Midwife’s Notes


In Memory of Nellie Tookalak

The article was written by Nellie Tookalak and presented at a conference of Obstetricians and Gynaecologists held inMontreal, Canada.

Innulitsivik Maternity Centre, POVUNGNITUK, QU JOM IP0, CANADA)

Phone 0011 1 819 988 2428

My name is Nellie Tookalak. I am a Community Midwife working at the Innulitsivik Birthing Centre in Puvirnituq. The story I am telling you is a story about success. It is not only about personal success, but about the success of a community, the success of Inuit families reunited for birth, and in the process, finding confidence, respect, one piece of ourselves we once had lost.

Before I tell you the story of our Maternity, I will tell you a little about myself. I am married with 7 children and a grandson. I became interested in midwifery because I wanted to help women learn to care for themselves and their newborn. I started training in February 1991. I was first trained as a postnatal worker. After 6 months of work as a postnatal worker, our Maternity Coordinator offered me to become a student midwife and I accepted.

I myself have experienced labour and birth in Moose Factory, in southern Quebec, and also in my community, Puvirnituq. There were many differences for me. When I went to Moose Factory, I had to leave my husband, children and family for one or two months, which was hard on all of us. In Puvirnituq, my family helped me through labour and birth and welcomed my children into the Inuk world. In Moose Factory, when I went for prenatal visits, I was never told how I was doing. I received no teachings. During labour and birth no-one told me what to expect and I didn’t choose my own birthing position. All I was taught was how to bathe the baby the next day after birth. My first newborn was stillborn. My baby stopped moving during my pregnancy but I didn’t know what it meant. That was hard. My second labour was hard and very long with no labour support. The other births were nice and fast. I gave birth twice in Puvirnituq. In my prenatal visits I was taught about pregnancy, labour and birth. I had support during labour and I was taught how to care for myself and my newborn. I had never breast fed for long periods of time with my other babies because I knew nothing about breast feeding, but my youngest child I fed until he was five. This happened because I had the support of a Community Midwife. I am a Community Midwife now and I am proud to be working with Inuit women and families and keeping them healthy and strong.

So what is a Community Midwife? The Community Midwife is a midwife whose speciality is health teaching and preventative care for the family in the childbearing year. She is a consultant regarding any regional policies and guidelines affecting perinantal care. She is able to give prenatal and postnatal care and lead community health programs in an appropriate cultural context for her community. She is skilled in well women care and is a counsellor for family planning. She is able to recognise and screen for abnormal conditions which require consultation with a midwife or a physician. She works in a team with a midwife or physician at the time of birth. She remains a part of the health care team for each woman and baby under her care even when care has been transferred. She is a respected leader in her community.

In the 1960’s the government in Canada, in control of us, made a policy to evacuate women from their homes to give birth. People from far away in miles and in culture forced their way on us. There wasn’t any research program to see if the evacuation policy was a reasonable idea for our people. We were not consulted regarding what help our people needed, or what would help us progress in our own way.

Just imagine this: You are having a baby. A group of people with PhD’s have decided that Denmark’s perinatal statistics are better than Canada’s. They decide it will improve the medical outcome for you and your baby if you are flown to Denmark three weeks before your expected delivery date. You will remain there, without your family, until your baby is born. You arrive alone in this place where you have never been. You can’t adjust to their strange food so you eat very little for your last weeks of pregnancy. Everything is in a different language. Sometimes an interpreter is available. Your family calls after two weeks to say that your children have been taken to another relatives’. The house you know is already over-crowded. The children cry onthe phone to you and you know you can’t pay for this phone bill when you return home.

If you refuse this new plan, which has no evaluation of impact, you are considered selfish, under educated and willing to put your family’s health at risk! When you ask if this money could be used to simply improve the health care at home you are told studies need to be done first to see if it is possible. This is just a small piece of what injustice we have been put through by health care policies and policy makers.

Our community sees our Maternity as a major accomplishment in regaining our dignity. We are the leaders of our Maternity and we have the support and partnership of our professional co-workers. Our Maternity has been through many changes in the past few years. In the beginning our women used to ask their questions to the Qalunats (white people) not to us. Now women ask us the questions and they trust us. It means our self-esteem, not only personal but as a community is coming back. We are trusting our own people again. We are providing great care to our women and their families, in our cultural way, and within a provincial health care system.

We are chosen by our community to be educated as Community Midwives. Our Maternity has been open for 14 years now. Aquinisie Qumaluk has been graduated and practicing for 8 years and 4 other midwives for 4 years. A second Maternity has opened in a smaller village along the coast where two other women are studying and working preparing to be the Community Midwives. This community, Inukjuak, has been asking to have a Maternity for 8 years.

We, the Community Midwives, sit on a committee with physicians, midwives and nurses called the perinatal committee. At these meetings, protocols and guidelines regarding our perinatal services are made. We organise an individual care plan for each pregnant woman on our coast. We propose what the committee sees as the best care available for her at this time.

About the “what ifs”!! There has been almost 1,500 births at our Maternity since it’s opening. The statistics gathered have proven we are providing care that not only improved our cultural and personal lives but our perinatal mortality and morbidity rates. All this is being done 4 hours by plane away from obstetric services. Our team at Innulitsivik can and has successfully handled many complications including haemorrhages, surprise breeches and twins, and cord prolapses. These were all the scary things we were told we would die from if we stayed way up here to give birth. We have lost less babies than when we used to be evacuated south for supposed safety reasons!

When people worry about the “what ifs”; what if a baby dies, what if you need a caesarean,…? we also worry about what if we lose our culture, what if we lose our knowledge? We remember that our people had these skills traditionally. It is important that Inuit women can train on the job in their community, taking from the old and adding this to new teachings. At the Maternity we are acting as a model for this kind of learning.

Our maternity has been, and continues to be, the subject of many studies; the Royal Commission on Aboriginal People, the Birthing Centres Evaluation Project, the Projet Nord DSC CHUL, the Laval University to name some. A recent study by Susan Chatwood of the Department of Epidemiology and Biostatistics at McGill University, details the reasons for evacuation of women from our communities to give birth. We now can help other regions talk with figures and facts about unnecessary transfer of women to give birth. For instance, we always hear that a young women pregnant with her first child is too high risk to give birth in a remote setting. Such research and fear are based on the statistics of another race of people. Inuit women do not have the difficulties that medical authorities are telling us we will have. Our babies fit easily through our pelvis, so the best place for women giving birth for the first time is at home in their culture with their family’s support as they make an important transition in their life, the step into motherhood. She is best at home eating her country foods, being taught how to become a mother, being in labour with her mother, boyfriend, sisters and learning how to breast feed and care for her newborn. To begin parenting with confidence and knowledge is a way to prevent any unnecessary health and social problems.

85% of all coastal births are now happening in Puvirnituq. The other 15% of births take place in the outlying villages, or the women are flown south in the prenatal period or medivaced in labour. We have a 2.4% caesarean rate! and our perinatality statistics have improved since our Maternity opened. These are great accomplishments but we still face many challenges. Women from outlying villages are still leaving their families to give birth. STD rates are still high, many women still smoke during pregnancy. Toxoplasmosis and anaemia are still affecting our women.

We, as women, as a community, have the right to decide what to do with our bodies, with our lives. Many obstacles lie outside the doors of our

Maternity. Societies are changing. Things are getting better for us. That’s why we are here today. But people have only just begun to realise our ways deserve much respect. We, the Inuit Midwives, are asking for your support for Inuit and First Nations people to be heard. We want to decide on our own health care priorities. We want respect for our ways and our knowledge. We want families reunited for their births!