Once a cherished community event, birth was gradually removed from Aboriginal communities and relocated to settler hospitals where Aboriginal women were attended to by nurses and medical doctors instead of their aunties and traditional midwives. The insidious colonial erasure of traditional birth practices was arguably a method by which settlers imposed patriarchal values on Aboriginal societies and has contributed to a loss of cultural identity (National Aboriginal Health Organization, 2008). Simpson (2006) eloquently writes,

 

When colonization hijacked our pregnancies and births, it also stole our power and our sovereignty as Indigenous women...it undermined our sacred responsibilities as life-givers...it made us question our body's knowledge and our Grandmothers' and aunties' knowledge and our ability to bring forth new life (p.28).

 

In rural and remote communities where Aboriginal women have no access to medical maternity services, Health Canada recommends the routine evacuation of all pregnant women at 36 to 38 weeks of gestation, or earlier if pregnancy complications arise (Health Canada, 2013). While it is commonly believed the evacuation policy arose in the 1960s and 1970s in an effort to reduce high Aboriginal infant mortality rates (Payne, 2010), Lawford (2011) refutes this well-intentioned belief. Instead, she argues the removal of birth from Aboriginal communities was a means to assimilate and civilize Aboriginal women and she presents historical evidence from as early as 1892 of federal initiatives to both marginalize traditional Aboriginal birth practices and coerce Aboriginal communities to adopt the settlers’ bio-medical model of of birth.

 

Perhaps the most obvious examples of assimilation tactics employed by settlers are residential schools and the Indian Act. Aboriginal youth who were removed from their communities to attend residential schools did not learn their native language, cultural practices, traditions, or laws; consequently, entire generations of Aboriginal men and women have no memory or knowledge of their peoples' traditional birth ceremonies. Furthermore, from 1869 until 1985, the Indian Act mandated that when an Aboriginal woman married a non-Aboriginal man, she and her children lost their Indian status and were no longer allowed to participate in their Aboriginal communities. As a result of government-imposed marginalization, these women and their offspring were denied access to their traditional healers and midwives and were forced to give birth in settlers’ hospitals.

 

Concurrent with settler assimilation policies, the rise of the medical profession also contributed to Aboriginal peoples’ loss of authority over pregnancy and birth. In 1949 the medical profession in British Columbia successfully lobbied for legislation that banned the performance of “midwifery acts” by anyone other than a physician (Carroll & Benoit, 2004). As a result, traditional healers and midwifes were forced to either quit practicing or go into hiding, increasing the pressure on Aboriginal women to seek care from settler obstetrical services. More recently, the regionalization of health care services in an effort to contain health expenditures has resulted in the loss of many local maternity care services. Since 2000, more than 20 rural maternity care services across British Columbia have closed (Centre for Rural Health Research, 2014), affecting not only the people in those communities, but also the women who live in the outlying areas that feed into these rural communities for pregnancy care. Approximately 30% of British Columbia's Aboriginal population lives rurally, and their communities tend to be found in areas that are farther from urban centres (Moazzami, n.d.). Thus, pregnant Aboriginal women living in rural areas face the added complexity of the socially unjust distribution of maternity care services as a direct result of settlers' health policies.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Rural hospital closures of maternity services in British Columbia since 2000. Retrieved from https://centreforruralhealthresearch.files.wordpress.com/2012/01/bellacoolareport-crhrlogicmodelproject.pdf 

 

In areas with no local access to emergency cesarian services, Western medical professionals have deemed birth as "too risky" to allow. While this definition of risk arises from the clinical perspective of the unpredictable nature of pregnancy and birth, it ignores Aboriginal peoples' right to determine for themselves what constitutes safe care. For Aboriginal women, kinship ties and connection to the land play a significant role in their psychosocial health; severance from these moorings, particularly during a transformative life event such as the birth of child, is also "risky". In the words of Jusapie Padlayat (2012), elder and chair of the Inuulitsivik Health Board:

 

I can understand that some of you may think that birth in remote areas is dangerous. And we have made it clear what it means for our women to birth in our communities. And you must know that a life without meaning is much more dangerous (as quoted in Epoo, Stonier, Van Wagner, & Harney, 2012).

 

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. Women, particularly Aboriginal women, living in rural areas of British Columbia are more likely to have adverse perinatal outcomes, including out of hospital births, more frequent and longer neonatal intensive care unit admissions, higher likelihood of preterm birth, increased infant mortality and greater occurrence of postpartum depression (Gryzbowski, Stroll, Kornelsen, 2011; Society of Obstetricians and Gynaecologists of Canada, 2007). Furthermore, British Columbian women who have to travel more than 1 hour to access obstetrical care are 7.4 times more likely to experience moderate to severe stress (Kornelsen, Stroll, Grzybowski, 2011). 

