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ABORIGINAL MIDWIFERY AND TRADITIONAL BIRTHING SYSTEMS
REVISITED AND REVITALIZED:
INTERVIEWS WITH FIRST NATIONS ELDERS IN THE NORTHWEST REGION
OF BRITISH COLOMBIA
by
Kimberly A. Ross Leitenberger
B.A., Trent University,

1995

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARTS
in

FIRST NATIONS STUDIES

c Kimberly A. Ross Leitenberger

THE UNIVERSITY OF NORTHERN BRITISH COLUMBIA
November 1998
All rights reserved. This work may not be
reproduced in whole or in part, by photocopy or
other means, without permission of the author.

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0-612-62495-1

Canada

APPROVAL

Name: Kimberly A. Ross Leitenberger
Degree:

Master of Arts

Thesis Title:

ABORIGINAL MIDWIFERY AND TRADITIONAL BIRTHING
SYSTEMS REVISITED AND REVITALIZED: INTERVIEWS WITH
FIRST NATIONS ELDERS IN THE NORTHWEST REGION OF
BRITISH COLUMBIA

Examining Committee:

Chair: Dr. Alex C. Michalos

Supervisor: Dr. A n t o n ^ Mills,
First N^&^gn&_&&udip^ Pfpgram
UNBC,

Dr. James McDonald, First Nations
Studies Program UNBC

VtfVw-<_

Professor Annette Browne,
Nursing ProgramJJNBC—

Louis^^ilby, Director pf/Developmeiy
D z e - ^ K' ant^Friej^shijy" entre

External Examiner; Dr. Barbar^ ^erringer.
Social Work Program UNBC

Date Approved:

111

TABLE OF C0NTE31TS
Abstract

li

Table of Contents

iii-iv

List of Figures

v

Acknowledgments

vi

INTRODUCTION
CHAPTER ONE: LITERATURE REVIEW
1.1 Historical Perspective: The Decline/Disappearance
of Midwifery
1.2 The Rise of Two Official Discourses of Birth
1.3 Silenced Voices: Aboriginal Midwifery and
Traditional Birthing Practices
1.4 Colonization and First Nations Health and Well
Being
1.5 Aboriginal Women's Traditional Roles/Aboriginal
Health Principals
1.6 Given Voice: Aboriginal Midwifery and Traditional
Birthing Practices
1.7 Conclusion

3-35.
10.
16.
25.
26.
28.
30.
34.

CHAPTER TWO: MOVING TOWARDS THE CONTEMPORARY
2.1 Aboriginal Health Today
2.2 Infant and Maternal Health Indicators
2.2.1 Northwestern British Columbia
2.2.1a Infant Mortality
2.2.1b Low Birth Weight
2.2.1c Teen Pregnancy
2.3 Contemporary Birthing Issues
2.3.1 Birthing in the North
2.4 Conclusion

36-49.
37.
38.
39.
40.
41.
43.
44.
44.
48.

CHAPTER THREE: THE RESEARCH METHODOLOGY
3.1 Research, Knowledge and Power
3.1.1 Inuit Childbirth Study
3.2 Methodology
3.2.1 Community Based Research
3.2.2 Research Objectives
3.2.3 Research Design
3.2.4 Community Involvement
3.2.5 Methods of Data Collection: Indepth Interviews
and Focus Groups
3.2.6 Procedure
3.3 Data Analysis
3.3.1 Use of Results
3.3.2 Personal Interpretations of the Research
3.3.2a The Comfort of the Interview
3.3.2b The Time and Place of the Interview
3.3.2c My Concerns with the Interview Process

50-66.
50.
52.
54.
54.
55.
55.
56.
57.
58.
60.
61.
61.
63.
64.
65.

IV

CHAPTER POOR: FINDINGS
4.1
Personal Stories
4.1.1 Women's Own Birth Stories
4.1.2 Women as Midwives
4.1.3 Unique Instances
4.1.4 Maternal and Infant Deaths
4.2 Knowledge of Midwifery
4.2.1 Restrictions
4.2.2 Midwives Roles
4.2.3 Pregnancy and Labour
4.2.3a Medicines
4.2.3b Place, Preparation and Positions of Birch
4.2.3c Post Partum; Cleaning of the Infant, Mother,
Afterbirth and Cord
4.2.4 Breastfeeding
4.3 Contemporary Birthing
4.4 Conclusion

67-106.
67.
68.
7l .
72.
74.
78.
79.
83.
88.
88.
90.
93.

CHAPTER FIVE: MOVING TOWARDS THE FUTURE
5.1 Discussion of Findings and Related Themes
5.1.1 Contradictions and Complexities
5.1.2 Contemporary Dilemmas
5.2 Revitalization of Traditional Healing Strategies
5.3 Collaboration/Co-operation: Contemporary Examples
5.4 Aboriginal Midwifery in British Columbia Today
5.5 Conclusion

107-124,
107.
108.
109.
111.
113.
117.
119.

BIBLIOGRAPHY

125-131.

FIGURES

132-136.

APPENDICES
1. Interview Table
2. Letter of Intent and InterviewQuestions
3. Letter of Informed Consent
4. Community Access to Data/Results and
Statement of Confidentiality
5. Ethics Approval

137-143.
137.
138-140.
141.
142.

96.
98.
104.

143.

V

List of Figures
FIGURE 1
Map of First Nations of British Columbia
FIGURE 2
Infant Mortality Rates (IMR's) for Registered Indians,
Inuit and Total Population

132.
133.

FIGURE 3
Map of British Columbia Health Regions

134.

FIGURE 4
Map of British Columbia Local Health Areas

135.

FIGURE 5
Infant Mortality Rates (IMR's) Status Indians vs. B.C.,
Both Genders, British Columbia, 1992

136.

Acknowledgments
When asked to describe myself, more often than not, I begin with
the words "I am a woman". It is in this definition that I find
completeness and fulfillment, it also directs my experiences and the
perspectives derived from such experiences. Culturally constructed or
biologically based, my self image contains elements of both, and
although at times confusing and conflicting, a host of other roles both
imposed and chosen fill up my life; mother-to-be, wife, daughter,
sister, student, intellectual, friend.
Exploring this copie and conducting this research has added one
more experience to the myriad of others influencing my existence and
outlook not only in the way I define myself, but in the way I see the
world.
I need to thank so many people for both helping me in this process
and supporting me through this time in my life: *the Elders; Annie,
Lizzie, Margaret, Antonia, Mary, Sophie, Elsie, Gloria, Kathleen, and
all the Elders of the Prince Rupert Friendship House. My Committee and
UNBC professors: Antonia Mills, Jim McDonald, Annette Browne, Louise
Kilby and Heather Young Leslie. My support system: Janice Tollefsen,
Joycelyn Carnell, Stephanie Capyk and Dena Lehman. The professionals:
UNBC, The Dze L K'ant Friendship Centre, The Prince Rupert Friendship
House, The Northwest POP programs workers and coordinators, specifically
Deet Rattray and her family. Finally, my family: Harvey Ross, Beverley
Ross, Tracy, Cathy and Tricia, my dog Belle, the little one and my
beloved husband and life partner Joshua.
* first names only have been used in the acknowledgment of the Elders
for reasons of confidentiality

INTRODUCTION: TEE JOURNEY
The master's degree, a long standing component of the academic
ladder, is changing and evolving tc suit the contemporary needs of
students and the broadening world. A multitude of new ideas and ways of
thinking have bloomed in the 20th century and research, academically,
must accept this new direction as the millennium approaches. First
Nations Studies itself is a relatively new discipline in the larger
discourse of academia. Yet, it alone has changed and grown, influencing
other disciplines, such as Anthropology and Sociology, and intellectuals
alike. However,

its greatest accomplishment today may be in its

determination to include First Nations communities, the subjects of
research, into the development of their own knowledge. It is this
community centred approach which has led to the breaking of traditional
academic boundaries and ways of both interpreting and seeing the world.
My journey, of which this thesis is only one part, has no
recognizable beginning. It stems from a number of events in my life and
started long before I entered the First Nations Studies Graduate Program
at UNBC. Stemming from a newly discovered interest in midwifery as a
traditional woman's role and method for community healing I began
researching this topic while still an undergraduate at Trent University
in Peterborough Ontario. My interest continued even in the year I took
off between degrees to explore other aspects of life. I continued to
read feverishly anything I could on what was then merely a personal
passion. Something changed for me and my passion became the driving
force to leave my new existence and reenter the domain of academia. So
in the fall of 1996 I packed my bags and traveled to the then-unknownto-me city of Prince George in Northern British Columbia to participate
in a relatively new and innovative Masters Program being offered at the
University of Northern British Columbia. After an interesting year of

making new friends, acquaintances and colleagues my dream was beginning
to take shape.
The research part of this journey began in the summer of 199'^ when
I was completing my internship at the Dze L K'ant Friendship Centre in
Smithers, 3.C. The Friendship Centre serves much of the Northwest region
of the province, providing programs to many remote and outlying
communities. My duties included researching Fetal Alcohol Syndrome
program resources which resulted in the compilation of a series of Fetal
Alcohol Syndrome Resource guides chat are now used throughout the region
in the Pregnancy Outreach Programs and as supplements to FAS workshops.
Further to this, I was involved as a research team member on the Houston
Maternal Health Needs Survey conducted that summer. Working closely with
employees of the Friendship Centre and Pregnancy Outreach Programs I
helped administer surveys and write the final report with
recommendations. All of these experiences broadened my already deep
interest in maternal health issues and specifically my interest in
Aboriginal midwifery. Concerns unknown to me were brought forward with
this work and included the evacuation of women from their communities to
birth in larger centres with hospitals. Transportation,

financial aid,

isolation from family and racism are just a few of the issues facing
birthing women in the North. Much is being done to help ease these
problems. Pregnancy Outreach. Programs in B.C.'s Northwest are working
with women to give mothers-to-be support and information while giving
their babies the healthy start needed.
The Dze L K'ant Friendship Centre sees maternal health needs in
the Northwest as a priority area for research. Over the course of the
summer several small informal discussions between Friendship Centre
researchers and Pregnancy Outreach employees ignited the idea of
performing a Northwest Regional Maternal Health Needs Study. Being a
Masters student in First Nations Studies and needing a topic for my

thesis I was invited to interview Eiders from the First Nations
communities in the Northwest to gather traditional knowledge and
personal experiences about midwifery and birthing practices. An Elder is
considered to be a person who holds special and sacred traditional
knowledge about their Nation and community. I was thrilled to
participate and to research a topic of great interest to me. Also, this
partnership with the Friendship Centre ensured that my research was
community based, allowing for direct community input and participation.
As a first step I needed to carefully decipher the intent and
purpose that would form the basis of this research. The following is
what I discovered and adhered to as the main objectives:
• Record and preserve traditional knowledge from First Nations
communities
• Identify alternative birthing options/practices for women in the
Northwest
• Create a knowledge base for new and current health programs in the
Northwest
• Secure First Nations voices in the discussion on birthing options in
the Northwest
My research began with a thorough review of existing literature
which provided me with the historical perspective needed and expanded my
understanding of contemporary issues surrounding Aboriginal midwifery
and traditional birthing systems. As will be seen in Chapter One:
Literature Review, within these larger topics,

I explored the critical

issues and the major theoretical arguments. By exploring midwifery's
decline in Europe and almost complete disappearance in Canada, the
literature suggests a subsequent rise of two official discourses of
birth, a medical technology-oriented narrative and a feministrevisionist narrative. From the literature I was able to ascertain that
information on Aboriginal midwifery and traditional birthing systems had
been both ignored and overshadowed by these two birthing philosophies.
Further, by reviewing research on the effects of colonization on the
health and well-being of First Nations peoples and Aboriginal women's

cradit-ional roles, a picture formed as to why this data was missing.
However, several recent articles on traditional Aboriginal midwifery and
birthing practices along with life histories of First Nations Elders
have attempted to include Aboriginal voices in the current discussion of
midwifery.
The literature review gave my research direction and allowed me to
develop a specific research question: what knowledge is available about
traditional Aboriginal midwifery and traditional birthing systems from
the First Nations communities in the Northwest region of British
Columbia and how can this knowledge be applied to contemporary birthing
issues in the North.
Chapter Two: Moving Towards the Contemporary outlines the general
situation of Aboriginal health in Canada today. This contemporary
continuation of Chapter One's discussion on the effects of colonization
with regards to First Nations health and well being is followed up by a
more specific look at the situation for Aboriginal infant and maternal
health. This section uses statistics such as infant mortality (the
number of deaths per 1000 live births up to and including the first year
of life for a given population), low birth weight rate (the number of
babies born in a given population weighting less than 2500 grams) and
teen pregnancy (the number of babies born to mothers within the age
range of 13-18 for a given population)

to give further insight into the

study area, Northwestern British Columbia.
One cannot forget the unique situation the North presents with
regards to health care access and delivery and it is important to this
topic to review the nature of birthing in the North for First Nations
people both historically and in contemporary times. Lastly in Chapter
Two, a summary of the critical issues outlined in my literature review
are combined with this information to tie the research back to the
research question.

