hen a baby comes into the world, a mother is born too—and research shows that when new mothers have access to good maternal and infant healthcare, it not only positively impacts their lives, but it also benefits entire communities and even countries.
But getting access to such quality healthcare can be challenging in some communities.
“Around the world, mainstream health systems do not always serve the needs of Indigenous or ethnic minority people, who tend to have poorer health outcomes compared to non-Indigenous counterparts,” explains , Global Director of Insights, Global Community Impact, Johnson & Johnson.
In Canada, for example, Indigenous midwives are primary healthcare providers who deliver culturally safe sexual and reproductive care for Inuit, First Nations and Métis communities. However, there are not enough Indigenous midwives to support all of these communities, so women from more isolated regions are not able to access equitable reproductive healthcare and frequently need to travel long distances to give birth.
To help address this, the National Aboriginal Council of Midwives (NACM) and Save the Children Canada have partnered with Johnson & Johnson on an initiative to support NACM's vision of having Indigenous midwives in every Indigenous community.
“We’ve always known that Indigenous midwives work in different ways from non-Indigenous midwives, but this initiative has allowed us to fully articulate those differences so we can create a national occupational standard that will support the development of educational resources, career planning tools and more,” says Claire Dion Fletcher, co-chair of NACM and a Lenape Potawatomi Indigenous registered midwife. “When a baby is born into a setting where Indigenous knowledge and tradition is respected and promoted, that baby is off to an amazing start.”
Just in time for the Women Deliver 2019 Conference in Vancouver—which champions the health and rights of girls and women—Lesley Paulette, an Indigenous registered midwife in the Northwest Territories, discusses her 30-year career of helping mothers, babies and families thrive.
Lesley Paulette: "I’m a Mohawk descendant, originally from eastern Canada, and while I always knew I wanted to focus my work on wellness among Indigenous people, I didn’t know I’d become a midwife.
I thought maybe I’d go to medical school, but I worried that working within a conventional model didn’t fit with how I saw the world. So when I was around 22, I asked myself a question: What is it that I’m supposed to be doing?
I went through my journeys of ceremony, reflection and prayer—but, no lightbulb moment came to me right away. Eventually I met Katsi Cook, a well-known women’s health advocate and Indigenous midwife who's also a Mohawk, and the lightbulb turned on. I knew I was meant to become a midwife.
"I realized I could help heal individuals, families and communities in a very real way"
When I started studying midwifery in 1987, there was no formal training or schools in Canada, so I apprenticed with midwives in Alberta. A few years later, I took distance education classes with an American midwifery program, and I continued to learn from both conventional and Indigenous midwives in Alberta and the Northwest Territories. I also learned from community Elders who shared how they handled things in settings where they had no medical backup at all.
I was one of the first midwives in Alberta to go through the evaluation process and become registered when midwifery was finally recognized as a valid healthcare practice in the province in 1998. Today, I work as a midwife with the Government of the Northwest Territories, Department of Health and Social Services, in Fort Smith and Yellowknife.
I loved midwifery from the start. I realized I could help heal individuals, families and communities in a very real way, and what I quickly came to see is that midwifery is about so much more than delivering—or 'catching,' as midwives say—babies.
Over the last 30 years, I’ve 'caught' several hundred babies. I’ve also worked with families to provide support to the women when they were pregnant and up to a year after the baby was born, as well as helped care for the infants in the first few days and weeks after birth.
This continuity of care gives us a chance to form a relationship with a woman and her family. That’s how trust develops—and those trusting relationships not only contribute to lower rates of preterm births, but also better overall health outcomes for women and their families.
As an Indigenous midwife, I help ensure the survival of the Nation. I collaborate with specialists, public health nurses, dietitians, primary care physicians and mental health counselors, creating an integrated team that helps women and their families stay healthy without having to leave their community.Share
"Indigenous midwives recognize that every community has a unique cultural story"
All of this work—these relationships we build, the trust that ensues and our ability to help women stay as close to home as possible for this important transition in their lives—is particularly helpful for Indigenous people, considering our past experiences.
In the last couple hundred years, there has been so much that the Indigenous people have had to survive. I believe midwives play a role in helping women and families take back their power and helping them heal.
As an Indigenous midwife, I literally help ensure the survival of the Nation by playing a role in renewing the strength that communities traditionally had. I help our patients navigate the healthcare system and get any additional resources they need. I also collaborate with specialists, public health nurses, dietitians, primary care physicians and mental health counselors, ultimately creating an integrated team that helps women and their families stay healthy without having to leave their community.
Providing this kind of care is so important because it’s how we traditionally lived. We had the skills and resources needed to birth our babies, raise our kids and teach them what they needed to know to be healthy and happy right where we lived. The concept of having to leave to meet all of those needs strips a community of its capacity for knowledge, health and self-care. That's why the work of NACM—and the goals of increasing the ranks of Indigenous midwifery—is so important.
Indigenous midwives recognize that every community has a unique cultural story and spiritual practices—understanding this is part of what culturally safe healthcare is about.
In my practice, we make sure our patients know they can incorporate the spiritual practices and ceremonies that are meaningful to them. For example, we make it possible for families to smudge the birthing room—a tradition where sage or another herb is burned to create a sacred space.
In Fort Smith, some families have a ceremonial way of preserving the baby’s umbilical cord stump to honor the new baby, so we make sure to save it if that’s important to a family. We make it clear to our patients, many of whom are exploring and reconnecting with their cultural identities, that this is a space where it’s OK to be you.
When I started working in the Northwest Territories, we had a lot of obstacles to overcome to help give Indigenous women the ability to make the choices they wanted, like staying in their own community to give birth. Today, at least in my part of the country, there have been some positive changes in that culturally safe healthcare is being practiced and recognized.
There’s also the fact that, especially in remote areas, we don’t always have the kinds of resources available to us that other midwives do—like medical backup or regular access to ultrasound machines. As a result, we develop skills other practitioners don’t have—we learn how to use our hands and our minds to uncover the nuances of our patients' health.
The moments I feel overwhelming gratitude for becoming a midwife are when I work with a young woman having her first baby. That woman has so many challenges and so much to learn in her journey to becoming a parent, and it’s an honor to be able to support her on that journey both physically and psychologically.
To help a woman dig deep, find the resources she didn’t know she had and blossom into a mother—that’s what makes me grateful for doing what I do. That journey into motherhood is helping prepare her for the rest of her life."