Birthing at home within Quebec’s borders

Many Crees of a certain age can remember the births of their family members for the simple reason that most babies at one time were born at home.

While childbirth has largely taken place in medical centres for the last few decades, a movement among Aboriginal groups advocates returning this event to the home, and this is why the National Aboriginal Council of Midwives (NACM) has just launched the Aboriginal Midwifery Toolkit.

The NACM launched the toolkit at the Centre de développement communautaire autochtone à Montréal March 28 in conjunction with the group Quebec Native Women to provide concrete knowledge and tools for First Nations, Inuit and Métis people who want to return birth and midwifery to the community.

According to NACM coordinator Valérie Perrault, the toolkit was developed after the group tested the level of interest among First Nation communities across the country. Perrault said that 120 communities expressed the desire to go down this path in various capacities.

Narrowing it down to three communities in British Columbia, Saskatchewan and Ontario, the NACM focused on what the needs would be for each community to create the needed tools and skills.

“There was a real need to get more concrete tools in place to bring births back to these communities to or at least bring prenatal care back as births may not be sustainable,” said Perrault.

The toolkit is found on the NACM website. It serves as an interactive online resource offering fact sheets, videos that describe the situation in each province and podcasts that describe the journey to become a midwife. They feature both student and working midwives.

Also available are site-specific sections that address pertinent legislation, governance and funding options, tools to assess community specific maternal health needs and ways to develop midwifery services within Aboriginal communities.

“It can be a complicated subject and while there are similarities between the communities, at the same time each community is so very specific. There are also vast differences between the situations, between the needs of urban Aboriginals and those in remote communities, there are also fly-in communities and communities of different sizes. So it is very hard to try to capture that whole diversity and still have information that is still useful for specific communities,” said Perrault.

The cultural significance of returning births to the community can have an enormous impact on the mother because it can be very difficult to execute a traditional sacred ceremony in a biomedical environment. Having culturally significant care is something that Perrault has said that her clients have really valued.

Even in the case of higher-risk pregnancies necessitating evacuation, midwife care is still relevant. Perrault said this is often how it will work in areas like Nunavik where there has been a successful midwifery program and midwives are an essential part of a multidisciplinary team.

According to Sam Gull, the Assistant Executive Director of Nishiyuu Muyipimaatsiiun at the Cree Board of Health and Social Services of James Bay (CBHSSJB), returning the births of Cree babies to Eeyou Istchee has long been in the planning.

Gull’s mandate within the Nishiyuu Muyipimaatsiiun department is to add traditional medicine and traditional healing practices to childbirth practices. More specifically, he ensures proper research is in place.

He is currently working on a five-year strategic plan based on a pilot project to gain traditional birthing knowledge from Cree Elders.

“What we have done is that we set out a target to interview 100 Elders and within those interviews we are asking them what happened in the past as far as they can remember or the stories that they heard about birthing practices. It is not just about the birth itself but also preparing the woman to understand how to take care of herself from the time that she knows that she is pregnant and using the rites of passage as soon as she gives birth,” said Gull.

Gull said that the CBHSSJB has conducted 70 interviews. At the moment they are still categorizing the themes discussed in the interviews.

The bigger goal is to design a program to educate new parents from the onset of pregnancy that involves grandparents to help teach new parents traditional roles in how to take care of themselves.

Cree births now number more than 400 every year in hospitals in Val d’Or, Chibougamau and, in more complicated instances, Montreal.

“Last year there was an understanding was made with the government that we would be bringing back birthing centres into the community. There are talks of definitely having one birthing centre in either Mistissini or Chisasibi but hopefully we can have both,” said Gull.

Where Nishiyuu Muyipimaatsiiun comes into play is for when the facility is created, a midwife will be able to follow the new mother from the very beginning. Gull said that the program they would like to create would use both medical and traditional knowledge to make sure that the mother is healthy as possible.

To recruit midwives, program development has been in talks since 2010 with the Université du Québec à Trois-Rivières, where the province’s only program exists, but it couldn’t move ahead until there was a plan for a birthing centre.

Now that a concrete plan is in place, developing an English-language program at the university for Crees is closer to reality.