Aboriginal Midwifery in Canada

An Aboriginal midwife is a committed primary health care provider who has the skills to care for pregnant women, babies, and their families throughout pregnancy and for the first weeks in the postpartum. She is also a person who is knowledgeable in all aspects of women’s medicine and she provides education that helps keep the family and the community healthy. Midwives promote breastfeeding, nutrition, and parenting skills. A midwife is the keeper of ceremonies for young people like puberty rites. She is a leader and mentor, someone who passes on important values about health to the next generation.

Aboriginal communities across Canada have always had midwives. It has only been in the last hundred years that this practice has been taken away from our communities. This occurred for a number of reasons, including colonization and changes in the health care system in Canada. As a result of losing midwifery, many rural and remote Aboriginal communities are currently required to deliver their babies and access care outside of their communities. Despite these changes, there are still some Aboriginal midwives practicing in a variety of settings across Canada. The vision of these midwives is to one day see “An Aboriginal midwife working in every Aboriginal community”.

Aboriginal Midwifery Practices in Canada

  1. Inuulitsivik Health Centre, Nunavik, Quebec: Since 1986, midwives have been the on-call primary care providers for maternity care for all women. This program is located in three communities along the Hudson Bay coast. The birth centres are a midwifery-led collaborative model of care, and involves effective teamwork between midwives, physicians, and nurses working in the remote villages and at the regional referral centres. Transfers from the community to the south have been greatly reduced, from 91per cent in 1983 to less than 9 per cent in 1998. Midwifery education is a key component of the birth centres, and training community members as midwives has both sustained the program and been one of its key elements of success.
  2. Tulattavik Health Centre, Nunavik, Québec: The situation on the Ungava Coast was different until fairly recently, since maternity services were provided until 2004 by physicians and nurses in Kuujjuaq. However, since 2009, midwives have been providing maternity services. Since the introduction of midwives in the community, transfer rates have significantly gone down and satisfaction for women and their families has increased. There are currently four midwives working in Kuujjuaq and they are the on-call primary care providers for all women on the Coast. Additionally, a community-based training program just started in August 2013 in Kuujjuaq.  
  3. Rankin Inlet Birthing Centre (RIBC), Nunavut: RIBC was established in 1993 and provides low-risk women with the option of community-based birthing. The need for this service was identified by many community members, political leaders, health care providers, and researchers involved in the region. The midwives provide prenatal care and attend births. A Perinatal Committee conducts weekly reviews involving risk assessments and eligibility of women to give birth in the community. A Maternity Care Worker Program and Midwifery Training are currently being offered through Arctic College.
  4. Cambridge Bay Birth Centre, Nunavut: In January 2010, the birth centre in Cambridge Bay was opened and began offering maternity services, including low risk deliveries. The midwives working at the centre will also be involved in midwifery education, using the same model of training available in Rankin Inlet offered through Nunavut Arctic College in Cambridge Bay.
  5. Fort Smith Health and Social Services Midwifery Program, Northwest Territories: In April 2005, the Fort Smith Health and Social Services Authority (FSHSSA) officially integrated midwifery services into its programming after a three year developmental project. Midwives had been working in the community for many years in a private practice and chose to become a part of the local health care system. A key part of the project was developing a multi-disciplinary approach to maternity care services. This included forming a Maternity Care Committee made up of midwives, physicians, nurses and clinical care managers. The Committee meets regularly to review clinical care plans and discuss various issues regarding clinical care and risk assessment.
  6. Kinosao Sipi Midwifery Clinic, Norway House Cree Nation, Manitoba: This midwifery practice was established in conjunction with the kanaci otinawawasowin Baccalaureate Program (KOBP) at the University College of the North in 2006. The clinic is located in the First Nations and Inuit Health hospital in Norway House, and has undergone numerous challenges in its implementation process. Currently, the midwifery clinic serves women both in pre and postnatal periods, and arranges transportation to the tertiary centre for their clients. The development of a low-risk elective birthing programme is still in process.
