by Alyssa Gagnon & Sara Mai Chitty

As Indigenous people in Canada, the act of simply existing makes our bodies inherently political. Subjected to many injustices and traumas since First Contact, autonomy over our identities and bodies has been stripped away in an effort to control resources on Turtle Island, at the expense of our health and wellbeing. Traditional practices that once defined our communities have been overlooked or forgotten, replaced by government policies that reinforce stereotypes and misrepresentation, and assert cognitive imperialism over traditional healthcare practices, privileging Western healthcare models over wholistic care. These systems perpetuate cycles of under-education, under-employment, and poverty, instead of looking at ways to incorporate traditional knowledge and practice into healthcare programs for Indigenous peoples.

Illustration: The Supervolcano by Mia Ohki

In order to obtain reproductive justice for Indigenous childbearers living in Canada, it is crucial that people have access to services in their communities grounded in accurate culturally and trauma informed information, to make the best decision for their bodies and babies’ health and wellbeing. Let us also mention that the birth of our Indigenous babies and apprehensions are not mutually exclusive events; the latter of which happens far too often. It is an unfortunate truth and one that cannot be tackled in a single article

Midwifery is one such example of care that restores land-based birth practices that were eroded by Health Canada’s evacuation policy, introduced in the 1960s. Many childbearing people who were sent out of their communities to give birth at that time, under the assurance that they would be safer, lost their babies to the Sixties Scoop; were coerced into sterilization procedures in the 1970s 1.; and are to this day subjected to alienating and condescending treatment by uninformed healthcare providers, resulting in a perpetuation of mistrust and trauma surrounding Western medicinal practices 2.

Due to the inherently political nature of Indigenous bodies existing – colonial approaches to Indigenous healthcare have negatively affected the health and wellbeing of our People as well as the viability of communities to be able to provide culturally appropriate healthcare programs on site. The act of giving birth in remote fly-in First Nations is rare, despite the fact that Indigenous midwifery is a crucial component of healthcare in Canada where childbearing people should have the right to participate in and have access in their communities.

According to Indigenous midwife Stephanie MacDonald, there are numerous reserves in Canada, but the number of Indigenous midwives still not match that number. However, they [midwives] are working diligently to be recognized for their unique role in Canadian society 3. Through midwifery, Indigenous communities are reclaiming bodily autonomy, the right to give birth in their respective communities (rural and remote), and practice something that has happened since time immemorial – the ceremony of birth.

In Northern Ontario, many must travel away from their communities to give birth to their babies – often well before their due dates. The importance of geographic location and reclaiming birth has been addressed by several studies based in different parts of northern Canada. According to one study, successful birth in remote communities such as Nunavik, Quebec can be attributed to the knowledge and skill of Inuit midwives 4. A large number of people (91%) were evacuated outside of their communities to give birth before midwifery services were available. (4:235) Another study by Rachel Olson and Carol Couchie based out of northern Manitoba provides findings consistent with the importance of birth and its geographic location. The authors contend that place of birth is central to health care received by Indigenous communities in Canada5. 

Karen Lawford and Audrey R. Giles’ literature review suggests that while the location of birth may seem trivial from a Euro-Canadian perspective, location of birth is a “component of identity for First Nations and invokes a responsibility and relationship to that land 6“. It is crucial that a community’s childbearing people have familial support in the perinatal period, which reflect qualities of culture and wellbeing, which is undoubtedly understood differently in the mainstream, biomedical model. Findings suggest that there is value in bringing birth back to northern Indigenous communities and should be supported by government policy.

1. Arsenault, Chris. Coerced sterilization of Canadian indigenous women in 70s widespread: researcher. Reuters [Internet]. 1 Sept 2015 [cited 19 Jan 2018].   Available from: https://www.reuters.com/article/us-canada-women-health/coerced-sterilization-of-canadian-indigenous-women-in-70s-widespread-researcher-idUSKCN0R12QM20150901

2. Leyland, Andrew et al. Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada.   Indigenous Health Working Group of the College of Family Physicians of Canada and Indigenous Physicians Association of Canada: 2016.

3. MacDonald S. A historical and cultural view of Aboriginal midwifery in Canada. Essentially MIDIRS 2015;6(4):24-28.

4. Van Wagner V, Osepchook C, Harney E, Crosbie C, Tulugak M. Remote midwifery in Nunavik, Quebec, Canada: Outcomes of perinatal care for the Inuulitsivik Health Centre, 2000-2007. Birth 2012;39(3):230-237

5. Olson R, Couchie C. Returning birth: The politics of midwifery implementation on First Nations reserves in Canada. Midwifery 2013;29(8):981-987

 

Lawford and Giles highlight that the relationship between health and land has not been taken into account by Euro-Canadian biomedical models of health 6. Janet Smylie and Billie Allan provide evidence that Indigenous people greatly benefit from community-based health initiatives, which help mitigate racism and improve health 7. It can be said that the implementation of midwifery services cannot be seen as a separate entity in the context of broader political processes and governmental relations, and that land-based care is a path to health and well-being in our communities.

