Aboriginal Midwifery in Canada: Blending Traditional and Modern Forms

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Aboriginal women in Canada have for many centuries faced social, political and cultural changes that have negatively affected their health, cultural identity, social structures and traditional values. Years of acculturation and assimilation have led to the decline of traditional midwifery practice in many parts of the country.

More recently, however, new government legislation, political rethinking and historical interest in the cultural role of traditional Aboriginal midwives have afforded legitimacy to a model that blends ancient traditions and modern techniques, enabling women to bring childbirth back to their communities.

In ancient times, the role of a woman as helper/ midwife was assumed to be the Creator's work and midwifery was viewed as a calling to a profession. Traditional Aboriginal midwives in BC were fundamental to the childbirth process and in passing moral and ethical values from one generation to the next. According to Fiske (1992: 201), among pre–contact Carrier peoples of BC, “reproductive roles were central to women's claims to social prominence. Carrier women who successfully raised their families and provided care and nurture to the needy became influential as family spokespersons. The wisdom of old women was and remains proclaimed in legend and song and institutionalized in the valued role of the grandmothers of the tribe.”

The definition of the term midwife varies among different linguistic groups. Among the Nuu-chah-nulth people of BC, it translates as “she can do everything.” The Coast Salish translate it as, “to watch-to care,” and the Chilcotin people translate it as “women's helper.” Whatever the term, the elders recall that pregnancy and childbirth took place within a closely knit nexus linking the midwife to the birthing woman, to the infant, to the husband/ partner, to the family, to the extended family and, ultimately, to the entire community.

There are a number of significant historical events that led to the demise of Aboriginal midwifery and the loss of women's rights to assist with birth within their traditional territories. Colonialism, the imposition of western medicine, the residential school system, and patriarchal government legislation and policies changed the social, economic and traditional ways of Aboriginal people and undermined many of their long–standing healing traditions.

The combined impact of these forces, in addition to devastating epidemics, played havoc on Aboriginal cultures and undermined the previous balance and harmony within communities. As a Stoney Creek Band elder summarized: “[ B]etween 1920 and 1993 we have seen a big change in our population. Years ago there were no drugs and we used herbs. In our way of life we depended on traditional medicine, and we helped ourselves. In the 1930s, midwives used medicines for dealing with rituals; they helped with ‘in–between.’ The traditional art of midwifery was learned from mother and grandmother. Today, modern medicine and doctors have taken over.”

The revival of traditional midwifery has not been an easy task. Many of the ancient practices have been lost and few Aboriginal midwives are left to pass along surviving indigenous knowledge. An examination of some of the emerging forms of Aboriginal midwifery indicates that the new initiatives attempt to blend both traditional and modern forms of midwifery to create innovative models that focus on culturally–relevant, community–based care.

The Innuulitsivik Health Centre, located in Puvirnitq in northern Quebec, is one of the oldest and most renowned Aboriginal midwifery initiatives in Canada. In 1999, the provincial government legalized midwifery as an autonomous profession. While this is a breakthrough for non–Aboriginal midwives, the post–legislation situation for Aboriginal midwives in the province is far from secure.

The new midwifery legislation contains two clauses that impact them directly. The first recognizes the five midwives working at the Inuulitsivik Maternity Centre by including them in the Québec Order of Midwives, provided they restrict their practice to the Nunavik territories. The second states that band/community councils are able to negotiate with the provincial Ministry of Health specific arrangements for the practice of “traditional midwives.”

But the Quebec law recognizes only one academic program, the one recently established at University of Québec at Trois-Rivières. Aboriginal midwives currently in training at Inuulitsivik are thus unable to apply for a midwifery license. On a more positive note, the Nunavik Midwifery Working Group has been formed to explore how the current provincial law might be reinterpreted or amended so that the apprenticeship model of educating Aboriginal midwives is given due recognition.

The Lewirokwas Midwifery Program is located in Akwesasne, a Mohawk reserve which straddles Quebec, Ontario and New York State. This program is currently being set up to educate and train Aboriginal midwives, and is free of constraints imposed by both Quebec and Ontario provincial laws. The new program aims to empower Mohawk women during pregnancy and childbirth, and to build on the existing knowledge base about Aboriginal midwifery and indigenous healing.

The North
Another well–known community–based birthing centre arrangement is available to Aboriginal women residing in the central Arctic region of Rankin Inlet, Nunavut. In 1995, its status changed from pilot project to a full program with a staff of three midwives, two Inuit maternity workers and a clerk interpreter. While the Rankin Inlet birthing centre is currently functioning outside provincial legislation, its long–term survival seems promising.

Despite a strong local demand from Aboriginal women, the Fort Smith Health and Social Services Board has so far refused to allow midwives to work at the Fort Smith Health Centre. The main problem seems to involve a series of legislative and insurance issues. Concern has been expressed that a number of road–blocks are slowing the process of returning childbirth to the Fort Smith region.

Tsi Non:we Ionnakeratstha Ona:grahsta' Six Nations Maternal and Child Centre. “Tsi Non:we Ionnakeratstha” is a Mohawk phrase meaning “the place they will be born;” “Ona:grahsta” is a Cayuga word meaning “a birthing place.” The centre, partly funded by the Ontario Ministry of Health, was established in 1996 and offers training to aboriginal midwives from the Six Nations Reserve. Native midwives are exempt from the provincial midwifery law and can practice on-and off–reserve as long as they provide services to Aboriginal families.

British Columbia
Aboriginal women in BC have taken a somewhat different path, seeking to work within the current midwifery legislation to establish a Committee on Aboriginal Midwifery under the umbrella of the College of Midwives of BC. To date, no specific initiatives have been developed in the province, although the legislation authorizes the establishment of such a committee. The College is currently looking at defining terms within the legislation and to engage in further community consultations.

The government of Manitoba has recently passed legislation granting midwives the option to attain accreditation through multiple routes, including apprenticeship.

Other Areas of Canada
The situation of Aboriginal midwifery in the other provinces is in flux. The fact that, to date, two provinces — Alberta and Saskatchewan — have chosen to legalize but not publicly fund midwifery services is worrisome. Given Aboriginal women's relative economic marginalization, very few can afford to purchase midwifery services on the market, even if those services are culturally appropriate and sensitive to their needs and concerns.

As evidenced by the various initiatives underway in BC and across the country, the opportunity to interface traditional Aboriginal ways of knowing with modern science is a formidable challenge, but not an impossible task. In reclaiming control over birth, these communities have begun the process of restoring balance and harmony among their people, while at the same time ensuring health and safety for Aboriginal mothers and babies.

This article is based on the chapter "Aboriginal Midwifery in Canada: Ancient Traditions/ Emerging Forms" in Reconceiving Midwifery: New Canadian Model of Care, University of Michigan Press (2001).

Cecilia Benoit, a Professor in the Department of Sociology at University of Victoria, has authored and co-edited several books about midwifery. She has served on the Executive of NNEWH and is a co-partner. Dena Carroll, MBA, BA Sociology, is involved with Aboriginal women's health, urban Aboriginal health centres and health policy in BC. A member of the Chippewa of Nawash Band in Cape Croker, ON, she is community partner with NNEWH and serves on the RNT Committee. Dena and Cecelia have co-authored other work related to midwifery, health regionalization and maternal health care.