Pond Inlet elder Regilee Ootoova feels the strength of a mother’s grip as the woman lays in bed and gets ready to push. Siblings, parents, and aunts file into the next room, allowing the mother to focus on the task at hand. “Just breathe,” Ootoova tells the women, who tries to fill her lungs and release, through the intense cramping. Her body tightens and it’s time to push.
As the pressure on her spine intensifies, the mother squeezes her eyes shut. She can hear Ootoova’s voice in the background over her own wailing. Beads of sweat run down her forehead until finally, after what seems like a lifetime, the soft skin of a baby’s head appears. Ootoova is there, ready to catch the slippery newborn who greets the world with a cry for the first time. Suddenly the pain from moments before dissipates as the mother lays eyes on her child.
After the baby is securely cradled inside her arms, her relatives return, ready to welcome the newest member of their family. Ootoova says she can almost feel the love in the room each time someone leans toward the tiny human. The love is obvious through the smiles on everyone’s faces and the way they gawk at the newborn in adoration.
For several years, Ootoova was the go-to Ikajurti (translates to the helper or midwife) in and around Pond Inlet. If asked, she would be there when the water broke, preparing and doing what she could to calm the parent before bringing in a new life. Before the mid-1960s, Nunavummiut often gave birth at their own house, or sometimes on the land where the news of labour spread quickly and sisters, grandmothers, mothers and friends would rush to the pregnant person’s side. They took turns rubbing her back, walking with, and supporting her. And then when it came time to push, these women would watch the midwife to learn how it was done. For many, it was spiritual and brought villages of people even closer together.
But when settlers pushed Northerners to give birth elsewhere, as early as in 1892 and more forcefully later on, it left a hole in the community. Nunavummiut had to fly to Iqaluit or Ottawa, just as others in the NWT and Yukon left for capital cities or further south. Today, advocates are calling on governments to bring midwives and doulas back to revive the tradition. Despite the continuing staff shortages as well as a lack of training programs and consistent government commitment, Northern parents have shown they would rather give birth with a midwife at their side than in a lonely hospital room down south.
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As airplanes became more accessible between the 1960s and the ’80s, the federal government made the existent birth evacuation program mandatory. At about 36 weeks pregnant, Northerners outside of the capital cities were ushered onto airplanes and put up in boarding houses for a month, surrounded by other expectant parents who were far from home and the language they grew up with. “The nurses and government didn’t ask midwives what they thought about sending pregnant women away to Iqaluit to have babies,” says Ootoova. “They just did it without us knowing. It hurts that this is what happened to our people.”
At the time, the federal government said sending families south was safer and would reduce the rate of infant mortalities. In 1981 that rate was at 12.7 per 1,000 live births in the NWT (then including Nunavut) and was 9.6 in the rest of Canada. By 2020, there were nine deaths per 1,000 in the NWT, and 4.5 in Canada overall. A 2022 International Journal of Circumpolar Health study cites a lack of Indigenous health professionals, limited infrastructure and poor and crowded housing as some of the contributing factors.
Although midwifery is a regulated industry across the North—beginning in the NWT by 2005, 2011 in Nunavut and 2021 in the Yukon—the evacuation program continues today for labour as well as ultrasounds and other prenatal appointments in most northern places. But rather than investing in those communities and sharing knowledge, the current health care system spends more than $10,000 to fly each family to give birth in other hospitals. And after the travel subsidy, a family in the Yukon is likely to spend about $2,200 of their own funds while they are away.
The evacuation program doesn’t just come at a financial cost to parents or the government. It affects the entire community. “It’s taking birth out of the community and exiling pregnant women to be in another place, to have their baby elsewhere and then come back,” says Fort Smith-based midwife Lesley Paulette. “It just leaves death in the community…lots of funerals, but no births.”
In the early 2000s, that was not the case for families in Rankin Inlet, where Cas Augaarjuk Connelly and Rachel Qiliqti Kaludjak made history as the first registered Inuit midwives. Connelly and Kaludjak had been working at the Rankin Inlet health centre since 2008 and 2003, respectively, where they could be seen milling between the two blue trimmed birthing rooms, helping new parents track their pregnancy or offering advice before the due date arrived. They kept parents calm in either English or Inuktut when labour finally came and offered up the inflatable birthing pool if necessary. Connelly and Kaludjak were well trusted in the community, seeing up to 10 clients a day and helping deliver an average of 50 babies a year.
But Connelly and Kaludjak told news sources that after years of facing burnout, mistreatment and racism from territorial government officials and southern health workers they quit in 2020. While they had previously worked with two other full-time midwives, the Inuit women ran the centre by themselves for their last six years. Meanwhile, when southern birth workers flew up, the local midwives wasted valuable time orienting new staff who would leave just weeks later and then repeat the cycle as new employees arrived.