For example, birth and the act of breastfeeding/chestfeeding are vital teachings in Anishinaabe culture. Leanne Simpson writes in Dancing on Our Turtle’s Back that breastfeeding is the very first treaty 8. Simpson writes: “Nursing is ultimately about a relationship. Treaties are ultimately a relationship. One is a relationship based on sharing between a [parent] and child and the other based on sharing between two sovereign nations. Breastfeeding benefits both the [parent] and the child in terms of health and in terms of their relationship to each other. And treaties must benefit both sovereign and independent nations to be successful 8.”

6. Lawford K, Giles A. An analysis of the evacuation policy for pregnant First Nations women in Canada. AlterNative: An Int J of Indigenous Peoples 2012;8(3):329-342.

7. Allan B, Smylie J. First Peoples, second-class treatment: The role of racism in the health and wellbeing of Indigenous peoples in Canada. Toronto, ON: The Wellesley Institute. 2015.

8. Simpson L. Dancing on our turtle’s back. ARP Books: 2011;106-108.

The correlation between the disappearance of birth from the land and the failed treaties and relationships between First Nations and the Canadian government cannot be overlooked in this context. By removing life givers from the land and disrupting cultural practices, the Canadian government effectively disconnected generations of Indigenous people from their ties with the land and their understanding of treaties, relationships to each other, animals, the government and resource-sharing.

Simpson explains that treaties are about commitment and compassion. “It’s about the love of the land and a love for the people. And it requires support of your family and your community. Treaties cannot be maintained without the support of your family, your community, and ultimately, your nation 8.”

Childbearers in Indigenous communities, rural or urban, that do not have culturally-appropriate and trauma-informed prenatal, birth and postpartum care, risk the health and wellbeing of themselves and their baby. The government of Canada denies reproductive justice to Indigenous childbearers through “good intentions,” but erodes the very relationships and treaties it claims to support in this act.

Obstacles that midwives and healthcare providers face in offering this kind of care are financial, continuity of care, ongoing education and transience of healthcare providers. Midwifery care is available in very few remote First Nations in Ontario. For example, Neepeeshowan Midwives was founded by Christine Roy in Attawapiskat in 2012 to provide midwifery care to the community, a grassroots organization committed to bringing birth back to the land 9. In addition to continuity of care, informed choice and choice of birthplace are two of the core tenets of midwifery care in Ontario where, “midwives support the… [client’s] right to choose where… [they] give birth [and] … recognize the client as the primary decision-maker and facilitate the collaborative process of informed choice by: [m]aking a best effort to ensure the client fully understands all relevant information prior to making a decision 10.

Midwives are trained in obstetrical emergencies. However, physicians in remote communities may still have a valid concern in the event of the need to perform surgery (emergency cesarean sections) or blood transfusions in the case of severe postpartum hemorrhage. In the event of such emergencies, clients are medevaced to more southern centres (weather permitting). Due to these, and other concerns, many people still deliver in hospitals hundreds of kilometers from home. The Non-Insured Health Benefits Program (NIHB), First Nations and Inuit Health Branch, Health Canada and Ininew Patient Services (IPS) fund the flights for patients/midwifery clients for their confinement at around 36-38 weeks gestation 11.

9.National Aboriginal Council of Midwives. Aboriginal Midwifery Practices in Canada [Internet]. 2012 [cited 19 Jan 2018]. Available from: http://aboriginalmidwives.ca/aboriginal-midwifery/practices-in-Canada

10. The Ontario midwifery model of care. The College of Midwives of Ontario [Internet]. 25 Sept 2013 [cited 20 Jan 2018]. Available from: http://www.cmo.on.ca/wp-content/uploads/2015/07/The-Ontario-Midwifery-Model-of-Care.pdf

11. National Aboriginal Health Organization. (2008) Celebrating Birth – Aboriginal Midwifery in Canada. Ottawa: National Aboriginal Health Organization.

12. Payne, E. The residential schools of medicine. The Ottawa Citizen [Internet]. 26 Nov 2010 [cited 20 Jan 2018]. Available from: http://www.ottawacitizen.com/health/residential+schools+medicine/3889424/story.html

13. Ministry of Health and Long-term Care. Ontario Improving Access to Aboriginal Midwifery Care. Ontario Newsroom [Internet]. 2017 [cited 19 Jan 2018]. Available from:

https://news.ontario.ca/mohltc/en/2017/02/ontario-improving-access-to-aboriginal-midwifery-care.html

14. Indigenous midwifery. Association of Ontario Midwives [Internet]. 2018 [cited 20 Jan 2018]. Available from: https://www.on

Through this funding, clients are only allowed to bring one escort to attend the birth, and all others who want to attend must pay out of pocket, which is next to impossible considering how expensive it is. Despite any concern of risk factors, this policy removes choice of birthplace from clients, forces them to leave other family members, makes them have to strategically choose who will care for other children, if any, while they are gone, and it costs the federal government millions of dollars according to Elizabeth Payne’s The Residential Schools of Medicine 12. Let us not forget that these current government agencies responsible for the care of Indigenous peoples’ health on reserves still operates under the regulation of the Indian Act; a blatant piece of legislation that still erodes our existence.

