When Nunavut doula-to-be Megan Levy Mason headed for the hospital to help with the final birth required for her certification, her mind was brimming with tips from her training.
She thought of all the ways she could support the expectant mother, her lifelong friend Naya Reynders, as she delivered at Iqaluit’s Qikiqtani General Hospital. Ms. Levy Mason would dim the lights to create a calm atmosphere. She would keep her friend moving to hasten the birth. She would offer gentle encouragement.
But when Ms. Levy Mason arrived, she found Ms. Reynders’s mother, Rhoda Ungalaq, had beaten her to the punch. “I walked in, and I had all this in my head,” Ms. Levy Mason said, “but I was seeing Rhoda and she was just doing everything that I’d been taught.”
Ms. Levy Mason soon learned that Ms. Ungalaq had helped deliver babies in the 1970s as an assistant and interpreter at the nursing station in Igloolik, a fly-in community in the northeastern Arctic. Born on the land and raised by a traditional Inuit midwife, Ms. Ungalaq, now 70, nearly became a midwife herself.
As Ms. Levy Mason and Ms. Ungalaq helped Ms. Reynders deliver a healthy baby boy on that day six years ago, they recognized a kinship between modern doula care and traditional Inuit birthing practices.
That prompted the pair to co-found Uummati, an Iqaluit-based perinatal support program that strives to keep the spirit of traditional Inuit birthing alive at a time when fewer options than ever are available to Nunavut women who want to have their babies close to home.
Nunavut has long struggled to provide labour and delivery services inside the territory, and as a result, residents who live anywhere other than Iqaluit are forced to leave their communities to give birth, often in the south. Two Nunavut communities outside Iqaluit that used to offer midwife-led birthing services no longer do because of a shortage of staff. Nearly all of the territory’s full-time midwife positions are unfilled.
Uummati’s work is not a substitute for offering birthing services in more of Nunavut’s 24 fly-in hamlets, but it does offer the Inuit women who deliver at Qikiqtani General extra support and a chance to connect with their culture.
Uummati is training people to become traditional Inuit birthing advocates, the kind who support a mother-to-be at the hospital or in the weeks before delivery. The organization runs weekly workshops at the Tammaativvik medical boarding home in Iqaluit where women from smaller communities on Baffin Island stay for about a month before their due dates.
Uummati also offered occasional workshops at Iqaluit’s Inuksuk High School before the pandemic interrupted in-person classes. Pregnant teens and their families can now take an Uummati-designed youth perinatal course online.
The goal of all these efforts is to let Inuit women know they can ask to have elements of a traditional Inuit birth integrated into their hospital experience, such as delivering in a squatting or kneeling position in a quiet, low-lit atmosphere to reduce stress.
“Right now, giving birth – leaving your family and your community and coming down here to Iqaluit – adds stress, a lot of stress,” Ms. Ungalaq said.
Traditional Inuit deliveries, by contrast, were naturally low-stress affairs, Ms. Ungalaq said.
Her mother often told matter-of-fact stories about births that took place on the land before Inuit families moved into permanent settlements in the 1950s, 60s and 70s. A couple might be travelling on their qamutiik, or sled, pulled by a dog team, when the wife went into labour. “The husband would quickly build an igloo. She would have the baby, clean up, hop on the qamutiik and go again,” Ms. Ungalaq said. “It was normal as that.”
Inuit life has changed dramatically since. Qikiqtani General is now the only place in the territory with labour and delivery services. That means many Nunavummiut are sent to southern hospitals, separated from their communities by thousands of kilometres as they bring a new life into the world, although government funding is available for one escort to accompany them.
In 2020, 41 per cent of the babies born to Nunavut mothers were delivered outside the territory, according to the government of Nunavut. That figure was closer to 50 per cent in the preceding years, when pandemic restrictions didn’t act as a disincentive to sending expectant mothers south to Winnipeg, Edmonton and Ottawa.
Even women who deliver at Qikiqtani General are often far from home. While many are residents of the capital, a city of 7,500 on the southern part of Baffin Island, the rest come from the more northerly fly-in hamlets that hug the island’s coast.
“Why is it that Inuit women have to experience this isolation when the rest of Canadian women can just go down the street to their hospital and give birth? Or have an option to have midwifery service in their home?” said Rosemary Cooper, the executive director of Pauktuutit, a national Inuit women’s organization. “That’s the missing link today.”