Despite Connelly and Kaludjak’s knowledge, Department of Health staff turned to the southern non-Inuit staff when they had questions. Kaludjak had been acting manager of the birthing centre for three years, but when the position officially came up, she was turned down for the role and was told to train the replacement. Yet the position remained unfilled. By 2020, the Government of Nunavut halted services in Rankin Inlet, not too long after Cambridge Bay’s midwifery program shut down for lack of staff.
Staff shortages is a national concern, as even the new midwifery centre in Whitehorse limited services after just six months. The facility had opened in July 2022 on Quartz Road. Filled with plants throughout most rooms, a lending library and fruit and tea on hand, it was designed to be a comforting space that integrated midwifery into the Yukon health care system. At first it offered just prenatal care, but by November, the team was ready to start “catching” babies.
In January, however, the centre announced that they would not be able to offer midwife-led births for the time being. The move comes down to a lack of staff to help run the facility. “When you only have two or three midwives in the community, all you need is for someone to be doing something, like a parental leave and someone gets sick,” says Yellowknife-based midwife Heather Heinrichs. “Suddenly, you can’t offer the same services.”
The Yukon government is continuing with an intensive recruitment campaign to hire additional midwives, but it remains a challenge, as it does in the NWT and Nunavut. One of the reasons behind this struggle is limited access to training. Nunavik has been a leader when it comes to its successful program teaching locals, but others haven’t been so lucky. Nunavut Arctic College ran a midwifery program in 2006, but lost funding in 2014, after a total of four students graduated from the program. Its low attendance is partially due to students being unable to travel far from home to shadow other midwives as part of their training. Even elsewhere in Canada, it’s difficult to obtain a midwifery degree. There are only six programs across the country, and each one takes on around 20 to 30 students a year—that makes for stiff competition between northern and southern students.
In the meantime, northern parents nearing the end of their pregnancy must pack their bags and head elsewhere for a month. If they already have children at home, that means finding someone to look after them. One escort can come along with an expectant mother for labour, but their accompaniment is not financially covered for appointments such as getting an ultrasound. That means the partner misses some monumental moments, like hearing the baby’s heartbeat for the first time.
Not having an escort means taking trips and navigating a new city alone, which can take a toll on a pregnant person, emotionally and physically. “One of the main risks associated with being displaced is stress, mental health concerns, loneliness,” says Sabrina Flack, project director for the Northern Birthwork Collective. “The impact of stress can end up causing further issues in pregnancy.”
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Flack spent much of her time as a teenager hanging out at her friend’s place. One day, her friend’s mother went into labour and asked the two 15-year-olds to come along to the hospital. Flack says much of the experience passed by in a blur as she watched her friend’s mother pushing through, until shortly into the labour, the doctor announced the baby was nearly there. “I jumped into full view and screamed, ‘Baby!’” Flack says, causing the mother to laugh once the pain was over. Soon, a tiny human was placed into the mother’s arms for the first time, showing Flack what a miracle birth can be. “I think seeing an experience like that made me not afraid of the birthing process from a young age… It was really special.”
Ten years later, while studying at the Institute of Holistic Nutrition in Toronto, Flack realized she wanted to switch her career path to birth work after studying reproductive health and nutrition during pregnancy and early childhood. She attended doula training in 2019 and then took an online doula program after moving to Yellowknife in January 2020. “I’ve just become more and more passionate the more I work.”
Flack and Degha Scott cofounded the Northern Birthwork Collective to advocate for midwives and the services they provide, while showing how it could take the burden off the general health care system. Because midwives do more than just supporting parents pre and post pregnancy; they also provide sexual health care, including Pap smears, and can administer abortions. “There’s a lot of stuff that folks in communities shouldn’t have to come all the way to Yellowknife for if there was more comprehensive care close to home,” says Flack. “This would also decrease the cost of medical travel.”
Plus, it would mean getting more aftercare if parents didn’t have to travel for it. Those heading south get a check-up 24 hours after birth and again a few days later. Then after a week or so, they are sent on a plane back home. At the Nunavik health care centres, however, doulas and midwives provide new parents with visits on the first, second, third and seventh day after birth, and again two, four and six weeks later. “There is a lot more follow up care in their language and in their community,” says Arian Navickas, a midwife with Inuulitsivik Health Centre in Nunavik.