Chapter Three: The Research Methodology, begins with a theoretical
discussion of the issues surrounding knowledge, power, interpretation
and research conducted from within an academic institution. Research
with Aboriginal peoples in the past has poorly served their needs. To
try and answer my questions regarding how to conduct ethical and
beneficial research cooperatively with First Nations peoples I briefly
examined a successful, community initiated, co-operative research
project:

The Inuit Childbirth Study. By involving the community,

focusing on traditional knowledge and transferring skills to the Inuit
researchers, the benefits and empowerment of this research design were
obvious.
An overview of the research methodology begins with an exploration
into the nature of the Community Based Research Design and how I
incorporated its primary steps into a research design. A discussion of
the community's involvement is followed by the data collection methods,
the procedure, how the data was analyzed and how the results will be
used.
Conducting research is a subjective process and the researcher's
world view, experiences and perspectives cannot be separated from the
process itself. I have attempted to place myself within this research by
outlining my personal feelings and experiences, good and bad, as I
followed this journey to the end. To try and account for my role as a
researcher. Chapter Three ends with a detailed investigation of my own
personal concerns and interpretations of the research process.
As will be seen in Chapter Fcvr: Findings, out of the original
three categories or sections of the interview questions, several
patterns began to emerge. In the first section. Personal Experience, the
Elders' stories of birth can be aligned into four categories: Women's
own birth stories. Women as Midwives, Unique Instances, and stories of
Infant and Maternal Deaths. Out of the questions on Knowledge of

Midwifery, a

tremendous amount of detailed information was presented. To

organize it I created several subheadings:

Restrictions, MidwivesRoles,

Pregnancy and Labour, and Breastfeeding. Like the interviews,

I ended

this chapter with a brief discussion of how the women felt about
Contemporary Birthing and the western medical system.
More came out of this chapter than the simple break down of
questions into subheadings. I discovered that there were a number of
base or common themes permeating all of the interviews and that these
base themes were present in a general way in every single interview.
Birthing was/is more than a physical or even a social event,

it was/is a

way of being

and reflected/reflects deeper philosophical and

metaphysical

beliefs. It was/is treated in a holistic manner as a

natural event in the course of life and was both community and family
centred. Births,

the knowledge surrounding birth and those who

participated in the birthing scene, created an oral discourse of
birthing where experiences and ideas were used as teaching methods.
Chapter Five: Moving Towards the Future; brings all these ideas
together in a discussion of the possibilities for using this information
in a positive way. It begins with a synthesis of the findings described
in Chapter Four and how these connect to the overall themes discovered
through the literature review. Key theoretical and practical
contradictions are discussed along with the tensions involved in the
move from midwife-centered birthing care to hospital deliveries. An
exploration into the revitalization of traditional healing strategies is
then followed fay some examples of contemporary collaborative initiatives
with regards to bringing traditional birthing practices and midwifery
back to the community. Finally, a brief look at the midwifery situation
in B.C. today gives us insight into the opportunities available for the
Aboriginal communities in Northwestern British Columbia.

Traditional practices have survived, not always intact, through
years of ridicule, denunciation, misrepresentation and punishment by law
at the hands of Western society. It is important that surviving
practices be protected from further loss and that they be strengthened
and adapted to contemporary situations. As stated in the Royal
Commission on Aboriginal Peoples (RCAP):

Traditional healing has endured major and deliberate
assaults on its validity. To try and protect and preserve
existing skills and knowledge, and at the same time
develop and extend their application, active support not just increased tolerance is required (Royal Commission on
Aboriginal Peoples(RCAP)1996:290).

This promotion of First Nations healing practices, such as
Aboriginal midwifery and traditional birthing practices,

is an important

and essential method of reviving Aboriginal health status and well-being
in Canada. Hopefully this thesis research can help the movement towards
decolonization, cultural revival and further the path of healing for
First Nations peoples.

CHAPTER ONE: LITERATURE REVIEW
Everyday one quarter of a million people are born worldwide and
historically midwives have been the primary caregivers of birth and the
birthing process (Burtch 1994a, Oakley and Houd 1990, Northrop 1994).
These women were active for thousands of years in pre-induscriai Europe,
Asia, Africa, Australia and North and South America providing childbirth
attendance and traditional healing for pregnant women. To date, Canada
remains one of only nine of the 210 countries in the World Health
Organization that have no provision for midwifery (Elkins 1985:320).
This is slowly changing however with the legalization of midwifery in
the provinces of Ontario, Alberta and most recently British Columbia.
To begin a discussion of the literature surrounding the topic of
Aboriginal midwifery and traditional birth practices, specifically in
British Columbia, a wider perspective must be taken. This perspective
must include a historical look at the development and decline of
midwifery practice in Europe and subsequently midwifery's almost
complete omission, except for traditional First Nations midwifery,
immigrant groups and what Burtch (1994a) calls the Traditional Birth
Culture that arose across the remote and outlying communities in Canada.
Further, we must follow the rise of two official discourses, the medical
and the natural, to come to the realization that culture has not been
thoroughly considered in either narrative.
For the purpose of this literature review, the focus will return
to the First Nations voices which have previously been ignored in the
discussion of birthing and birthing practices. Several recent articles
and studies outlined here have attempted to incorporate the Aboriginal
perspective in the current discussion of midwifery. They include
research on the effects of colonization on First Nations health and
well-being. Aboriginal women's traditional roles and responsibilities.

Aboriginal midwifery itself, traditional birth practices surrounding
pregnancy and childbirth and life stories of Aboriginal Elders from the
North.
One can find controversy in almost all aspects of the midwifery
movement beginning with the definition of what a midwife is. Burtch
(1994a) outlines two separate definitions of midwifery with the first
being a generic version,

the midwife being described as any person, man

or woman, who assists a woman in childbirth be they a nurse, midwife or
lay midwife. Burtch's second definition is more specific in that only
women can be considered midwives, with the original spelling of wife as
wyfe, Old English for woman. However, Burtch also mentions the
controversy involved in this definition as whether or not the term
midwife can be applied to all the women present at a birtn or simply to
the woman who actually delivers the child. Oakley and Houd (1990)
discuss the use of the word midwife as a reference to a long standing
tradition of alliance between women giving birth and the women that
attend them (1990:17).
The word midwife can be seen to have many historical base meanings
such as, with woman, old wife, traditional woman healer, good woman,
cunning woman, wise woman and in Quebec sage-femme. Benoit and Carroll
(1995), found that the professional label of midwife was not neoessarily
a recognizable term among the First Nations of British Columbia. The
Nuu-chah-nulth describe a midwife as, "she that can do anything", while
the Chilcotin refer to her as "women's helper" and the Coast Salish word
means to "watch and care" (1995:232). However, in terms of contemporary
health care. The World Health Organization has recently coined the term
Traditional Birth Attendant to refer to the main providers of pre, ante
and post natal care to women world wide

(Elkins 1985:320).

10

1.1 HISTORICAL PERSPECTIVE: THE DECLINE/DISAPPEARANCE OF MIDWIFERY

To give an understanding to the midwifery situation in Canada
today, an historical and cross-cultural perspective must be taken.
Burtch (1994a) describes the transformation of midwifery to have had
three stages. The first was the redefinition of birth as a medical
procedure along with the rise in technology surrounding life in general,
the second was the campaigning against midwifery and the third, the
complex issues surrounding the state and institutional control of
midwifery, specifically the medical system, educational system and
government. Burtch goes so far as to say that the "displacement of
midwifery by medical and nursing personnel is set in the larger
framework of technological advancements, centralization of maternity
services and formal bureaucratic structures"

(1994a:64).

To begin his exploration, Burtch refers to the changing patterns
of state control in pre-industrial Europe and uses Bohmne's

(1984, in

Burtch 1994a) three stage progression of the changing status of
midwifery. Bohmne's first stage. SoliZary Aid, locates knowledge of
childbirth through personal experience, such as witnessing births, and
suggests that giving birth was a necessary aspect of becoming a midwife.
However, in the Middle Ages midwives became licensed practitioners
appointed by the church and were required to uphold church values. This
is Bohmne's second stage, as the power over birth attendance left the
communities' hands and entered the domain of the church and birth became
not a matter of choice but a regulated affair (Burtch 1994a:64).
Midwives at this time were not paid and were expected to prevent
abortions, infanticide, watch for changelings, baptize and establish
paternity of the newborn infants. However, in the early thirteenth
century Barber surgeon guilds were established to deal with abnormal
births and by the fourteenth century physicians also became licensees of

II

the church. These guilds significantly diminished women's roles as both
midwives and licensees of the church.
Along side the previously mentioned move to church control was a
period in history that many contemporary women call the Burning Times or
the Women's Holocaust (Burning Times 1990). In the 16th and 17th
centuries all across Europe millions of people were hanged, drowned or
burned at the stake, having been accused of the practice of witchcraft.
The persecution of witches grew out of a larger punitive movement. The
Inquisition, an investigative body established out of the church (Marron
1989:23). With regards to witchcraft.

The Malleus Maleficarium, or The

Hammer of Witches, a treatise written by the Dominican Friars, gave the
power to imprison,

torture, convict and punish anyone accused of

practicing witchcraft. The majority of people accused and killed were
women who had some sort of power within their communities, be it as
healer, land owner or midwife

(Burtch 1994a, Oakley and Houd 1990).

Overwhelming misogyny became the established norm as women were deemed
passive and easily courted by the devil. As the organized religion of
Christianity spread across the Western world, they robbed the earth and
women of their respected positions, power and divinity, even into the
colonies of the "New World" (Burtch 1994a:67, Marron 1989:22).
Bohmne reveals the third change to be the move to traditional
professionalization, a secular position, from a church assigned
position. The issue of traditional professionalism arose as medicine
became organized and midwives were deemed as lacking in an acceptable
knowledge base. Until the 13th century the medical profession was open
to anyone, but with the establishment of medical guilds, a universitygiven license became a necessity. As women were barred from attending
universities this became an impediment to them practicing midwifery
legally. Coupled with the rise of technology in birth, specifically the
development of the forceps in the 17th century, these changes allowed

12

the disciplines of obstetrics and gynecology to overtake the centuries
of midwifery history in Europe. The big push for full obstetrical
control came with the complete redefinition of birth as a pathology
(Oakley and Houd 1990:31). However, up until the late 19th century there
was still resistance to the male centred physician birth, as male
midwives were targeted for indecency and had to practice with sheets
tied over their heads or in the dark (Oakley and Houd 1990:30).
Bohmne's final stage is that of present day midwifery, a self­
regulating and licensed profession in Europe, with local and
international organizations who specialize in combining theoretical
knowledge of medicine and practical midwifery skills

(Burtch 1994a:68).

To achieve this however, midwives had to continually lobby government
for change and during the late 19th century many midwifery-related bills
were passed in England. The first act governing midwifery was made law
in 1902 following the efforts of The Midwifery Institution. This bill
gave midwives legal recognition but the profession remained under
medical control (Burtch 1994a:68). However, changes in 1936 and 1951
located the role of midwives in Britain where it stands today.
Oakley and Houd (1990) elaborate on this takeover of childbirth by
the medical profession as not only a professionalization of the birth
scene but also as a process that systematically excludes the issues of
race, class and specifically gender (Oakley and Houd 1990:24). Oakley
and Houd discuss the removal of women from the birthing scene as a
"colonization" of midwifery, a formerly women-centred, controlled and
regulated event:
Female midwives were part of a female controlled
reproductive care system...[and] it was precisely
this that posed so much of a threat to the church,
the state and the emerging medical profession
(Oakley and Houd 1990:26).

13

As with Burtch (1994a), Oakley and Houd also discuss the
persecution of witches and the development of The Malleus Maleficarium
as central to the decline in the midwifery movement in Europe. However,
Oakley and Houd see the accusation of witchcraft as synonymous with
hostility to women and women's real or imagined power

(1990:20). The

Malleus Maleficarium contained very real descriptions of midwives
performing infanticide and the claim of women's sexual appetites that
drove them to "congress with the devil and to use their work as midwives
for this purpose" (Oakley and Houd 1990:27). Midwifery based knowledge
such as abortificants and herbal contraceptives as well as birthing
being a woman's domain permitted women control of their own reproductive
lives. This underlying attack on women and midwives through their sexual
being was partly directed at this large body of knowledge.
Oakley and Houd (1990), concurrent with the description of the
decline of midwifery as a misogynist issue, believe that the biggest
factor in the relegation of the birthing scene to men and medical
science came with the redefinition of pregnancy and childbirth as a
pathology. As a pathology, childbirth and pregnancy required strict
control of when, where and how the birth took place. It implied the
notion that at any moment "something could go wrong" (Oakley and Houd
190:32) and therefore continuous monitoring and surveillance by an
obstetrician was necessary. This was not only a medicalization of
childbirth but a definition which undermined the entire rationale of a
woman centred birth culture and midwife attendance (Oakley and Houd
1990:31). They argue that the triumph of obstetrics over midwifery was a
strategic "success", based not only in the definition of childbirth as
an illness but in the public defacing of midwifes as incompetent. This
propaganda, not unlike The Malleus Maleficarium, arose everywhere
including 20th century obstetrical textbooks:

their [midwives] thinly veiled advertisements

14

in the newspaper show them, to be willing abortionists;
and since they have the right to give certificates of
stillbirths, who knows whether or not an infant's death
is due to natural causes or to criminal manipulation
(A Textbook of the Science and Art of Obstetrics; Garrigues
1902 in Oakley and Houd 1990:27).
Oakley and Houd are firm in their representation of the care of
female midwives to birching woman as being a long standing tradition.
They argue that the fundamental difference between midwifery and
obstetrics lies in the intervention-oriented philosophy of medicine and
that this difference is deeply rooted in the socially constructed views
about women and reproduction rampant in our culture

(1990:33).

