The Cree Health Board has launched its groundbreaking midwifery training program – Eeyou Istchee Pimâtîsuwin Chiskutimâchuwin (EIPC). An emotional gathering July 26 brought together people who have worked for decades to return childbirth to the territory.
“Since time immemorial, Cree women have given birth on the land,” stated CHB chairperson Bertie Wapachee. “For decades, Cree women have expressed a desire to reclaim this traditional practice. This program enables our trainees to follow in the footsteps of their grandmothers and ancestors.”
This unique collaboration with the Ordre des sages-femmes du Québec (OSFQ) will train Cree midwives to provide comprehensive care throughout low-risk pregnancy, labour, birth and postpartum stages. While the first four chiskutimwaakanch (learners) selected from over 30 applicants recently began in Chisasibi, the program will expand to Waskaganish in January, followed eventually by Mistissini.
Lamenting that too many Cree women have experienced obstetrical violence giving birth outside their communities, Wapachee said traditional birthing practices promote holistic health, belonging and unity. In her opening prayer, Irene Bearskin House spoke of the ancient gift that is the Cree welcoming song for newborns.
An advisory group of community representatives oversees the program content and selection process. As Quebec’s Midwives Act enables Indigenous programs to provide provincial licenses without education prerequisites, admission criteria prioritized personal qualities like patience, compassion and commitment.
“It was clear from the beginning of community consultations that the program had to be accessible and sustainable,” said Jasmine Chatelain, a registered midwife and EIPC’s planning, programming and research officer. “We focused on people who are really invested in supporting the reclamation of traditional midwifery skills and cultural teachings.”
To support aspiring midwives financially during their on-the-job training, the chiskutimwaakanch receive compensation, complete with benefits and holidays. Gaining both modern medical skills and traditional knowledge, trainees working alongside experienced midwives are expected to complete 60 births to qualify as certified professionals.
While traditional midwives delivered babies on the land until being outlawed in the 1970s, a birth re-enactment in 2016 demonstrated how Cree knowledge could complement modern practices. Services with non-Indigenous midwives soon followed in 2017, resulting in the first mîtchuap (teepee) birth in over 50 years occurring in Chisasibi in 2022.
“There’s nothing different from a hospital than a teepee in terms of medical equipment and medication,” asserted Chatelain. “The difference is access to more hands if you have an emergency. Midwives are by far the experts in managing labour and birth here.”
From a slow trickle, pandemic restrictions swiftly accelerated births in Eeyou Istchee to the point where 85% of pregnant women in Chisasibi are currently cared for by midwives. Chisasibi now hosts about 35 to 40 births annually from mothers across the region, a number that has been increasing in recent months as midwives have begun prenatal and postnatal care in Whapmagoostui, Wemindji, Eastmain and Nemaska.
While birth homes are planned for construction in Waskaganish, Mistissini and Chisasibi, an interim birthing home in Chisasibi welcomed its first baby in November 2021. The vision is to restore utinaausuwin (midwifery) “from root to branch” with an Eeyou-Eenou kaa utinaausut (midwife) for every family.
Midwives provide abundant information to help mothers make informed choices, supporting their decisions to give birth in hospital or any dwelling on the land. The EIPC curriculum includes making various traditional dwellings, following the appropriate protocols and ceremonies.
Although research shows that out-of-hospital birth is just as safe, even in remote areas, that’s based on thorough screening that continues throughout labour. Midwives would recommend moving closer to hospitals or medevac if a “pink flag” signals higher risk. While they’re trained for unpredictable emergencies, nurses are increasingly being trained to be safety backups for birth.
The chiskutimwaakanch will eventually be sent off-territory to Puvirnituq and later Val-d’Or and Gatineau to achieve the necessary birth volume, develop clinical skills in diverse environments and build working relationships with obstetricians. Nunavik’s trailblazing maternity department in Puvirnituq was created in 1986 and now hosts about 250 births annually.
“I’d say our program is an adapted version of their program,” explained Chatelain. “They started midwifery services and their education program before it was legal. Inuit women just said we’re not going south anymore so you better figure it out.”
Provincially recognized since 2008, Inuulitsivik’s internationally acclaimed programs have led to over 90% of deliveries being done in Nunavik. Hired as consultants two years ago, Inuulitsivik has generously shared knowledge and materials instrumental to EIPC’s curriculum.
Legendary midwife Akinisie Qumaluk, whose 746 births included her great-grandchildren, joked at the launch about getting normal sleep now that she’s retired. Visiting Eeyou Istchee for the first time last spring, Qumaluk was excited to meet dozens of relatives of her ancestor Agnes Snowboy.
As training stems from traditional knowledge, Cree Elders are as integral to the program as the non-Indigenous midwives mentoring the students. There’s a policy, procedure and budget to have an Elder in every single visit with clients, students and births.
“We’re the first department to ever have Elders in clinic,” Chatelain shared. “When I was figuring out how to compensate them no one knew what to do because it had never been done.”
Cultural resource officer Paula Napash has been a vital bridge between students, Elders and midwives, maintaining cultural safety and serving as “a true mentor” to the students. While Cree midwives won’t have every skill or resource, they will be expected to link families with knowledge keepers, traditional healers and community organizations beyond the CHB when necessary.
Students will soon be working with Elders and midwives to lead open workshops for families focused on cultural teachings around nutrition, for example. As “leaders in reproductive justice,” Cree midwives will become valued educators for all stages of women’s sexual and reproductive healthcare.
Chatelain suggested midwives could help compensate the chronic nursing shortage, such as in Wemindji where there’s currently no Awash nurse. While a few students from EIPC’s long waiting list will begin in January, she hopes to also add students in Whapmagoostui, sharing services and mentoring with Inuulitsivik.
“My dream is we have students in every community whether or not there are births happening because where there are services there is education,” affirmed Chatelain. “I am very proud this program has been created from the ground up – we all carry a piece of the puzzle.”
by Patrick Quinn, Local Journalism Initiative Reporter