That extra care can be essential in smaller remote communities, where knowledge about birthing, nutrition and healthcare isn’t always accessible. Just ask Melina Livermore, a doula based in Taloyoak, Nunavut. As the only doula for the region, she often spends her time on phone calls or video chats helping teach and support new parents. “Pregnancy, sex and breastfeeding are some things that just don't get talked about as often as I think that they should,” says Livermore, who is also breast feeding specialist. When parents are too embarrassed to ask for help with things like latching, they choose formula instead—which can cost up to $80 in Taloyoak. “There is definitely a lot of hesitation and still a lot of controversy and just a lack of support in terms of breastfeeding, in my community specifically.”
When it comes to child-rearing, there is much work to do before many Northerners can feel comfortable discussing their own autonomy. But the topic of midwifery is one that locals have gladly spoken up for, even before it was a registered industry.
When Paulette first arrived in Fort Smith in the 1980s, no formal midwifery program existed until she and another midwife, Gisela Becker, got to work around 2000. They were able to get support from Michael Miltenberger, the Minister of Health at the time, because he was from Fort Smith and understood the demand for birth workers. The process got fast-tracked, but there still much more to do when it came to educating people about what midwifery was. “A lot of people,” says Paulette, “had preconceived notions about it and had their own ideas about how it should be limited and controlled.”
She and Becker went from one meeting to the next, explaining what midwifery really is to politicians, health professionals and the public. Many professionals were hesitant, believing the role was entirely based on holistic healing. They didn’t understand that today, it’s a combination of tradition and modern science. Luckily, the public seemed to have a better understanding and more than half of childbearing families in Fort Smith were turning to midwifery care outside of the health centre. During public meetings, residents stood up, expressing their support for bringing back an integral part of birth in Indigenous communities.
The public opinion around midwifery has only grown since and is recognized by most Northerners as a legitimate industry. According to a 2019 Yukon study, What We Heard, 76 per cent of participants wanted midwifery services in their community, while only seven per cent said they were not interested in those services at all.
Midwifery officially became regulated in the NWT in 2005, when Paulette and Becker began working at the Fort Smith Health Centre. Between then and 2011, 244 birthing parents out of 264 turned to midwifery services in Fort Smith. Most communities still regularly send parents elsewhere to give birth, but Paulette and Becker’s work opened doors for other midwives to help the industry flourish.
“Go ask Lesley!” was the response Heinrichs and Toni Fehr consistently heard upon starting a similar program in Hay River. The two Winnipeg-born birth workers had each moved to the NWT in 2014 after the territorial government recruited them to bring midwifery back into the community. Over six months, the women learned everything from accessing medical records to learning how to call a medavac. After the program launched in February 2015, local families could access ultrasounds, screenings for medical concerns, education on sexual health and birth workers to help deliver babies. Heinrichs thanks Paulette and Becker for helping them get the program off the ground and integrating midwifery into the health system. Paulette “really led the way and helped set up the framework for other midwives to come and start offering care here.”
Midwifery has had an easier time growing in Nunavik, where the programs are considered the most successful in Canada. Students can obtain training and experience from within the centres by northern and southern health workers who teach a blend of modern science and traditional knowledge. Plus, students get paid for their training, giving them an incentive to work in the field.
Because patients receive optimal healthcare while getting treatment from people they know and who understand where they’re coming from, about 85 per cent of people in Nunavik give birth in a local community, while the other 15 per cent go to Montreal for higher risk pregnancies. “The big thing we really pushed is that we want [southern workers] to come up and teach us how to become midwives, but not to take over and make this their own,” says Navickas. “There is a component every year where we have elders talk to the students and the midwives about traditional practises.”
While there is no official program in the NWT, the Northern Birthwork Collective is creating the curriculum for Indigenous birthwork training. It does not replace having an official midwifery degree, but it’s a step to getting people into the field. Paulette and Heinrichs are helping design the curriculum with the hope that it can be a pre-requisite to a formal education in midwifery.
Flack says the program can revitalize tradition while helping individuals understand how colonial practices have impacted traditional knowledge. “There is a lot of anti-Indigenous racism within the healthcare system and so [the program will make sure] that health workers are trained to support people moving through a system that inherently harms them.”
In Pond Inlet, Ootoova is bringing birth back into the community with a series of courses, ranging from childbirth to sewing. As the elder on staff, she teaches nutrition, childcare and ways to integrate Inuit tradition into the birthing process. It’s a way to share all aspects of Inuit traditional life and to pass down her knowledge about midwifery to the next generation.
It may be some time before the North establishes a pan-territorial midwifery program, but the work is getting done. Advocates push on to revive the tradition and the miracle that comes with giving birth. As Ootoova says, “It’s best if we talk about this and start planning to have midwifery in our community before we die, so we can pass on this knowledge.”