Although medicalized birth has also become the norm in North
America, both Oakley and Houd (1990) and Burtch (1994a) see the events
surrounding the decline in midwifery in North America as taking a
different path from that of their European counterparts. While in Europe
the midwife never fully disappeared from the birthing scene and finally
secured a legal footing as birth attendants, midwifery in Canada was
almost completely wiped out with only recent acceptance of professional
status.
Burtch (1994a) maintains that until recently the history of
midwifery in Canada shows a lack of documentation and this is partially
due to the illegal or alegal status of midwifery in Canada. Community
midwives,

fearful of prosecution,

kept no birth or statistical records.

Further adding to midwifery's lack of documentation is the fact that
until recently the history books have been written from a patriarchal
point of view, by men, for men and from the male perspective, which in
most cases focused on the superiority of hospital births and described
midwife attended births in a negative light (1994a:72). However, some
brief historical accounts do describe community or neighbour midwives
and it is here that we encounter references to cross-cultural and First
Nations midwives for the first time. Burtch contends that midwives were

15

iategral parts of Mennonite communities, first generation Japanese
Canadians in the lower mainland of British Columbia and that:
Historical accounts indicate that Native midwives
assisted settlers and one another in the colony of
British Columbia (Burtch 1994a:74).

Medical and state control was established in the more eastern
settlements of present day Nova Scotia and Quebec as early on as 1788
when the British government required midwives to have certification and
in 1795 with the Upper Canada Medical Act. Amendments to this act in
1806 protected midwives to some extent. However, medical dominance
forged its way just as it had in Europe with the entrenchment of powers
over birth to the state including licensing,

the system of medical

registration and the necessity of medical education (Burtch 1994a:76).
In these new settlements, doctors needed to develop family practice and
again echoing the movements in Europe, the medical community "used
campaigns of vilification, characterizing midwives as ignorant, dirty
and dangerous." Thus by 1879, ninety-five percent of midwifery licenses
were issued to male physicians (Burtch 1994a:77).
However, Burtch contends that in the more western colonies and
less densely populated areas the nature of midwifery took a different
shape.

Here, the geography allowed for a more community-based,

neighbourly network of midwifery to develop. Burtch following Mason
(1988), describes Traditional Birth Culture as focused on the continuity
of care of the woman, the need to stay with her throughout her entire
pregnancy, the use of a variety of positions, moving around during
labour, familiarity, companionship, provision for bedrest among women
following birth and the use of reciprocity rather than payment for
service (1994a:75).
Change for more rural areas came after the first World War as
community midwifery was almost completely eradicated by physicians, the

16

public health nsovement and the growing involvement of nurses in
maternity care. This came at a time when nurses were becoming more and
more a part of the medical hierarchy and a period of domiciliary
midwifery practiced extensively by public health nurses began in the
1920's and continued until the 1940's (Burcch I994a:79). It has been
estimated that only forty percent of Canadian mothers delivered in the
hospital in 1939, and that by 1959, ninety-three percent of births were
performed in hospital, suggesting that the largest change came after the
second world war with the development surrounding health care plans and
the generally improved conditions within hospitals including
accessibility (Burtch 1994a:79).
Oakley and Houd (1990) do not lose sight of the difference between
the European history of midwifery and the Canadian one, but do see the
conquest of obstetrical science over midwifery in both Europe and North
America as having one important similarity; that this triumph was not
only of obstetricians over midwives but represented male ascendancy over
women on many levels

(1990:30). They believe history proves the argument

for the midwifery profession being more female than male and it has been
the rule and not the exception that women in childbirth have been
attended by their own sex (1990:35) .

1.2 THE RISE OF TWO OFFICIAL DISCOURSES OF BIRTH

What arises out of these two histories of midwifery, the European
and its North American counterpart, are two official discourses of
childbirth, a medical, state controlled narrative and a natural,
feminist-revisionist narrative. It is necessary to explore the nature of
these discourses to reveal the lack of cross-cultural input and
specifically the lack of First Nations voices.
Katz-Rothman (1986) in her article "The Social Construction of
Birth", describes the history of childbirth as a chronicle of political

17

struggle as different Interest groups, namely the medical profession and
its opponents, have worked to gain control over childbirth

(1986:104).

Katz-Rothman continues to describe this as siTntclic Inceraccicnism, when
several social meanings are attached to a single physical reality.
Birthing can be seen as a physical as well as a social event and as in
every social event, alternative constructions of these events can take
place:
Which version is accepted and acted on is a reflection
of the power of each participant. The consequences,
of course, depend on the definition of the situation.
Those who define, control (1986:105).

When obstetricians overtook midwives as the primary caregivers of
the birth scene it was not a forced physical change but more
ideologically based as the medical system gained control through
redefining birth as a pathological event.

Burtch (1994b) states that

this redefining of birth failed to prove midwifery inferior to science
and that in reality midwives were preferred by women. This ideology of
medical control was reinforced by legislation which restricted other
forms of birth attendance. Community control was replaced by sanctions
of power by the state:
As Foucault notes of the disciplinary society,
discourse and surveillance serve to produce
docile bodies. Obedience becomes normal, disobedience
suspect and dealt with punitively. The community of
women thus became medicated through much larger
structures of power and knowledge as these events
became cast as medical events (Burtch 1994b:151).

Katz-Rothman (1985) and Burtch (1994b), like Oakley and Houd
(1990), each argue that a second official discourse has arisen as women
became unhappy with the medical version of childbirth with its rates of
intervention and obstetrical rituals. Along with the definition of birth
as pathology, there is also a revisionist feminist narrative of birth as

18

a women-centred, natural event

(1986:106). Benoit and Carroll

(1995)

have also taken up these two definitions as the official discourses of
contemporary childbirth. Their discussion of the medical narrative views
the subordination and/or elimination of midwifery by obstetrical science
as an issue of progress where new and more advanced technology has aided
the birthing woman. They claim it is filled with images of the primitive
folk healer who, inferior and undereducated, used her charms and rituals
but could not compete with technology, specifically the use of forceps,
as the "art and science of obstetrics conquered the ordeals that nature
had placed on women" (Benoit and Carroll 1995:227). At the base of this
narrative is a professional/non-professional dichotomy that does not
recognize the issue of class and race but more importantly the issue of
gender. The feminist narrative, according to Benoit and Carroll, takes
up issue with the medical version on this very point as it tells of a
male medical takeover of pregnancy and childbirth and the ensuing
decline in women centred, midwifery care. On top of the
professional/non-professional dichotomy outlined in the medical
narrative, the feminist revisioning focuses on the inequality of power
in the defining of the relationships in childbirth. Radical thinking can
be seen in the following quote:

Birthing women and their newborns will continue
to be victimized until obstetricians are vanquished
from parturition and midwives'" key role in the birthing
chamber is restored (Benoit and Carroll 1995:228).

Beyond these radical descriptions of an obstetrician-free birth
experience,

the feminist revisioning has been important in its movement

to give women alternative birthing choices and in the reorganization of
maternity services

(Benoit and Carroll 1996:228). Demand for health care

changes coming from dissatisfied women and the quest for reform oriented
around women-centred health and birthing care lead to the development of

19

. the Natural Childbirth Movement in the mid-20th Century. Women began to
realize that birth was a time of great opportunity to get in touch with
their true power and that a willingness to assume responsibility and
reclaim the power of birth would only occur when technology was moved
where it belonged, in the service of birthing women not as their master
(Northrup 1994:413).
The Natural Childbirth Movement created a discourse which
emphasized the beautiful and unrestricted in birth based on the notion
of the primitive woman who "goes off into the bush, gives birth
painlessly and then goes right back to work" (Cossett 1994:10). less
Cossett

(1994) in her book Women Writing Childbirth: Modern Discourses

of Motherhood comes at this discussion from a different angle. By
analyzing literary accounts and collections of real birthing stories,
Cossett believes childbirth has been dominated by a male perspective and
needs to be made more visible and told from the woman's point of view.
Women must live up to this ideal of the inherent and instinctive
power of birth. Cossett (1994) however, recognizes this as a cultural
construct and further delegates it to be western and male in origin.
Dick Read, an obstetrician, was the first to write on the possibilities
of Natural Childbirth in 1933, introducing the primitive woman, the
dichotomy of nature versus culture and the civilization of the
primitive. According to Cossett, in Read's model, originally the woman
is culture-less, and that civilization and culture have removed women
from this ideal birthing state (1994:10). Read is obviously working with
the nineteenth century ideals of social evolution and natural theology
based on the notion that the natural is inherently good. Read's
interpretation has the painlessness of childbirth as part of a woman's
state of mind, that she has not yet been taught to fear childbirth. Read
continues by arguing that it is only the "highly trained, charismatic
obstetrician who can counter the woman's civilized fears and restore

20

^them to their natural state" (Cossett 1994:12). Although the underlying
theory of Natural Childbirth has patriarchal origins, it was women and
midwives who took up this approach and used it to give power back to
women in childbirth. Read wrote two other books, Revelations of
Childbirth and Childbirth without Fear, both of which were largely based
on women's stories of natural childbirth. This was the beginning of
female appropriation of Read's theory but Kitsinger's The Experience of
Childbirth: Giving Birth How it Really Feels, was the first book in the
early twentieth century to be written by a woman for women (Kitsinger
in Cossett 1994:23).
The Lamaze method, developed by Dr. Fernand Lamaze, can be seen as
based on Read's ideas of childbirth without fear, as the woman
conditions herself against pain and therefore overcomes the natural.
Kitsinger is wary of the Lamaze method's "mechanistic breathing" but
still tends towards Read's discussion of the primitive and spiritual
nature of birth (Cossett 1994:23). Lamaze training, to Katz-Rothman
(1985), was a process of distraction from the actual birth experience
and women were positively reinforced for making it though a contraction
without crying out. She describes Szasz and Hollander's classic article
on the three basic patient/practitioner relationships developed in the
hospital setting. The first. The Active/Passive Model, involves an
anesthetized woman whose birth is completed by forceps and caesarean
section. In this relationship,

the doctor defines normalcy and each of

the following relationships have the potential to become active/passive
since in the hospital setting the doctor always has the power to render
the patient unconscious (Katz-Rothman 1985:113). The second
relationship.

The Guidance Co-operation Model,

forms the basis for the

Natural Childbirth Movement whose goal was for the individual birthing
woman to be polite, tactful and never fanatical

(1985:114). The doctor

guides the receptive woman through the process and with the help of her

21

husband is "coached" through the birth (1985:114). The third model is
the most difficult to obtain in the hospital setting. The Mutual
Participation Modal is described by Szasz and Hollander as a team
working towards a common goal. When it is achieved however, the woman is
again separated from her birthing experience as she becomes only one of
a number of people participating in the birth of her child. Further, her
ability to naturally birth, even using the natural childbirth philosophy
is overshadowed by the hospital procedures:

Positioning her and draping her in such a way
that she cannot directly see the birth, not allowing
her to touch her genitals or the forth coming baby,
tells the mother that the birth is something that
is happening to her, or being done to her, and not
something that she is doing (Katz-Rothman 1985:116).

Staff then remove the baby and it is cleaned, processed, measured
and presented to the mother. With this she becomes the receiver and not
the producer. We see that the re-definition of birth as a natural event
and the subsequent Natural Childbirth Movement did not challenge the
medical definition of birth but simply better prepared women for the
hospital experience

(Katz-Rothman 1995:113). Cossett

(1994) wonders if

the contradictions that are found in the notion of the primitive woman
giving birth painlessly and the reality of the modern woman consulting
her handbook can lead one to ask if "natural childbirth is really
natural or is it a cultural practice we learn from books?" (1994:23).
However, we see some women appropriating the primitive woman stereotype
and obscuring her male origins while others focus their energies on
discrediting the patriarchal base all together. Nonetheless, Cossett
argues that both dominant theories will always create four
possibilities, each a success story and each a failure. She states that
women will either find power or guilt in their ability or inability to
perform up to each ideal. On the medical side, women can experience a

22

anaesthetized pain-free technology based birth while on the natural side
the experience becomes an ecstatic drug-free painless birth. Failure
comes to the woman who does not enjoy the medical version, unable to use
her body properly but failure to not fully enjoy the natural birth can
also leave women with this same feeling of failure (1994:87).
Gossett's goal is to return to the maternal subjectivity which was
destroyed as women and childbirth became objectified through
medicalization (1994:02). She finds maternal subjectivity an
oppositional discourse and believes the Natural Childbirth Movement
gives women consciousness to discuss women centred birth. However,
Cossett brings up the interesting point that "Natural Childbirth
rhetoric...as much as the hospital birth system itself are cultural
products of particular historical moments"

(1990:03). She goes further

to introduce the notion that the Natural Childbirth Movement is anti­
feminist in its dependence on the stereotype of the primitive woman and
essential motherhood. The post-modern dilemma that Cossett presents is
evident in her need to affirm women's voices as marginalized subjects
while showing that these voices have also been culturally constructed by
prevailing discourses and cultural practices

(1994:03). We find no

authentic voice or voices of women even as the shadow of the medicalized
birth is lifted.
Cossett focuses on the two major narratives,

the medical and the

natural, but sees this dichotomy in itself as a myth as other discourses
become available. She specifically mentions the oral traditions of the
West, Che "Old Wives Tales"

(1994:05), as well as "other cultural

stories of race and class which are largely omitted from the official
discourses" (1994:05). It is in the hidden stories and practices where
the unacceptable accounts of childbirth can be found, the oral
traditions of women, usually mother to daughter, where the pain and
wisdom of childbirth are revealed. Reflected in these stories are images

23

of the peasaat crone or midwife^ who has her own competing knowledge to
that of the medical knowledge and who does not let the woman endure
birth alone as the natural model projects:

Anthropological research has suggested that painless
childbirth is by no means universal or even common
among sc called primitive cultures. Instead, a wide-range
of different cultural beliefs and practices surround
childbirth providing parallels with almost every approach,
interventionist, non-interventionist, male or female centred
to be found in the west (Cossett 1994:10).

