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Birth in a northern nation

The majority of Nunavut’s children are born thousands of kilometres away from home. The territory is working to reverse that trend.

Hey there, time traveller!
This article was published 19/12/2014 (971 days ago), so information in it may no longer be current.

RANKIN INLET — Samantha Tutanuak’s straight, dark hair is growing long — a bit brittle now from Rankin’s cold and wintry wind, but she’ll get a trim after the baby’s born. An old Inuit myth ties haircuts during pregnancy to umbilical cord complications during labour, so it’s important to her to wait it out.

The 23-year-old finance clerk from Rankin Inlet, NU, had a feeling she wouldn’t make it past her late-December due date. The baby had already dropped lower, and history told her to expect an early arrival. Her daughter, Monique, had been born two weeks premature on Dec. 28, 2012.

The little girl was ready for a little brother or sister. They were all ready for this last, long month to come to a close. The tree had been up since the beginning of December and Tutanuak and her boyfriend, Hunter Nakoolak, were anxious to celebrate Christmas and two birthdays.

The idea of spending the holidays 1,500 kilometres away in Winnipeg freaked her out. She couldn’t imagine missing Christmas with her family or having them miss the birth of her child.

Samantha Tutanuak gave birth to her second child, a boy named Michael Angelo, in Rankin Inlet on Dec. 12.


Samantha Tutanuak gave birth to her second child, a boy named Michael Angelo, in Rankin Inlet on Dec. 12.

"I personally just wanted to give birth here because it’s holiday season, so I chose to stay home and just be with my family," Tutanuak said.

The choice she made is still an alternative one in Nunavut. Home to Canada’s youngest and fastest-growing population, the territory had for generations been dependent on southern specialists and out-of-territory hospitals to receive its pregnant women and deliver their babies.

Women would have to pack up and get on a plane at least three weeks before their due date, leaving their families behind to bring new life into the world in an unfamiliar place. Expectant mothers from Nunavut’s seven Kivalliq communities north of Manitoba — stretching from the mouth of the Thelon River near the geographic centre of Canada to the west coast of Hudson Bay and up to the Arctic Circle — are routinely sent to Winnipeg, usually alone.

After decades of women’s grassroots work to bring birth back to their communities, that is slowly changing.

Nunavut’s government, recognizing the social and financial value in making it easier for women to have babies closer to home, set out a plan to expand the midwifery services offered in Nunavut and reduce the number of out-of-territory births.

Northern babies

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Birth in an igloo



The territory put forth a five-year plan — ending this year — that would dedicate resources to improve the health of mothers and babies in a place where infant mortality rates are roughly six times higher than the national average, where consistent access to affordable, healthy food is a struggle and where smoking rates during pregnancy in some parts of the territory climb upwards of 80 per cent.

The goal was to stop forcing out expectant mothers and start giving them a choice.

It’s a choice some clients of Nunavut’s most well-established birthing centre take for granted now, a touch of complacency from the first generation of Nunavummiut to grow up with regular midwifery care. And as demand for care increases at the Rankin Inlet Birthing Centre, staff retention issues and a lack of northern-based midwife training programs come into focus.


When Tutanuak went into labour in Rankin Inlet’s whimsically named Birthday Room — a couple of weeks early, just as she predicted — her family was packed into the room and down the hall.

Nakoolak, her mom Bernie, sister Karen, aunt Belinda were all there to welcome Michael Angelo Arna&uk Maliki Tutanuak, born eight pounds, nine ounces at 12:34 p.m. on Dec. 12, 2014. (The ampersand in his name represents an Inuktitut sound not made in English -- a "voiceless lateral fricative" that sounds roughly like "ksl.")

It was a hard labour, four hours of back-rubbing and trying not to cry.

"I had a few tears just before I started pushing him out just thinking that I will be a mother to another baby," she said.

Michael Angelo’s arrival cued a bond with big sister Monique — who went from apprehensive to protective in the three hours it took for mom and baby to get the all-clear to go home with the family.

Monica Ugjuk gave birth 13 times, including twice out on the land, and now passes on Inuit birth traditions.


Monica Ugjuk gave birth 13 times, including twice out on the land, and now passes on Inuit birth traditions.

Tutanuak had the luxury of a support-network, something not often afforded to women who give birth out-of-territory on their own.

