Bringing birth back to remote Manitoba First Nation

Santina Tait is seven months pregnant, waiting in Winnipeg to give birth to her second child.She remembers the last time she was pregnant in the city.

When my water broke I phoned my mom to come, but [the baby] came so quick. And I was going to take an epidural to prolong my labour so [my mom] could be here. I really wanted my family or someone to be there with me, but it couldnt happen.

Tait lives in Norway House, a Cree community of about 7,000 people thats over an eight hour drive north of Winnipeg. Its not unusual for pregnant women from there to end up in Winnipeg. Since the 1970s most First Nation women living on remote reserves have been evacuated to urban hospitals to give birth.

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These days the women from Norway House are usually sent alone on a bus, weeks prior to their due date,andput up in the band's boarding house where theyre often surrounded by people who are seriously ill.

Its stressful, its depressing, said Tait.Especially when youre pregnant and you want someone with you.

But not all the pregnant women in Norway House give birth in Winnipeg. In fact, theyre increasingly refusing to obey the evacuation policy, opting to give birth at the local hospital instead. Many say this trend has been inspired by the only midwife in a First Nations community in Manitoba, Darlene Birch.

When the midwife came to town

Darlene Birch arrived to work in Norway House in 2006, when the University College of the North (UCN) started an aboriginal midwifery program and the Kinosao Sipi Midwifery Clinic. The mandate: to train aboriginal women to work as midwives in northern Manitoba.

I think that the uniqueness and the true value of the program was how it was in response to communities and to traditional midwives that were still alive, said Birch.

Traditional aboriginal midwives like tokeep a very broad perspective about midwifery because it gives us not just a bigger bag of tricks but a larger understanding ... in every way, like spiritual, cultural.- Darlene Birch

By building the program curriculum with input from those women, Birch was able to learn about and document their skills.

"Traditional aboriginal midwives like to keep a very broad perspective about midwifery because it gives us not just a bigger bag of tricks but a larger understanding ... in every way, like spiritual, cultural.

The UCN program did not stay in Norway House. In 2010 the university suddenly announced it would move south to Winnipeg. Birch didnt follow.

With Darlene, its really good, said Santina Tait.

Shes recommended all of her pregnant friends go see the midwife. Its partly because Birch is Mtis and provides culturally relevant care. But also because shes known for providing a level of continuity and thoroughness that isnt possible with the doctors.

Tait said friends of hers who had prenatal care with the medical team often complained.

Its a different doctor all the time They have to keep explaining themselves over and over, and some of them dont even go anymore because theyre sick of explaining.

With roughly 150-200 new babies being born to women in Norway House every year there is no shortage of work. Birch figures she provides prenatal and postnatal care to about half the pregnant women in the community now, but the vast majority are still sent to urban centres for the births.

The women who stay and the ability to choose

When I visited Birch in her clinic, an unexpected delivery happened just above us on the second floor. Thewoman showed up in labour weeks before her due date. The baby was breech, but everything turned out fine. Less than 24 hours later, the mom had left to care for her newborn and other children at home.

Dana Coates was sent to The Pas, where she had to spend five weeks before giving birth to her first child. Its a time she doesnt reflect fondly upon. So when Coates became pregnant again, she went to see the midwife.

Having a birth plan in the community meant Coates didnt have to stress out about being separate from her family, or what to do about work. She teaches primary school, and with a June due date she was determined to stay on the job aslong as possible.

The one doctor that saw me in Darlenes office said if I was like fourcentimetresdilated that they wouldnt be able to send me out. So I was far enough along when I got to the hospital I was like seven to eightcentimetresand I had to stay.- Dana Coates

Coates said she was warned in advance the medical staff might judge her for staying in the community to have her baby. And there was the concern the doctor might overrule her entirely.

I was a bit worried they would send me out. The one doctor that saw me in Darlenes office said if I was like four centimetres dilated that they wouldnt be able to send me out. So I was far enough along when I got to the hospital I was like seven to eight centimetres and I had to stay.

Its not hard for women to learn the rules in Norway House, which gives them the opportunity to plan a community birth in secret if they choose. Birch said sometimes this means they avoid seeing the doctors for prenatal care so they can stay off the radar and avoid being medevaced out.

Birch said if the medical team and midwifery clinic could work together in a more supportive manner, to promote prenatal care in a way that women wouldnt have to worry about being sent away, then more would come.

Repatriation of birth a communityimperative

Samantha Folster, band councillor and Santina Taits mother, knows the stress the evacuation policy puts on young women and their families all too well. If it were up to her, Norway House would have a birthing centre to serve the community and other nearby First Nations, like Cross Lake and the Island Lakes region.

Only one of her children was born in Norway House. And she missed the birth of her first grandchild. She remembers racing down Highway Six, trying to get to Winnipeg to be with her daughter when she went into active labour.

I felt really guilty for not being there for. She really really wanted me to be there and I couldnt, she said,

Folster is working closely with a University of Winnipeg researcher, Jaime Cidro, who received a grant from the Canadian Institutes of Health Research (CIHR) of more than $100,000 to do a community study about the feasibility of repatriating birth to Norway House.

Probably 80 percent of the babies could be born here, in Norway House, said Folster, pointing to the women already refusing evacuation.

Many women are saying no, Im not leaving. Im going to stay here.

Last year half a dozen women opted to stay under the care of the midwife.

Its unclear how much its costing the federal government to send women away, to pay for their food, their boarding and other expenses to have babies in the city. But Folster figures that amount could likely serve as further justification for their cause.

Were moving forward, were trying to bring the birthing back, which is awesome ... Its not just a baby being born, and you go home and thats it. Its a huge celebration for our people.-SamanthaFolster, Norway House band councillor

And then, theres the symbolic value of repatriating birth.

Theres always been that practice of traditional life, and its coming back. Weve been through so much through the residential schools and all the other things that came with that, she said.

But were moving forward, were trying to bring the birthing back, which is awesome ...Its not just a baby being born, and you go home and thats it. Its a huge celebration for our people.

Norway House may be the most likely candidate for a birthing centre in northern Manitoba, but the community has a long way to go to make that a reality.

At this point, Folster just hopes she can make it to Winnipeg in time to see the birth of her second grandchild.