 

For Aboriginal women, birth outside of their community exacerbates the socioeconomic disparities they already face in their daily lives, including financial burden, lack of access to appropriate health services, inadequate food and housing, racial discrimination, language barriers, marginalization, and, most significantly, a loss of social support. A particularly vulnerable group are first time Aboriginal mothers; in addition to facing the daunting experience of labouring and giving birth to their first child away from the support of their family, for many of these teenagers, it is their first time leaving their family and community. The number of Aboriginal women in British Columbia giving birth before 20 years of age is four times higher than for Non-Aboriginal women (National Collaborating Centre for Aboriginal Health, 2014). At a time when they most need the reassurance and comfort of their families, these young women/children are thrust into a foreign place, surrounded by strangers.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2. Preterm birth rates (%) between 1981 - 2000. Source: National Collaborating Centre for Aboriginal Health. Retrieved from http://www.nccah-ccnsa.ca/docs/fact%20sheets/child%20and%20youth/Our%20Babies,%20Our%20Future%20(English%20-%20Web).pdf

 

For these reasons, Aboriginal women living areas of British Columbia with no institutionalized obstetrical services have repeatedly voiced the need to return birth to their communities. Women in Bella Bella and Waglisla, having recently lost the maternity services in their community, expressed the importance of community support and ties with their traditional territory as integral components of the birth experience (Kornelsen, Kotaska, Waterfall, Willie, & Wilson,  2010). Similarly, women in Alert Bay, Bella Coola, Old Massett, and Skidgate described the loneliness, disconnection from their communities, isolation from family and culture, and discrimination when giving birth outside of their home, and hoped to “bring back the celebration of life” to their communities (Varcoe, Brown, Calam, Harvey, & Tallio, 2013). It is evident that although the ceremony of birth has been removed from these Aboriginal communities, it has not, in spite of settlers' best efforts, been forgotten.

 

 

 

References

 

Carroll, D., & Benoit, C. (2004). Aboriginal midwifery in Canada: Merging traditional practices and modern science. In I. L. Bourgeault, C. Benoit & R. Davis-Floyd (Eds.) Reconceiving midwifery (pp. 263-286). Montreal, QC: McGill-Queen's University Press.

Centre for Rural Health Research. (2014). Optimal perinatal surgical services for rural women. Retrieved from https://centreforruralhealthresearch.files.wordpress.com/2014/06/policy-brief_optimal-perinatal-surgical-services-for-rural-women_final.pdf

Epoo, B., Stonier, J., Van Wagner, V., & Harney, E. (2012). Learning midwifery in Nunavik: Community-based midwifery for Inuit midwifes. A Journal of Aboriginal and Indigenous Community Health, 10(3), 283-299.

Gryzbowski, S., Stroll, K., & Kornelsen, J. (2011). Distance matters: A population based study examining access to maternity services for rural women. BMC Health Services Research, 11, 147-156.

Health Canada. (2013). Adult care, chapter 12: Obstetrics. Retrieved from http://www.hc-sc.gc.ca/fniah-spnia/services/nurs-infirm/clini/adult/obstet-eng.php

Kornelsen, J., Kotaska, A., Waterfall, P., Willie, L., & Wilson, D. (2010). The geography of belonging: The experience of birthing at home for First Nations women. Health & Place, 16(4), 638-645.

Kornelsen, J., Stroll, K., & Gryzbowski, S. (2011). Stress and anxiety associated with lack of access to maternity services for rural parturient women. The Australian Journal of Rural Health, 19(1), 9-14.

Lawford, K. (2011). First Nations women's evacuations during pregnancy from rural and remote reserves. Retrieved from http://www.collectionscanada.gc.ca/obj/thesescanada/vol2/OOU/TC-OOU-20356.pdf

Moazzami, B. (n.d.). Strengthening rural Canada: Fewer and older: The population and demographic dilemma in rural British Columbia. Retrieved from http://strengtheningruralcanada.ca/file/Fewer-Older-The-Population-and-Demographic-Dilemma-in-Rural-British-Columbia1.pdf

National Aboriginal Health Organization. (2008). Midwifery. Retrieved from http://www.naho.ca/midwifery/

National Collaborating Centre for Aboriginal Health. (2014). Strong women, strong nations: Aboriginal maternal health in British Columbia. Retrieved from http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/129/2014_07_09_FS_2421_MaternalHealth_EN_Web.pdf

Payne, E. (2010). Evacuating women out of remote communities to give birth is traumatic, harmful to communities and costly. So why is it still happening? Retrieved from http://media.knet.ca/node/10998

Simpson, L. (2006). Birthing an Indigenous resurgence: Decolonizing our pregnancy and birthing ceremonies. In D. M. Lavell-Harvard & J. C. Lavell (Eds.) Until our hearts are on the ground: Aboriginal mothering, oppression, resistance and rebirth (pp. 25-33). Toronto, ON: Demeter Press.

Society of Obstetricians and Gynaecologists. (2007). A report on best practices for returning birth to rural and remote Aboriginal communities. Retrieved from http://sogc.org/wp-content/uploads/2013/01/188E-CPG-March2007.pdf

Varcoe, C., Brown, H., Calam, B., Harvey, T., & Tallio, M. (2013). Help bring back the celebration of life: A community-based participatory study of rural Aboriginal women's maternity experiences and outcomes. BMC Pregnancy and Childbirth, 13, 26-36.