Tradition is important in this family, whose respected matriarch, Samantha’s maternal grandmother Monica Ugjuk, gave birth 13 times — including twice out on the land.

"There’s a tradition where when you’re in labour you can’t scream, you can’t cry; and my grandma told me also not to do that. So when I was in labour with my daughter, I didn’t scream and I didn’t cry. Of course I wanted to," Tutanuak smiled, "but I didn’t."

Elders say the labour will last longer and become more painful if the mother makes a lot of noise, so better just to keep composure — easier said than done if you have no idea what to expect. That’s where midwives come in. Tutanuak said they helped her remain calm by showing her pictures of the labour process and giving her a tour of the birthing room beforehand.

The midwives also helped her adopt some healthier habits. Tutanuak smoked through her first pregnancy — a major regret.

"I was being really selfish, not really thinking of the health of my baby," she said. Even though her daughter was born healthy, Tutanuak quit this time around.

Access to consistent pre-natal care is spotty across the territory, where many communities rely on jack-of-all-trades nurses to solve most of their health problems.

Two birthing rooms inside the Kivalliq Health Centre serve low-risk women who choose to have their babies in Rankin Inlet.


Two birthing rooms inside the Kivalliq Health Centre serve low-risk women who choose to have their babies in Rankin Inlet.

Tutanuak knows how lucky she is, living in Rankin, being able to give birth in her community, and having access to midwives who could teach and guide her through the pregnancy. She’d like to see more access to pre-natal care across Nunavut, not just in regional centres such as Rankin Inlet.

"Every mother deserves to know how their baby is doing while they’re pregnant. That’s one thing that I find really important, and I really enjoy the birthing centre here because I get to find out how my baby is throughout the whole pregnancy. And it’s too bad that other mothers in other communities don’t get that."

She recalls the experience of a friend in Coral Harbour, a community of about 800 people 466 kilometres north of Rankin Inlet. Her friend had gone into labour two months early at home, and local nurses were called in to help.

"While she was giving birth, the nurses were telling her just to lay down while she was in labour, and the way she was explaining it to me, she was in a lot of pain just sitting there. Here, the midwives, and my family who went through labour before, were encouraging me to move around and keep my body going so that the pain can go by faster." Keeping active before and during labour, along with squatting or kneeling birthing positions, are traditional teachings the midwives can pass on — a cultural connection that birth has brought back to the community.

It doesn’t matter where her midwife is from, Tutanuak said, as long as she’s capable, "But it’s nice to have people of your own kind, other Inuit. Because they know the traditions, they know the stuff that might be going on in the community."


Registered midwife Cas Connelly works in the office she shares with her co-worker Rachel Jones.


Registered midwife Cas Connelly works in the office she shares with her co-worker Rachel Jones.

It’s just before 10 a.m. on a Monday. Rachel Jones and Cas Connelly have already been at work for more than an hour this morning, and on-call 24 hours a day for the past few weeks while a third midwife, Amanda Tomkins, is away. She’ll be back in a couple of days, and a temporary midwife from down south is scheduled to join them before the end of the month. Then they’ll be back to their regular complement of four — three full-time midwives and one casual.

But for now it’s just the two of them, working full-on in this hamlet of 2,245 on the western shore of Hudson Bay, where they grew up. Because Rankin Inlet is a regional centre, the midwives also see expectant mothers from across the Kivalliq, home to about 10,260 people.

After graduating from Nunavut Arctic College’s midwifery program, Jones and Connelly passed their national registration exams about five years ago — the first Inuit to do so — and have been working together ever since. Their camaraderie reveals itself in the way Connelly’s bubbling laugh answers Jones’ sarcastic crack, in the way Jones finishes Connelly’s sentences.

The midwives who run the Ranking Inlet Birthing Centre keep their offices in a public-health building across town from the health centre, running back and forth to collect babies' charts.


The midwives who run the Ranking Inlet Birthing Centre keep their offices in a public-health building across town from the health centre, running back and forth to collect babies' charts.

In the office they share to complete the piles of paperwork that come with birthing centre supervisory duties, the Inuit midwives prepare for a full clinic day. They’ll expect to do everything from testing for sexually transmitted infections to prescribing birth control to administering the sickly sweet orange syrup used for gestational diabetes tests. That’s in between following the progress of expectant mothers and their growing fetuses, as well as checking on infants and their mothers up to eight weeks post-partum and running blood samples and charts back and forth between the newer Kivalliq Regional Health Centre across town, where babies’ medical information is kept.

