Indigenous Midwifery Practices in Canada
Introduction
The indigenous people of Canada are the initial occupants of the present day Canada. They include the First Nations, Inuit and Métis. The indigenous people had a solid cultural health infrastructure even before the advent of modern medical system (Waldram, Herring & Young, 2000). The cultural health system had elements like midwifery, surgery, diagnosis and prescription principles. However, by the transition of the cultural health systems through periods of colonial influence, they have been significantly diluted. The indigenous body of beliefs about healthcare, wellbeing, spirituality and physical health, were considered deficient and substandard to the colonial health systems (NAHO, 2008). Due to the erosion of the values of the original indigenous healthcare system, the indigenous people are currently faced with a myriad of grave health concerns. They were, therefore, replaced by new age colonial practices that deviated from the cultural beliefs of the indigenous people. This paper discusses the place of indigenous midwifery practice in mainstream healthcare. It examines the cause of the disparity in health state between the indigenous and the non-indigenous occupants of Canada. It studies the strengths and weaknesses of the indigenous midwifery practices which determine its acceptance to the mainstream healthcare system. Finally, it lays down the essentials of the most appropriate model of the healthcare system to deal with the health problem among the indigenous people.
Indigenous Midwifery Practices in Canada
“encompasses care of women during pregnancy, labour, and the postpartum period, as well as care of the new-born.”
In the indigenous system of midwifery, a midwife was a childless woman who was considered as a godmother of all the children in the society. It could also a man or a child who would assist in child delivery in case no one else was around (Carol and Benoit, 2004). Due to their nomadic nature, it was necessary to have everyone equipped with midwifery skills. The set of knowledge system was passed from generation to generation, not by inheritance but by learning from an experienced midwifery practitioner. The midwifery system of the Canadian indigenous people covered all aspects of childbirth. This included care to the mother during pregnancy i.e. prenatal care, assistance during birth and assistance to the mother after birth i.e. postnatal care (Carol and Benoit, 2004).
In the present, the maternal healthcare system in Canada is faced with countless challenges whose gravity intensifies daily (Milne, 2001). The greatest challenge is that there is an alarming shortage of maternal healthcare providers. The problem is even more pronounced in the indigenous communities. This is due to marginalisation and abject poverty experienced by these communities. It can also be attributed to the illegalization of midwifery in many Canadian provinces (Milne, 2001). According to data provided by the World Bank for the year 2010, the maternal mortality rate in Canada is 12 deaths per 100,000 births. The maternal death rate in 1990 was 6 deaths per 100,000 births. This shows that the maternal death rate has doubled in just 20 years. There is thus the need for measures to be taken to curb the high maternal mortality and other challenges facing the maternal healthcare system in Canada.
In an opinion poll conducted in 2002 by The National Aboriginal Health Organization (NAHO), 63% of the First Nation respondents and 57% of the Métis respondents, identified non-compliance to the cultural health policies as the prime factor contributing to the worsening state of maternal health (NAHO, 2008). It is because of this reason that the healthcare administration has started paying attention to culture and regarding it as a crucial component of health in the society. The cultural indigenous system of HealthCare conceptualises health as a single entity consisting of spirit, mind, emotions and the body intertwined together (Battiste and Henderson, 2000). It capitalises on the optimal health and wellbeing of the human being unlike the traditional, modern medicine that primarily examines the human being as an organism and is concerned with the aspect of dysfunction. Unlike the traditional, modern medicine that is universal, the indigenous medical knowledge system is localised and focuses on specific social and natural elements in the locality of an individual to customise treatment options (Battiste and Henderson, 2000).
In order to tackle the chronic problems in the state of maternal health care, in Canada, there is a need to come up with a framework that incorporates the concepts of cultural indigenous medicine practice, and those of modern medicine. The culture of the indigenous people has a bearing on the willingness and timing of seeking medical services. It also dictates their likelihood to either accept or reject treatment. The culture also determines the willingness to stick to the treatment. Therefore, culture is largely responsible for the success or failure of treatment and preventive measures advanced by modern medicine. The indigenous people have complained for ages on how the health system has failed to put culture in consideration. This causes a lot of problems to the effectiveness of the system because the indigenous people feel alienated and dejected. Therefore, a successful intervention must include policies that make the indigenous people feel less culturally invaded. These policies should focus on the shift of cultural attitudes about modern medicine, and at the same time, cause less cultural intimidation to the indigenous people. This creates cultural security and increases the willingness of the indigenous people to co-operate with the conventional health system.
Currently, only two provinces i.e. Alberta and Saskatchewan have legalised indigenous midwifery. However, they do not fund it. Many indigenous women are poor. Therefore, they can’t afford midwifery services being offered in the market. Being illegal in most provinces, midwifery is not an option for the poor women. The women opt to give birth with no professional assistance. This poses a danger especially if there is a high risk pregnancy. Many indigenous communities live in isolated locations. In most cases in order to give birth, the women have to be airlifted to the hospitals where they are to receive specialised care. Most women are uncomfortable with this as it alienates them from their families at the moment that they are supposed to be closest to them for moral support. There are also challenges of a language barrier between the native women and the euro-Canadian health practitioners which make communication difficult (Houd, 1990).
One of the barriers to acceptance of indigenous midwifery has been whether it is safe enough to be practiced. A dissection of the aboriginal midwifery practices shows that the midwife is involved in the birth process pre-natal, ante-natal and post-natal. The pregnant mother is advised on what foods to eat and what foods not to eat (Ross Leitenberger, 1998). The pregnant woman was prohibited from eating aged foods. This includes foods like cheese. In modern medicine, this can be said to be of great benefits to the child. Research has shown that eating aged foods especially blue cheese in pregnant women can cause Listeriosis. This disease can cause serious health complication to the mother to be and the unborn child. There is a high risk of miscarriage or the chances of a still birth. When a pregnant woman is suffering from this disease, the chances of suffering complications to the pregnancy are one in five. Therefore, it can be argued that the indigenous midwifery practices were preventive in nature and prevented the incidence of many complications. Consequently, they can be regarded as safe medically and culturally from that perspective.