  7. Seventh Generation Midwives Toronto: This urban Aboriginal midwifery practice was established by a group of Registered Aboriginal Midwives and Aboriginal Midwifery Students in 2005 with a focus on serving the urban Aboriginal community in downtown Toronto. SGMT works with the urban community to improve Aboriginal maternal and infant health by supporting women to reclaim control of birth for themselves, including the choice to incorporate traditional teachings and ceremonies. The midwives provide prenatal care from the beginning of pregnancy to six weeks post partum and have a special designation from the university-based Midwifery Education Programs in Ontario to prioritize clinical placements for Aboriginal students at their clinic. They attend births at home, in their clinic and at Sunnybrook hospital.
  8. Tsi Non:we Ionnakeratstha Ona:grahsta’ Six Nations Maternal and Child Centre, Ontario: Opened in 1996, the birth centre consists of Aboriginal midwives and support staff and provides a balance of traditional and contemporary midwifery services and programs. The establishment and on-going operation of the practice is a community driven process through its advisory committee, and provides on-going support and direction for centre. The midwives work under an exemption clause that allows them to practice and serve families in their community. The Centre also supports an Aboriginal Midwifery Education Programme.
  9. Kontinenhanónhnha Tsi Tkaha:nayen, Tyendinaga Mohawk Territory, Ontario:  This private practice opened in May 2012 with a focus on returning traditional birthing practices to Tyendinaga.  The midwives work under an exemption clause and provide Aboriginal women and families the option of community-based birthing in both rural and urban areas. The Kenhte:ke Birth Advisory Working Group was formed in February 2012 to develop plans for the “Kenhte:ke Birthing Centre.”
  10. Neepeeshowan Midwives, Attawapiskat, Ontario: 'Neepeeshowan' is Cree for a blooming flower. This practice opened in the Fall of 2012 in Attawapiskat, a Cree community of 1900 people located 500 km north of Timmins. Women of Attawapiskat give birth to about 50 babies per year. At the moment, there is one midwife but there are plans to have two midwives, to also provide access to midwifery education for Cree women, and eventually expand midwifery services to all coastal communities. Currently, Neepeeshowan Midwives cares for most pregnant women of the community, and planned community births for women experiencing a healthy pregnancy are starting gently. This new midwifery practice is the culmination of decades of advocating from women of Attawapiskat. It provides care and services in the Weeneebayko Area Health Authority (WAHA), which includes the communities of Moose Factory, Moosonee, Fort Albany and Attawapiskat.
  11. K’Tigaaning Midwives, Powassan, Ontario: Carol Couchie and her daughter Rachel Dennis bought in October 2013 a long-established practice in the North Bay region and renamed it K’Tigaaning Midwives in honour of their community in Nipissing. The catchment area includes North Bay, Nipissing First Nation as well as surrounding areas. They are delighted to be able to provide care in their home community.  
  12. Ionteksa’tanoronhkwa “child-cherishers” Homebirth Midwives, Akwesasne, Ontario: Jasmine Kahentineshen Benedict and Joyce Wathahiiostha Leaf founded this practice.  Their mission is “to revitalize our culture and strengthen our people through a modern Onkwehon:we midwifery practice that uses both our traditional knowledge and non-Indigenous midwifery training to ensure the safety of the child and the well-being of the family." They have been quite interested in the prospect of developing a birth center at Akwesasne. Their hope is that a birth center would give clients a safe and comfortable place to give birth as a viable alternative to the hospital setting. Through their experience as Indigenous women, daughters, mothers, and midwives they have observed first-hand the negative impacts upon the entire community associated with limited options and lack of culturally appropriate services regarding reproductive health. Midwives have the potential to make a significant contribution to the health of women and their families, as this empowerment begins in the womb. Traditional midwifery empowers women through the birth process and builds a stronger community through the celebration and strengthening of their cultural distinctiveness as an integral part of society.

Midwifery Education

There are many paths to becoming a midwife. Education is an essential part of restoring midwifery to Aboriginal peoples across Canada. This knowledge must be brought home to our communities.

All midwifery education programs provide are a combination of classroom-based or academic learning and, clinical placements or apprenticeship in midwifery clinics. Midwifery education includes courses from the social sciences, humanities, and sciences. Teaching methods combine lectures, seminars, laboratories, distance learning and mentorship. Regardless of the program you enter, midwifery education takes place in many settings, including a university or college campus, midwifery clinics, hospitals, and birth centres. Most midwifery programs expect that you will be willing to relocate for parts of your education program.

Midwifery education gives students the opportunity to develop both the hands on clinical skills and theoretical knowledge necessary to be primary caregivers for women, babies, and their families throughout pregnancy and the first six weeks postpartum.

See also:
Community-based programs
University-based programs

Community-based programs

There are currently three community-based programs, offered in three Aboriginal communities in Canada. For more information, please contact the programs directly.