"We have to do a lot more than anybody else would have to do," Connelly says, because apart from being considered primary caregivers in Nunavut, the midwives don’t have local obstetricians or surgeons to rely on in case something goes wrong. It takes at least six hours to get an expectant mother to Winnipeg in an emergency — too long to wait if the labour is already in trouble. So the midwives handle normal births only, carefully screening women for possible complications — such as low blood iron levels, high blood pressure and diabetes. Those deemed high-risk are sent to Winnipeg, and women who choose to stay against medical advice must sign a waiver.

"It’s quite daunting and shocking for the midwives that come from the south and realize what responsibilities they have up here," Jones adds.

Air-born baby

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Delsie Palvialok

There’s a certain notoriety that comes with being the lady who had a baby on the tarmac, but Delsie Palvialok doesn’t mind.

The birth was the easy part — the baby just kind of slipped out while the 25-year-old lay in the aisle of a freshly landed Calm Air plane, giggling over the absurdity of the situation while surrounded by 13 other passengers.

She didn’t even push, and Jackson was born: A healthy boy at six pounds, eight ounces. She held him close as paramedics carried her out of the narrow aisle, and as they lifted her onto a waiting stretcher bound for the Churchill hospital, she shielded the naked baby from blowing snow and cold, freezing cold wind. And that was the hard part: holding him close, breastfeeding him while in hospital, getting attached to this boy who was already promised to another family member.

She re-tells the story three months later — soaks in the details again with a soft-spoken matter-of-factness — but it doesn’t feel that long ago.

She’d planned to give birth at the birthing centre in Rankin and had arranged for her cousin and his wife in Cambridge Bay, NU, to adopt the baby. The adoptive mom had flown to Rankin to be there for the big day. But a few days before Palvialok’s due date, a checkup revealed her stomach measurements had changed.

Staff needed to check the baby’s condition, but Rankin Inlet’s ultrasound machine was broken. So Palvialok was sent with a nurse escort to Winnipeg, where doctors determined she and the baby were healthy. Not due for another nine days, Palvialok opted to go home. She felt fine, and anyway, she didn’t want to miss her six-year-old daughter’s kindergarten graduation. On the way home, she gave birth as the plane landed in Churchill.

By the time she got home with baby Jackson, after spending two nights in the Churchill hospital, she was reconsidering the adoption. She’d already given up one son, to the same couple who planned to raise Jackson, and now she thought about keeping this boy.

“I got attached to him because I had to breastfeed him,” she said. “They told me, ‘you’re going to have to breastfeed the baby because we can’t find milk, we can’t find bottles.’”

It was hard, Palvialok said, but talking to her aunts helped remind her of everything she’d be giving up by taking care of a newborn — her job, undivided time with her daughter — and everything she was trying to give Jackson by having family adopt him.

“So that’s when I started to finally let go,” she said. “It’s good because he’s with his big brother.”

The job stress sometimes gets to them — a ringing phone will have them gasping awake in the dead of night, heart pounding, wondering if someone’s gone into pre-term labour. Calendars of missed milestones — a brother’s wedding, a son’s kindergarten presentation, every community fishing derby for the past six years — are traded for the responsibility of helping women bring new life into the world in their home community.

"It’s like that for midwives all around the world, but for us, still immersed in our culture of the land and hunting and fishing... I don’t want to be all corny, but you know, being Inuit and being able to hang on to that part of our culture is very, very difficult and being a midwife at the same time because of the call schedule and the demands," Jones says.

There’s extra pressure, they both say, because they’re from here, taking calls at home at all hours from a high school acquaintance, a friend of a friend’s second-cousin, a perfect stranger — worried women who need to know if something is wrong with their baby.

Yet, at the end of each visit, the midwives make doubly sure they encourage women to call if they have any questions, any concerns at all. It could be nothing, but it could be something.

"I think it’s just become the norm," Jones says. "The new generation now that are in child-bearing years, never, ever experienced not having a birthing centre. Some of them were born at the birthing centre here and now are having babies, so they don’t know any different. So for them, it’s just the way it is, and that’s what you get and that’s their expectation that they’re able to call us at any given moment and get a hold of one of us 24 hours a day and they know that. And they’re just comfortable with that."