Cossett sees these notions of the "other" woman, be she of a
different race or simply a non-mother as important aspects of women's
oral traditions and suggests that they fracture the essentialist base of
both official discourses. Natural Childbirth sees every woman as a
mother or potentially a mother while the medical discourse reduces the
woman through the disciplines of gynecology and obstetrics to her bodily
functions.
To believe in women's role as natural is to say that a woman has a
specific female nature or essence. Theoretically defined, this concept
is termed essentialism and is a belief in a true essence, that which is
irreducible and unchanging (Fuss 1989:20). Diana Fuss (1989) describes
the difficulties in negotiating around the theories of essentialism and
its opponent, constructionism, when dealing with issues related to
feminism. Essentialism has been used in feminist theory in a number of
ways, including the claim of a female essence, of universal female
oppression, and the autonomy of a female voice

(1989:20). Essentialism

universalizes all women and in turn ignores the fact that all cultures
have a variety of myths, models, roles and symbols of women and that it
is necessary to recognize the plurality of women's voices, experiences
and perspectives.
As with Cossett, a dilemma arises for Fuss (1989) in her need to
give voice or voices to marginalized women. Fuss states that although

24

this process of using identity or essence has limitations, essentialism
must be acknowledged as a method for resistance as the "risking" of
essence has long been used by people who base their social rights on
group identity (1989:106). We must also recognize that some contemporary
theories of identity negate cultural beliefs in which women's role is
directly tied to their connection to nature and where this connection is
not oppressive. Power and privilege come into play here: it depends upon
who is using essentialism or constructionism, how they are deployed and
where their effects are concentrated (Fuss 1989:106).
Burtch (1994a) sees criticisms of the medical model as ranging
from the feminist standpoint of male dominance over women's bodies to
criticism from within the medical institution itself over high
intervention rates

(I994a:05). Burtch states that the Western medical

model, although reducing infant and maternal mortality rates, can do so
without compromising the needs of women during pregnancy. He continues
his discussion of the medical system's dominance noting it as a
particular effect of "Statism"

(1994a:14) where there is a growing trend

for government involvement in social activities such as reproduction and
reproductive technologies. He finds the medical model instrumentalist,
in its exclusion of non-professionals and elitist, in its serving of
only the dominant class. Although discourses such as neo-marxism and
post-modernism are critical of the patriarchal ideology of the medical
institution Burtch argues that a culturally based critique is also
needed:

Another point is the great variation in birthing
practices across cultures (and within) as set against
the often monistic premises of obstetrical training
including the restriction of delivery positions,
length of the second stage of labour, and increases
in the rate of interventions such as caesareans (1994a:30).

25

To recap,

the history of midwifery from the Western perspective

results in the rise of two official discourses or narratives, a medical
and a natural or feminist. Each is formulated however, from a series of
culturally constructed and historical events. Both are deficient in
their exclusion of cross-cultural social realities and histories of
childbirth. Recognition of alternative Western and cross-cultural oral
discourses and traditional knowledge, including the voices of First
Nations,

is necessary to expand and include other perceptions of

parturition.

1.3 SILENCED VOICES: ABORIGINAL MIDWIFERY AND TRADITIONAL BIRTHING
PRACTICES
Every culture around the world has a system of management
surrounding childbirth. These systems include belief structures,
traditional practices during preconception, pregnancy, labour, delivery
as well as in the post natal period. As previously outlined, both
Cossett

(1994) and Burtch (1994a&b) have acknowledged this lack of

cross-cultural perspective, and, in Benoit and Carroll (1995) the
silenced voices in the discussion of midwifery are recognized as those
of the First Nations people. They argue:

that a deeper understanding of the interplay between
medical science and gender entails the unraveling of a third
history of midwifery, one that places the singular
concerns of traditional Aboriginal midwives, their
birthing families and their relationship to their
geo-cultural community central to the chronicle (1995:226).

Benoit and Carroll situate Aboriginal midwifery within the context
of the larger literature on midwifery, presented here, and incorporate
data gathered from two focus groups held in British Columbia and
sponsored by The Aboriginal Health Policy Branch of the Ministry of
Health. This recent work with Aboriginal people suggests that a third
history of midwifery is evident in Canada (1995:230). They emphasize the

26

need to recognize the variety of culturally rich and politically diverse
First Nations both historically and in contemporary times, and that when
one is exploring First Nations health it is essential to examine a
multitude of factors, including political, economic, social and cultural
changes through time. This narrative then, must begin with an
exploration of the effects of colonization on the health and well-being
of the First Nations peoples, expand to include a discussion on the
changing roles of First Nations women and review briefly some of the
current historical knowledge surrounding Aboriginal midwifery and
traditional birthing practices in Canada.

1.4 COLONIZATION AND FIRST NATIONS HEALTH AND WELL BEING

Upon contact, a massive decline in the First Nations population
occurred with the introduction of foreign disease, resulting in
epidemics of small pox, measles, influenza and tuberculosis

(Benoit and

Carroll 1995, Graham-Cummings 1967). Hundreds of thousands sickened and
died as a result of their encounters with Europeans. "Famine and warfare
contributed but infectious diseases were the great killer. Influenza,
measles, polio, diphtheria, small-pox and other diseases were
transported from the slums of Europe to the unprotected villages of the
Americas" (Royal Commission on Aboriginal Peoples

(RCAP) 1996:112). The

subsequent decline in th.e indigenous population is often described as a
holocaust (RCAP 1996:112). However, the major factor in the decline of
the health and well-being for the First Nations was the nature of the
colonial relationship, its primary goal being the elimination of First
Nations culture, physically and ideologically (Benoit and Carroll 1995,
Young 1984).
With the implementation of the residential school system, young
people were physically and ideologically separated from their
communities and traditions when they were forced to leave their homes to

27

attend the schools. Abuse was rampant in these schools and pregnancy was
not unheard of as young women who had been raped where often forced to
abort their pregnancies either against their will or through continued
physical abuse (Benoit and Carroll 1995:239, see also Miller 1996). A
whole generation left the residential school system with no connection
to their traditional ways and a negative view of themselves,

their

culture, their bodies and the reproductive process. The
multigenerational effects of the residential school system have been
deemed a syndrome (Medical Services Branch 1991:16,

Furniss 1994:126).

The paternal attitudes of the Indian Act and the reserve system
resulted in a widespread loss of culture, language, traditional roles
and family units due to a variety of imposed changes such as the growing
dependence on western food staples such as flour, sugar, lard and tea.
The introduction of alcohol, first as a trade item, had a deep and
difficult impact on First Nations communities, greatly excellerating
this process. A newly formed dependence on the Western health care
system arose as traditional healing methods were lost or forced
underground (Benoit and Carroll 1995:237, Royal Commission on Aboriginal
Peoples

(RCAP) 1993:73, Graham-Cummings 1967:121).

The inability to deal with the European diseases and famine began
a period of adoption of Western health and healing methods. With the
colonization of the First Nations peoples and the subsequent attempt to
eradicate their culture, traditional knowledge was often set aside as
First Nations peoples were sometimes imprisoned for practicing
traditional ways of being. Traditional healing and spiritual beliefs
were condemned by the colonizers as witchcraft. Therefore, the church
and state could offer relief through Western religion and medicine from
the massive numbers of deaths. Although death was a natural aspect of
life and both women and children were known to have died in childbirth
prior to contact, Benoit and Carroll (1995) contend that recent evidence

28

suggests that rates of mortality and morbidity for mothers and infants
in early Aboriginal societies were lower than after colonial impact
(1995:235). They suggest that soaring infant mortality rates post­
contact and the newly created dependence on the Western health care
system gave rise to the move to hospital births as Aboriginal midwifery
and Traditional birthing knowledge was lost or went underground. As with
the movement from women centred births in Europe, the redefining of
birth as a pathology backed by legislation made the move to obstetrician
centred births in Canada both a forced physical change and an
ideological one (Burtch 1994b:151).

1.5 ABORIGINAL WOMEN'S TRADITIONAL ROLES/ABORIGINAL HEALTH PRINCIPLES

Since contact, colonization has taken a great toll on Aboriginal
peoples but perhaps its greatest toll may have been on Aboriginal women
as their traditional roles were all but erased by the new foreign
government :

One can trace the diminishing status of Native
women along with the continuing process of
colonization (RCAP 1993:73).

Prior to contact. Aboriginal women were respected a^'d equal
members of their Nations. Women were seen as the centre of life and
being able to bring forth life was considered sacred (Malloch 1989:106).
Paula Gunn-Allen (1984) states that most American Indian tribes believed
the primary potential of the universe was essentially female and that
this is still true today:

Pre-conquest American Indian women valued
their role as vitalizers. Through their own
bodies they could bring vital beings into the
world - a miraculous power whose potency does
not diminish with industrial sophistication or
time (1984:27).

29

Bearing children was a transformative act, and contrary to the
biological base of the medical model, the power of thought and mind were
what gave rise to biological change just as it gives rise to social
change (Gunn-Allen 1984:28). Gunn-Allen continues by describing woman's
power as not so much in her ability to birth but in her power to make,
to create and to transform. She sees the physical and cultural genocide
of the First Nations peoples as being mostly about the colonizer's fear
of the gynocentric societies of the New World.
Malloch

(1989)in her article "Indian Medicine,

Indian Health: A

Study between Red and White Medicine", concurs with Gunn-Allen in that
birth is a sacred event which can strengthen a family and a nation. It
is a natural process, one that must be protected rather than interfered
with, and it is women who are the centre of this process (1989:108). She
continues by discussing the difference between the value systems of the
Western medical model and Traditional First Nations healing. The
principals she outlines include that good health is a gift from the
creator and therefore a personal responsibility. When one neglects
oneself it is disrespectful to the creator. First Nations traditional
health and medicine, according to Malloch,

is active and oral, and

related to a whole way of life. It is also based on the principal of
balance in the four areas of self: the physical, mental, emotional and
spiritual. Unbalance in any one area can cause illness as the other
areas are thrown off kilter (1989:106). With a focus on prevention.
First Nations values of healing do not simply stop at the individual but
come from past generations, to the family, community or nation and into
future generations

(1989:106).

The promotion of this medicine wheel

ideology is in part a response to the put downs of traditional healing
as witchcraft historically. This positive re-interpretation of a First

30

Nations healing model has been adopted by many different Nations across
the country.

1.6 GIVEN VOICE: ABORIGINAL MIDWIFERY AND BIRTHING PRACTICES

Malloch follows up this broad discussion of First Nations health
with a more detailed discussion of First Nations traditional midwifery
as an example of this philosophy of health. It must be reiterated here
however,

that along with these generalist principals of health and

healing,

the diversity and variety of First Nations beliefs surrounding

health and healing are vast, with each nation and community having
differing practices.
Midwives, states Malloch, are herbalist, gynecologist,
obstetrician and nutritionist all rolled into one. Usually mothers
themselves. Aboriginal midwives help women throughout their entire
pregnancy, and at the time of their delivery "she helps them to discover
and take responsibility for their female power" (1989:108). This is
echoed in Terry and Calm-Wind's(1989) article "Do-Dis-Seem", an article
outlining the traditional role of midwives of the Nishnawbe First
Nations in Ontario.
Pre-contact Aboriginal groups in B.C. also saw birth as a natural
and sacred event, part of the cycle of life and with this holistic
version of the world, the midwife was an integral part of the
continuation of the cycle

(Benoit and Carroll 1995:234) . This holistic

approach required continuous care, prenatally, through labour, delivery
and beyond the post-partum period extending into the child's later life.
Similar to Malloch's (1989) and Terry and Calm Wind's (1989)
descriptions, Benoit and Carroll

(1995) discovered that a midwife had

many functions and apprenticed with older more experienced women.
However, it was the community who determined the level of skill and
technical knowledge needed. Midwifery was a well-respected calling, and

il

a midwife had to be a long standing member of the society as well as
have a deeper understanding of the nature of illness and other human
misfortunes

(Benoit and Carroll 1995:234). Young pregnant women were

councelled early in life about proper and improper behaviour and later
complications were often related to the failure of the mother, father or
even community, to follow these do's and don'ts. An enormous energy
surrounded the birthing mother and child and it was the responsibility
of the midwife to pay attention to this. Delivery often occurred in
kneeling or squatting positions, herbal remedies were used and abdominal
massage was a common method for repositioning breech babies. The
afterbirth also held cultural significance for many First Nations, with
a variety of ceremonies performed (Benoit and Carroll 1995:235).
Along with the traditional responsibilities of the Aboriginal
midwife, the First Nations peoples had individual systems of birthing
practices and beliefs from pre-conception to child rearing. The Native
Infant Education class at Malaspina College in Duncan B.C., along with
Medical Services Branch, have produced a book which is a gathering
together of traditional knowledge regarding childbirth reflective of the
Salishian and Nuu-chah-nulth Nations of Vancouver Island (see also
Rattray 1997, for Traditional birthing practices for the First Nations
of the Northwest of British Columbia). Teachings of The Elders (1984)
uses images and traditional teachings to outline the oral information
passed down generation to generation from the Elders. It begins by
describing how women and their families must be prepared to have a child
and continues by outlining both dietary and behavioural restrictions for
pregnant women and their partners. Birth as a holistic event is echoed
in these stories and the teachings continue into the post-partum period,
early childhood and even into adulthood.
As an intimate part of life, birth and birthing stories are
endlessly touched upon in almost any Aboriginal life history. Stoney

32

Creek Woman (Moran 1988), the life story of Sai'Kuz Elder Mary John,
Life Lived Like a Story, (Cruikshank 1990), containing the life
histories of Angela Sidney, Kitty Smith and Annie Ned, as well as
Voisey, Okalik, Brown and Napayok's

(1990) article "Cultural

Perspectives on Pregnancy and Childbirth" are three Northern examples.
In each story the women share their personal birth experiences as well
as

the births they attended as women's helpers. Traditionalbirthing

practices are discussed in the context
on birth,

of the changing medical discourse

its redefining as a medical event and the larger picture of

colonization, the North and First Nations peoples.
Mary John's own mother acted as a midwife and after her death,
Mary's aunties and other relatives attended her births:

There was an elderly midwife who put her hands
across my back and stroked me. I can still remember
how that stroking made the pain less. The labour pains
did not stop but they were greatly eased (Mary John
in Moran 1988 :73).

