More Indigenous midwives could help end long-distance travel for births

VANCOUVER (CityNews) — Indigenous women in Canada are far more likely than non-Indigenous women to give birth hundreds of kilometers from home — far from family, disconnected from culture and community.

Nearly one in four Indigenous expectant mothers who live in rural communities travel long more than 200 kilometres to deliver their babies. For non-Indigenous women, that rate is only about two in every hundred. These are some of the findings in a recently-published study that suggests training more Indigenous midwives would allow births to take place in Indigenous communities, on Indigenous territories.

“Access to birth close to home, surrounded by loved ones, is taken for granted by most Canadians,” says the study, published in the Canadian Medical Association Journal in June.

“Indigenous people in Canada experience striking inequities in access to birth close to home compared with non-Indigenous people. These inequities are localized to rural and remote areas of Canada, and undermine Indigenous family and community relationships at a critical time”

Today on @CityNewsVAN & @NEWS1130: it's a plea for more resources as a shortage of Indigenous midwives continues from coast to coast to coast. I'm speaking w/Evelyn George of the @NACMidwives just weeks after a study calling for more supports was published. #bchealth #bcpoli pic.twitter.com/kNocWd0FIz

— Ria Renouf ???? (@riarenouf) August 31, 2021

Evelyn George is with the National Aboriginal Council of Midwives. She is no longer practicing, but participated in the study. Travelilng to give birth, she explains, needs to be understood in the context of the forced separation of Indigenous families.

“To have this family separation in the context of and in the histories of colonialism — around the 60’s Scoop, the Residential School era, overrepresentation of Indigenous children in child welfare — it’s a big deal to be routinely separating Indigenous families for something that we know we can restore back into the communities,” she explains.

“It’s been a colonial process that’s come in through the healthcare system of needing to evacuate people or having people travel for birth. That’s actually what this research study was about is how often that happens for Indigenous people compared to the rest of the population. You can see how that’s really problematic, that it’s disrupted the fabric of our communities around knowledge transmission, around birth teachings and reproductive health teachings”.

“It’s very isolating. People describe it as traumatic, and we see the effects of that.”

George says this upheaval causes disruption and disconnection.

“Depending on where you are, depending on the services available to you, people are travelling vast distances. A lot of people are actually flying out. Tthen when they go into these places where they’re waiting to have their baby, they’re usually staying in a hotel. Most of the time they’re alone,” she says, adding that even with a change in policy that pays for a companion to travel, it’s not always easy for a support person to take time off work or find childcare.

“It’s very isolating. People describe it as traumatic, and we see the effects of that.”

RELATED: Indigenous patients feel unsafe in B.C. health-care system: new Turpel-Lafond report

In Plan Sight, a 2020 report into anti-Indigenous racism in B.C.’s health care system found that Indigenous women were less likely to hav access to a midwife, and less likely to give birth at home.

“First Nations expectant mothers received fewer antenatal visits than Other Residents, and as well were less likely to access midwifery care, have an obstetrician present during delivery, or deliver at home.”

That same report found that “Indigenous patients’ requests for cultural protocols, such as surrounding birth and death, were ‘regularly’ or ‘occasionally’ denied” and that “Indigenous patients and families described health providers specifically denying that culture had any role in their care, and of being prevented from, or demeaned for, participating in ceremony, dance and other cultural practices.”

RELATED: Dix says review launched into allegations of racism against pregnant Indigenous woman

The fear of child apprehension and mistrust of the state, was another thing the report found shaped Indigenous women’s experience at hospitals.

“Interactions with social workers or MCFD representatives were noted by multiple Indigenous respondents as something they and/or their families are particularly fearful of when visiting hospitals or giving birth due to concerns
that their children will be apprehended,” it says.

“This perceived lack of safety is also evidenced by the disproportionate rate at which Indigenous women leave hospitals against medical advice.”

 

MORE: when she used to practice, Evelyn George of @NACMidwives says it was common in places like Nunavik to see lights around a home as the community waited for the birth of a child. She explains the significance…#bchealth #bcpoli #cdnhealth #cdnpoli pic.twitter.com/m6G9WQA2US

— Ria Renouf (@riarenouf) August 31, 2021

George says restoring birth to communities means more than just having routing medical care available, and Indigenous midwives understand that.

“From a clinical perspective, its standard care, but at a community level the needs of our communities vary and so we work to meet the needs of our unique communities,” she says.

“We work together with Elders and knowledge keepers to restore the rites of passage and the ceremonial aspects of childbearing and link that together with the other rites of passage throughout our lifetime. Again and again, you will see trauma and death in the community, and birthing is where you close that loop and close that circle. You feel that continuation of life and it’s refueling and recharging people.”

‘We need to look at this through a trauma lens, through an Indigenous rights lens’

The support for Indigenous midwifery, and desire to address how the burden of travelling to give birth is disproportionately put upon First Nations people should be seen as part of a broader struggle for self-determination and reconciliation.

“We’re seeing lots of communities, from coast to coast to coast, really coming out and saying this is how we want to birth our babies. This is what we want to return to our communities,” she explains.

“We need to look at this through a trauma lens, through an Indigenous rights lens, through a social justice lens, a health access equity lens, and really be thinking, ‘Okay. It’s not on Indigenous communities to do the heavy lifting, to restore what’s their right to have. It’s on us as a healthcare system, as a community as health care providers, as policy people to drive this forward, to at least make it an option.”

There is just one midwifery school with a focus on Aboriginal care in B.C, at the University of British Columbia.

It's a practice that First Nations groups across the country want restored. @RiaRenouf is hearing from the National Aboriginal Council of Midwives amid a recent study calling for more supports from coast to coast to coast. pic.twitter.com/t1guZ97QIq

— CityNews 1130 Vancouver (Inactive) (@news1130) August 31, 2021

In a statement, B.C.’s Ministry of Health says there are currently 24 “self-identified Indigenous midwives” in the province, and that two seats in the midwifery program at UBC are held for Indigenous applicants. However, those students won’t necessarily be working in rural or remote Indigenous communities.

“The Ministry of Health is working closely with our First Nations health governance partners and Metis leadership to make positive change in care for Indigenous peoples, including pregnant people,” it reads.

“The Ministry of Health provides funding to BC Association of Aboriginal Friendship Centres to deliver the Doulas for Aboriginal Families Grant Program. Voices and experiences of Indigenous doulas are centered throughout processes in the program, with trauma-informed, culturally safe and strengths-based teachings in mind.”

The ministry also says it is “fully engaged” and “collaborating with Indigenous partners” on implementing the recommendations from the In Plain Sight report.