More than 20 years since the birthing centre was founded, the number of babies born in Rankin Inlet is sporadic, varying wildly from year to year.

Between 1993 and 2013, 769 babies were born at the Rankin Inlet Birthing Centre. During the same time, 542 were born in Winnipeg and 276 were born elsewhere in Canada to mothers from the Kivalliq region, according to the birthing centre’s records. Of course, those figures don’t account for the much higher number of women who rely on the birthing centre for all their pre-natal and post-partum care, regardless of where they end up having their babies. Last year, for example, only 34 babies were born at the birthing centre, and midwives saw roughly 100 clients. With four full-time midwives for the region, the birthing centre could deliver at least 120 babies a year on top of pre-natal care.


High-risk pregnancies aside, about a third of the women who are eligible to give birth here still choose to go to Winnipeg. Some may heed the advice of mothers, aunts or grandmothers who had all their children in hospital. Some may be nervous, preferring to be in an urban centre with easy access to surgical equipment in case something goes wrong. And some may just be exercising their choice.

"It would be good to know, what value do they see in coming to Winnipeg to deliver? What would make them want to deliver in Rankin Inlet?" says Dr. Anne Durcan, who co-ordinates an Inuit health program at the University of Manitoba.

Durcan muses from her office inside U of M’s Bannatyne campus, where she spends two half-days a week as the Inuit health co-ordinator for the J.A. Hildes Northern Medical Health Unit. She splits her time between here and the North-End Mount Carmel clinic.

The northern health unit, which already works with health care staff in Rankin Inlet, is currently helping the birthing centre build a data-collection system. A lot of information has been collected over the years about birthing in the community, but there’s been no one-stop shop to organize and interpret the data, Durcan said. A new system would aim to gather the birthing centre’s records and previous research so the territorial government can better understand the effectiveness of the midwives’ care.

"Subjectively, I just think (the birthing centre is) great and I know that the midwives are committed and that the community loves it, but it’s good to have that objective information as well," said Durcan. She and her husband spent a year working as family doctors in Rankin Inlet from 1996 to 1997.

"I think any organization in health care should, we should all strive to justify that we’re providing a service that is needed, valued and of high quality, cost-effective and relevant to the population."

The 20-year-old Rankin Inlet Birthing Centre has been an example for other remote communities looking to reclaim birth, but Durcan cautions against cookie-cutter models of care. For a health program to succeed, it must be deeply rooted in the community, she said. And communities across Canada have a role to play.

"I always remember the Golden Boy points North because that’s where our future lies. And as fellow Canadians, they deserve the same quality, access and standards of care as the rest of Canadians. Health care should be accessible and of high quality. If we’re concerned about the integrity of our country, we have to really focus on the well-being of the North."


"It’s hard to explain. I just know I really want the baby here."

Petula Panigoniak is six months pregnant, 18 years old and very nervous.

"I’m just hoping I don’t get sent out, because I don’t want to be alone," she says, balancing her year-old nephew on her knee, an easy smile spreading across her face as she sneaks a peek at his chubby little cheeks.

Petula Panigoniak waits for her midwife appointment with her boyfriend Clark Adams and her nephew Sivui.


Petula Panigoniak waits for her midwife appointment with her boyfriend Clark Adams and her nephew Sivui.

Without support from the midwives and family, the recent high school graduate says she might have considered abortion.

"I was scared. I didn’t know how to react. I couldn’t find a way to tell my mom — like, my whole life changed knowing a baby’s going to be there. I didn’t know what to expect from my family or my boyfriend’s family."

After she told them she was pregnant, her boyfriend’s parents agreed to adopt the baby. She’ll be around to help out, but eventually she’d like to go to college, travel and pursue a nursing career.

"But I don’t know if I’ll miss the baby because it’s my first baby."

As her looming anxieties swirl, Panigoniak finds herself overwhelmed with questions. What’s happening to her body? What does labour feel like? And what’s going to happen afterward?

That’s why she comes to the midwives.

"It’s good that they always have answers," she says.



