Midwifery-Led Perinatal Services On The Hudson Bay Coast, Nunavik
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George LessardMidwifery-Led Perinatal Services On The Hudson Bay Coast, Nunavik
Uploaded by
George LessardMidwifery-led perinatal services on the Hudson Bay Coast, Nunavik
The remote region of the Hudson Bay Coast, Nunavik in northern Quebec has been providing complete midwifery-led perinatal services and a community-based midwifery education programme for local women since 1986. Bringing birth and the common knowledge associated with maternal and child care back to the region was a communityinitiated endeavour in response to the evacuation policies implemented in the 1970s in many northern and remote regions of Canada. This policy of sending women south for months at a time to give birth resulted in health, social, cultural and financial difficulties for the affected families that are now well documented. Additionally, women began to lose confidence in themselves and in the birth process, and many of the cultural values, traditional knowledge and meaning related to birth and childcare were also in danger of being lost. The people of this region decided to take matters into their own hands, and since the programmes introduction, communities have remained pre-eminent in the orientation and operation of their maternity services. Three midwifery-run maternities now serve the seven villages along the coast, covering approximately 5,500 Inuit and 200 births a year. Theirs is a young population, with nearly 50 percent of the population and 25 percent of the birth mothers under the age of 20. Flying time to the nearest tertiary hospital is approximately six to eight hours, if weather conditions permit. Midwives and midwifery students provide complete pre-, peri- and postnatal care from conception to six weeks postpartum to all women on the coast, regardless of medical or social status. They also provide well-woman and well-baby care to the population of their villages. All care takes place in Inuktitut, the local language. There are currently 10 locally educated, fully licensed Inuit midwives and 11 students in the region. Southern Quallunak' registered midwives rotate their time, contribute to formal training, and support and mentor the students. The midwives work closely in the villages with nurses, doctors, social workers and community health workers in the areas of primary care and public health education. The maternities are funded by and considered integrated into the provincial health care system, and the midwives are paid by the Quebec Ministry of Health. Students, who provide complete primary care from day one of their training, are also paid, partially from the Health Ministry and partially from a grant from the regional board of education. Midwifery training takes place on the job and is tailored to the social and learning needs of each student. The curriculum is similar in content and competencies to that of other midwifery programmes in Canada, and adapted to northern practice realities. As such, there is increased emphasis on community health and education, emergency care, and the integration of traditional and modern skills and knowledge. In 2008, the Order of Quebec Midwives together with the Quebec Ministry of Health formally recognized the Inuulitsivik Midwifery Education Programme. Graduates now receive full licence privileges along with graduates from the midwifery programme at the Universit du Qubec Trois Rivires. This is perhaps the first time anywhere in the world that traditional pathways to learning midwifery have been recognized alongside those gained through a university education. Inuulitsivik maternities were the subject of several studies from 1989 to 2009. These studies consistently showed a decrease in perinatal mortality rates, prematurity and intervention rates with very high satisfaction among the women and families. The most recent study looked at 1,388 births retrospectively and found that 85 percent of pregnant women gave birth in the region and perinatal outcomes were comparable to those in southern regions of Quebec and other parts of Canada. Intervention rates were much lower, including a
Prepared as a background document for The State of the Worlds Midwifery 2011 - launched June 2011
Disclaimer: While all efforts have been made to verify the information in this document, responsibility for the contents and presentation rest with the author(s). The views and opinions expressed in the document do not necessarily correspond with those of the State of the Worlds Midwifery 2011 Editorial Committee.
caesarean-section rate of 1.6 percent, induction rate of 8 percent, analgesia rate of 9.4 percent and a 75.7 percent rate of intact perinea. Breastfeeding rates remain high. The conclusions of the study support: the premise that safe care can be provided away from caesarean-section capacity; midwifery as a model of care in remote communities; and local education of Inuit midwives as a strategy to improve perinatal outcomes in Inuit communities. Most important, women and families in Nunavik continue to receive safe, high-quality care in their own language, on their own land, from women they have known all their lives. Note: Details about the programme or relevant statistics available on request from: tocchionero@[Link] Prepared by: Tonia Occhionero, Executive Director, Canadian Association of Midwives
Prepared as a background document for The State of the Worlds Midwifery 2011 - launched June 2011
Disclaimer: While all efforts have been made to verify the information in this document, responsibility for the contents and presentation rest with the author(s). The views and opinions expressed in the document do not necessarily correspond with those of the State of the Worlds Midwifery 2011 Editorial Committee.