Kitty Smith, a Tlingit Elder from the Yukon Territory, described
one of her births as follows:

They put two sticks [upright and parallel]
in the ground. I hold them. Then somebody holds my back;
somebody holds my knees [in an upright position].
I had none of my babies at that doctor place (1990:246).

Okalik states in the old days women were not scared of birth
because it was seen as a natural event and there were traditional
systems to deal with the birth:

We Inuit look at pregnancy as natural as breathing.
We don't look at it as a sickness because it is not
a sickness, it is a way of life (Voisey et al 1990:39).

33

Napayok claims that careful monitoring by the Elders was essential
and that women were assisted by women who had helped during many labours
but at the same time were apprenticing with an older midwife (Voisey et
al 1990:40). Positions and practices varied with each cultural group
across the Northwest Territories but she agrees with Okalik that women
were not afraid of the birthing process. Women were taught what it was
going to be like when they were in labour and what kind of pain to
expect. Mariam Brown, a midwife herself, discusses how:

In the traditional way, the knowledge was passed
down from generation to generation or it was passed
down from one particular woman to another (Voisey
et al 1990:39).

The Inuit settled in Pangunitung in 1962 and even with the
establishment of a hospital, Inuit midwives continued to practice and
mothers were given a choice for delivery. Starting in the 1970's women
began to be flown to the south while the mandatory evacuation policy of
the 1980's forced all women to leave their communities to birth (Voisey
et al 1990:38). Marium's last delivery as a midwife was in 1965 and she
feels that the legislated takeover by hospitals slowly eroded the
numbers of Inuit midwives practicing in the North.
All the Elders feel that it would be better for the mother, infant
and family if women were able to birth in their communities:

We always wanted women in our communities to have
their babies in the community as long as the medical people
know that it will not endanger the mother (Voisey 1990:38).

Slowly, information on traditional practices through contemporary
studies or the life histories of Elders is resurfacing. Traditional
Aboriginal knowledge of birthing, birthing systems and midwifery is
becoming an accepted part of the discourse surrounding the empowerment
of birthing women and their communities.

34

1.7 CONCLUSION
Given the tremendous diversity of traditional practices,
ceremonies and tribal beliefs associated with childbirth as well as the
differential roles of Aboriginal women in traditional societies there is
difficulty in arriving at a definition of midwifery that encompasses all
Aboriginal peoples (Benoit and Carroll 1995:231). However, reproductive
wisdom was common knowledge throughout all communities and was passed on
generation to generation orally, contrary to both the medical narrative
and the feminist narrative. The literature reviewed here shows us that
the current medical birthing model comes from a history of both
professional and masculine dominance over woman's traditional role of
midwife and caretaker of the birth scene. The subsequent rise of the
Natural Childbirth Movement in opposition to this, although giving more
freedom and flexibility to women, did not fully challenge the ideology
of the medical birth. It simply better prepared women for the hospital
experience. Both narratives however exclude culture in their discussion
of birth and birthing practices.
First Nations women are recovering from a time when their
traditional knowledge was repudiated by the colonial powers and they are
revitalizing their cultural roles by learning, and sometimes relearning,
traditional beliefs. The courage to revitalize traditional birthing
practices and midwifery is similar to the feminist movement against the
patriarchal medical model yet the two movements are not the same. First
Nations women's loyalties are oriented towards First Nations issues and
communities, rather than to the feminist birthing movement which
revolves around Natural Childbirth and the reimplementation of midwifery
into the professional scene. The present situation allows physicians to
claim a monopoly over obstetrical knowledge and for feminists to claim
control over women's knowledge (Benoit and Carroll 1995:23). An
understanding of the diversity of cultural systems and beliefs of the

35

First Nations peoples is essential to the discourse surrounding birth if
true empowerment of women in reproduction is going to succeed.

36

CHAPTER TWO: MOVING TOWARDS THE CONTEMPOBARY
It has only been in the recent past that health care providers
have acknowledged that health is not simply being free from disease but
that a person's or community's environment: socially, mentally,
physically, culturally and economically can have an impact on the health
status of the individual

(Young 1994:230). Recognition of the context of

health, largely measured by health status indicators and social
determinants of health, such as socio-economic status, is key to the
understanding of current Aboriginal health needs and only by addressing
the base issues, such as the repercussions of colonization,

is change

possible.
The history of colonization and changing health status for First
Nations discussed in the previous chapter is directly linked to the
contemporary health situation for Aboriginal peoples in Canada today.
Loss of culture, abuse at residential school as well as governmental
policy aimed at assimilation, have left many First Nations with a sense
of low self esteem and cultural worth. In turn, the social determinants
of health, grounded in socio-economic status, are the root causes for
the low life expectancy and high infant mortality for First Nations in
Canada.
First Nations peoples in the North face unique challenges with
regards to health care both historically and in contemporary times.
Along with mandatory evacuations and limited access to appropriate
services,

it is important to examine health status indicators such as

Infant Mortality, Low Birth Weight and Teen Pregnancy Rates, to come to
an understanding of how British Columbia and the Northwest Health Region
fit into this larger picture of the health of First Nations peoples and
contemporary birthing.

37

2.1 ABORIGINAL HEALTH TODAY
Ic can be said that most Canadians enjoy relatively healthy lives
and that Canada is widely thought to be one of the best countries in
which to live.

In 1994, Canada placed first when the United Nations

Development Program measured the quality of life

around the world:

M o s t C a n a d i a n s e n j o y a d e q u a t e f ood and sh e l t e r ,
c l e a n water, p u b l i c s a f e t y , a c c e s s to r e s p o n s i v e
m e d i c a l a n d s o c i a l s e r v i c e s a n d th e g o o d h e a l t h
t h a t r e s u l t s f r o m t h e s e t h i n g s (RCAP 1 9 9 6 : 1 0 7 ) .

However,
there are some

with regards to the First Nations

population in Canada,

very significant health status inequities in comparison

to the general population and these are part of the historical legacy of
the colonial relationship (RCAP 1996:96}. Some of these inequalities
include substandard housing and sanitation, unemployment and poverty,
discrimination, racism, violence, inappropriate or absent services and
the subsequent high rates of physical, social and emotional illness,
injury, disability and premature death (RCAP 1996:107). These inequities
are reflected in various health status indicators. Life expectancy at
birth is 7-8 years less for Status First Nations and the Infant
Mortality Rate (IMR)

is twice as high as the national average.

Infectious diseases of all kinds are more common in Aboriginal peoples
and the overall rates of injury, violence and self-destructive behaviour
are disturbingly high. As a result, the mortality rates in all age
groups are higher than average for Aboriginal peoples. Low education
levels, high unemployment, welfare dependency, conflict with the law and
incarceration all contribute to a poor context of social health for
Aboriginal peoples (RCAP 1996:108).
These statistics are only symptoms of a larger problem which has
its roots in the past; a history of genocide and oppression:

38

Healing in Aboriginal terms, refers to personal and
societal recovery from the lasting effects of oppression
and systematic racism experienced over generations. Many
Aboriginal people are suffering not simply from
specific diseases and social problems, but also
from a depression of spirit resulting from 200 or
more years of damage to their culture, languages,
identities and self-respect (RCAP 1996:109).
The Royal Commission on Aboriginal Peoples

(RCAP)

Final Report

(1996) concluded that extensive involvement of Aboriginal people in
their own health care is the only way to lessen the gap between the
Aboriginal and Non-Aboriginal populations with regard to health and
well-being. The Commission's recommended action included that Aboriginal
communities be given control over the resources they need to improve the
conditions that affect their health status through self-government and
the settlement of land claims (1996:96). This can only be achieved when
both Aboriginal and Non-Aboriginal people come together to address these
root causes of the First Nations populations poor health status.

2.2 INFANT AND MATERNAL HEALTH INDICATORS

As with other health concerns for First Nations peoples, poor
neonatal and infant health is largely the result of the social
determinants of health and to a lesser extent, the health care options
for pregnant women and new mothers. The Infant Mortality Rate (IMR)
among Aboriginal People in Canada has declined steeply from as high as
200/1000 in the 1920's and 30's to approximately 14/1000 among Status
First Nations and to about 20 for Inuit peoples in the 1990's (The
Ministry of Health 1998:108) (Figure #2). Yet, a significant difference
in the rates for Aboriginal and Non-Aboriginal people remains:

The IMR for Canadians generally is about 7/1000
live births. Thus the ratio of Aboriginal to
Non-Aboriginal infant deaths is about the same
today as it has been for the past 100 years - about
twice as high for Indian people and three times as
high for Inuit in the Northwest Territories (RCAP
1996:127) .

39

2.2.1 Northwestern British Columbia
The Northwest of British Columbia is a unique region as the
determinants of health are effected by geographical isolation, severe
weather conditions and a resource dependant economy (Dze L K'ant
Friendship Centre 1997:01). The Northwest Region stretches from the
Yukon Border in the North, encompasses the Queen Charlotte Islands
(Haida Gwaii), to the west. Hartley Bay in the south and is bounded in
the east by the town of Houston (Figure #3). The Local health areas
include Smithers (#54), Terrace (#88), Nisga'a (#92), Prince Rupert
(#52), the Queen Charlottes (#50), Kitimat (#80), Telegraph Creek (#94)
and the Stikine

(#87)(Figure #4).

The three major hospitals in the Northwest; Bulkley Valley
Regional Hospital in Smithers, The Prince Rupert Regional Hospital in
Prince Rupert and Mills Memorial Hospital in Terrace are all located in
the south of the region. Other hospitals frequented for delivery include
Fort St. John General Hospital in Ft. St. John, Wrinch Memorial Hospital
in Hazelton and the Whitehorse General Hospital in Whitehorse, Yukon
Territory (Capyk 1997 MS:190). However, all hospitals are difficult to
access from some of the more Northern communities. Roads can be
impassable and dangerous in the winter and sometimes even flying is
impossible.
There are many barriers for health care delivery in the Northwest
but there are specific obstacles for pregnant women and new mothers many
of whom lack adequate and appropriate perinatal services. In the
communities without hospital services women must leave 3-4 weeks ahead
of their due date to deliver in the larger centres of Terrace, Prince
Rupert or Smithers. Finding a new doctor, lodging, child care, financial
support and transportation are customary difficulties faced by women in
the North. Additionally, mental health issues such as separation from

40

loved ones, loneliness and stress negatively effect these women's
birthing experiences.
B.C.'s Northwest has the highest percentage of First Nations
people (24%) compared to any other area of the province (B.C. Ministry
of Health and Ministry Responsible for Seniors 1997; . As was outlined
earlier in the chapter, Aboriginal populations must add issues such as
racism and a legacy of colonization to an already imperfect health care
system.
The context of health can be gleaned by reviewing a population's
health status indicators and in the case of perinatal health needs,
indicators such as Infant Mortality Rates, Low Birth Weight Rates and
Teenage Pregnancy Rates are indicative of a region's health status.

2.2.1a Infant Mortality Rate
The Infant Mortality Rate of a given population can be described
as the total number of infant deaths up to and including the first year
of life (excluding stillborns). IMR's are measured over a specific time
period and are usually outlined as a number out of one thousand live
births. Infant Mortality Rates are important health status indicators
because they give insight into some of the environmental and socio­
economic factors effecting the health of a population (B.C. Ministry of
Health 1996b):

There is no starker measure of a society's
commitment to its children than the infant
mortality rate." Canadian Council on Social
Development (National Council of Welfare 1997:05).

Infant Mortality Rates are inclusive of the first year of life and
the social determinants of health, such as an individual's or
community's socio-economic status, greatly effect these rates (Young
1994). Northwestern B.C.'s IMR is noticeably higher than B.C. on average
(B.C. Ministry of Health 1996b):

41

Total Population IMR
• NWBC: 7.8/1000 in 1995
• BC: 5.9/1000 in 1995
• Status First Nations in BC: 13.9/1000 in 1992 (Health Canada
1995:110).
As previously mentioned,

IMR's for Native people have declined

since the 1950's however they are still well above the national average.
Status Indians in B.C. have an IMR twice that of the general population
(Figure #5). Considering that NWBC has a higher percentage of First
Nations peoples and a high IMR in the general and status First Nations
populations, perinatal health is of grave concern for Northern British
Columbia's Aboriginal population (B.C. Ministry of Health 1997). Both
Young (1994) and the Canadian Council of Welfare

(1997) stress that

IMR's, since they include the first year of life, are indicative of a
population's health status in general. Simply creating better access to
services has not and will not suffice for Aboriginal communities. To
change high IMRs two things need to occur. Firstly, the social
determinants of health and socio-economic status of First Nations, the
resulting legacy of colonization, need to be addressed. Secondly,
working in conjunction with the processes of decolonization in
Aboriginal communities, adequate and culturally relevant pre-natal and
post-natal care for pregnant women, their babies and their families must
be implemented.
2.2.1b Low Birth Weight

Low Birth Weight (LBW) has become one of the leading causes of
concern affecting a child's ability to thrive and develop properly:
Low birth weight refers to babies who weigh less
than 2500 grams or 5.5 pounds at birth. Approximately
75 percent of infant deaths can be explained by low
birth weight. Low birth weight is also a leading
underlying cause of illness in infancy and childhood
(National Council of Welfare 1997:03).