There are about 800 births a year in Nunavut, many of them from mothers in Arviat, a hamlet 215 kilometres south of Rankin Inlet. Babies are born to mothers from the Kivalliq community at one of the highest rates in Canada, keeping its population predominantly young and making the hamlet a prime candidate for its own birthing centre. But the government doesn’t have enough midwives to run it. So Arviat mothers are still turning to Rankin Inlet’s birthing centre for help. They still have to leave home to give birth, but the cost is easier to bear.

Jackie Otuk can’t wait to meet her newest grandson, and she hopes she won’t have to wait too long. Her daughter, Esther, is already a few days overdue, anxious for the arrival of her second child, to be called Ryan. The Arviat family has been staying with relatives in Rankin as Esther prepares to give birth at the birthing centre for the second time — even three-year-old big brother Tanner has plans to come up for a visit. Regular airfare between Arviat and Rankin Inlet is $500 — compared to $2,000-plus to Winnipeg and back. There, a family visit would be impossible, Jackie knows. She has six children, all born in Manitoba: Churchill, Thompson and Winnipeg.

"I see a lot of difference," she says, gazing thoughtfully at her very pregnant daughter, her panik. "When I would go down to have my babies, there was no interaction between myself and the doctor. Just, ‘OK, see you next week.’

"But with her, she can talk to (the midwives) freely. We can interact with them freely. And at the birthing centre, where they go and have the baby, it’s well-equipped and it’s comfortable, not like down south where they say, ‘OK, she just had her baby, let’s move her now.’ They’ll move her when she’s ready."

"They take more time to interact with the patient, and not just rush, rush, rush like they do down south."


Fresh from the airport, midwife Amanda Tomkins is back in clinic mode and back on call.

It’s Wednesday afternoon and the birthing centre’s third midwife has just returned to Rankin after a medical leave in Winnipeg, hot on the heels of her maternity leave. The mom of three, originally from Toronto, has been working as a midwife in Rankin for eight years.

Midwife Amanda Tomkins (left) finds a fetal heartbeat for Allison Chidley and her husband Graham Wells to hear for the first time.


Midwife Amanda Tomkins (left) finds a fetal heartbeat for Allison Chidley and her husband Graham Wells to hear for the first time.

In her examination room during a break between patients, Tomkins marvels at the thought: The first baby she caught here will be eight years old. Moms do all the work in labour, Tomkins says, so midwives don’t take credit for "delivering" the baby, just for catching it. The community has embraced her — and for the most part it’s embraced the birthing centre, too.

She understands why some Nunavut women so vehemently want to stay in their communities and out of institutionalized hospitals to give birth.

She and her husband adopted their two oldest children here and, after a 31-hour labour, she gave birth to a daughter in August 2013. Her pregnancy was considered too high a risk for her to stay in Rankin, so she and her family stayed in a Winnipeg hotel for five weeks — a horrific experience, she says.

"It was everything I didn’t want it to be. As a midwife, I couldn’t get a midwife (in Winnipeg), and everything that I could possibly imagine that I didn’t want to happen, happened, except a C-section. I was just like, ‘OK, I have to give up control because none of this is what I would have wanted.’ "

Among some young women — usually first-time moms — who have the option to birth in Rankin, Tomkins senses complacency: They’ve grown used to seeing the midwives, if only for prenatal care. But they still want to birth in Winnipeg so they can stock up on cheap diapers, wipes and onesies.

"The women, they don’t know what they’ve got. They don’t know the difference. A lot of them are happy that we’re here and they get to birth in their community. And a lot of them are like, eh, ‘I don’t care. I want to go shopping. How soon can I go?’"


The Nunavut government ranks pregnancy among the top five reasons for medical travel in the Kivalliq region and across Nunavut. Each Kivalliq baby born in Winnipeg costs the government roughly $14,000, said Fuad Maliha, director of the Kivalliq Regional Health Centre in Rankin Inlet.

That doesn’t include the cost of a medevac flight, if one is summoned in an emergency. A medevac from Rankin Inlet to Winnipeg, for example, costs the Nunavut government about $15,000, and scheduled return flights run around $2,000, not including accommodations. It makes good financial sense to encourage low-risk women to give birth within Nunavut, Maliha said. But they need more midwives — and midwives who will stay.

Fuad Maliha, director of the Kivalliq Regional Health Centre, said he'd like to see more midwives working in the region.


Fuad Maliha, director of the Kivalliq Regional Health Centre, said he'd like to see more midwives working in the region.