Another positive practice involved in indigenous midwifery is the restriction of the pregnant woman from accessing negative sights and sounds. It was believed that the negative sights and sounds would be passed to the unborn baby (Ross Leitenberger, 1998). This has a direct relation to modern medicine because it helps to avoid stress by reducing the level of corticotrophin-releasing hormone in the blood. This hormone is responsible for most of the preterm births, miscarriages and low weight births. In addition to that, corticotrophin-releasing hormone has the effect of suppressing the immune system in the mother. This increases the chances of the pregnant mother to get in contact with infections. The infections would put the life of the mother and that of the child in danger. Avoiding negative sights and sounds, and replacing them with positive ones also keeps the blood pressure in check. It also keeps the heart healthy. The midwives played soothing percussion music to the mother. The mother was also dressed in colourful garments adorned with bright birds’ feathers (Ross Leitenberger, 1998). The soothing music was meant to scare away the evil spirits. This is evidence that the indigenous midwifery practices were safe (Ross Leitenberger, 1998). It justifies that they deserve a place in mainstream healthcare.
Another component of indigenous midwifery was post-natal care. This involved ways of reducing postpartum-haemorrhage. This was made by the use of special herbs. It was also made through the application of hot stone massage to alleviate the pain and reduce post natal depression (Battiste, 2000). All these were done to make the birth process safer and easier for the mother and the child. The main goal of mainstream healthcare especially maternal healthcare is ensuring the safety of the mother and the baby. There is documented success of the indigenous midwifery practices in doing so (Battiste, 2000). This is an additional reason why indigenous midwifery deserves a position in the mainstream healthcare.
Indigenous midwifery was faced by some challenges and had a couple of shortcomings. High risk births posed a challenge and they usually resulted in either maternal death or miscarriage. These complications were seen as a way of the departed elders punishing the living. The underlying health dynamics that may have caused these complications were not examined. For instance, in a case where a woman had successive miscarriages, they became alienated from the society as they were viewed as cursed. This was done oblivious of the fact that a myriad of medical conditions is responsible for such phenomenon. These include medical complications such as defects in the mother’s genetic makeup, abnormalities in the uterus, and abnormalities in the immune system of the mother.
The indigenous midwifery practices cannot be said to be 100% effective. They had their limitations and lethal assumptions. However, the cost of not including them in the mainstream healthcare is high and, therefore, there will be more disparity in healthcare between the indigenous people and the other Canadians. In order for the indigenous people to accept change the have to be assured that their cultural safety is not invaded. This way they will be more willing to shift their attitude towards modern medicine.
The solution advocated by this paper is not merging the mainstream and the traditional indigenous birthing methods. The indigenous midwifery practice has its limitations, and if these are merged with the mainstream healthcare, the model will not be efficient in achieving its goal. The goal is reducing the health challenges facing the indigenous people. In order to achieve this goal, there is a need to adopt the culturally significant aspects of the indigenous midwifery practice. The above should be adopted based on an informed foundation provided by modern medicine. Aspects of this system which have been found to be wanting should be replaced by more efficient and modern practices in healthcare. This includes the use of modern technology in screening for potential health risks to the mother and the unborn child.
The result of this model will not be a replacement, but rather a stronger interdisciplinary association that retains the important features. These features are conformance to the culture to induce a sense of cultural security and the use of informed mainstream methods to make the right choice for the mother and the child. It is believed that there will be quality community based midwifery practice, and more favourable outcome when the indigenous midwives are given a platform to practice and be equipped with more relevant skills to handle the day to day challenges. There will be widespread cultural rejuvenation and improvement of the health standards if the indigenous midwifery practices are given a place in the mainstream healthcare system.
Currently, there are only three indigenous birthing centres in the whole of Canada. With the incorporation of modern practices to improve on the safety of the mother and the child, they are proving to be a phenomenal success. However, being only three, translates to hundreds of thousands of indigenous people without proper culturally accepted maternal care centres. Therefore, there is need for the current healthcare system to be restructured to accommodate contemporary indigenous midwifery practice, and appreciate the invaluable indigenous knowledge. The indigenous midwifery practices deserve a place in the mainstream healthcare system.
Reference
Battiste, M. & Henderson, J. (2000). A recognition of being, reconstructing native womanhood. Toronto: Second Story Press.
Carroll, D. & Benoit, C. (2004). Aboriginal midwifery in Canada: Merging traditional practices and modern science. McGill-Queens University Press.
Oakely, A. & Houd, S. (1990). Helper in childbirth. Midwifery Today. New York: Hemisphere Publishing Corporation
Milne, J. K. (2001). Human resources crisis in obstetrics and gynaecology. SOGC News
National Aboriginal Health Organization (NAHO) (2004). Exploring models for quality maternity care in First Nations and Inuit communities: A preliminary needs assessment. Ottawa: National Aboriginal Health Organization and First Nations and Inuit Health Branch.
Ross Leitenberger, K. A. (1998). Aboriginal midwifery and traditional birthing systems revisited and revitalized: Interviews with First Nation elders in north western region of British Columbia. Unpublished Master’s Thesis, University of Northern British Columbia.
Waldram, J. B., Herring, A. D. & Young, T. K. (2000). Aboriginal health in Canada: Historical, cultural and epidemiological perspectives. Toronto, ON: University of Toronto Press.