Ontario:

Tsi Non:we lonnakeratstha Ona:grahsta’ Aboriginal Midwifery Training Program

The Tsi Non:we lonnakeratstha Ona: grahsta’ Aboriginal Midwifery Training Program is three years in length, and consists of tutorials that address Aboriginal women’s unique health issues. The program combines western obstetrical practices and standards with traditional Aboriginal practices and standards. All training components are completed at the Maternal and Child Centre with Aboriginal midwife instructors.

 

Quebec:

 

Nunavik Community Midwifery Education Program

The program is an academic and clinical education program for Inuit women working in their own communities on the Hudson and Ungava Coasts of Nunavik (Northern Quebec). The program uses a modular, competency-based curriculum. The program emphasizes learning in ways appropriate to Inuit culture, including learning in the Inuktitut language, and focuses on the role of the midwife in community health, especially in the areas of sexual health and well woman care. This program is offered through maternity programs in health centres on the Hudson and Ungava coasts in Quebec.

 

Nunavut:

 

Nunavut Midwifery Education Program - Arctic College

The Midwifery Program is offered in partnership with the Department of Health and Social Services, and prepares graduates to enter into midwifery practice in Nunavut. Prior to the Midwifery Diploma Program, students complete the Maternity Care Certificate Program.  The program introduces students to the cultural, spiritual and traditional practices of Inuit midwives and is also designed to reflect the goals, values and ethical codes established as territorial and national standards and regulations.  It is expected that graduates from the program will be able to meet standards set by the Canadian Midwifery Regulatory Committee (CMRC) and provide care that is culturally appropriate for and acceptable to the residents of Nunavut.

University-based programs

The midwifery education program is a direct entry (no previous degree or health care training required), four year baccalaureate program. There are seven university-based midwifery education programs available in Canada. Each program administers exams recognized by their respective provincial regulatory bodies.

Ontario

Laurentian University
935 Ramsey Lake Road,
Sudbury, ON, P3E 2C6
Tel: (705) 675-4822
* This program is offered in both English and French.
www.midwifery.laurentian.ca

McMaster University
Michael G. DeGroote Centre for Learning & Discovery
(MDCL) Third Fl.,
3103-1200 Main Street West
Hamilton, ON, L8N 3Z5
Tel: 905-525-9140, Ext. 26654
* This program is offered in English only
www-fhs.mcmaster.ca/midwifery

Ryerson University
350 Victoria Street,
Toronto, ON, M5B 2L4
Tel: (416) 979-5104 or (416) 979-5271
* This program is offered in English only.
www.ryerson.ca/midwife

Quebec

Université du Québec à Trois-Rivières
Casier postal 500,
Trois-Rivières, QC, G9A 5H7
Midwifery Program Tel: (819) 376-5045 or 1-800-365-0922
* This program is offered in French only.
www.uqtr.ca/sage-femme

British Columbia

University of British Columbia
B54-2194 Health Services Mall,
Vancouver, BC, V6T 1Z3
Tel: 604-822-0352
* This program is offered in English only.
www.midwifery.ubc.ca

Manitoba

University College of the North
kanaci otinowawosowin Bachelor of Midwifery (KOB) Program
Unit 4-471 Portage Ave. Winnipeg, MB, R3B 2E4
* This program is offered in English only.
Tel: 204-946-0440

www.ucn.ca/sites/academics/midwifery/Pages/Midwifery.aspx

Alberta

Mount Royal University
Bachelor of Midwifery
4825 Mount Royal Gate SW
Calgary, AB, T3E 6K6
* This program is offered in English only.
www.mtroyal.ca/midwifery

Midwifery Regulation

Midwives apply for registration with the governing body (the College) of their province or territory in order to practice midwifery. However, in Nunavut, British Columbia, Ontario and Quebec has legislation that provides an exemption from registration for Aboriginal midwives.

In Nunavut and British Columbia, the exemption is only available for midwives who practiced Aboriginal midwifery prior to the coming into force of the Act. In Ontario, Aboriginal midwives providing care to Aboriginal communities are exempt from the Regulated Health Professions Act. The Ontario Midwifery Act allows Aboriginal midwives who provide traditional midwife services to use the title “Aboriginal midwife”. The Quebec statute allows Aboriginal midwives to practice without being registered members, provided that the nation, group or community has entered into an agreement with the government. The education path you choose will address this and will guide you through the possibilities of the registration or exemption process.