"We still like to have it as a priority. We want to encourage it. We want to put more resources in it and the best way to do it is to get more midwives. It is really difficult to recruit midwives at this stage." Union agreements paved the way for nurses in Nunavut to receive incentives that encourage them to stay in the territory, he said, "but somehow they fell short with the midwives."

Recruitment might be easier if Nunavut midwives had the same incentives as nurses, he said, such as an extra salary boost. Midwives, who are Nunavut government employees, earn a starting salary of $93,951 to $106,626 for a 37.5-hour work week, not including benefits and a northern living allowance of about $15,000. Midwives hired by the Winnipeg Regional Health Authority, on the other hand, can expect to make roughly $70,000 to $90,000 a year.

"So it is really good compared to the south, but the north is always very expensive, and if they give them the same incentive as the nurses, then it will enhance the program," Maliha said.

Rankin’s birthing centre, with an annual operating cost of $958,698 last year, is the oldest and most established birthing centre in Nunavut. It’s served as a model for Cambridge Bay’s growing birthing centre, established in 2010, and for as-yet-unsuccessful midwifery birthing centres in Iqaluit, the capital, and in Arviat, Nunavut’s second-largest community with one of the highest birth rates in Canada.

Efforts to expand midwifery programs in both of those communities hit some bumps, said Meaghan Moon, the Iqaluit-based territorial maternal newborn services co-ordinator, because of staffing retention issues and a lack of clinic space.

"There’s lots of effort being made, but it takes time," she said, adding the government’s commitment to midwifery is ongoing. "In the meantime, babies are being born, so it always feels urgent."

Staff retention is a major barrier to expanding midwifery services in Nunavut, and with midwifery education courses on hold at both Nunavut Arctic College and Winnipeg’s University College of the North, options are scarce for Nunavummiut who want to pursue a career in midwifery.


It’s Katrina Pameolik’s first day at work as a receptionist. It’s not quite her dream of becoming a midwife, but at least it’s close, proximity-wise.

Settled in at her new desk, the quiet and conscientious teen greets arriving patients from behind an open window that looks out into the waiting area.

Katrina Pameolik, who works as a receptionist in Rankin Inlet's public health building, says she won't give up on her dream of becoming a midwife.


Katrina Pameolik, who works as a receptionist in Rankin Inlet's public health building, says she won't give up on her dream of becoming a midwife.

The 19-year-old is a new addition to the administrative staff at the public health building in Rankin Inlet, right down the hall from the midwives’ offices. She’s been interested in the health of babies "since forever," even before she gave birth to her now-two-year-old daughter, Sophia Skye, whose name is tattooed in flourishing script on her forearm. Her labour lasted 22 hours in a Winnipeg hospital room, where her mother and boyfriend comforted her. Though she’s committed to empowering women to give birth close to home, when faced with high risks, she decided to do what was safest for the baby.

After spending a summer shadowing the midwives, observing their work and even handing them tools during a local woman’s smooth and speedy two-hour labour and real live birth, Pameolik is ever more determined to make a career of "catching babies."

"It really opened up my eyes. I realized that I wanted this as a permanent job," she says.

Research explores repatriation of birth in northern Manitoba

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Repatriation of birth has long been a struggle in many remote communities where pregnant women still face confinement in an urban centre.

New research from the University of Winnipeg aims to find out whether bringing birth back to northern Manitoba communities is actually feasible.

Jaime Cidro, an assistant professor in U of W’s department of anthropology, received a two-year Canadian Institutes for Health Research grant worth $114,300 to study the effects of birthing in Norway House, Man.

Her research team is set to begin interviewing women, medical professionals and community leaders this month to compare the psychological effects of leaving to give birth versus staying home, evaluate perceptions of risk and scrutinize the numbers to determine whether the population could support a birthing centre.

“Returning birthing is about returning control over women’s bodies and decisions about what they want to do,” Cidro said. “So I think (receiving the grant) is a victory in terms of understanding the importance of women and First Nations communities in having self-determination around health.”

Cidro said she hopes the research will eventually be used to develop community policies around giving birth in Norway House.

Problem is, she hasn’t been able to get any formal training.

