Outsourcing births

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While the midwives were already working in Arviat, the town was also building a birthing centre separate from the community’s health centre. Why was the physical space of a centre such a priority?
It was important to us to make birth a time of wellness, instead of something associated with illness. We wanted to have a separate place for births outside of the overcrowded health centre, a safe space that wasn’t focused on illness. One of the most frequent comments we got from women was that they wanted to be away from the health centre. We’re affected by the same chronic health concerns that affect many other northern communities, like tuberculosis [TB] and respiratory illnesses. It’s stressful for an expecting mother to be sharing space in a small health centre that deals with all these concerns.

You mentioned family – what did the midwives mean for those relationships?
It opened a space for fathers to come in and participate if they wanted to. If you’re a woman just going to a medical checkup at the health centre, the father can’t really participate in getting tests. With the midwives, there was a recognition that fathers and husbands have a role in supporting a healthy pregnancy, and some of those ways they can support women were being talked about. If you’re talking about things like nutrition and development, prep for delivery – those are things dads can participate in. They could learn about behaviours you can expect, how you can help. The longer we had them, the more involvement there was – our hope is that birth will go back to being a family-centred celebration as opposed to an appointment in the health centre. There was more support in general because it was a more public thing, a more community event.

When mothers do fly out for care as they do again now, how do the families who stay behind cope?
It’s very stressful to have mothers gone. First, if there are other children staying home, there’s often no reliable child care available. So if a woman is going out to give birth, the father may not be able to have them go into day care –depending on the age of the child, there are waiting lists. There’s also the cost of childcare to consider – keep in mind the mother may have reduced income because of maternity leave. That just leaves family members to care for them. Dad may become Mr. Mom, and a suddenly single parent who may not have support to draw on. Because he’s caring for the kids, he can’t leave to hunt and bring in country food. That means more store food, which is expensive and not as healthy.
The mother is aware of all this when she’s sitting in Winnipeg, in a transient centre with a TV and little else to do. Moms are under considerable stress, and they have little or no money there in case they need to take a taxi for example. And it’s not always easy to communicate with the family back home – when families don’t have a telephone, some women end up phoning the radio station to try to get messages to their family via the broadcast.

Some of the prenatal and postnatal appointments obviously can’t be done in the 2 months just before birth. Who is handling them?
We’re supposed to have 7 nurses, but are usually missing some – there are 5 at the moment. It’s these nurses who are now picking up the prenatal and postnatal work. So the kind of care that prenatal moms were able to receive –education, info care, nutrition training, fitness and health, breastfeeding benefits – has been replaced by back-to-the-basics tests and iron pills.

Has this affected care for others in the community?
We have no mental health positions, so nurses also pick that up, and it’s a significant load – they have 40 clients on injectable medications and another 60 on oral medications. All our public health challenges – TB, respiratory illnesses – it all falls to the health centre. So there are no preventative measures going on, they just don’t have the time or resources. Our Home & Community Care Nurse position has also been vacant for the past four years so the health centre nurses also pick up those duties. Ideally our community health rep should be doing public health, but they get swallowed up doing things in the health centre and don’t get out on the front line a lot of the time. The same thing has happened with the maternity care worker who is still here. She may be involved with immunizations for infants, but there’s no home visiting or outreach, and in terms of infant care, [no] infant checks.