Bringing traditional midwives back to Cree communities in Quebec

On the mother's right: a Doppler kit to listen to the baby's heartbeat, a blood pressure cuff, and a shiny stainless-steel umbilical cord clamp. On her left: a moss pad to absorb blood, handmade swaddling blankets and a caribou-hide rattle to welcome the newborn baby.

This birth re-enactment playing out in a teepeein Chisasibi, the largest Cree community on Quebec's James Bay coast, is part of a push by the Cree Board of Health and Social Services to bring midwifery services back to Eeyou Istchee after decades of sending women to hospitals in southern Quebec.

"When we welcome the spirit into the human body, we are in the presence of the divine. That hits hard," said Kathy Shecapio after the presentation.

• LISTEN: Cree elder Jane Matthew on traditional childbirth practices (Cree language)

She is interim assistant executive director of the Cree Health Board's Nishiyuu department, which is overseeing the midwifery program. She says Cree culture is "really spiritual."

"There are 24 steps that the mother must take from the moment she realizes she's pregnant, until shortly after the birth, that are part of the ritual."

That spiritual element has been missing from the hospital births of recent years, Shecapio said.

Family and community

The goal of the re-enactment Tuesday was to show the public the role of a modern midwife, and the role of a traditional midwife. In the re-enactment, two Chisasibi elders who delivered dozens of babies decades ago share their knowledge and rituals, while a registered midwife from southern Quebec demonstrates the role of the modern midwife.

The idea is that soon modern midwives will provide perinatal and birth services in Cree communities with training from elders in Cree tradition so that the spiritual elements of birth can continue.

"The very act of a baby being passed from person to person, and welcomed and kissed and returned back to the mom is very touching for me. It has really shown me how deeply, profoundly important it is that family and community be present when a baby is born," said midwife Jasmine Chtelain, who is also helping design the Cree Health Board's midwifery program.

"To separate the community from the baby means to break up the community, and I just got a really visceral, visual lesson on that while doing this ritual."

Away from home

Cree women are sent to Val d'Or, Chibougamau or Montral to give birth. That means they're often separated from their partners, older children and extended family for weeks. They have to switch to their second or third language in the delivery room to get a glass of water or tell the doctor where it hurts.

• LISTEN: Paula Napash on midwifery and childbirth tradition (Cree language)

Paula Napash played the mother in the birth re-enactment, accompanied by midwives and surrounded by extended family and Cree tradition. But in real life, she gave birth to all three of her children in the francophone town of Val d'Or, a three-hour flight from home.

"I found it took more time for me to deliver my child because I was stressed about my other child back home," said Napash.

The Cree Health Board is working on a plan to hire registered midwives in all the Cree communities in Quebec, starting with Chisasibi, Waskaganish and Mistissini. Women with low-risk pregnancies could choose to give birth at the local health centre, and traditional Cree teachings would be included in perinatal and childbirth services.

"Young women need to speak to people who know about it, and there are only a few of us left," said Jane Matthew, one of the elders who demonstrated how she used moss and rabbit fur to diaper a newborn.

"When they see it, they will fully understand."

Benefits versus risks

Eventually the plan includes training Cree midwives, a process that could include a university program as well as years of on-the-job apprenticeship.

There's just one university in Quebec that offers a midwifery training program; it's 1,500 km from Chisasibi, and the courses are offered in French, which is a third language for some, and not spoken at all by many Cree.

For now, consultation continues with elders, clinical staff and community members. The Council of Physicians, Dentists and Pharmacists for the Cree Board of Health passed a resolution earlier this year supporting the board's midwifery program, although some doctors and nurses remain concerned about safety, and are uncertain how it will work.

For Kathy Shecapio, the question of security is not only about the physical risks of birthing in the remote communities of Eeyou Istchee, but also the cultural risks of sending women out.

"Removing women from their communities and their culture is like an extension of the residential school system," she said.

"What the people here are saying is that they are paying a very heavy price, not having birth in the territory," said midwife Jasmine Chtelain.

"I believe that to support women and their families to be empowered and have self-determination around something as basic as giving birth will feed into a more healthy population in general. What I'm hearing from everyone is that the benefits outweigh the risks."