Birthing options weren’t always so limited in Nunavut, the jurisdiction with the highest birth and fertility rates of any province or territory.
The territory recorded 21.4 live births for every 1,000 residents in 2020, more than twice the national average of 9.4. Nunavut’s fertility rate – a measure of the average number of children each woman has over her lifetime – was 2.72 in 2020, the most recent year for which Statistics Canada has published data. The Canadian fertility rate that year was 1.4.
Until mid-2020, midwives delivered babies at a birthing centre in Rankin Inlet, Nunavut’s second-largest community. The government of Nunavut suspended the service after the two nationally certified Inuit midwives who were the backbone of the program reluctantly quit, citing burnout and mistreatment from managers and the government.
They were among the first graduates of a midwifery program at Nunavut Arctic College that shut down in 2014 because enrolment was low and federal funding ran out.
Nunavut’s department of health has since commissioned a study of the maternity care needs and desires of women in the central Kivalliq region, where Rankin Inlet is located.
Cambridge Bay, the largest community in western Nunavut, has occasionally offered midwife-led birthing services, too. Thirty-four babies were born there between 2015 and 2020. Like in Rankin, the service has been suspended because of a lack of staff, a spokeswoman for the Nunavut health department said.
The territorial government has funding for 10 registered midwives, but only one of those positions is filled, “despite ongoing recruitment efforts,” the spokeswoman, Danarae Sommerville, said.
Registered midwives require formal training and a university degree. Traditional Inuit midwives, on the other hand, have experience delivering babies based on knowledge passed down from older Inuit, not a postsecondary degree. Doulas, such as Ms. Levy Mason, are trained companions who support pregnant women physically and emotionally through their labour but don’t actually deliver babies.
Attracting and retaining health care staff in the Arctic is a chronic challenge, exacerbated now by the pandemic. A case in point is Yellowknife’s Stanton Territorial Hospital, which closed its labour and delivery ward for nearly three months this winter because of a nursing shortage, forcing the Nunavut women who normally deliver there to travel to Edmonton.
Ms. Ungalaq and Ms. Levy Mason, a non-Inuk who grew up in Iqaluit as the daughter of teachers who moved to the North before she was born, see their perinatal support program as a bridge between the past and present for women like Maggie Aqpik, a 30-year-old mother of three who participated in some of Uummati’s early group sessions.
Ms. Aqpik especially enjoyed an Uummati challenge that encouraged pregnant women to bundle up and head outside first thing in the morning for fresh air. She now oversees communications for Uummati and leads workshops at the boarding home in English and Inuktitut when COVID-19 protocols allow her in.
Some of the expectant mothers she meets at the boarding home are young, shy and living away from home for the first time. “It can be hard on them being away from family,” said Ms. Aqpik, who is originally from Kimmirut, a community of about 400 people a half-hour away from Iqaluit by Twin Otter plane. “They often feel isolated.”
Last week, Uummati began filming segments for an advanced online training course for Inuit doulas and birth advocates featuring Ms. Ungalaq and Natsiq Kango, a traditional Inuk midwife. On a bench draped in a sealskin blanket, they demonstrated different birthing positions, which tend to vary by region of the Arctic, Ms. Kango, 65, said.
Ms. Kango’s own children and grandchildren don’t have much interest in traditional birthing practices, she said. Meanwhile, elders such as her 101-year-old mother-in-law, a traditional midwife who still lives in an oil-heated shelter in Arctic Bay, won’t be around forever to share their wisdom.
“We are losing a lot of our traditional knowledge,” Ms. Kango said. “Videoing this particular topic is a must. We need to bring it out to the world. We need to bring it out to our people.”
The Globe and Mail’s health reporter Kelly Grant is taking an in-depth look at health care in Nunavut and the challenges its residents face accessing it. Over the course of 2022, she’ll examine why the territory’s residents have some of the worst health outcomes in the country and what changes are needed to deliver better care.
Ms. Grant is working with photographer Pat Kane. Based in Yellowknife, Mr. Kane takes a documentary approach to his stories that focus on Northern Canada. Mr. Kane identifies as mixed Indigenous/settler and is a proud Algonquin Anishinaabe member of Timiskaming First Nation in Quebec.
If you have information to help inform The Globe’s reporting on Nunavut, please e-mail firstname.lastname@example.org
Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.