An amendment to provincial regulations governing midwifery that took effect May 22 enables Indigenous trainees in community-based programs to provide full perinatal care throughout pregnancy, birth and new life.
The change follows a campaign by the Cree Health Board, the Inuulitsivik Health Centre, the Ordre des sages-femmes du Québec and other organizations.
“We changed the law,” said Jasmine Chatelain, managing director of the CHB midwifery education program. “Now our students are no longer limited and can learn all requirements for becoming a licensed midwife. The by-product is that Indigenous people can become midwives.”
The health board’s groundbreaking midwifery training program, Eeyou Istchee Pimâtîsuwin Chiskutimâchuwin (EIPC), launched last July with four learners in Chisasibi and one in Waskaganish. But they were legally restricted from delivering a baby and other procedures, such as injections and vaginal exams.
The CHB hired students as Primary Care Community Representatives to provide counselling, take blood pressure, weigh babies, and check an unborn baby’s position in the womb. Learning side-by-side with practicing midwives, they supported childbirth with what Chatelain calls “four-handed catches”.
“Our program is focused on learning by doing so every single client has a student who follows them,” Chatelain explained. “They do all the pre-natal and post-natal visits, a lot of the counselling and education, partly because they speak Cree. Our students can go on medevacs when women are transferred in labour or for something urgent.”
However, before the regulatory change, only students in a Trois-Rivières university program and immigrating midwives in approved bridging programs were allowed to perform many professional acts. Despite Nunavik’s longstanding community education program, Indigenous trainees were completely omitted from the law.
The Ordre des sages-femmes du Québec regulates midwifery acts in the province, and were instrumental partners in lobbying the government to change the law. The OSFQ also collaborated with the EIPC program to ensure Cree graduates have equivalent competencies to university programs.
“We could not have done this without them,” Chatelain asserted. “They’ve been very outspoken about being in this tricky position, responsible for public safety and wanting to be part of reconciliation, supporting Indigenous self-determination.”
Several individuals and organizations issued letters of support for the regulatory change, including the National Council of Indigenous Midwives. It currently applies to four Indigenous midwifery programs running in Quebec’s Cree, Inuit, Akwesasne and Innu communities.
While expectant mothers from Nunavik were sent to Moose Factory starting in the 1970s, women began refusing to leave and communities mobilized to create the Inuulitsivik Midwifery Service in 1986. The EIPC program worked extensively with Inuulitisivik education coordinator Kimberly Moorhouse and her team to develop its curriculum.
As the self-paced program requires trainees to attend 60 births, they will have access to clinical learning opportunities outside of the region to increase their birth volume, such as the Inuulitsivik Health Centre or Val-d’Or hospital. Expanding their exposure to different skill sets and environments will better prepare trainees to expect the unexpected.
“In Chisasibi now, we’re doing 85% or 90% of pregnancies,” said Chatelain. “Once a month, students lead a breastfeeding drop-in and it will be up to 30 people showing up. Every time the students do something public, we have an amazing turnout, so the community is really responding to it.”
By the end of March, the Chisasibi trainees had accompanied 22 births, 300 pre-natal visits, 177 post-natal visits and 45 school workshops and community health education activities.
Pre-natal and post-natal midwifery services expanded to Waskaganish last September, with births expected to begin towards the end of this year. Midwives are already doing 80% of follow-ups. One student began in Waskaganish in March with another to be added when capacity is available. A third birthing hub will eventually be developed in Mistissini.
“In labour, mothers are going right into their maternal language so having people there who can speak with them is incredible,” said Chatelain. “There’s a level of empathy. These students know what it’s like to have their baby in Val-d’Or so can connect with these women in a way no other midwife can.”
The EIPC program began with a week on the land, making a teepee, gathering medicines and learning traditional ceremonies. Elder Jane Matthew has shared her wealth of lifetime experience, from catching her first baby at about age 7 to her last one three years ago at age 91.
“We did a demonstration of how it was done a long time ago when women gave birth in the teepee,” recalled student Linda Gray. “There was a placenta ceremony and naming ceremony. That helped me connect with my roots. It was awesome how the course started off.”
Gray embodies the commitment of Cree midwives to reclaim the traditional practice, moving from Mistissini last summer to join this first cohort. Coming from a lineage of midwives, Gray has experienced the joy of witnessing babies being born surrounded by their families without having to leave their community.
Although there are challenges participating in a program that continues to evolve and being on call all week to meet mothers, Gray wouldn’t have it any other way. She believes bringing births back to the territory makes family bonds stronger with young fathers becoming more involved.
“When you catch that baby you’re overjoyed,” Gray said. “My first baby I attended to, I was crying with the little girl there at the birth of her sister. It’s magical. We have a planned teepee birth this summer, so I’m excited for that. It will be my first time.”