Birth in a Northern Nation
December 22, 2014 10:58 AM Subscribe
The majority of Nunavut’s children are born thousands of kilometres away from home. The territory is working to reverse that trend. Longform journalism by Katie May.
This is a fascinating piece, and one that hits close to home. I've spent most of my life in the North and was born in the Arctic, though I was lucky enough that my town - population 2500 or so - somehow had a hospital. I knew Ms. May when she was a reporter in the Northwest Territories, and I'm very glad to see that she's doing well.
That said, I'm disappointed that the piece doesn't pick up on what continues to be a massive problem in the North, and especially in Nunavut: there is serious distrust of local medical staff. This is often with very good reason, both historically and recently. CBC North did a terrific investigation not long ago into the actions of a nurse in Cape Dorset whose medical negligence contributed to the death of a three-month-old boy, and who was repeatedly promoted despite a horrific range of accusations against her.
This kind of stuff goes back for generations; there's an old story of a travelling dentist in the 60s who would be sent up on the federal government's dime to treat various Inuit communities once a year or so. His salary was tied to his work. Fillings were worth such-and-such, teeth extractions more, so when there was a cavity, he'd just yank the tooth to get the higher pay. I don't know if this is apocryphal or not, but it's tossed around so much I think most people take it as gospel.
This distrust kicks in in two ways. First, locals aren't necessarily keen to engage with local medical practitioners, which means that they don't get a full amount of prenatal care. Secondly, it means that a lot of people view Winnipeg - or Ottawa, if you're from Eastern Nunavut - as a least-worst option for places to give birth. Yes, you're away from your home, but you trust the medical staff there more than you trust the local MD and nurses. The story hits on this: a third of the women who are eligible to give birth in Rankin still opt to go to Winnipeg. I wonder, too, how many who are viewed as "high risk" would not have been had their prenatal care been better.
The Government of Nunavut is fully aware of this problem, which is why there's so much talk of midwives in the story; they are much, much more accepted locally, because they don't carry the godawful stigma that has attached to traditional Western medical professionals, and specifically to the Western medical professionals who work locally. It really is, though, just a bandaid solution. The Inuit infant mortality rate is shockingly high, and that's not the kind of thing that can be addressed strictly with midwives. I would have loved to have seen this piece dive more into that problem, because making sure the baby arrives with all fingers and toes is just the beginning of ensuring a healthy child. Focusing on how bad it is to give birth in Winnipeg ignores the bigger issue that - for many locals - it's better than the alternative.
posted by ZaphodB at 5:09 PM on December 22, 2014 [16 favorites]
That said, I'm disappointed that the piece doesn't pick up on what continues to be a massive problem in the North, and especially in Nunavut: there is serious distrust of local medical staff. This is often with very good reason, both historically and recently. CBC North did a terrific investigation not long ago into the actions of a nurse in Cape Dorset whose medical negligence contributed to the death of a three-month-old boy, and who was repeatedly promoted despite a horrific range of accusations against her.
This kind of stuff goes back for generations; there's an old story of a travelling dentist in the 60s who would be sent up on the federal government's dime to treat various Inuit communities once a year or so. His salary was tied to his work. Fillings were worth such-and-such, teeth extractions more, so when there was a cavity, he'd just yank the tooth to get the higher pay. I don't know if this is apocryphal or not, but it's tossed around so much I think most people take it as gospel.
This distrust kicks in in two ways. First, locals aren't necessarily keen to engage with local medical practitioners, which means that they don't get a full amount of prenatal care. Secondly, it means that a lot of people view Winnipeg - or Ottawa, if you're from Eastern Nunavut - as a least-worst option for places to give birth. Yes, you're away from your home, but you trust the medical staff there more than you trust the local MD and nurses. The story hits on this: a third of the women who are eligible to give birth in Rankin still opt to go to Winnipeg. I wonder, too, how many who are viewed as "high risk" would not have been had their prenatal care been better.
The Government of Nunavut is fully aware of this problem, which is why there's so much talk of midwives in the story; they are much, much more accepted locally, because they don't carry the godawful stigma that has attached to traditional Western medical professionals, and specifically to the Western medical professionals who work locally. It really is, though, just a bandaid solution. The Inuit infant mortality rate is shockingly high, and that's not the kind of thing that can be addressed strictly with midwives. I would have loved to have seen this piece dive more into that problem, because making sure the baby arrives with all fingers and toes is just the beginning of ensuring a healthy child. Focusing on how bad it is to give birth in Winnipeg ignores the bigger issue that - for many locals - it's better than the alternative.
posted by ZaphodB at 5:09 PM on December 22, 2014 [16 favorites]
Having to give birth away from your support network and the places you know sounds awful. I'm glad there's an alternative now for at least some of these women.
A friend of mine was in labour during the Christchurch earthquake, and in the hours afterwards the hospital wasn't equipped to handle complicated births, which hers turned out to be. She was evacuated to Auckland or Wellington (I can't remember which) and her family couldn't come with her. She lost so much blood she nearly died, and her husband missed the birth and was unable to be with her in the first few hours after she woke up. The whole thing was extremely traumatic for the whole family, and while I guess it's maybe not as bad when you know all along that you'll be transported somewhere else, rather than it being an emergency situation, it still can't be great for anyone's mental health.
posted by lollusc at 7:19 PM on December 22, 2014
A friend of mine was in labour during the Christchurch earthquake, and in the hours afterwards the hospital wasn't equipped to handle complicated births, which hers turned out to be. She was evacuated to Auckland or Wellington (I can't remember which) and her family couldn't come with her. She lost so much blood she nearly died, and her husband missed the birth and was unable to be with her in the first few hours after she woke up. The whole thing was extremely traumatic for the whole family, and while I guess it's maybe not as bad when you know all along that you'll be transported somewhere else, rather than it being an emergency situation, it still can't be great for anyone's mental health.
posted by lollusc at 7:19 PM on December 22, 2014
ZaphodB, thanks for giving us more context. The one midwife in the article who was so dismissive of patients who choose to go to Winnipeg ... ugh. I've used a certified nurse midwife for my pregnancies, but I still chose to give birth in a hospital because I wanted the additional medical resources available to me and the babies if we needed it. Doesn't seem so odd to me that other women would feel the same way.