42

LfiW is Che result of aii array of demographic factors, medical
conditions and behavioural problems all of which interact with each
other often augmenting the situation. Medical complications related to
LBW can include premature labour, febrile illness, high blood pressure
induced by pregnancy•and infection while demographic factors include the
mother’s socio-economic status, her level of education, the age at which
she conceived, her marital status and race, in addition to these
variables; smoking, stress, nutrition, alcohol use, access to prenatal
care and lack of social support Ceui further compound the outccxne. Low
Birth -Weight has been linked to poor family support throughout pregnancy
and more detrimental health issues like spousal assault and f a m i l y
violence (National Council of Welfare 19S7:06j.
Any babies born weighing less than 2500 grams are included as low
birth weight babies and are usually expressed as a rate per iüûü live
births, such babies have an increased chance of morbidity and premature
mortality. Although Northwestern B.C. is about average with ther province
as a whole, one must consider the high proportion of First Nations in
the population (B.C. Ministry"of Health 1996b):

Total p o p u l a t i o n LBW

•• ItWBC: 45.32/1000 i n 1995
• BC: 45.3/1000 in 1995
•

Status First Nations

in BC:

58.5/1000 i n 1992 ( H e a r t h c a n a d a 1995:

109 j .
The higher low birth weight rates for First Nations are indicative
of many of the demographic and medical factors outlined previously
including high

nina.vetVe smoking and inadequate nutrition of

mothers while pregnant, in NnBC there Is a growing need for programs
oriented towards First Nations mothers emphasizing healthy lifestyles
during pregnancy (Health Canada 1995:107).

43

2.2.1c Teen Pregnancy
Pregnant teens are at risk of having Low Birth Weight babies for
psychosocial and economic reasons such as single parenthood, poverty and
poor education and less for biological reasons

(National Council of

Welfare 1997:06). Since the majority of teenage pregnancies are
unintended (951) and teen pregnancies are more likely to have poorer
birth outcomes,

the rate of teenage pregnancies in a particular

community must be included when assessing maternal health needs (B.C.
Ministry of Health 1996b).
With regards to Teen Pregnancy, the Northwest Is significantly
above average compared to the rest of the province and the rate is even
higher among Status First Nations in B.C.

(B.C. Ministry of Health

1996b):
Total Population TPR
• NWBC: 78/1000 in 1995
• BC: 49/1000 in 1995
• Status First Nations of BC: 200.2/1000 in 1992 (Health Canada
1995:109) .

It is important to note that the Canadian fertility rate for
Aboriginal youth ages 15-19 is four times that of the Non-Aboriginal
population. Native women tend to have children earlier in life,
reflecting Traditional patterns of child rearing (Health Canada
1995:107). Since the First Nations populations have generally poorer
health, as outlined previously, it is essential that areas of high First
Nations populations with above average teen pregnancy rates have
adequate and appropriate community and culturally based prenatal and
early infancy programs (B.C. Ministry of Health 1996b:134).

44

2.3 CONTEMPORARY BIRTHING ISSUES

Several contemporary birthing issues emerge from the discussion of
Aboriginal health and well-being. These include the factors related to
infant and maternal health and whether contemporary communities can
improve their infant and maternal health care status through
retraditionalization. Further, a review of the history of birthing and
midwifery practices in the North reveals that the practice of mandatory
evacuation is being reworked in an attempt by some Aboriginal Nations,
such as the Inuit, to return birthing to the North.
Factors influencing Aboriginal infant and maternal health include
the change in childbirth practices as traditional methods were denounced
and Western medical ones adopted. Childbirth practices and policies have
been the subject of extensive debate in recent years and they are seen
as an important issue by Aboriginal people. By incorporating Aboriginal
traditions and perspectives into perinatal health care strategies as
well as addressing the base causes of poor health, such as the social
conditions brought on by the history of oppression, change can occur.
Many Aboriginal people argue that normal birth, where health and safety
are not threatened, should once again become a non-medical,
community event

family and

(RCAP 1996:128).

2.3.1 Birthing in the North

As was outlined in Chapter One, the two "official discourses" on
birthing, the medical and the natural, have ignored the voices of First
Nations peoples in the current discussion of birthing. Moreover, these
"official discourses" have not only silenced the voices of Aboriginal
midwifery in Canada, they also silence the North,

forgetting

historically and contemporally, the people who reside here.
Environmentally, culturally and ideologically, the North is unique in

45

its needs and development of health care and birthing systems. The
reclaiming and return to traditional birthing systems,

including

Aboriginal midwifery and traditional beliefs has taken shape for the
Inuit of the Northwest Territories. Traditionally, childbirth beliefs
were constructed parallel to general understandings of illness and
misfortune and pregnancy involved dietary restrictions as well as social
contact restriction. A natural and communal experience, childbirth was a
vital part of Inuit culture and the practices surrounding the birthing
scene varied within each of the different groups of Inuit people spread
across the Canadian North

(O'Neil 1990b:57).

From the onset of pregnancy the young women were counselled,
instructed and encouraged to attend births as a way of understanding the
birthing process. Traditionally women were surrounded and supported
during pregnancy and birth by their extended family and older women
(Paulette 1990:45), A healthy vigorous lifestyle, a good diet as well as
the squatting or kneeling positions for delivery led to few
complications for women. Women recovered more quickly with the aid of
supportive relatives and breastfeeding was conducted for up to three
years as a healthy way to nourish the baby and as a natural child
spacing method (1990:45). The role of the midwife was an honourable one
and it had a spiritual dimension. The Elders regretted the intrusion of
the Western medical system as it eroded strong family bonds (Paulette
1990:46) .
The medicalization of childbirth in the North was a complex and
dynamic issue, involving the extension of power of the south over the
north, of men over women, and of the dominant society over First Nations
groups (O'Neil 1990b:55). Formal Western medicine did not venture into
the far North in some places until the 1950's- According to O'Neil
(1990b), the first step in the medicalization of childbirth lay in the
tramsfer of births out of the local settings and into the nursing

46

stations. Medical training and professional ideology were brought
directly from the government and medical institutions into the
communities (1990b:59). Starting in the 1960's and up until the late
1970's most Northern nursing stations were staffed by foreign trained
nurse-midwifes. These nurse-midwives held a pivotal role in the Canadian
history of both the North and midwifery:

One could say that the irony of the history of
midwifery in the North is that the new demands
for midwifery services in the south emerged as
this enclave of practicing midwifes started to
disappear from the North (1990b:63).

This decline in births in nursing stations was largely due to the
federal government's official policy of the 1980's of evacuating all
pregnant women in the North to Southern centres to deliver (O'Neil
1990b:61, see also Stonier 1990). This shift took place for several
reasons. According to medical authorities the move to hospital births
was part of an improved system of evacuation and assessment. Following
the premise of the superiority of the medical model, hospital births
were considered safer and equal access to the advantages of Western
technology was seen as beneficial for Inuit people. Due to the influence
of the medical model, traditional midwifery had few supporters except
among the women and their communities

(O'Neil 1990b:61). Simple access

to services, although initially improving IMRs, can no longer be seen as
a solution to the poor health status of Inuit communities; IMRs today
remain three times the national average (RCAP 1996:127).
Seen in its historical context the demise of the Northern midwife,
both the nurse midwife and the Inuit midwife, was part of a much older
competition for control over childbirth between the medical profession,
women and midwives similar to events in Europe and other areas of Canada
(O'Neil 1990b:66).

47

For the Inuit communities,

the continuing colonization of their

culture, in this instance through childbirth control, resulted in loss
of knowledge, skills and identity (O'Neil 1990b:65). The traditional
teachings of the Elders were devalued and women were left with a lack of
knowledge about their bodies,

female health and the traditional birthing

process. Women were caught between two worlds, a traditional one which
was broken down by years of colonization and a medical one which forced
women to leave their communities to deliver. The change from the
traditional midwife attended birth had several negative effects on
Northern communities including the separation of families, specifically
the partners (a link has been made between this separation, and family
violence), language and cultural barriers for mothers in the strange
Southern hospitals as well as the lack of post natal support in the
communities (O'Neil 1990b:46, see also Gallagher 1997 and Stonier 1990).
The Royal Commission on Aboriginal People's hearings in the
Provincial and Territorial North found that Medical Services Branch's
mandatory evacuation of all pregnant women was of special concern for
First Nations Peoples. Similar to Paulette's (1990) findings, the
Commission heard testimony on how these evacuations have meant an end to
family-centred births, community based care and the possibility of
culture-based birthing choices (RCAP 1996:134). The movement of the
birthing scene out of the hands of the midwives has interfered with
indigenous birthing knowledge, local midwifery skills and traditional
family centred ceremonies.
The idea that midwives can provide safe, supportive and costeffective care for pregnant women in low risk childbirth situations has
become more widely accepted in Canada in the last 10-15 years with the
legalization of midwifery in Ontario, Alberta and most recently British
Columbia

(RCAP 1996:134). However, barriers to this movement for

Aboriginal communities have included ignorance of traditional ways by

48

the Western medical system and a history of paternal attitudes towards
health care for First Nations peoples. Pressure for community-based
culturally-sensitive birthing services in the North reflects the need to
address the problems that have accumulated over the past 500 years as a
result of imposing Western principals of healing and government
protocols on Aboriginal communities. As Martha Greig of Pauktuutit
states:
We seek alternatives which benefit the entire
family and which do not expose women and
newborn infants to unnecessary risk; alternatives
which allow us to feel pride and respect in
ourselves and our culture. Unfortunately, the
debate we often find ourselves engaged in is
premised on a disrespect for our history and for
the knowledge and skills which many of our Elders
still possess. Recognition of our traditional skills,
knowledge, values and approaches to life is necessary,
not just around the issue of childbirth but in all
spheres (RCAP 1996:136).

2.4 CONCLUSION
The poor health status of the Aboriginal populations of Canada is
a direct repercussion of the effects of colonization. The social
conditions that contribute to a poor health status: unemployment,

low

education levels, poverty, inadequate diet and housing are more
prevalent for First Nations communities due to their long history of
oppression and colonization by the Federal Canadian Government. First
Nations Peoples must add issues of racism,

lack of culturally specific

services and jurisdictional issues to the already long list of
difficulties in receiving appropriate health care service in the North
(Dze L K'ant Friendship Centre Houston 1997:01). The problems run deep
and health status indicators, such as low life expectancy, high infant
mortality, high accident, injury and mortality rates are compounded by
the social ills facing First Nations. It is these social determinants of
health which need to be recognized as the primary causes of the higher

49

than average infant mortality, low birth weights and high teen pregnancy
rates for First Nations peoples.
The North is infamous for its needs in the area of birthing
change. A review of the situation for Inuit communities gives insight
into challenges faced by other Northern regions, such as B.C.'s
Northwest. The Provincial Health Officer's Report for 1996 identified
Aboriginal populations and Northern Regions of the province as suffering
higher rates of Infant Mortality, Low Birth Weight and Teen Pregnancy.
For all regions and populations of B.C. to achieve the health status of
the healthiest region, programs need to be designed which address the
social determinants of these health inequalities (BC Ministry of Health
1997). The move to revitalize traditional beliefs in all aspects of life
for Aboriginal peoples is one way of working towards improved health and
well-being. In the area of birthing, the collection and use of
traditional birthing and midwifery knowledge is a growing field of
interest as Elders, once again, are looked to as the holders of sacred
and empowering information.

50

CHAPTER THREE: THE RESEARCH METHODOLOGY
3.1 RESEARCH, KNOWLEDGE AND POWER
It must always be remembered that research tools
have been developed by people who see the world
in a particular way. Everytime a research tool is used,
researcher must be aware of the bias of its creators
'Kirby and McKenna 1989:44)

the

When deciding upon a research process for this thesis, it became
apparent that I needed to examine the issues surrounding standard
research processes, my concerns with research conducted from within an
academic institution as well as my own personal interests in the
research topic. I needed to account for why I wanted to do research, how
my experiences would shape my research methodologies and what the goals
of the research project would be. One of my foremost concerns centred
upon the connection between the community's needs and my interests,
which lay in the areas of women's traditional roles, midwifery, the
birth-cycle and traditional healing methods, more specifically,

the

relation between traditional women's roles and the current health care
system.
To try and answer some of my questions regarding my role as a
researcher I needed to explore the ethical and methodological
considerations of doing research from within an academic institution. A
deeper look into issues of knowledge production was paramount in order
to gain a better perspective of how I could fulfill my obligations to
the university without compromising the integrity of the community
input. My research needed to be completed in such a way that the voices
of First Nations women, aspects of their traditional roles as well as
their experience as marginalized peoples were all accounted for.
Kirby and McKenna (1989) argue that knowledge is often used within
the Western world to maintain oppressive relationships and the
institutionalization of knowledge has led to a monopoly on the creation

51

of certain kinds o f knowledge. On top of the institutions themselves^
ethical guidelines, research areas, research methodologies and funding
help to legitimate the monopoly and maintain certain social relations
(Kirby and McKenna 1989:52) . In previously written material, many
interactions have not been investigated and many voices have been absent
from the research process:
Demystifying the research process is the first
step in decoding and demythologizing the way
knowledge is created (Kirby and McKenna 1989:24).

