The Aboriginal midwives who work on the Six Nations of the Grand River territory (near Brantford) are actively involved in improving the health of their entire community. In addition to caring for women from conception to birth, they offer health education, disease screening, well-woman care and cultural teachings for women of all ages. “Our scope is comprehensive. We strive to improve the overall health of our people. We do so much more than birth,” says Julie Wilson, the supervisor of the Maternal and Child Centre at Six Nations.
Six Nations is the largest First Nation in Canada and the only territory in North America where the six Iroquois nations – Mohawk, Cayuga, Onondaga, Oneida, Seneca and Tuscarora – live together. The sign outside the Maternal and Child Centre reflects the honour and responsibility of bringing new life into the world in two languages. Tsi Non:we Ionnakeratstha means “The Place They Will Be Born” in Mohawk. Ona:grahsta is Cayuga for “A Birthing Place.”
…in addition to offering prenatal classes with an indigenous component for all the women in the community (it’s not necessary to be a midwifery client) and providing primary care for pregnant women, the midwives provide additional services that range from fertility counselling to screening for breast and cervical cancers.
The midwives begin to plant the seeds of health and wellness by teaching the girls in their community about their changing bodies and some of the challenges they may face as they come of age. They share these teachings at a summer camp they hold for girls aged nine to 13. When the girls aren’t riding horses and doing archery, the midwives lead age-appropriate discussions about puberty, menstruation, domestic violence and suicide. They talk to the older girls about choices, like abstinence and safer sex. The midwives weave messages about the importance of self-respect and resilience into their conversations with the girls by telling them about the importance of finishing school and reinforcing the message that it’s never okay for a man to hit a woman.
For women in their childbearing years and beyond, the midwives hold an annual Women’s Wellness Day where they give breast exams and Pap smears and teach breast self-examination. The day is typically attended by between 20 and 30 women, but those who can’t make it are welcome to schedule appointments at any time throughout the year. Wilson says that due to mistrust of the western medical system, prior mistreatment in hospitals, sexual abuse issues and discomfort with the idea of seeing a male doctor, many women in Six Nations would not have screening tests done if midwives did not provide the service.
“Some women are in their ’60s and they’ve never had a Pap because they’ve never trusted anyone enough to do that. I’ve heard women say – and really mean it – that they would rather die of cancer than get a Pap [outside of the community]. But they come here and they feel very comfortable because maybe the midwife delivered their grandbaby. They feel comfortable getting the service done with their own people, with a trusted community member,” says Wilson.
Wilson supervises five Aboriginal midwives. Four of the midwives provide primary care to pregnant women and their families and the fifth is a community breastfeeding consultant who is on call 24 hours a day, seven days a week to midwifery clients and other residents of Six Nations. The centre also employs a maternity care worker who acts as a postpartum doula. The birth centre recently marked an important milestone: a woman who was born during the birthing centre’s early days recently delivered her own baby there.
Many women meet the midwives when their sister or cousin is a midwifery client and they go on to become clients themselves. Each year the midwives at Six Nations attend a total of 100 births. Half of the babies are born in the birthing centre, the others are born in their parents’ homes.
Wilson says clients have a deep appreciation for the care and attention they receive from the midwives and the health services and cultural teachings they offer. “One woman said it was the first time in her life that anyone had ever really listened to her. She said she felt very well cared for and respected with the midwives sitting with her, wanting to know how she was doing and really being with her,” says Wilson. Being listened to and feeling understood empowers many of the midwives’ clients to find their voices and make healthier choices for themselves and their families.
“The rewarding thing is when you see moms become healthier during each pregnancy. Over the different courses of care they develop better parenting skills. They have better diets for themselves and their children. They become more vocal and more involved in their care. So they really start to take ownership of their health and their life,” says Wilson. Wilson says healthy mothers are the foundation of a healthy community because the wisdom they share with their children will be passed on to their grandchildren.