Quebec Cree expand at-home birthing options

"The bringing in of a new life is integral to community health," said Jasmine Chatelain, a registered midwife and the planning, programming and research officer (PPRO) with Cree health's new midwifery education program.

Decolonization of birthing soon to include on-territory training of Cree midwives

In June 2020, Carrie Napash gives birth at home in Chisasibi, Que. surrounded by family and with help of a midwife. Since 2019, more than 57 babies have been born on-territory in Eeyou Istchee, the traditional name of Cree territory in Que. (Nerea Chabot Soloaga/CBHSSJB)

More Cree in northern Quebec will be able to have their babies in their home communities — the way it was before European contact — as midwifery services continue to expand in the territory.

In November, a new interim birthing home in Chisasibi welcomed its first baby. 

And now, the Cree Board of Health and Social Services of James Bay is creating an on-territory education program to train Cree midwives.

"The bringing in of a new life is integral to community health — and by health, I mean all four aspects of health; spiritual, mental, emotional and physical," said Jasmine Chatelain, a registered midwife and the planning, programming and research officer (PPRO) with Cree health's Eeyou Istchee midwifery education program.

The program does not yet have an official name.

The bringing in of a new life is integral to community health.​​​​- Jasmine Chatelain, midwife

The health board has been working since 2004 to return birthing to the territory. 

And between 2019 and 2021, more than 57 Cree babies have been born on the territory with the help of midwives.

Currently, there are no Cree midwives and Chatelain says Cree Health hopes a home-grown program will change that. 

"Our program is learning by doing," said Chatelain, adding the trainees will be paired up with an experienced midwife. 

"The minute a student starts their program, they are joined at the hip to a midwife or another kind of healthcare provider or knowledge-keeper."

A birth re-enactment Chisasibi in 2016 with knowledge keepers Martha Tapiatic Pachano, left, and Jane Matthew. (T.Philiptchenko/ CBHSSJB)

Right now, there are two ways to become a midwife in Quebec — through a four-year university program or through a program like the one Cree Health is creating. Quebec's Midwives Act gives Indigenous communities the power to train their own midwives. 

Leaving family to attend school in the south is a huge obstacle for many Cree to becoming a midwife, said Chatelain. 

"Education programs in the South are not structured in such a way that matches how Cree people learn and teach," said Chatelain, adding the Cree program is built around Indigenous ways of learning and with a goal of reducing barriers.

"So instead of trying to put a square peg in a round hole, instead of trying to force Cree people to adapt to a different way of doing things, we would like to support people to learn how they learn and where they live," said Chatelain.

Cree program modelled on Nunavik

Cree newborn Cayde Snowboy with her grandmother in 2019 in Chisasibi, Que. (Tatiana Philiptchenko/CBHSSJB)

The Cree education program is being modelled after Inuulitsiviup Nutarataatitsijingita Ilisarningata Aulagusinga (INIA) education program with the Nunavik Regional Board of Health and Social Services.  INIA was the very first midwifery program in Canada, started in 1986. 

Now in Nunavik, there are 10 Inuk midwives and 15 midwifery students, and more than 92 percent of Nunavik babies are born on the territory.

"They have very, very good outcomes," said Chatelain, adding the statistics regarding mortality, complications and pre-term pregnancies are better than in the South. 

We are pleased to be part of the process with them.​​​​​- Arian Navickas, Inuulitsivik Maternities, Nunavik, Que. 

Nunavik health is also sharing their knowledge and making many of the INIA teaching materials available to CBHSSJB. 

"We are pleased to be part of the process with them," said Arian Navickas, Midwifery management support for Inuulitsivik Maternities, Nunavik, Que. in an email request for information.

Interim birthing home opens in Chisasibi

Another birthing option was made available to Cree parents late last year, with the opening of an interim birthing home in Chisasibi, which is the largest of the Cree communities, with a population of more than 5 thousand. 

In 2022, construction will begin on permanent birthing homes in Chisasibi, as well as regional centres of Mistissini and Waskaganish, according to the Cree health board website. 

Opening of the temporary birthing home in Chisasibi, Que. on December 1, 2021. (from left to right) CBHSSJB Chairperson Bertie Wapachee, Marcella Washipabano, Sylvie Carignan, Gabrielle Dallaire, Maude Poulin, Denise Perusse, Arlene Swallow, Lisa Bobbish, Mariève Hémond, Sara-Michelle Bresee, Margaret Dick, Sarah Tapiatic, Natasha Bates (Marcel Grogorick/CBHSSJB)

The temporary Chisasibi home has a comfortable bed, a bathtub and access to a kitchen and is meant to put the mothers-to-be at ease, according to Denise Perusse, the birthing home coordinator for the Cree health board.

"The idea is when you come here, 'home' is the key word,"  said Perusse.

The idea is when you come here, 'home' is the key word.​​- Denise Perusse, birthing home coordinator, Cree health

"You feel like you can come in. You can take your coat off, make yourself a coffee or tea and relax. The room is made to be intimate and relaxing."

For Cree health board Chairperson Bertie Wapachee, it represents a real step forward for the Cree nation. 

'It's overwhelming to see this in place," said Wapachee in a statement. 

"When we expand, every young mother will be able to have that service. It's quite an accomplishment for our Nation," he said.

Cousins Cayde and Ela Snowboy in 2019 in Chisasibi, Que. (Tatiana Philiptchenko/ CBHSSJB)

Chatelain said Cree health doesn't yet have a firm start date for the education program, but they are currently aiming for June of 2022.  It will take between four-and-a-half to five -and-a-half years for a Cree student to become a certified midwife. She says interest in the program is already "overwhelming".

And she says having Cree midwives delivering Cree babies will make all the difference in the world.

"It will have really positive ripple effects throughout the community in ways that you can't even imagine," said Chatelain. 

"Eeyou Istchee always had midwives, and it's time to restore that."