It is impossible to discuss the research process without talking
about power and influence. When one engages in research, oneengages

in

the production of revealing possible knowledges. Due to the multifaceted
nature of the world, the same situation or experience can be looked upon
as giving many different kinds of knowledge

(Kirby and McKenna 1989:25).

People experience the world in different ways and this requires a
recognition of that difference within the research process.
Interpretation underlies this entire process, from the beginning to the
end, and must be accounted for by the researcher (Kirby and McKenna
1989:26). Methodologies carry with them assumptions which shape the way
information is gathered, analyzed and the knowledge created. When doing
research from the margins,

reestablishing the traditional relationship

between the researcher and the subjects of research is essential to
ensure that the voices of the marginalized are not misinterpreted or
misused (Kirby and McKenna 1989:22).
The academic perspective is based on the principle of academic
freedom, the search for knowledge and the entitlement to carry out this
search without interference. However, to maintain the integrity of the
University community there is the obligation to use such freedom in a
responsible and ethical manner. All academic institutions have ethical
guidelines intended for the research that is done out of their

52

particular

institution.

the highest

ethical

British Columbia
There
to a d h e r e

standards

is h o w e v e r ,

Nations communities.

Nations

in r e s e a r c h

a professional

ethical

is e s s e n t i a l ,

responsibility by

and any academic

respect

of each Aboriginal

to

viewpoints within communities

reflecting

the m u l t i p l i c i t y of

must be presented where possible

researchers,

which they consider paternalistic,

of the needs

of

o f the

knowledge and value

Furthermore,

th e r e s e a r c h m u s t b e o f b e n e f i t

th e c o m m u n i t y

First

the n e e d s

a n d the

to t h e c o m m u n i t y

(RCAP 1993:05). N a t i v e c o m m u n i t i e s m a y b e w a r y o f

involved

First

people have distinct

research within

th e t r a d i t i o n a l

community.

the r e s e a r c h e r

when working with

t hat A b o r i g i n a l

communities must be collaborative,

final product of

it s u p p o r t s a n d e n c o u r a g e s

(The U n i v e r s i t y o f N o r t h e r n

considerations

Recognizing

community and giving
systems

is no e x c e p t i o n ,

1 998:97).

to s p e c i a l

perspectives

ÜNBC

colonial,

research and
and ignorant

(Young 1994:225).

3.1.1 INUIT CHILDBIRTH STUDY

To g e t a b e t t e r u n d e r s t a n d i n g o f
r e s e a r c h worked,

t h e w a y in w h i c h c o m m u n i t y b a s e d

it w a s

important

to e x a m i n e a p a r t i c i p a t o r y r e s e a r c h

project which had been

successful

in i d e n t i f y i n g

community,

collaborating with

the community,

the n e e d s o f

represented a cross section

of the community and benefited the community by transferring
skills

to

Medical

it s m e m b e r s .

F a c u l t y at

th e

research

The Inuit Childbirth Study u n d e r t a k e n b y the

the U n i v e r s i t y of M a n i t o b a

is o n e s u c h r e s e a r c h

project.

In 1989, the University of Manitoba established a collaborative
and participatory research program within the Keewatin region of the
Northwest Territories:

This group has established a research agenda which relies
on the structured participation of [Native] and Inuit
representatives in development, design, implementation
and analysis of research projects dealing with community-

53

based health policy (O'Neil 1991:216).
The program was initiated in response to concerns from both the
medical and Inuit communities about the obstetric policy which forced
all babies from the Keewatin region to be born in Manitoba. Inuit women
were concerned that they no longer had the option to give birth in their
home communities. The health care providers were interested in
addressing the morbidity rates among the children left at home when the
mother was evacuated to Manitoba and if the emotional stress of
evacuation was related to birth complications (O'Neil 1991:223).
The community involved outlined their main concerns into three
broad areas of research; the experience of women in childbirth, the
stress created on the family by the mother's absence and addressing the
problem of regaining traditional knowledge for empowerment. Three data
collection strategies were used. Inuit researchers administered
questionnaires to pregnant women at several intervals in the birthing
cycle and also to the families while the mothers were gone (O'Neil
1991:225). The research staff then reviewed the obstetric records in
Winnipeg for the years 1980-88 and conducted open-ended interviews with
doctors, nurses, Inuit Elders, Inuit midwives and others involved in the
health care field (O'Neil 1991:225).
This large research project is an example of a community-based
participatory research project which involved collaboration with the
community on their health care needs, acknowledged a cross section of
the community and transferred research skills to Inuit people. Its use
of traditional knowledge and the recognition of the distinct
perspectives of the Inuit allowed this project to re-evaluate the
traditional scientific approach to health care to include social,
cultural and environmental variables.
By examining this previous study, as well as addressing the
ethical and methodological concerns which arise from research conducted

54

out of an academic instirotion with marginalized individuals,

I decided

that community-based participatory research was the best method for
exploring my own research interests.

3.2 METHODOLOGY
3.2.1 Community Based Research
Community Based research considers the welfare and needs of the
community through promoting social change, community development and
being community initiated. When research is community initiated and
reflects the needs of the community, the relationship between the
researcher and the community changes. Openness and close co-operation
allow for a positive relationship to develop and it is essential that
the research benefit the community in some way (St. Denis 1992:57).
Within the area of data gathering, emphasis must be given to traditional
knowledge, language and value systems, by allowing the communities to be
involved in the gathering and interpretation of the data. Too often
research results have been used to meet the needs of the status-quo and
focused on the negative aspects of Native life, without seeking to
explain the causes

(Macaulay 1994:1988). Use and ownership of the

knowledge has become a key concern within First Nations communities and
by having the communities review results prior to publication and
involving communities in the interpretation of results, this concern can
be eased.
Community-based participatory research is not a fool-proof
methodology and there is no standard formula for performing this type of
research. It can become another method of manipulation if not carefully
undertaken:
It takes careful planning, genuine and
personal commitment to involvement, community
acceptance, appropriate research methods and a
conducive cultural and political climate
(St. Denis 1992:69).

55

However, if appropriate research methods are used,

following the

ethical and methodological considerations previously mentioned,
community-based participatory research is an excellent way to undertake
research. If commitment to collaboration and Aboriginal perspectives is
shown by the researcher,

the community is likely to benefit from this

approach.
3.2.2 Research Objective

The purpose of this study was to get a broad idea for the
Northwest region as to what knowledge is available about past First
Nations birthing practices, why these changed and how they could be
incorporated into current health programs surrounding birth.
As part of the community-based research process it was necessary
to decipher the intent and purpose that would form the basis of the
research. The following is what was adhered to as the main objectives:

• Record and preserve traditional knowledge from First Nations
communities
• Identify alternative birthing options/practices for women in the
Northwest
• Create a knowledge base for new and current health programs in the
Northwest
• Secure First Nations voices in the discussion on birthing options in
the Northwest
3.2.3 Design
My concern regarding the research process itself was oriented
around both fulfilling my obligations to the University but also
producing something of value to the community with which I was working.
Inclusion of First Nations perspectives and participation through out
the research process as well as addressing the specific needs of the
communities were integral aspects of the research. The use of a
community based research design allowed me to reinvent the relationship

56

between the researcher and the subjects of the research and account for
the role of experience in the research, for both myself and the
participants. The final research design followed this format:

•
•
•
•
•
•
•

outlining the intent and purpose of the research
literature review
background study
findings/ethnographic descriptions
methodology and how results will be used
describing the nature of the relationships in the research
discussions

3.2.4 Community Involvement
It is essential to consider the welfare and needs of the community
when undertaking research. The Dze L K'ant Friendship Centre had already
identified infant and maternal health as a serious research concern for
the Northwest. As an invited member of their larger study and by
aligning myself with other key community organizations I was able to
ensure that the research would be useful and necessary within the
Northwest. The Dze L K'ant Friendship Centre's use of a community based
research design in previous studies influenced the methodology of this
thesis.
The Friendship Centre and its affiliated community groups and
organizations became an important network for the development of the
research. Many relationships had already been forged through my previous
work, however, some developed as the research progressed. The Prince
Rupert Native Women's Group, The Prince Rupert Friendship House Elder's
Group, the Dease Lake, Prince Rupert and Smithers Pregnancy Outreach
Programs were some of the extended organizations I approached for
assistance and guidauice throughout the research.
To include the community throughout the entire research process I
had the interview questions reviewed by members of the community who had
lived and worked in the Northwest for many years. Further, community

57

members were solicited for their advice on who to interview and even
participated in the interview process. I traveled to the communities
myself, stayed with members of the communities when possible and had
community members attend interviews with me.
Community based research emphasizes traditional knowledge and
community interpretation of that knowledge. In an attempt to achieve
this, I gave interviewees the questions ahead of time, allowed them to
steer the interview and ensured them access to their tapes, transcripts,
and the final report. They were informed chat their knowledge and the
data would not be used in any subsequent studies without their
permission. Recognizing their right to and ownership of the knowledge
presented, the Elders were given the opportunity to edit and review
transcripts and were presented with regular updates on the thesis
progress.

3.2.5 Methods of Data Collection: Indepth Interviews and Focus Groups

Data was collected using indepth interviews and one focus group
discussion. The process for the selection of interview participants was
done in co-operation with Louise Kilby, Director of Development at The
Dze L K'ant Friendship Centre and key community representatives from the
Northwest. The interview participants were Elders who had experience
either with delivery or birthing at home and who were known to be the
holders of traditional information within their respective First Nations
communities. These women were suggested to me by members of the
aforementioned community organizations which supported and encouraged
the research. Since many of these organizations are oriented around
pregnancy health in First Nations communities, they were familiar with
the Elders in each community who would be able to share traditional
information with me. Several other participants were previously known to
me through their work at ÜNBC as speakers on traditional healing and

58

women's roles. Having attended their lectures and visited their homes, a
relationship had been formed and they were happy to participate in the
research.
It was established early on in the research process that longer,
more personal interviews would enable me co gather the most detailed and
useful information. The interviews took place in Dease Lake, Smithers,
Prince Rupert, Houston, Stoney Creek and Terrace. Focus groups portray a
different dynamic as participants are often more comfortable talking in
groups and use one anothers answers as catalysts for further discussion.
At the focus group in Prince Rupert approximately eight people
participated. However, indepth interviewing and focus group organization
are time consuming processes and at approximately one to three hours
each, I was limited to conducting seven interviews and one focus group
in the four month data gathering stage.
3.2.6 Procedure

The Northwest region of British Columbia has a number of First
Nations groups including: Haida, Haisla, Gitxsan, Wet'suwet'en, Tahltan,
Kaska, Tlingit, Nisga'a and Carrier. Each First Nations group as well as
each community is unique and has distinct traditions, memories,
experiences and contemporary needs. From the very beginning, the study
was limited by the vastness of the region, traveling time, the
remoteness of many communities as well as the extensive variety of First
Nations groups. To try and overcome these limitations several centres in
the region were adopted as reference points and the interviews were
focused around the following areas: Dease Lake/Stikine,
Smithers/Houston, Vanderhoof/Stoney Creek and Prince Rupert/Haida Gwaii.
These areas were chosen with regards to their geographic location and
coverage of the two major health regions in the Northwest; #13 and #15,

59

the Northwest Health Region and the Northern Interior Health Region
respectively.
The interview questions were organized into three themes or areas
of discussion. The leading section revolved around the interviewee's
Personal Experiences, while the second section branched from this to
include the interviewee's Knowledge of Midwifery and Traditional
Birthing Practices. Finally, the interviewees were asked their opinions
on the current health care system and Contemporary Birthing in their
communities. Although preference was given to older women as
interviewees, an opportunity arose for a discussion with three
generations of Wet'suwet'en women on the topic of traditional birthing
and their recently departed grandmother (great and great-great too) who
was a well respected community midwife. This interview gave me
tremendous insight into the generational transitions birthing women in
the North have faced. Group interviews or focus sessions had been
suggested initially by my committee as an additional method employed to
gain a broader cross-section of the region and besides the Wet'suwet'en
women, I was able to achieve this when I presented my research at the
Prince Rupert Friendship House's Elders Group. A discussion ensued which
gave me not only more relevant data but new insight from the male
perspective. Some male participants gave information obtained from other
female relatives but most turned the discussion quite openly over to the
female participants in the group. In an interesting dynamic, it became
apparent that the women were seen as the holders of this important
information.
In total seven interviews were conducted between September of 1997
and December of 1997. I spent approximately 11 hours and 45 minutes
interviewing 9 participants in addition to the Friendship House Focus
Group where eight people participated. In an attempt to preserve
valuable First Nations traditional information, audio tapes were made of

60

all interviews and despite complete inaudibility of one interview, all
but one were transcribable. The focus session held with the Elder's
Group of the Prince Rupert Friendship House was not taped however, due
to the nature of the meeting. Hand written notes taken during the
discussion as well as personal reflections written immediately after the
meeting were used.
From these interviews I gathered 60 single-spaced pages of
interview notes and transcriptions, spending approximately 45 hours and
15 minutes both transcribing the tapes, adding my personal thoughts and
logging the information into computer files. Some of the more personal
sections were edited out either by request of the interviewee or by my
own personal decision.
3.3 DATA ANALYSIS

A qualitative approach to the research process was used and for
the data interpretation Thematic Analysis was applied (Kellehear 1993).
The transcriptions,

interview notes and personal reflections of each

interview, in conjunction with previous information discovered through
the literature review, were searched for themes. This type of approach
was subjective and interpretive and input from the participants,
community members and the Friendship Centre staff broadened the
perspective of the research.
The foundation of my analysis was based on the three original
categories first developed in the interview questions; Personal
Experience, Knowledge of Midwifery and Traditional Birthing Systems and
Contemporary Birthing. However, with deeper analysis, several key
patterns or topics emerged within each original heading, producing a
more detailed thematic outline. These themes oriented themselves around
a holistic way of being, where a midwife attended birth was treated as a
natural event. A discourse of birthing stories arose from this oral

61

teaching method and the community played an expanded role in. these
birthing systems as both a support system and an educational network.

