An E-News reader asks: How do we help women in isolated communities
birth with dignity and freedom, trust themselves, and not be
separated from their families? Who in their communities will provide
midwifery services and how will they go about doing so? And what can
we do to help? Where do we start?
This is an issue that has and continues to affect many women in
northern and remote areas of Canada. It is difficult to attract
caregivers (physicians, nurses, midwives, etc.) to communities
outside the urban centers. The long hours on call, difficulties in
transporting in poor weather, poor financial incentives and isolation
from professional peers and backup are all factors.
If all of one's training and experience has been in a large centre
with quick access to specialized help, it is pretty scary to be the
sole responsible practitioner "north of 60" with a 28 week pregnant
teen who you think may be having an abruptio placenta. Oh, and by the
way, there's a blizzard and no transport available for a week until
the weather clears, no O.R., no ultrasound and no blood bank. So
before we condemn the caregivers for wanting to ship every pregnant
woman out of town, consider the whole picture.
Fortunately, there is an awareness of the stress to families of
routine evacuation of pregnant women "south" for their births, and
solutions are being sought. In northern Quebec the Puvirnituq
midwifery training project continues to train Inuit women to care for
birthing women in the north. Their outcomes are excellent and a
second birthing centre is now operating in the Inukjuak Health
Centre. Students from the McGill University rural medicine program
spend some time with the midwives while doing their northern
rotation. This helps spread the message that birth in the communities
can be a safe option.
In B.C., the British Columbia Reproductive Care Program recently
sponsored a Rural Obstetrics Conference with representation from
medicine, nursing, midwifery and consumers. They have drafted a
Consensus Statement supporting birth in rural and remote communities.
This is an evidence based paper that supports birth in communities
with no c-section capability for first and second time moms, among
other recommendations.
If trying to establish or maintain a rural birth service, I would
recommend the BCRCP consensus paper as a solid tool to convince
administrators and policy makers. It was used to good effect in our
rural community (where the two midwives are the only perinatal
caregivers) to establish communication protocols with larger centres
and to support our ongoing home and hospital birth practice.
Dialogue, positive energy and respect are the keys to getting
everybody on board. Birth "in the sticks" is a safe option for women
and families.
-M.R.
====
We experience the same dilemma in the Highlands and Islands of
Scotland. It probably exists in many other isolated communities
worldwide, and there are no easy solutions.
Some thoughts for this midwife are:
-Get together with other midwives practising in remote, rural, and
isolated areas--by phone, email, newsletters, whatever--for mutual
strength and support, sharing of professional models and strategies
relevant to this type of practice (which is so very different from
city/town/large hospital practice).
-Develop skills and knowledge to be able to provide midwifery care
appropriate to remote practice. Only then go out and offer care
confidently to the women.
-Recognise and foster the abilities of women in remote areas to
evaluate their well being and that of their babies, with you as a
teacher and interpreter and not always a "hands-on" practitioner, as
hands-on is often not feasible where vast distances are involved.
Remote & rural midwifery practice in developed countries is a unique
experience. I would welcome further correspondence to enrich the
ongoing Scottish dialogue.
-Sue
Scotland
farrow3@zetnet.co.uk
====
The question you've asked does not, it would seem, have an easy
answer. I live in a remote community and have chosen to birth here
myself as well as support birthing women. That there is a
homebirthing community in this area is a very big bone of contention
to the majority of the recognised perinatal caregivers of the
surrounding areas. A significant factor is that the closest hospital
is two hours away (unless one is flown in by helicopter). Still,
there are people who are going to birth here, and do birth here, no
matter what, as long as there are no health risks (and very
occasionally even when there are).
As a busy mother, particularly one who has had a previous homebirth,
there was no way I was able to leave my community even if I had
wanted to (which I didn't). I was, of course, very well informed
regarding my choice and the logistics accompanying it, and I see this
as a very important part of helping women here. I have also been
around the hospital system and more medicalized practitioners a fair
bit and I do understand where the concern comes from. If
practitioners in this locale don't have any concern at all then they
are living in a fantasy world.
I also see how, when one's training has consisted of the fear-based
tactics of the medical model as we know it, one could be a whole lot
more concerned than is necessary. To empower birthing women in these
areas we must be straight up about the realities, focus strongly on
prevention and on maintaining excellent health/nutrition, and truly
believe in our hearts that birth really is a normal physiological
process.
Women providing care in these areas must be courageous and strong,
particularly if they are working outside legal parameters. We must
bridge the existing gaps, strive to build communication, and work on
making the priority the birthing community, not the political agenda.
There is so much more I could say but this conveys my general feelings.
-Amber
====
Midwifery Today Issues 40 and 42 include an excellent two-part
article on the Inuit of Northern Canada from the perspective of a
community midwife who has worked with them. After presenting an
analytical framework that shows how some types of logic can be
supervalued while others are devalued or ignored, the author tells
the story of one Inuit settlement's attempt to reintegrate the
authoritative knowledge of the community by supporting Inuit midwives
as they choose their own criteria for decision-making in birth. Issue
40 also includes stories and articles by Inuit women.
Purchase these two issues together for the special price of $16.00
(regular price, $10 ea.). Call 1-800-743-0974 and mention code 940
for the special price.
Reprinted from Midwifery Today E-News (Vol 2 Issue 29 July 19, 2000)
To subscribe to the E-News write: enews@midwiferytoday.com
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PO Box 2672-940, Eugene OR 97402
541-344-7438, midwifery@aol.com, Midwifery Today
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