Indigenous midwifery in the context of reconciliation

For International Day of the Midwife, I was asked to reflect my thoughts about Indigenous midwifery in the context of reconciliation. It started with a question about the difference between an Indigenous midwife and a non-Indigenous midwife. First, however, you need to understand what Indigenous midwifery is.

Our role in the community

Indigenous midwifery has always played an important role in our communities. Traditionally, as the carriers of knowledge on the whole health of our families and our people, midwives were the connectors to a much wider understanding of wellness across the life stages. The intimate nature of being someone’s midwife meant we have always been the keeper of family and community ‘secrets’. In some Indigenous communities, midwives were called “Nation Builders” because of their deep understanding of the needs of the families and community they served.

A deep awareness of the interconnectedness of all things, knowing what the skills, talents and potential individuals and families had, and the wisdom to look forward and see what gaps or needs may lay ahead meant traditional midwives were leaders in their community, sought after for advice and given the authority to make important decisions. The resurgence of midwifery in Canada has allowed for a new generation of our people to reclaim traditional knowledge and practices for families at the earliest stage of life – starting from pregnancy, birth and the first weeks of life. They are helping to build a foundation for life-long well-being in our community and spawning a new generation of Indigenous leadership.

Understanding Indigenous midwifery is understanding this role first and foremost in the context of the community it serves. How Indigenous midwifery services are provided, or should be provided, will vary across Nations. The roles within this construct are uniquely framed using concepts that emphasize the importance of relationships, reciprocity, balance and ceremony. Underpinning these community-specific contexts, however, are some practising Indigenous worldview values that I’ve come to understanding as universal truths.

Indigenous midwifery reflects a holistic model of care that relates to the person in a context of the interconnectedness of family, community and nation all at once. Indigenous midwifery sees the significance of the individuals’ relationships with their family, including the importance of intergenerational connections. In the context of our colonial legacy, it also understands the intergenerational impacts of family disruption, and how family can include inter-sectional and non-conventional roles that include blood relations, chosen family, adopted family, and/or family re-found. For an individual, balance of physical, mental, emotional and spiritual also allows for balance across relationships and responsibilities. Care that separates the individual from their family removes a critical element of that balance.

Indigenous midwifery understands of the importance in balanced representation across ages and life stages, including the unique value each person brings whether they are a child, youth, adult or Elder, whether they are a woman, a man, other or both. Each one has a responsibility and a role in our community and practising for fulfilling that role simply by virtue of being.

The role of an infant is to bring joy to our community. When they are upset or unwell, it is because they are out of balance, and it puts the family out of balance as well. Therefore, the family must assume responsibility to help restore that balance for their infant so that they can all achieve their full potential. Indigenous midwifery is supporting balance for individuals, families and communities, and in that context, contributes to strong nations.

Providing culturally informed care

Indigenous midwifery is being able to provide care that is culturally safe, informed and grounded. It understands individual lived experiences in the historical context of a legacy of colonization, that could include a history of past, current, intergenerational and complex traumas, a burden of poorer health outcomes, either by genetics, influences of the social determinants of health or ill-designed coping strategies. Providing culturally informed care includes facilitating, participating and sharing traditional teachings, practices and ceremonies for the birth year journey, ensuring the individual, family and community participates in that journey. Indigenous midwifery respects and values all the ways of knowing and doing that contributes to health and wellbeing and works with those different approaches to create a customized care plan to meet a family’s individual needs.

Engrained in our creation stories is a concept and understanding of children as our most sacred gift. Across Nations, in the telling of these stories, time stands still and we unleash an understanding that it is not just a story about the creation of our ancestors, but also the creation of ourselves and of those faces yet to come. Pregnancy is a sacred responsibility where we realize this role as life-giver for our people. Indigenous midwifery is understanding they are the person who stands in that doorway helping to bring this gift from the spirit world into the physical world.

Indigenous midwifery can be provided by a trained non-Indigenous provider. In my mixed urban-based midwifery practice, the Indigenous midwives bring many important gifts. Kinship connections run deep across cultures and the same holds true for Indigenous people – we are all naturally drawn to people like ourselves. Indigenous midwives provide important role models for a community, mirroring hope, belonging and a sense of pride in our identity as Indigenous people. They bring a rare but concrete visibility of our people in the health service delivery.

Equally as important is the role our non-Indigenous midwives play. They are important allies to our clients and the community, defending Indigenous rights and leveraging their privilege by such means as challenging larger oppressive power structures, ensuring we are involved in decision making and speaking out when it is appropriate to affirm that intended and unintended impacts on the Indigenous community are also taken into consideration. They recognize their needs will sometimes need to take a back seat and pick up extra workload, so the Indigenous midwives can simply be who the community needs us to be. Allies understand the complexity of intergenerational colonial trauma and reflect on their own personal, historical and systemic relationships to Indigenous people. They recognize how things such as racism, discrimination, disclosure, violence and structural oppression against our clients can impact the Indigenous midwives differently, because they too are part of the community and may experience these things. They endeavour to act as an interface for some of the vicarious traumas and validate our truths each and every day, so we can continue to see the beauty in all things and the sacredness of this work. We stand beside each other as equals because the intersectionality of this relationship is one of the strongest demonstrations of reconciliation in action that I can think of.

Indigenous midwifery and reconciliation

Reconciliation is the action of supporting community-driven solutions. Solutions to the many challenges already lie within our communities, and self-determination is critical to their successful implementation, however, it will take time and support to realize those solutions. In Canada, there is a growing body of evidence to support returning Indigenous midwifery to our communities as a best practice for improving the health and well-being of our people. More and more communities are expressing an interest and intent to bring Indigenous midwifery back because it is a model of care that makes sense to our people.

The National Aboriginal Council of Midwives (NACM) was officially formed in 2008 with a goal, like so many other Indigenous populations around the world, to bring birth closer to home for our people. As one of the founding members, I am part of this vision of having “An Aboriginal midwife in every Aboriginal community”. Paralleling the roles and relationships of the Indigenous and non-Indigenous midwives at my practice, for several years now Save the Children Canada has been supporting NACM leadership to advance the growth of Indigenous Midwifery in Canada and internationally, letting our leadership define the needs and priorities so we can re-build the foundations for a new generation of Nation Builders. In this way, the partnership between NACM and Save the Children Canada is demonstrating this same kind of reconciliation in action, and I would encourage everyone who is looking for a way to enact the Truth and Reconciliation Commission of Canada’s Calls to Action to look at this model for their own organizations.

On International Day of the Midwife, I honour everyone who is practicing the magnificence of Indigenous midwifery, but I also honour everyone who is following the magnificence of reconciliation in action.

Sara Wolfe RM MBA
Indigenous Midwife, Seventh Generation Midwives Toronto