She applied to Nunavut Arctic College’s three-year midwifery diploma program — the same one Rachel Jones and Cas Connelly completed when the roving program was offered in Rankin Inlet — for an expected fall 2014 start in Iqaluit. She was willing to move nearly 1,200 kilometres across the territory with her family to enrol.

"But I got an email saying it got cancelled due to not enough applicants."

She also applied to the Winnipeg-based aboriginal midwifery bachelor program through University College of the North, but never heard back. That program, too, was on hold pending further review, and is now expected to start anew next fall in partnership with the University of Manitoba.

The troubled program, which was launched in Norway House and The Pas in 2006 and moved to Winnipeg four years later, was eventually cancelled, producing only a handful of graduates and being the subject of a lawsuit brought forth by a group of former students who accused the school of failing to provide them with an education. Even though they had completed the available courses, they argued, a lack of hands-on clinical training made them ineligible to graduate. UCN settled the lawsuit and later joined forces with U of M to start accepting midwifery students for a Winnipeg re-launch of the program in September 2015.

Pameolik isn’t discouraged. She’ll apply again whenever the courses re-open.

"My mind is set on the midwifery program," she said. "I’ll go for it no matter where it is."


When an early version of the Rankin Inlet Birthing Centre opened in 1993, born out of community-backed pilot projects and staffed with temporary midwives supported by University of Manitoba’s J.A. Hildes Northern Medical Unit, Nowyah Williams began to see the change she’d been working for.

It had all been worth it: A hard-earned registered nurse’s assistant certification, countless late nights spent at the health centre, years of grassroots advocacy to persuade politicians, and women themselves, that mothers in Nunavut deserved a choice.

After multiple misdiagnoses and a brief battle with cancer, Williams died in April 2013 — but not before starting to see the fruits of her labour.

Born in Coral Harbour in 1951, Williams was sent to live with relatives when she was two, after her mother died. Her adoptive parents became mom and dad, and they lived off the land then. But as a young girl, Nowyah was sent to residential school in Churchill. Though she missed out on learning to sew as a girl, she retained her mother tongue and would later use Inuktitut to skilfully soothe pregnant women in mid-contraction. Cut off from her family 830 kilometres away, she finished school in northern Manitoba before spending a year studying nursing in Ottawa. When she returned to Coral Harbour to practice at the local nursing station, she saw a jarring divide, one that sliced the family bonds of a lost generation.

Pregnant women, otherwise healthy, were forced onto flights and into southern hospitals where nurses and doctors who didn’t speak their language and didn’t understand their culture would put them in beds on their backs, disregarding traditional squatting labour positions, and eventually send them packing, to reunite with their families in remote communities seven or eight days later.

"We have what it takes to help these women. Why can’t they stay at home and deliver?" Nowyah would often wonder with rhetorical acerbity. "No, we don’t have a choice there. We don’t have a say. We get them a plane ticket and we put them on the plane."

Charlene Williams-Kaludjak remembers well her late mother’s frustrated refrain. She was a teenager when the family — including her younger brother and their dad, an Anglican minister — moved from Coral to Rankin in the early 1990s. Her mother, having by then been twice forced out of territory to give birth by herself and having looked helplessly into the faces of so many others who were made to do the same, began in earnest her quest to bring birthing back home.

Charlene Williams-Kaludjak with her two-month-old adopted daughter Nowyah, who was named for Nowyah Williams, a driving force in starting up the Rankin Inlet Birthing Centre.


Charlene Williams-Kaludjak with her two-month-old adopted daughter Nowyah, who was named for Nowyah Williams, a driving force in starting up the Rankin Inlet Birthing Centre.

Now, sitting in Rankin’s former health centre where Williams attended some of her first births as a midwife, Williams-Kaludjak smiles down at her baby Nowyah, the sleeping two-month-old in her arms, and thinks of all her late mother accomplished.

"She loved seeing this place filling up with all the pregnant ladies that were coming here to deliver," she said. "She loved being able to go down the street and say, ‘I caught him! I caught her! I cut her cord! I was there at her birth!’ I don’t know how many graduation ceremonies we went to (where) she used to try to count how many of the kids whose deliveries she had been at. She lost count years ago. Years and years and years ago, she lost count."

Williams’ dream of seeing enough midwives for each community in Nunavut has yet to be realized, despite a government pledge to expand midwifery services and reduce out-of-territory births by the end of 2014. But she’d be proud of the progress, her daughter says.

