

 

Given the multitude of socioeconomic barriers faced by Aboriginal women as a result of colonization, attaining the certifications to practice as Registered midwife in their community can be a daunting task. Furthermore, in light of the many injustices faced by Aboriginal communities, it is unlikely that reestablishing local maternity care is high on the list of battles to fight when unsafe drinking water, domestic violence, and inadequate housing threaten the well-being of these communities on a daily basis. Thus, if midwifery services are to be offered in rural and remote areas of British Columbia in the near future, they must be developed in collaboration with the members of Aboriginal communities they are to serve. Settler midwives, if invited into these communities, will be  necessary for the establishment of these services until the communities can begin to heal and produce their own midwives, or, as the Nuu-chah-nulth say, "she who can do everything".

 

 

References

 

Bedard, R. E. M. (2006). An Anishinaabe-kwe ideology on mothering and motherhood. In D. M. Lavell-Harvard & J. C. Lavell (Eds.), Until our hearts are on the ground (pp. 65-75). Toronto, ON: Demeter Press.

 

Inuit Women's Association of Canada. (1995). Special report on traditional midwifery. Suvaguuq: National newsletter on Inuit social and cultural issues,10. http://www.naho.ca/documents/naho/english/midwifery/suvaguuq.pdf

 

MacDonald, M. E. (1999). Expectations: The cultural construction of nature in midwifery discourse in Ontario. Retrieved from National Library of Canada Dissertations. (ISBN 0612392856)

 

Munro, S., Kornelsen, J., Gryzbowski, S. (2013). Models of maternity care in rural environments: Barriers and attributes of interprofessional collaboration with midwives. Midwifery, 29, 646-652. http://dx.doi.org/10.1016/j.midw.2012.06.004

Nestel, S. (2006). Obstructed labour: Race, gender, and the re-emergence of midwifery. Vancouver, BC: UBC Press.

National Aboriginal Council of Midwives. (2012). Community-based programs. Retrieved from http://www.aboriginalmidwives.ca/aboriginal-midwifery/community-based-programs

National Aboriginal Council of Midwives. (2012). Midwifery regulation. Retrieved from http://www.aboriginalmidwives.ca/node/2270

National Aboriginal Council of Midwives (2012). Mission and vision. Retrieved from http://www.aboriginalmidwives.ca/about

National Aboriginal Health Organization. (2008). Celebrating birth: Aboriginal midwifery in Canada. Retrieved from http://www.naho.ca/documents/naho/english/midwifery/celebratingBirth/Midwiferypaper_English.pdf

Olson, R., & Couchie, C. (2013). Returning birth: The politics of midwifery implementations on First Nations reserves in Canada. Midwifery, 29, 981-987. http://dx.doi.org/10.1016/j.midw.2012.12.005

Society of Gynaecologists and Obstetricians of Canada. (2010). Returning birth to Aboriginal, rural, and remote communities. Retrieved from http://sogc.org/wp-content/uploads/2013/01/gui251PS1012E2.pdf