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Question: I’m pregnant and from a First Nations community in Ontario. Because of some complicated health issues, a doctor said I should deliver my baby in a hospital. We still wish to follow our traditional birthing practices with a midwife. Will a hospital let us do that?
Answer: Yes, many hospitals can accommodate your wishes.
Since 1994 in Ontario, midwifery has been a regulated medical profession, just like physicians, nurses and physiotherapists. They are provincially licensed and their services are covered by the Ontario Health Insurance Plan. So it’s now fairly common to find midwives in the maternity wards of many Ontario hospitals.
At Sunnybrook Health Sciences Centre there are midwives with special training in Aboriginal birthing customs. They are part of a group practice known as Seventh Generation Midwives Toronto. This practice was set up by Aboriginal women and Aboriginal Midwives, who recognized that Aboriginal families often need care that is culturally safe and supportive.
Alanna Kibbe, the head midwife at Sunnybrook, says the various Aboriginal communities across Canada follow a variety of different birthing customs. Some, for instance, practice smudging – a ceremony that involves burning a small bundle of traditional medicine such as sage.
If your baby must be delivered by Cesarean section in the sterile environment of an operating room, it may not be possible to carry out a custom like smudging during the birth. But, in general, the care provider should be able to abide by your traditions.
“I was at one birth where the woman’s granny stood in the corridor outside the OR and continued drumming during the Cesarean,” said Ms. Kibbe.
Claire Dion Fletcher, another midwife who practices at Sunnybrook, points out that the act of birth itself is considered a spiritual event among many Aboriginal people. “Because birth in and of itself is a ceremony, just honouring it and respecting it as a ceremony is sometimes all that happens,” in terms of observing traditional practices. At other times, there may be extended family present to bring in the baby with a welcoming ceremony.
It’s also important to keep in mind that midwives do more than attend the delivery. They provide healthcare, support and guidance both before and for six weeks after the birth for both mothers and babies. Midwives will come to where you are staying after the birth to help with any medical needs and also offer support for breastfeeding. Midwives with special training can make sure that the mother’s and baby’s care is in line with traditional beliefs and practices.
So returning to your question, it is certainly possible to follow your customs while having your baby in an Ontario hospital.
But what would happen if you lived elsewhere in Canada? The answer varies from place to place. Most provinces and territories have incorporated midwives into the health-care system and allow them to be involved in hospital births. Others have not taken this step, or are still in the process of doing so.
A detailed breakdown of midwifery services across the country can be found on the website of the Canadian Association of Midwives.
Overall, there are about 1,200 midwives across Canada, with almost half of them located in Ontario.
The number of midwives with specific training in Aboriginal practices is substantially smaller.
“Our total membership is 64 at the moment,” said Valerie Perrault, project coordinator for the National Aboriginal Council of Midwives whose office is located in Montreal.
Some of these Aboriginal midwives work almost exclusively on reserves and have received their training through community-based programs. Others have completed University degrees and have licenses to practice in hospitals.
Although the number of Aboriginal midwives is limited, it is sometimes possible for other health professionals to tap into local resources so a family’s wishes can be accommodated. “Whether there are Aboriginal midwives [available] or not, there are usually resources in the community – like Aboriginal Patient Liaison Staff or First Nations’ health centres – they can ask for guidance,” says Ms. Perrault.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor
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The midwives at Seventh Generation are Registered Midwives who are Aboriginal. The term Aboriginal Midwife, according to the midwifery act, belongs to women who practice within the law, but outside of the College of Midwives.
The first birthing centre in Ontario has been running by Aboriginal Midwives for 17 years on the Six Nations of the Grand River Territory. They practise according to the traditions of the women who come for care, as long as they are part of an Aboriginal Family (the mom may be non-Native, but the father of the baby is Native).