"In other parts of Canada and other parts of the world, people take it for granted. It’s not a big issue. It’s not something that they have to think about.... You don’t have to pack a suitcase with three weeks’ worth of clothes and you don’t have to get on a plane, and you don’t have to worry about staying at an Inuit centre or a centre for transients for weeks at a time and being away from home. And if you have other children, you don’t have to worry about leaving them or your spouse. And those are all things mom felt were so important," Williams-Kaludjak said.

"Thanks to my mom, I will never, ever, have to know what that feels like."



Inside a Winnipeg boarding home

WINNIPEG — Steps away from a no-smoking sign, she inhales. A twist of smoke escapes her lips as she smiles politely, her puffy cream jacket in no way concealing a bulging baby bump.

She doesn't really feel like talking, content to stand alone in the fall chill outside the Kivalliq Inuit Centre while a group of other women lights up and laughs together a few metres away from the West End boarding home's front doors. But a mention of home brightens her youthful face.

Women who are sent to Winnipeg to give birth typically stay at the Kivalliq Inuit Centre for a few weeks leading up to their due dates.


Women who are sent to Winnipeg to give birth typically stay at the Kivalliq Inuit Centre for a few weeks leading up to their due dates.

It can get lonely here, she concedes, if you don't know anyone.

She's from Rankin Inlet, NU, nearly 1,500 kilometres north of Winnipeg by air. And she’s waiting out a lonely few weeks at the Winnipeg boarding home until her partner can fly down to be with her for a scheduled cesarean section. Their new baby will be one of a large percentage of brand-new Nunavut residents from the Kivalliq region to have Winnipeg stamped on their birth certificates.

Inside the Kivalliq Inuit Centre boarding home, pregnant women — "pre-natals" as staff sometimes call them — mix with patients awaiting all manner of scheduled surgeries and medical procedures. They might meet signed-in relatives and friends in the first-floor visitors' lounge, passing glass display cases featuring donated ukpiks, ulus and carvings, or they may spot familiar faces hanging out by the foosball and air-hockey tables in the game room or reading books in the little library.

Upstairs, in dorm-like rooms with three or four narrow, numbered beds, a wall-mounted flat-screen TV and storage lockers, many Nunavut women will feel their first contractions after weeks of waiting. Most will be rushed to Women's Hospital or St. Boniface. They'll labour in a hospital room surrounded by nurses they've never met, get the go-ahead to push by whichever physician is available and treated by capable but often visibly rushed staff.

The lucky ones — those who were approved for a paid escort or can afford an extra return flight and hotel stay — will have their mothers, boyfriends or husbands with them in the delivery room, urging them on when they feel defeat creep in, then celebrating with them the arrival of a new family member.

But many will be alone.

The 120-bed boarding home is designed to reflect Northern life with clean, curved lines and rounded surfaces of stone and wood. Since 2003, residents from Nunavut's Kivalliq region have stayed in this privately owned residence when they come to Winnipeg for doctor appointments.

A whiteboard on the wall across from the stately front desk lists flight departure times and instructs guests to be out front with their luggage in plenty of time. A wall of closed circuit TV screens displays a digital patchwork of mostly empty corridors throughout the residence. Nearby, rows of constantly ringing phones are answered by busy, Inuktitut-speaking clerks.

Down the hall in the dining room, traditional food is on the menu, but the inner shelves of a large communal fridge are brimming with labelled plastic bags of guests' own char, muktuk and other favourites. Guests can forgo meals at the cafeteria-style serving line and instead prepare their own meals. A yellow-tiled corner set aside from the main eating area is built to be hosed down after guests complete the messy process of cutting and eating their raw meat. All around, colourful nutrition posters espousing in Inuktitut the benefits of berries, fish, caribou meat and other country food.

But even bringing small comforts from home can't make up for being here. Many Nunavummiut will tell you: A Manitoba birth certificate just doesn't instil the same sense of cultural pride.


Winnipeg Free Press copy editor Katie May was awarded the 2014 Greg Clark Award, which allowed her the experience of spending a week at the Rankin Inlet birthing centre. her goal was to observe how its approach might help solve the maternal-health crises in remote communities in northen Canada.  She travelled to Rankin Inlet in September. The award is named for one of Canada's greatest journalists.

Read more by Katie May.


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