Outsourcing births

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Publication Date: 
Thu, 2011-03-31

The Network speaks with health advocate Shirley Tagalik about why her northern town is fighting to bring maternity care back to their community

By Signy Gerrard

One year after the high-profile announcement of the Canadian Government’s Maternal Health Initiative, Nunavut health activist, education advocate, and mother Shirley Tagalik wonders when maternity in her community will become a priority again.

Tagalik lives in Arviat, a community of close to 3,000 in Nunavut that is consistently home to Canada’s highest birthrate. Approximately 70 Arviat women give birth each year – but none of them in Arviat itself. Instead, when women reach their final weeks of pregnancy, they pack a bag and get on a plane, to be flown to a larger centre such as Winnipeg or Rankin Inlet and spend the remainder of their pregnancy waiting to give birth in a hospital. These flights are part of northern Canada’s boarding-out medical system, and even for a low-risk delivery, can cost the health system $12,000 and have a new mother spend a month or more away from her home and family.

For a brief period in 2008, however, Arviat hoped that many of these flights might no longer be needed. For a few months, they had a birthing centre under construction, two midwives working, and for the first time in years, three babies born in their town.

These births came after years of hoping and agitating by the town. They first formed a local health committee back in the 1980s to take on the task of lobbying the Northern Medical Unit for a birth centre that would allow pregnant women to remain in the community. When the Nunavut government made local births a priority and began a pilot birthing centre program in Rankin Inlet, they lobbied to make their town home to one of the next Centres. Two decades later, federal funding was finally made available in 2005 and 2006 for Nunavut Arctic College to train midwives and maternity care workers, and for the creation of some new positions in Arviat. One maternity care worker was trained, and funding to renovate their old health centre into a birthing facility was allocated in 2006 - 2007. Two midwives were hired from the south, and along with the local maternity care worker, got to work in the health centre while they waited for the birthing centre construction to finish.

But with prenatal and postnatal care for the 45 women pregnant at any one time in Arviat, births, and community work, all in a cramped shared space, the two midwives quickly found themselves burning out. Even with the support of a maternity care worker, they felt the number of clients they had required a third or even fourth midwife. When more were not hired, one eventually resigned, and the second followed suit shortly after. Instead of restaffing in Arviat, the midwife positions were relocated to Rankin Inlet. Arviat is now served by occasional midwife visits and the remaining maternity care worker. The town’s nurses have taken back all the prenatal care, with the maternity care worker providing assistance with basic procedures and tests like weighing. Renovations to the birthing centre have ceased and the incomplete building sits mostly empty.

We spoke with Shirley Tagalik about what this closing has meant for maternity care, health care, and the community as a whole.

Network: What was it that the midwives brought to Arviat?
Tagalik: From the health committee’s perspective, the midwives were able to give really comprehensive services. It wasn’t just birth, it was care before and after. It was nutrition, prepping women for breastfeeding, yoga, a chance to talk about stress management, if you had other children talking about how to involve and prep them for the new baby. And there was follow up care – even for those who gave birth in the south, they did home visiting, created networking groups for mothers to share and support each other. A recent outbreak of RSV/pneumonia in our community meant that about 30 babies were sent out to hospitals in the south with one death occurring. Had there been post-natal follow-up home visits happening in the community as should happen with midwifery services, the community strongly believes that the extent of this illness could have been reduced. There were all the things you want to see out of a public health approach. wellness issues instead of making birth into a medical illness. There’s been a real separation of birth from family and community and we wanted to change that.

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