Would a potential solution be to offer nursing/midwifery scholarships to members of the community, so that those interested in a medical career would have the opportunity? And there might be more trust to go around ...
posted by stowaway at 10:36 PM on December 22, 2014
Would a potential solution be to offer nursing/midwifery scholarships to members of the community, so that those interested in a medical career would have the opportunity? And there might be more trust to go around ...
posted by stowaway at 10:36 PM on December 22, 2014
Yes, thanks ZaphodB for the context. That's definitely an omission from the article.
The story in Cape Dorset sounds both appalling and yet too similar to the situation in other places that have trouble keeping long-term medical staff.
posted by Banknote of the year at 9:14 AM on December 23, 2014
The story in Cape Dorset sounds both appalling and yet too similar to the situation in other places that have trouble keeping long-term medical staff.
posted by Banknote of the year at 9:14 AM on December 23, 2014
Stowaway, I absolutely think so, but there's an issue in that not many Northerners are keen to travel all that far. It can be a horribly hard thing to travel far to go to school when you're looking at 4 or more years far away from your support network. (I know this very well; the closest university to my home town is just under 2000 kilometres away.)
As a result, the big drive in the Northwest Territories has been to create local educational options. Specifically, one of the success stories in the NWT has been the BSc Nursing program that's been created at Aurora College in Yellowknife, in partnership with the University of Victoria. It means that Northern students can complete an entire nursing degree in Yellowknife. For Aboriginal students, that means either being able to study at home, or being close enough to home that you can travel there for breaks; it also means that you're more likely to stay in the North when you graduate. It's been a huge help in putting local people in medical ofices and the program's been rightly lauded. Arctic College in Nunavut just launched a similar program last year, and I'm very hopeful that it will help, but we're still 2 and a half years away from the first graduating class .
Now, we just need a local medical school...
posted by ZaphodB at 11:20 AM on December 23, 2014 [4 favorites]
As a result, the big drive in the Northwest Territories has been to create local educational options. Specifically, one of the success stories in the NWT has been the BSc Nursing program that's been created at Aurora College in Yellowknife, in partnership with the University of Victoria. It means that Northern students can complete an entire nursing degree in Yellowknife. For Aboriginal students, that means either being able to study at home, or being close enough to home that you can travel there for breaks; it also means that you're more likely to stay in the North when you graduate. It's been a huge help in putting local people in medical ofices and the program's been rightly lauded. Arctic College in Nunavut just launched a similar program last year, and I'm very hopeful that it will help, but we're still 2 and a half years away from the first graduating class .
Now, we just need a local medical school...
posted by ZaphodB at 11:20 AM on December 23, 2014 [4 favorites]
Also, thanks for the positive comments folks. I'm hugely proud of my home, but it's not without some serious problems.
posted by ZaphodB at 11:32 AM on December 23, 2014
posted by ZaphodB at 11:32 AM on December 23, 2014
"But they still want to birth in Winnipeg so they can stock up on cheap diapers, wipes and onesies."
-Tomkins
If she thinks that's the reason, it seems like it might also be worth finding a way to have cheaper diapers locally. I mean, how much would they have to spend letting diapers go at a loss, to still come out ahead if some women choose to not take the plane ticket?
(Though I agree, it doesn't seem at all illogical to want to be near a hospital, in case there are problems.)
posted by Margalo Epps at 10:28 PM on December 25, 2014
-Tomkins
If she thinks that's the reason, it seems like it might also be worth finding a way to have cheaper diapers locally. I mean, how much would they have to spend letting diapers go at a loss, to still come out ahead if some women choose to not take the plane ticket?
(Though I agree, it doesn't seem at all illogical to want to be near a hospital, in case there are problems.)
posted by Margalo Epps at 10:28 PM on December 25, 2014
British Regulator Urges Home Births Over Hospitals for Uncomplicated Pregnancies
posted by homunculus at 3:38 PM on December 26, 2014
posted by homunculus at 3:38 PM on December 26, 2014
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I had a home birth with a midwife. It was wonderful. Of course, my kid decided to come the ONE DAY that my midwife was unavailable, so a midwife 2 hours away had to come "catch". But relatively easy, low-risk pregnancy ended with a relatively easy birth. And climbing into my own bed afterwards was pretty nice, too.
My midwife has since moved a few hours away to another portion of our state. For some reason, even though she was a teaching midwife, no one has stepped up to fill her spot in the midwifery practice she was a partner in.
My cousin is now retired, but she was a prenatal nurse for the First Nations community in her area in Ontario. Her daughter had a child just a couple weeks before I did. She seems strongly against midwives and home births. Her mother's best friend is a retired midwife from England, too. When I asked her about it, she said that their local hospital was too small to be able to handle unexpected homebirth mothers in emergencies. I ... don't know if I believe that answer but I didn't press the issue. But that is in western Ontario - not even more remote Nunavut!
I admire midwives so much. Mine gave me tiny glimpses into how busy and irregular a midwife's schedule is - babies like to be born in the early hours of the day, apparently! I wish I were the type of person who could become a midwife, but I know myself as one who doesn't listen to others very well. And I think the trait I loved the most about my midwife was her willingness and ability to listen.
posted by jillithd at 12:49 PM on December 22, 2014 [1 favorite]