“Lost births,” service delivery, and human resources to health

Abstract

Purpose The purpose of this paper is to advocate for improved service delivery of maternal-newborn care in northern Indigenous communities. This is done through critical examination of the loss of pregnancy and birthing knowledge and practice in these communities, from both a historical and contemporary lens. Supporting the return of traditional midwifery practices to the communities is the recommended solution. Design/methodology/approach The paper is a general review of the available literature regarding Indigenous birthing practices, historical and contemporary Canadian maternal health service provision, and midwifery. Findings Current maternal health care practice in these northern communities is not resolving service delivery and human resource inadequacies, highlighting the need for a community-based and midwifery-driven primary health care approach. Potential recommendations include implementing a comprehensive birthing initiative, innovative midwifery training, and promotion and support of the role of the community midwife. Originality/value “Lost births” is a largely unrecognized issue in Canadian public health literature. The value of this paper lies in its potential to stimulate discourse and advocacy.

Reproductive health interventions for Inuit youth in the north: a scoping review

“… Setting Sample/ population Topic of article Focus of results Description of intervention/ research Cardinal (2018) [ 2 ] No Northern Canada Women of child-bearing age in northern Canadian communities Northern midwifery Review, not empirical research study. Author promotes northern midwifery and education of midwives Community-based and midwifery-driven primary health care, in order to improve Indigenous reproductive health in the north Cavanaugh (2009) [ 3 ] No Northern Canada Women of child-bearing age in northern Canadian communities Fetal fibronectin tests for identifying high-risk pregnancies The use of fetal fibronectin tests to prevent unnecessary travel to give birth Using the fetal fibronectin test as a method of intervention to reduce the number of “low-risk” pregnancies being evacuated to the south Chamberlain et al (2001) [ 4 ] No Northern Canada Nulliparous pregnant mothers in Iqaluit, Nunavut Northern birthing centres Comparing mothers’ birthing experience in Community A versus Community B The establishment and effectiveness of northern-based birthing centres to better support Inuit maternal health Corosky and Blystad (2016) [ 5 ] Yes Arviat, Nunavut, Northern Canada Nine male youth aged 17–22, 10 female youth aged 16–22 Methods to improve access to and quality of reproductive health supports How to make reproductive health resources effective for an Inuit youth target population A community health research model was followed to generate data on youth experiences of reproductive health support access in the north Couchie and Sanderson, (2007) [ 6 ] No Northern Canada Pregnant Indigenous women in remote and rural northern communities Northern midwifery …”

“…These articles expanded on the need for Inuit midwives as a reproductive health intervention that could be brought back to the north to reclaim traditional birthing. Prior to the 1950s in Canada, Inuit women would give birth in their homes assisted by midwives or other females [ 6 ]. Traditional Inuit birthing was known to be a celebration and included ceremonies, gatherings and community traditions [ 6 ].…”

“…Prior to the 1950s in Canada, Inuit women would give birth in their homes assisted by midwives or other females [ 6 ]. Traditional Inuit birthing was known to be a celebration and included ceremonies, gatherings and community traditions [ 6 ]. After the 1950s, due to colonial influences and advancements in medical obstetrics, the belief grew among some that midwifery practices were unsafe [ 6 , 15 ].…”

“…Traditional Inuit birthing was known to be a celebration and included ceremonies, gatherings and community traditions [ 6 ]. After the 1950s, due to colonial influences and advancements in medical obstetrics, the belief grew among some that midwifery practices were unsafe [ 6 , 15 ]. Some regions of Canada began preventing midwives from practicing and most funding was cut [ 6 ].…”

“…Governments also reasoned that northern community health centres and midwives were not able to properly care for mothers with high-risk pregnancies or premature infants [ 5 ]. Since then, in an effort to provide “universal care”, most Inuit expectant mothers living in northern communities are transferred to urban health centres at around 36 weeks’ gestation in order to give birth [ 6 ].…”