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Nunavik women giving birth closer to home

"It is much more comfortable being cared for by Inuit"

JANE GEORGE

Staying at home and having your baby - that's just a dream for most women in Nunavut, who must travel during late pregnancy to give birth in Iqaluit, Rankin Inlet or southern hospitals.

But a growing number of women who live along Hudson Bay and Hudson Strait in Nunavik are able to have their babies in or near their home communities through a system of midwife-run maternity units.

The home-grown and supported services are a source of joy and pride to the communities, as the recent celebration of Salluit's own Irnisursiivik Maternity shows.

On March 21, Irnisursiivik held its official opening, two years after the birth of the first baby at the unit. Of the babies born in Salluit since 2004, 69 have been born at the maternity unit located in the community's new, ultra-modern health clinic.

Staff asked for donations from local organizations and businesses to help fund the opening, and netted $5,000. A community contest was held to select a logo and name for the maternity unit.

For the opening, kids from Salluit's youth rehabilitation facility decorated the clinic; school buses brought people up for the occasion, and everyone brought along food to share.

An elder and the first baby born at the maternity unit officially opened Irnisursiivik, with a ribbon-cutting ceremony. Then, T-shirts and cups featuring the new Irnisursiivik logo were handed out to all couples who had babies there.

"It really showed this maternity unit belongs to this community," said Jennifer Stonier, a licensed midwife in Quebec who practices in Salluit.

But Irnisursiivik is a maternity unit that almost didn't happen. A botched cancellation of the maternity program meant Stonier showed up in Salluit in January, 2004, keen to start the program. But it was cancelled at the last minute by the cash-strapped Inuulitsivik health board.

The community nurses didn't know Stonier wasn't coming, and Maggie Tayara was eager to start her training to become the first midwife from Salluit. So Stonier and Tayara got to work.

With no funding, they decorated the maternity unit with the help of contributions from local businesses, and then started documenting support for babies to be born in Salluit.

Community members went on the record, saying:

• "Birth is not always smooth. This is important. There are high risk and low risk. There should be no blame if something bad happens, like the baby or the mother dies. The traditional way of living was without blame when something tragic happened."
• "Everyone understands that some women - the ones with a chance for complications go South. But those who are healthy should stay."
• "It is much more comfortable being cared for by Inuit. It is important to teach Inuit to take care of births."
• "The health administrators say they have no money. Well our families don't have much money either. When a woman goes south or to Puvirnituq, she needs to take money for living expenses. At home that money is needed to buy food and pampers for her kids. Everyone is hurt a bit when she leaves."

Stonier and Tayara received permission to deliver pre- and post-natal care, but, then, babies started being born at the maternity, mainly due to Salluit's legendary poor weather.

The first birth was a "beautiful, beautiful, beautiful birth," recalled Stonier, with the young mother's entire family there to celebrate the occasion.

Some Inuulitsivik doctors were angry afterwards, she said, but they soon realized "that a life without meaning is much more dangerous."

Irnisursiivik represents an extension of midwifery services, which have been offered since 1986 on the Hudson Bay coast from the Inuulitsivik maternity unit in Puvirnituq.

Salluit was at that time designated to be the third site for a maternity unit following the opening of Inukjuak's unit in 1998.

Salluit's goal is to create a team of four or five senior Inuit midwives, supported by rotating midwives from the South to provide back-up and training.

Results from Inuulitsivik's two other maternity units are already impressive. During its first year of operation, Inukjuak transferred about 56 per cent of the women either to Montreal or Puvirnituq. The transfer rate is now about 14 to 21 per cent. There has been no rise in the number of medevacs.

Inuulitsivik's maternity in Puvirnituq succeeded in reducing transfers to the South from 91 per cent in 1983 to less than 9 per cent in 1998. The prematurity rate went from approximately 11.4 per cent in 1983 to 7.4 per cent in 1997. And most intervention rates remain far below those in the South.

The midwives see every pregnant woman weekly, and provide full care - in Inuttitut - during labour and delivery. Home visits are made daily in the first week following the birth. Midwives follow the woman and baby until six weeks after the birth.

However, in communities where the relationships between the women and the midwives are lifelong, care and counseling for mothers and babies usually extends far beyond that period, say midwives.

Nunavik now also has a midwifery association, which was created at the First Midwifery Gathering on Nov. 24, 2005. This association provides a forum for Nunavik midwives to discuss midwifery issues, to work towards the official recognition of Inuulitsivik midwifery services and to support the development of midwifery services throughout Nunavik.

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