Due to the hard work of Indigenous midwives, stakeholders, community members, and an increase in awareness, the Ontario government committed in 2017 to “improving access to culturally appropriate child and maternity care for more Indigenous people across the province 13.” Recently, centres able to provide culturally appropriate care in Ontario have been funded: Dilico Family Health Team Clinic in Fort William First Nation, K’Tigaaning Midwives on Nipissing First Nation Territory, Kenh:ke Midwives in Tyendinaga Mohawk Territory, Onkwehon:we Midwives in Akwesasne, Shkagamik-Kwe Health Centre in Sudbury, and the Southwest Ontario Aboriginal Health Access Centre in London, Ontario 14.  In addition to health centres and midwifery practices providing culturally appropriate care, perhaps funding could also be allocated to develop more community-based Indigenous midwifery education programs as well as train more second attendants and doulas.

As there are more than 200 reserves and settlements in Ontario alone, many still do not have access to information about delivering babies with midwives, let alone the option. As well, educational and financial obstacles within remote communities prevent many Indigenous people from pursuing careers in these fields, strengthening and build capacity in their communities. Improving health outcomes of Indigenous communities is complex in the way that the systemic deficiencies in many programs and services offered by the Canadian government perpetuate these issues.

If a governing body such as the Society of Obstetricians and Gynecologists of Canada (SOGC) put out a policy statement in October 2017 that supports the return of birth to rural and remote Indigenous communities 15, then physicians and other stakeholders should support it so long as the client is considered low-risk and that proper risk assessment is followed through as on-going basis. In urban centres, research toward improving Indigenous maternal and infant is under way.  For example, researchers received

15. No-251-Returning birth to aboriginal, rural, and remote communities. J of Obstet & Gynec Can Oct 2017;(251):e395-e397

16. Whalen J. ‘We can’t do it alone’: Indigenous maternal health program aims to address inequality of health care. CBC News [Internet]. 25 May 2017 [cited 4 Feb 2018]. Available from: www.cbc.ca/beta/news/canada/toronto/indigenous-maternal-health-program-1.4130303

$2.6M grant to improve Indigenous maternal and infant is under way. For example, researchers received $2.6M grant to improve Indigenous maternal and infant health. Funded through Merck Canada’s Merck for Mothers program and based out of Toronto, “Kind Faces Sharing Places: An Action Research Project for Indigenous Families During and After Pregnancy and Birth” aims to improve the health care outcomes for Indigenous populations, for which the mortality rate is up to 4 times greater than the national average. (16) Places like the University of Toronto’s Waakibiness-Bryce Institute for Indigenous Health, Seventh Generation Midwives Toronto, and Nishnawbe Homes have created a support network that is accessible to Indigenous families due to the program’s initiatives 16. A study by Angela Bowen titled ‘Bringing Birth Back: Improving Access to Culturally Safe Birth in Saskatchewan.

Indigenous people’s bodily health relies on the health of the land and positive relationships between folks responsible for their care. By fostering and maintaining relationships with the land through birth and breastfeeding/chestfeeding practices and teachings, Indigenous communities can improve health outcomes and treaty relationships with the government. This is where true reconciliation lies. The birth of our people is an overt opposition to all genocidal tactics historically and presently imposed upon us. With the support of our allies, interprofessional colleagues in urban centres, government funding, and our community members, we are slowly seeing a shift across the land. From coast to coast, reserves and off-reserve communities have slowly started receiving the care that they deserve. If Canada should want to uphold our treaty rights, let it begin with a fundamental piece of the puzzle – the birth of our People.

Alyssa Gagon

Alyssa Gagon

Alyssa’s spirit name is nipi (water). Her family is from the James Bay and she grew up on Taykwa Tagamou (New Post) territory. She is a First Nation Studies graduate from Western University, a third year student in the Midwifery Education Program here at Ryerson, an artist, and a mother to two young children.

Sara Mai Chitty

Sara Mai Chitty is an Anishinaabe journalist and a member of Alderville First Nation. She graduated with her master’s of journalism in 2015 and has worked for non-profit organizations training Indigenous and non-Indigenous community members in journalism practices in London, Webequie and Kasabonika Lake First Nation, Ontario. She is now freelancing out of London, ON.

Mia Ohki

Mia Ohki

Mia Ohki is a Metis Japanese-Canadian artist, born in Connecticut, USA, and raised in Alberta, Canada. She presently lives and works between Edmonton and Calgary, AB. Mia primarily illustrates with black pen on white paper to convey ideas surrounding the social, feminine and cultural influences in her life, however her art is mostly influenced by her background, with Japanese and Metis culture frequently appearing in the subject matter.