Many Nunavik women still like long-distance births
“Change makes people afraid”
If you could give birth safely near your home, why would you want to travel 1,500 kilometres to deliver?
But that’s what many pregnant women from communities along Nunavik’s Ungava Bay coast still prefer.
For the past eight months, many expectant mothers have been able to choose where to give birth: they can go to either Kuujjuaq or to Montreal before their scheduled delivery date.
In Kuujjuaq, a midwife looks after all births, with backup from an on-call doctor if required, while in Montreal, all births take place in a hospital under the care of an obstetrician.
Of the 90 Ungava Bay women who gave birth since last January, about a third decided to travel to Montreal.
Another third went south on their doctor’s recommendation.
Only 31 opted to give birth in Kuujjuaq.
Perhaps that’s because being able to make a decision about where to give birth is a new thing for Ungava Bay women.
Since 2004, when Kuujjuaq lost many of its longstanding resident doctors, all women from Ungava communities have been flown out to Montreal at the end of their pregnancies.
“Change makes people afraid,” suggests Tulattavik’s resident midwife Marie-Josée Gagnon, when asked why women would still decide to go to Montreal.
A recent study on birth outcomes in Nunavik shows midwifery is a safe choice.
There’s little difference between the outcomes of midwife and physician-attended births in Nunavik, the study said, suggesting that midwife-led maternity care is a safe alternative for deliveries in low-risk pregnancies.
The advantages of giving birth in Kuujjuaq include being closer to home and involving family and friends in the birth, Gagnon said.
Gagnon, an experienced midwife who has practiced in Switzerland and Africa, has worked at the Tulattavik hospital in Kuujjuaq for about a year.
During this time, Gagnon set up an office, equipped a birthing room and developed protocols for working with medical staff at the hospital — in addition to delivering many babies.
But Gagnon said she’s still a long way from meeting her goals for midwifery in Kuujjuaq.
She’d like to see more births at Tulattavik so there could be a second midwife in Kuujjuaq.
One of the two midwives could then be freed up to visit communities outside Kuujjuaq, Gagnon said.
“If we want to evolve, we need people,” she said.
With more births, Tulattavik could also start an Inuit midwife training and apprenticeship program, similar to one that has existed in Puvirnituq for more than 20 years.
The Inuulitsivik health centre now operates three birthing centres along the Hudson Bay coast, in Inukjuak, Salluit and Puvirnituq.
From 1989 to 2000, Inuulitsivik midwives handled 73 per cent of all deliveries from that region of Nunavik.
Along the Hudson Bay coast, all pregnant women deliver with midwives, unless a committee that includes midwives and doctors, decides a pregnancy would better be handled in the South.
This may some day be the practice in Ungava Bay communities, if the new Nunavik midwifery working group is successful at harmonizing midwifery services and training throughout Nunavik.
In the meantime, allowing pregnant women from the Ungava communities to choose to go to Montreal comes with a high social cost because women often leave their spouses or other young children behind.
Offering this option is also more costly to the health system.
Studies show women who give birth in the South are more like to deliver their babies by caesarean section.
As a result, during their fertile years, these same women will be obliged to return to Montreal when they give birth again because no obstetric surgery is performed at the Tulattavik hospital.
And this will create more even more dependency on medical services in the South.
There are other barriers to be overcome before midwifery can thrive at Tulattavik.
These include resolving the hospital’s lack of space, resident doctors and capacity to conduct ultrasounds on pregnant women, although the hospital is equipped with ultrasound equipment and has on-site technical staff to do the job.