Inuit-run clinics give indigenous women the right to give birth at home

As Canada tries to make amends for its brutal history of relations with its indigenous population, the clinic is as an example of a way forward, write Amber Bracken and Megan Specia

Inuit women pull their children on sledges in the arctic village of Kuujjuaq (Alamy)

The woman’s moans of pain mingle with the intermittent beeping of a fetal heartbeat monitor. Her midwife gently coaches her in their mother tongue, Inuktitut, as the morning sun casts a cool light across the floor.

Finally, a baby’s wail breaks through. His shrill cry is a reminder of what Inuit midwives have reclaimed: the right of pregnant women to choose to give birth in their hometown after years of being pressured to travel south to have their babies.

As Canada tries to make amends for its brutal history of relations with its indigenous population, midwives and other members of the community in Inukjuak, a town of around 1,800 people in a remote region of Quebec, point to the clinic as an example of a way forward. Today, around three out of four pregnant women in the town give birth in its clinic, attended to by Inuit midwives. “I feel relieved to be able to give birth at home, where my family is,” says the new mother, Susie Mina.

Reconciling with indigenous populations is one of the most pressing issues facing Canada these days. Prime minister Justin Trudeau has called it a priority of his government. History curricula have been revamped in schools; public meetings routinely begin with a recognition of the indigenous lands they are held on and buildings have been renamed.

To many here, the Inukjuak clinic is a tangible example of what is possible. For countless generations, the Inuit of the Nunavik region in northern Quebec lived as nomads, travelling across the wind-battered landscape to follow the herds they hunted seasonally. But in the 1950s, the Canadian government pressured families to settle in permanent communities.

The move fit squarely into the pattern of how Canada treated its indigenous people, including forcibly separating indigenous children from their families and sending them often great distances to residential schools that stripped them of their language and cultural identity.

In many remote Inuit areas, the government’s national health service also began pressuring pregnant women to travel hundreds of miles south to give birth in hospitals. Inukjuak women were sent to Montreal or Moose Factory, Ontario, rather than relying on local midwives who had traditionally provided care.

The stated reason for the practice, which began in the early 1970s, was to improve birth survival rates and reduce complications in far-flung communities with no hospitals and limited prenatal care.

But for many indigenous women, the policy turned pregnancy into an illness and deprived them of care by traditional methods.

Many also found the experience of being sent from home isolating and sometimes traumatising. Because they left their communities well before their due dates, they spent weeks away from their families to give birth in unfamiliar surroundings, tended by doctors and nurses who didn’t speak their first language.

A one-day-old baby’s footprints are taken by a trainee midwife at Puvirnituq hospital (Alamy)

In 1986, local elders who wanted to bring birth back to Nunavik persuaded a hospital in the region to begin a training programme to certify Inuit women as midwives. Eventually, three maternity clinics led by Inuit women were set up in villages on the Hudson Bay coast.

In 1996, one of these clinics opened in Inukjuak, which is now a cluster of a few hundred homes, three stores, a post office and a few other buildings connected by gravel roads. It is nestled against the windswept shore of the bay, accessible to the outside world for much of the year only by an airport with a single runway. Everyone in Inukjuak knows everyone else.

In the winter, the rocky rolling hills are buried by snow. They come alive in the summer, covered by green for a few precious weeks as the daylight stretches well into the night. “It keeps coming back,” the mayor of Inukjuak, Simeonie Nalukturuk, says of the grass, wildflowers and the berries that seem to disappear for good in the winter.

The return of giving birth in Inukjuak brought its own kind of renewal, the mayor says. Before the evacuations, newborns were celebrated and greeted by every community member. After, that tradition suddenly stopped. “There was nothing to celebrate,” he says. “I think we even forgot how to celebrate the birth of our little brothers and sisters.”

Now, to signal each new arrival, the maternity clinic flicks on the strand of Christmas lights hanging from its window frame. The names of the new babies, often ones that honour deceased relatives, are announced on the radio.

Brenda Epoo, 49, a midwife at the clinic, says the former practice of evacuating every woman was damaging. “Telling them every pregnancy is dangerous and sending them somewhere else – to the hospital where they don’t know their customs, their culture, their way of life – it’s not right,” she says. “It’s not a disease, it’s life.” Over the years, she has delivered hundreds of newborns. Some are the children of babies she also delivered.

Telling them every pregnancy is dangerous and sending them somewhere else – to the hospital where they don’t know their customs, their culture, their way of life – it’s not right

The clinic has five midwives and three student trainees, who assess and monitor the women throughout their pregnancies and after birth. The midwives are trained to provide emergency medical interventions, though performing caesarean sections and giving epidurals are outside their skill set.

Only expectant mothers deemed high risk are transferred south, with their consent, to a hospital. Across Nunavik, almost 200 babies are delivered by midwives each year, about 40 to 50 a year in Inukjuak alone. During the years of the evacuation policy, the mortality rate during and directly after birth was high for the babies of women in the Nunavik region, in part because of the limited prenatal services.

During the final years of the policy, the mortality rate was three times higher than it was for the same time period in Montreal, according to a study from McGill University.

Since the midwifery programme began, that rate has dropped significantly. The latest figures, from 2000-2015, show that the combined fetal and neonatal mortality rate in the Nunavik villages was 7.7 per 1,000 births compared with 5.8 for Canada in total.

Inukjuak has a population of around 1,800 (Ian Schofield)

But it’s not all about numbers. Most of the 13,000 people who live in Nunavik speak Inuktitut as their first language. Now it’s also the first language their newborns will hear.

Mina, the new mother, gave birth to her first son in Montreal because her pregnancy was deemed high risk. Her later pregnancies, attended by the midwives in Inukjuak, were very different. “I felt more comfortable giving birth here because I didn’t have to speak English,” she explains.

Her midwives, she says, also understood how she felt without her having to utter a word because of their shared cultural touchstones. The simple raise of an eyebrow or the wrinkle of a nose could take the place of words.

After she gives birth, Mina hands the baby to her mother, Lilly Mina, who delivered all of her own children, including Susie Mina, in the south. “I am so grateful that they can be born here,” says Lilly Mina. Tears stream down her cheeks as she clutches her new grandson to her chest.

When Megan Epoo, the niece of midwife Brenda Epoo, became pregnant, her aunt served as her midwife, and, along with other women in her family, guided her through her pregnancy. Her daughter, Hailey Epoo, is now nine. On a recent day, she and a friend skipped rocks in tide pools outside a canvas tent on the land the family has camped on for generations.

First-time mothers here are often young, Megan Epoo says; and having their own mothers, aunts and sisters there for their labour is vital. “She knows what I’ve been through. She knows my entire life,” she says of her aunt. “Her advice has meaning to me.”

Epoo says being able to give birth in Nunavik was particularly significant to her because the policy of pressuring women to travel south to have their babies was part of the overall history of the treatment of indigenous groups, which has brought generational trauma to the community.

Levels of alcohol abuse, domestic violence and death by accident are higher here than the national average. The life expectancy in Nunavik is far below the rest of Quebec, and the suicide rate is troublingly high. “I hurt when I think about it too much,” Epoo says. But, she adds, “Having the privilege to give birth here is like beating the system.”

© New York Times