Part 2:  Sexual and Reproductive Health Issues of Concern to Aboriginal People

Be sure to read Part 1 before working on this unit. See these other units for more issues related to birth:

Unit 5 — Teen Pregnancy
Unit 6 — Women and Sexual Health
Unit 8 — Birth Control and Pregnancy Options
Unit 9 — Healthy Pregnancies
Unit 15 — Family Violence

Introduction

Birth is a most sacred event, as the spirit of the new child enters the world. First Nations, Inuit and Métis women deserve a safe, secure environment, the support and caring of their families and communities, and the competent care of service providers as they prepare for and give birth, and care for their new infants.

Midwifery and Birthing Centres

Many Aboriginal women still have to leave their communities to give birth in safe conditions. Unfortunately, even well-equipped local heath centres can’t always provide birthing care because they don’t have enough midwives, nurses and doctors. When births used to take place in the community or on the land, the woman’s husband, parents and in-laws often played important roles in the birthing process. Today, these roles have been overtaken by medical staff working in far away centres.

Many of us are working in our communities and nations to identify and reclaim traditions and beliefs about birth, to bring the birthing process back closer to the community, and to make it more culture-based. Gaining control over pregnancy care, birth and infant care is an important part of building strong families, communities and nations.

The birth of one of Anne’s children did not begin until she returned home from the hospital. Elders, and members of her extended family brought comfort to Anne with familiar Anishnawbe humour. They reassured and encouraged her to allow the natural process of childbirth to occur in its own time. There was no pain. A moss bag was ready for the baby’s arrival, and the mother was immediately given a broth of salmon or white fish to begin the lactation process.1 (click here for footnote)

Better Birth Experiences for Aboriginal Families

Below are some key issues to address and ways that health care providers and others can support Aboriginal women during the birth of their children.

Prenatal Care

Pregnancy is not an illness. It is a natural process that, in most cases, does not present a risk to either mother or child. However, living as healthy a life as possible during pregnancy will benefit both mother and child when the time of birth arrives.

Healthy eating will help your baby have a healthy birth weight. Exercise will keep get your muscles ready for labour — it’s hard work to deliver a baby!

Traditionally, pregnant and nursing mothers led a healthy lifestyle with lots of physical activity and a nutritious diet. Keeping active was seen as essential to promoting quick labours and ensuring the placenta did not stick to the womb ... Women were encouraged to eat a variety of foods, especially cariboo, char, muktuk, and seal, but they were advised not to eat too many berries and never to eat aged food while pregnant.

No one was sheltered from birthing knowledge. Children and young adults gained experience from watching, and men often assisted their wives. The entire family was involved more actively in the events surrounding pregnancy and birth than is the case today.2  (click here for footnote)

Communities can work to have trained midwives and local birthing centres so that prenatal care, birth and postnatal care can happen close to family and friends. Growing general interest in midwifery and a rethinking about the role of traditional Aboriginal midwives are resulting in a new model for prenatal and birthing care in Aboriginal communities. The model blends ancient traditions and modern midwifery knowledge and techniques, allowing women to bring childbirth back to their communities.

Today more and more Aboriginal communities have access to a maternity program or birthing centre providing trained midwives. Here are a few examples:

The movement to restore access to Aboriginal midwifery services and other community support for pregnant women and their families is growing across Canada. For example, a well-established community-based birthing program exists in Rankin Inlet, and Aboriginal women in British Columbia are working with the College of Midwives of B.C. to increase access. The blend of ancient traditions with the best of modern midwifery practices offers promise for Aboriginal women and their families.

It is such a gift to be able to help each other to ease the pain associated with birth and help make labour much easier.⁶ (click here for footnote)

Pilot coordinator Katsi says: I was born in the big white iron bed my paternal grandmother, Elizabeth Kanatires (She Leads the Village) Herne Cook used to deliver many of the babies in my generation at Akwesasne. She learned her midwifery skills while assisting her mother, Millie Kanaratiostha Gareau Herne who was also a midwife. What a model of continuity of care that I continue to deliver the children of children whose parents were delivered by my grandmother!

My grandmothers passed on to me a rich heritage of midwifery. From them I learned the use of sacred plants, prayers, the disciplines of the home, the power of dreams, and the strength of the spirit of the individual and of the family. I am lucky to be part of a generation that grew from people who survived many hardships with strength, dignity, common sense and humour. Katsi Cook, Iewirokwas Midwifery Program, Akwesasne, New York, USA

Until local midwifery services and birthing centres are more widely available, community services can offer support to families while the mother is away having a baby. This will make it easier for her to leave, and will provide a proper welcome home when she returns.

Traditionally, a large circle of family members supported the pregnant woman and were around to help and advise before, during and after birth.

Today, family support is often harder to come by, with family members living in different places and family problems affecting the ability to care for one another. Community services can work to encourage and strengthen family ties, provide services in ways that welcome fathers and support their involvement in the birth process, and offer programs such as support groups and buddy systems to provide support to pregnant women and new mothers.

Breastfeeding

Breastfeeding brings many benefits to baby and mother. Your breast milk is the best food you can give to your newborn child. It may not be easy at first, but most women can successfully breastfeed their children with the help and encouragement of their health care providers, family and friends.

The midwives teach the women about good nutrition, parenting after giving birth and breastfeeding. In many cases, they successfully encourage women to breastfeed even if their newborn babies are going to be adopted. When women learn the critical role of breastfeeding in developing the immune system, they are happy to breastfeed the  babies ...7 (click here for footnote)

There are many traditional practices that can help Aboriginal women care for their newborn babies. Health care providers, midwives and the Elder women teach the younger women what these traditions are, and why they benefit both mother and child.

Providers of maternity care need to be aware of the possible effects of childhood sexual abuse on a woman during her pregnancy and childbirth. Some women fear being touched or examined. Some suffer traumatic flashbacks of their childhood abuse during childbirth. Such responses interfere with the birth and with a healthy relationship between the mother and caregiver. It is important for providers of childbirth services to learn the signs of childhood sexual abuse and how to care for pregnant Aboriginal women who have experienced sexual violence.⁸ (click here for footnote)

As Aboriginal women and health care providers, we must also be prepared to confront racism in health services associated with childbirth.

¹  Aboriginal Women’s Health Conference Bibliography, Native Physicians Association in Canada, Ottawa, 1994, p. 33.  (back to paragraph)

²  "Special Report on Traditional Midwifery," Suvaguug, X(1) (1995): 8, Pauktuutit Inuit Women’s Association, Ottawa.   (back to paragraph)

³  Based on "Aboriginal Midwifery in Canada: Blending Traditional and Modern Forms," CWHN Network (Summer 2001): 6.   (back to paragraph)

⁴  A Guide for Health Professionals Working with Aboriginal Peoples, Janet Smylie, Society of Obstetricians and Gynaecologists of Canada, Ottawa, 2001, p. 47.  (back to paragraph)

⁵  "Aboriginal Midwifery in Canada: Blending Traditional and Modern Forms," p. 7.  (back to paragraph)

⁶  Can I Have Something for the Pain, NIICHRO Training Session, National Indian and Inuit Community Health Representatives Organization, Kahnawake, Québec, no date. Available at: www.niichro.com/Healthteachings/ht_4.html  (back to paragraph)

⁷  Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapirisat of Canada, Ottawa, 2000, p. 37  (back to paragraph)

⁸  Childhood Sexual Abuse and its Effects on Childbirth, Regine Spindler, no date. Available at: www.gentlebirth.org/archives/abusepaper.html  (back to paragraph)