Birth on the Land: Memories of Inuit Elders and Traditional Midwives

By Beverley O'Brien

In Birth on the Land, Elders and traditional midwives from ten Nunavut communities share memories of traditional birth.
They share how they sometimes laboured and birthed quietly and alone, while other times they were surrounded by the love and support of their family or community. They describe, and even demonstrate, what they did to facilitate an easy birth and give newborns the best possible start in life.
The Elders and traditional midwives also share memories about the transition from giving birth in igluit or tents to having to do so in the company of strangers in institutions introduced by southern colonizers. They remember a time when pregnancy, birth, and death were accepted
as a part of life, and when Elders, rather than southern caregivers, were the sources of wisdom and authority.
Birth on the Land reintroduces contemporary readers to the time-honoured midwifery practices that were used in Nunavut for generations, and provides invaluable insight for caregivers in contemporary Nunavut about caring for pregnant women and giving birth the "Inuit way."

An English / Inuktitut tumble.

• Language: English
• Publisher: Nunavut Arctic College
• Release date: Jun 11, 2024
• ISBN: 9781897568927

Book preview

Cover: Birth on the Land: Memories of Inuit Elders and Traditional Midwives by Beverley O’Brien.

Description

A photograph of a greenish stone sculpture showing the pregnant belly of a woman with her hands on her thighs, and the head of a baby emerging between her legs. Two arms wrap around the belly from behind. A face is visible in the top-right corner of the image.

Birth on the Land

Memories of Inuit Elders and Traditional Midwives

Birth on the Land

Memories of Inuit Elders and Traditional Midwives

by

Beverley O’Brien

Published in Canada by Nunavut Arctic College.

www.nacmedia.ca

Box 600, Iqaluit, nu, x0a 0h0

Text copyright © June 2012 Nunavut Arctic College

Design and layout by Inhabit Education © June 2012 Nunavut Arctic College Media

Cover photo © Beverley O’Brien

Cover Artwork: Photo of Birthing Scene by artist Elijah Michael. Used by permission of the artist’s estate.

Isbn: 978-1-897568-10-1

Publishing services provided by Inhabit Education

All rights reserved. The use of any part of this publication reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, or stored in a retrievable system, without written consent of the publisher, is an infringement of copyright law.

We would like to acknowledge the generous financial support of the Department of Health & Social Services for this publication. We would also like to thank the Faculty of Nursing, University of Alberta, for lending their academic support and expertise to this publication.

Logo: Nunavut Arctic College Media. Logo: Faculty of Nursing University of Alberta.

Contents

Map of Nunavut

Introduction

Chapter One

Memories of Life on the Land

Transition from life on the land

Large families with many losses

Chapter Two

Memories of Being Pregnant on the Land

Sources of prenatal knowledge

Diagnosis of pregnancy

Activity

Maternal behaviours

Symptoms of pregnancy

Nutrition and diet

Chapter Three

Memories of Birth on the Land

Birth setting on the land

Maternal age at first birth

Role of birth attendants

Role of women

Role of men

Role of children

Labour

Birth position

Fundal pressure

Pain management

After-birth care

Vaginal lacerations

Complicated births

Concepts of birth control on the land

Acceptance

Chapter Four

Memories of the Transition from Birth on the Land to Institutional Birth

Chapter Five

Memories of Caring for Babies and Children on the Land

Memories of caring for babies on the land

Maternal nutrition

Maternal complications following birth

Memories of naming a new member of the community

Nurturing the baby

Packing newborns and the function of the amauti

Chapter Six

Memories of Adoption on the Land

Chapter Seven

Sharing Memories with Contemporary Midwifery Students

Advice for midwifery education

Collaborating with the midwives to share wisdom

Continuity of care and preparation for birth

Teaching new midwives to protect the privacy of birthing women

Ability to assist in births on the land and away from communities

Summary

Contributing Elders and traditional midwives

Acknowledgements

References

A black and white map of Nunavut. Various place names are featured, including Victoria, Ellesmere, Devon, and Baffin islands. Northern Canada and part of Greenland are also visible.

