Midwifery re-affirmed in Attawapiskat

Traditional midwifery is alive and well in Attawapiskat after a decades-long struggle, albeit not without some growing pains. As a result of a critical meeting in Moose Factory on March 19, restrictions were released and a new acceptance and support for midwifery emerged for the people on the James Bay coast.

The gathering, held at the Weeneebayko General Hospital in Moose Factory, was called by Christine Roy, who has been instrumental in working with community leadership, Elders and other members of Attawapiskat First Nation to establish an Indigenous midwifery practice.

“It was wonderful to see so many people come together to find a solution to a decision that was derailing our midwifery practice in Attawapiskat,” Roy told the Nation.

The meeting was organized in response to the decision by the Weeneebayko Area Health Authority (WAHA) to no longer accept planned births in Attawapiskat. WAHA previously had limited the midwives’ scope of practice to attending emergencies in the community.

“For thousands of years Cree midwives, as they are known in Cree, ‘Kakishkapeshegit’, have been caring for Cree women in a traditional role that is part of the culture,” noted Roy.

Elder Dorothy Wynne, of Moose Factory, echoed a traditional sentiment while speaking to the assembly of community leaders and health-care providers. She has long been an advocate for a return to Indigenous midwifery for remote communities and is a recipient of the Ontario Medal for Good Citizenship.

But the fight to have this practice recognized began back in the early 1980s, when the Ontario government and provincial advocates began discussing the regulation of midwifery. During the consultation process that led to the creation of the Midwifery Act in 1994, Indigenous advocates, including those from the James Bay coast, successfully lobbied for an exemption of Aboriginal midwives in the new law.

This exemption identified Aboriginal midwifery as the responsibility of Aboriginal communities. Over the course of two decades, several initiatives were established to bring midwifery back to First Nations. Since then, Indigenous health advocates for building local midwifery practices have been supported by other organizations.

In 2010, the Society of Obstetricians and Gynaecologists of Canada (SOGC) published a policy supporting the return of birth to Indigenous and rural and remote communities. According to the new policy, “The SOGC strongly supports and promotes the return of birth to rural and remote communities for women at low risk of complications.”

In 2011, Roy was hired by WAHA to conduct consultations and create a proposal for midwifery services with the eventual goal of establishing practices in communities on the James Bay coast.

“There is a lot of research that shows that medical relocation for birth has negative effects, especially for Indigenous women from remote communities,” said Roy. “Allowing women to give birth in their home land is not only healthier for families but it also gives the community the chance to celebrate the birth of the child. This also allows local young women to see midwifery as a career choice.”

The WAHA board of health adopted the proposal and in 2012 the Ontario Ministry of Health approved funding for Neepeeshowan Midwives, a remote midwifery practice on the James Bay coast. Roy then led the building of a practice in Moose Factory, creating the foundation for services in Attawapiskat.

In December 2012, Neepeeshowan Midwives began their practice in Attawapiskat. Since then, they have assisted in 39 births in the community and they have supported 255 women during their pregnancies.

However, their progress was stalled in 2015 when WAHA informed Neepeeshowan Midwives that the local hospital would be unable to assist midwives with planned deliveries in the community. The original concern from WAHA was that there was no access to an operating room or blood products if they were needed.

In the fall of 2017, Roy gathered support from Attawapiskat’s chief and council as well as from local members through petitions, to reaffirm their support for choice of birthplace and maintain low-risk planned births for the community. This led to the meeting March 19 to discuss planned birth in Attawapiskat Hospital for low-risk women.

“As result of this meeting and based on the input of our Elders, leadership and health experts, a solution was reached to allow the midwifery practice in Attawapiskat to continue,” said Roy.