Prepared as a background document for
The State of the World’s Midwifery 2011
- launched June 2011
Disclaimer: While all efforts have been made to verify the information in this document,responsibility for the contents and presentation rest with the author(s).The views and opinions expressed in the document do not necessarily correspond with those of the State of the World’s Midwifery 2011 Editorial Committee.
Midwifery-led perinatal services on the Hudson Bay Coast, Nunavik
The remote region of the Hudson Bay Coast, Nunavik in northern Quebec has beenproviding complete midwifery-led perinatal services and a community-based midwiferyeducation programme for local women since 1986. Bringing birth and the commonknowledge associated with maternal and child care back to the region was a community-initiated endeavour in response to the evacuation policies implemented in the 1970s in manynorthern and remote regions of Canada. This policy of sending women south for months at atime to give birth resulted in health, social, cultural and financial difficulties for the affectedfamilies that are now well documented. Additionally, women began to lose confidence inthemselves and in the birth process, and many of the cultural values, traditional knowledgeand meaning related to birth and childcare were also in danger of being lost. The people of this region decided to take matters into their own hands, and since the programme’sintroduction, communities have remained pre-eminent in the orientation and operation of their maternity services.Three midwifery-run maternities now serve the seven villages along the coast, coveringapproximately 5,500 Inuit and 200 births a year. Theirs is a young population, with nearly 50percent of the population and 25 percent of the birth mothers under the age of 20. Flyingtime to the nearest tertiary hospital is approximately six to eight hours, if weather conditionspermit. Midwives and midwifery students provide complete pre-, peri- and postnatal carefrom conception to six weeks postpartum to all women on the coast, regardless of medical or social status. They also provide well-woman and well-baby care to the population of their villages. All care takes place in Inuktitut, the local language. There are currently 10 locallyeducated, fully licensed Inuit midwives and 11 students in the region. Southern ‘Quallunak'registered midwives rotate their time, contribute to formal training, and support and mentor the students. The midwives work closely in the villages with nurses, doctors, social workersand community health workers in the areas of primary care and public health education. Thematernities are funded by and considered integrated into the provincial health care system,and the midwives are paid by the Quebec Ministry of Health. Students, who providecomplete primary care from day one of their training, are also paid, partially from the HealthMinistry and partially from a grant from the regional board of education.Midwifery training takes place on the job and is tailored to the social and learning needs of each student. The curriculum is similar in content and competencies to that of other midwifery programmes in Canada, and adapted to northern practice realities. As such, thereis increased emphasis on community health and education, emergency care, and theintegration of traditional and modern skills and knowledge.In 2008, the Order of Quebec Midwives together with the Quebec Ministry of Health formallyrecognized the Inuulitsivik Midwifery Education Programme. Graduates now receive fulllicence privileges along with graduates from the midwifery programme at the Université duQuébec à Trois Rivières. This is perhaps the first time anywhere in the world that traditionalpathways to learning midwifery have been recognized alongside those gained through auniversity education.Inuulitsivik maternities were the subject of several studies from 1989 to 2009. These studiesconsistently showed a decrease in perinatal mortality rates, prematurity and interventionrates with very high satisfaction among the women and families. The most recent studylooked at 1,388 births retrospectively and found that 85 percent of pregnant women gavebirth in the region and perinatal outcomes were comparable to those in southern regions of Quebec and other parts of Canada. Intervention rates were much lower, including a