Introduction

As a nurse practitioner in the early 1980s in what is now Nunavut, I encountered a traditional midwife for the first time. A young woman in active labour had been admitted to the nursing station during the night. An elderly woman stopped by to be with her, and she indicated the position of the baby to me with her hands. I don’t remember if she said anything, or even if we spoke the same language, but I could see that she was a caring and knowledgeable person who was there to support the young woman. By that time, these traditional midwives—who learned to be there for birthing women by carefully observing the practices of the generations that came before them—were quickly becoming invisible.

More and more, young women were obliged to give birth in these small nursing stations staffed with foreign health care providers, isolated from those who had traditionally provided support and comfort. The first hospital in Nunavut was established by the Anglican Mission in Pangnirtung in 1930 and officially closed in 1974. Within a short period of time, birth was further institutionalized, with almost all women being evacuated from community-based nursing stations to either Iqaluit or Yellowknife, depending on the region they called home. The only hospital remaining in Nunavut was located in Iqaluit. In fact, by 1980 it was reported that up to 98% of all Inuit women were required to leave their communities to give birth (Douglas 2006).

Years later, it was still the norm for babies to be born in institutions far away from their communities on the land. It was increasingly rare for Inuit women to labour and give birth outside of large urban centres (specifically Yellowknife, Montreal, Ottawa, Winnipeg, and Edmonton). By 2006, more than 80% of women in Nunavut needed to travel more than 100 km to give birth, sometimes leaving their families and the familiar Inuit lifestyle behind for weeks (Public Health Agency of Canada 2009). It is important to note that air travel in the North and accommodation in the south are far too expensive for most birthing families to consider relocating to await labour and birth, so women travel alone and must adapt to a sometimes unfamiliar environment for this important and transformative event.

Pregnancy and birth are normal and expected ways of being for young women in many cultures—a part of living, rather than a tumultuous event that can only take place within a tightly controlled and sterile environment. Removal of birth from the communities had, and continues to have, a profound effect on all aspects of community life.

Globally, the midwifery model is intended to provide continuous and holistic care to birthing families. Cornerstones of midwifery include the promotion of normal birth, partnership with birthing families, and the availability of informed choice, including the choice of where to give birth (ICM 2011). A holistic model of midwifery, rooted in Inuit values and beliefs, with access to the best available evidence that can be utilized within their culture, was proposed by the Government of Nunavut (GN) as an approach to supporting Inuit in their desire to reclaim birth within their communities. The GN, in partnership with Nunavut Arctic College (NAC), implemented a program to prepare maternity care workers and midwives in Nunavut to support women during pregnancy, birth, and new parenthood in a manner that respects and utilizes cultural values and knowledge, while meeting high Canadian maternity care standards.

A black and white photograph of three women sitting at a table, smiling. There are various objects on the table, including papers, surgical supplies, and a baby doll. Behind them are chairs and posters on the wall.

Maternity Care Worker/Midwifery Education students practise suturing.

A Maternity Care Worker (MCW)/Midwifery Education Program for residents of Nunavut was implemented in 2005. The program rotates to communities throughout the three regions of Nunavut and so far has been, or is being, conducted in Rankin Inlet, Iqaluit, and Cambridge Bay. Further, the program is multilayered, meaning that students are awarded a Maternity Care Worker (MCW) certificate from NAC when they complete the first stage. They may then choose to work in their community as an MCW or enrol in the Midwifery Education Program. They are awarded a midwifery diploma from NAC when they complete the second stage. After receiving their midwifery diploma, they are also eligible to write the Canadian Midwifery Regulatory Exam (CMRE). Further, students who are awarded a midwifery diploma may choose to continue to the next stage, in which they earn a degree in Health Sciences from Laurentian University. Laurentian University offers many courses via virtual classrooms and independent study, so students who wish to do so may continue to work part-time in their communities while earning a degree.

A black and white photograph. An older woman stands on the left, wearing glasses and a light-coloured top. To the right is a younger woman who wears a light-coloured embroidered top and a graduation cap.

One of the first MCW graduates.

Graduates from the MCW program are currently practising in Iqaluit, Rankin Inlet, and Arviat, while the first two Inuit midwifery graduates (2010) are practising in Rankin Inlet. Three more students completed the MCW program in 2012 and are currently enrolled in the Midwifery Education Program at the Cambridge Bay site. Obviously, to inform the MCW and Midwifery Education Program, it is critical that traditional midwives and Elders who have experience with birth on the land be asked to participate and share their knowledge. It is essential, and equally important, that all maternity care providers, especially midwives in Nunavut (both Inuit and non-Inuit), recognize the profound contribution that these traditional midwives and Elders have made, and continue to make, to the well-being of birthing families in Nunavut.

I had the privilege of taking part in conversations with Elders and traditional midwives throughout Nunavut during several visits in late 2010 and 2011. The purpose of these conversations was to gain insight about their memories of birth on the land, and to understand the impact that the transition to institutionalized birth has had on their culture. Most of the conversations took place in the homes of the Elders, and all but four were conducted with the help of translators in either Inuktitut or Inuinnaqtun. The translators included community activists and health care workers who were personally known to the Elders and traditional midwives.

The first conversation was with two traditional midwives from Arctic Bay, and took place over two days at Nunavut Arctic College in Iqaluit. The second conversation was with one midwife and took place in her home in Kinngait over two consecutive afternoons. Both of these conversations were conducted in Inuktitut by an Inuit community activist and translated into English as they took place. They provided a background for conversations that followed with Elders and traditional midwives from Cambridge Bay, Bathurst Inlet, Taloyoak, Rankin Inlet, Whale Cove, Arviat, and Iqaluit. In addition, a conversation was conducted with a group of three midwives from Pangnirtung. Each of these conversations lasted about one to one and a half hours. All conversations were audio recorded and the English translations were transcribed verbatim for this work. Audio conversations in traditional languages have been retained and will be made available. Photographs were taken to further illustrate the work of those who met with us.

The protocol used for the creation of this book was approved by the Nunavut Research Institute and the Health Review Ethics Board (Panel B), University of Alberta. Honouring and recognizing the contributions of the Elders, traditional midwives, and community activists, while understanding the need to respect their confidentiality, was an important consideration in preparing this book. For this reason, I will acknowledge all contributors, but hold confidential their names when using specific quotes verbatim. It is the memories of these Inuit Elders, traditional midwives, and community activists that generated the themes for this book. It should be noted that the memories recorded here are only snapshots from a particular time in the life of each person who shared them with me. This book is not intended to be a comprehensive review of all maternity care practices in the ever-changing history of Nunavut.

A Note on Language

Out of respect for the Inuktitut language, this book uses proper Inuktitut pluralization for Inuktitut words, inluding the use of singular, dual, and plural nouns.

Chapter One

Memories of Life on the Land

Living in an iglu was the most memorable because that was a shelter for us to live in, to sleep in, to eat in, [and] to celebrate [special times] … with family and friends who came to our community or the little village we lived in. In the igluit we lived in we had … a woman’s lamp, an oil lamp [a qulliq]. We made tea out of the kettle on the oil lamp … then on top of that my grandfather made a makeshift stove and then we would gather wood around the lamp … Being in the iglu, it was like it was something real that was an experience that I have … I think my grandmother and grandfather would travel a lot from … different parts and places; like up and away from the water, up to the land, where there are only lakes. So we [would go] hunting for muskox and whatever we can find on the land … my grandfather hunted seals in the ocean in the summer and caribou, muskox, and wolverines and moles, or [trapped] white foxes