3.3.1 Use of Results
The information presented here is part of a larger study on
Maternal Health Needs in B.C.'s Northwest being organized by The Dze L
K'ant Friendship Centre and incorporated as supplemental material for
both the proposal for funding to initiate the study and as direct data
towards the regional analysis. Over the summer of 1998, a stage two
funding proposal for the B.C. Health Research Foundation was completed
and word on the official beginning of this project is due in the
beginning of January 1999.
Although a copy of this thesis will be housed at the UNBC library
and The Dze L K'ant Friendship Centre,

I have decided to complete a

secondary document, A Community Summary,

for wider circulation within

the communities of the Northwest. The Community Summary will be
available to each participant. The Dze L K'ant Friendship Centre, The
Prince Rupert Friendship House, the Pregnancy Outreach Programs in the
Northwest and The University of Northern British Columbia.
3.3.2 Personal Interpretations of the Research

Researchers doing community-based participatory research must
examine their own role in the research process and recognize their
underlying assumptions and ideologies (St. Denis 1992:58). Kirby and
McKenna (1989:52) refer to this as recording conceptual baggage. In
recording an individual researcher's conceptual baggage, questions that
must be addressed include: What do you know about this topic already?
-iia’ are your certainties and uncertainties about conducting the
research? The answers to these types of questions stem from an
individual's world-view and by self-describing this world view a clearer

62

picture of how the researcher's perceptions shape the research process
can be discovered. Layering ideas, by continuously rethinking and
rewriting conceptual baggage, is an excellent tool to account for the
individual's influence as well as the historical and political context
surrounding the entire research project

(Kirby and McKenna 1992:52).

Throughout my interviews and data collection process,

I kept

detailed personal notes in a journal. I felt it important, as Kirby and
McKenna suggest, to continuously think and write out my "conceptual
baggage" (Kirby and McKenna 1992:52). My journal was not restricted to
my feelings regarding the interviews, but encompassed my perceptions of
the participants' responses and my own mental, emotional, physical and
spiritual states. Most of my journal entries fulfilled only a role to
myself, giving me an opportunity to evaluate my progress, celebrate my
triumphs as well as providing a forum to release tension, stress,
frustration and self-doubt. However, the notes I prepared after the
interviews aided in the development of the themes that emerged from my
data in Chapter Four: Findings and in making the subsequent interviews
more enjoyable, comfortable and beneficial.
I have taken these post-interview notes and subdivided them into
three separate categories, each revealing something different about the
research process and my experience in it. Many factors influenced my
methodology and the limitations set out previously in this chapter are
no exception. The very nature of longer, more personal interviews
created difficulties in acquiring a level of comfort that enabled a
meaningful exchange of information to take place. This was compounded by
financial constraints, seasonal traveling restrictions and cultural
differences.

I found that the main focus of each post-interview

personal reflection revolved around The Comfort of the Interview, The
Time and Place of the Interview and My Own Concerns with the Interview
Process.

63

3.3.2a The Comfort of the Interview
My own personal comfort in the interview process grew with time
and experience. Being Non-Native had an inherent effect on how I
conducted my interviews and how the participants felt in discussing
their cultural heritage with me. I cannot speak on behalf of the
participants, however, from my own Western academic perspective, I can
safely say that I have tried to deal with the philosophical and
theoretical dilemmas that accompany cross-cultural data collection and
interpretation by involving the community at all levels and by aligning
myself with an aboriginal organization.

The Dze L K'ant Friendship

Centre.
It is important to remember that no researcher works in isolation
of their personal life, no matter how hard they try. Although this type
of experience was part of a lifelong dream and extremely fulfilling,

the

physical distance between myself and my family and loved ones, not to
mention the illness of my father, made conducting my research a
difficult and lonely process.
Again,

I cannot speak on behalf of my participants, however, their

overall comfort varied according to topic, who was present at the
interview and whether or not we had a previous relationship. Most of the
Elders responded without reserve to my questions and offered personal
stories both positive and negative. However, some issues were not easily
discussed with some participants and if I sensed hesitation,

I would

avoid the topic. Several participants, although opening up to me,
preferred that the information be edited out of the audio tape.
Of the interviews I conducted,

I was the only interviewer in four;

the rest included guests, both mine and the participants, while
community representatives were present at two. These additional people
gave insight into the discussion, helped me to expand my interview
capabilities and eased the tension of first meetings. I had known

64

several of the Eiders prior to their participating in the study, both
intellectually and socially. These were by far the most rewarding and
beneficial interviews.
Over the course of the research period, I found myself attending a
number of conferences,

including The Communlcy Action Program for

Children's Northwestern British Columbia Pregnancy Outreach Programs
Training Conference and The Determinants of Health: Action for Health:
Working Together for Healthier Communities Conference, both relating to
the topic of my thesis and it was at these meetings chat several
spontaneous interviews occurred. Our common interests and the social
nature of smaller conferences gave these interviews added importance as
we could discuss fairly openly our opinions and insights into the topic
at hand.
3.3.2b The Time and Place of Che Interview

The time and place of each interview also had a great effect on
its outcome. The place of each interview was decided upon by the
participant and most chose their own homes. If their home was not
feasible or uncomfortable for them, I gave them the opportunity to chose
a neutral place instead. Besides peoples' homes, I conducted interviews
in restaurants and at both The Dze L K'ant Friendship Centre and The
Friendship House in Prince Rupert. Interviews held in participants homes
involved distractions such as visitors. However, Che interviews in the
participants homes were definitely the most comfortable and visitors
often added to the discussion. As was mentioned in the above section, I
met some interviewees at conferences held within the region. Both the
atmosphere of the conference and the timing of the interview along with
our common interests in the topics changed the dynamics of the
interview. We were now colleagues immersed in a discussion of issues

65

that effected our lives and as always the topic of birthing invited
others to join in and share their experiences.
3.3.2c My Concerns with the Interview Process
I have already raised a number of concerns and most revolve around
my own personal skills as a interviewer and the way in which I, as a
representative of the University, must conduct my research.

I tried to

enable the Elders I talked with to feel comfortable enough to share
stories or knowledge that they felt important before I started into a
series of questions. Often, however, the participants needed the
direction of the questions even with my attempts to give them control of
the interview. Although all of my interviews lasted between one and
three hours, my lack of interviewing experience made me feel that
justice to the Elders' knowledge was not achieved. In the interviews
where other people attended,

this was not such an issue. Each person had

their own questions and curiosities with regards to the topic of
discussion. Even simply watching their interviewing methods gave me
ideas to enhance my interview skills.
Further to this, from the onset of this process,

I have had

reservations with regards to the nature in which informed consent is
achieved. The University requires consent for the interview to take
place and proof that the participant is aware of how the information
presented will be used. Although I, as a researcher, can get consent
either in written or verbal form (audio taped), I had serious
reservations when using either of these methods with First Nations
Elders. Many people in the communities assured me that if an Elder
agrees to speak with you,

this is their consent and the requirement of a

signature can lead to immediate mistrust of the interviewer. These
concerns stem from the issues raised previously where research on First
Nations historically, has been performed unethically. Although the

66

purpose of obtaining informed consent protects both the research and the
participant, First Nations cultural differences, with regards to
knowledge and the passing on of information, are not accounted for in
the current academic method of achieving informed consent.

67

CHAPTER FOCR: FZRDIR6H
4.1 PERSONAL STORIES

The art of storytelling is of great importance to First Nations
groups as their culture, history and knowledge is passed from generation
to generation orally. The ease with which midwifery and birthing
traditions were discussed by the participants in my interviews was
refreshing and the willingness with which the women shared personal
experiences of birth was astounding. All the Elders I talked with chose
to relate personal stories and each woman felt quite comfortable in
discussing their birthing experiences both negative and positive. The
stories ranged from interesting, funny, deeply moving to extremely sad.
Women recalled the births of their own children, the babies they helped
to deliver and one woman told me the story of her own birth, a premature
one, which had been told to her by her mother.
In addition to these stories, unprecedented birth stories were
also part of the oral discourse of birth and many remarkable birth
situations filled our conversations.

In strength that is hard to find,

the women also informed me of the stories of lost mothers and babies so
that the real risks associated with pregnancy and childbirth would not
be forgotten.
These personal experiences can be divided into four separate types
of stories; the women's own birth stories, be they hospital or home, the
women's stories of others' deliveries, either as midwives or
participants and the women's knowledge of deliveries with special
significance, such as breech births or births in unique places, which
had become part of a wider knowledge base. Lastly, the Elders spoke of
the sad tales of death, of mothers and children, due to pregnancy
complications.

68

The patterns that emerge from these stories revolve around the
belief in birth as a natural and normal event. As well, the narratives
shared from woman to woman, specifically the unusual birth situations,
are part of a larger birthing discourse where stories are used to teach
and share knowledge,

(see Appendix One: Interview Table).

4.1.1 Women's Own Birth Stories

Women tend to enjoy discussing the births of their children even
if the experience was not pleasant. In hospital, at home, or in the
bush, these stories never deviate from the base philosophy that women
have an inherent ability to birth and prefer to be attended by women
during this process. Socially, this becomes a method of sharing
information between women and the degree to which the women in the
interviews gave details on the births of their infants reflects this
pattern.
Although more than one interview included stories of breech births
and the complications associated with that kind of delivery, only one
woman, a Carrier Elder, had had a breech birth herself:

Sometimes I h a d a b r e e c h birth wi t h one of the
b o y s . . . I h a d a r e a l l y h a r d t i m e . . . . I h a d to
l a y d o w n a n d o n e o l d lady, v e r y g o o d a t it,
s h e t u r n e d t h e b a b y r i g h t around, yeah, a n d t h e n
it w a s b o m
Yeah, s h e j ust w o r k o n m e a n d the
b a b y c o m e . . . t h e y k n o w t h e y p r e t t y g o o d that
tim e ( I n t e r v i e w 3 : 1 9 9 7 ) .

A

second Carrier

E l d e r h a d an u n e x p e c t e d d e l i v e r y w h i l e she

o u t in the b u s h d r y i n g m e a t
there

to h e l p h e r t h r o u g h

f o r the w i n t e r .

Luckily,

h e r a u n t i e wa s

the delivery:

Just m y a u n t i e . M y h u s b a n d wa s t h e r e a n d m y u n c l e
w a s t h e r e b u t w e h a d t w o tents, l i k e that, o n e t e n t
h e r e a n d o n e t e n t h e r e a n d in b e t w e e n a b i g c a m p f i r e . ,
a n d m y h u s b a n d a n d m y u n c l e were, y o u know, j u s t s i t t i n g
b y t h e fire.

was

69

Several times she tried to get up and get dressed to go to the tra±a
which was only an hour to the hospital but her labour was too strong and
she finally decided to stay at the camp:
I'd dress up to try and get on the train, oh
I don't know why I was so crazy! What if I had
it on the train?
After finally deciding to stay, her auntie helped her through the
delivery and to this day her son returns each year to the place he was
born:
It was such a struggle and....when ---- was
born, my aunt said " Oh!! It's a boy, it's a
boy" she said. She was so happy it's a boy...
We go there every summer, to do our, there's a
fish camp. So he goes back, "You belong here,
you were born right here." (Interview 7:1997).
In contrast, when discussing the women's personal experience of
birthing, one woman in particular, who had had all her children in
hospital remembers very little of the experience except the strict rules
and unpleasant procedures. Not only was she denied visits from anyone
but her grandmother,

she had to labour alone as her husband was not

permitted in the delivery room. She was severely drugged and tied down
in the stirrups of the delivery bed. Her babies were locked in the
nursery and she saw them only briefly each day when it was time to feed.
The Catholic hospital run by nuns left her feeling helpless and looking
back, she can't help but feel angry for not standing up for herself
(Interview 5:1997).
Ironically, this woman's grandmother was a well known midwife in
her community and had delivered her and all of her siblings. It was the
great-granddaughter however, who would benefit from her great­
grandmother's knowledge. During her first pregnancy, after suffering
through months of constant nausea and vomiting, and being in and out of
the hospital due to the resulting weight loss, it was her great­

70

grandmother, a Wet'suwet''en community midwife, who gave her some natural
remedies to ease her sickness:
G: I was lucky to be pregnant with GD when my
grandma was alive, she gave me lots of natural ways
to make me feel better.
K: Oh.
G: Like for nausea and vomiting, she would say,
uh, what was that stuff she used to?.. She had all
kinds of different medicinal stuff but that one was.,
she boiled a root and she make me drink it and she said
it would make me feel better. Yeah. It was something
else that she, she had it given to her and ah, it
tasted gross, it didn't taste very good....
and it helped cause remember how sick I was with
GD. I was in and out of the hospital cause I
was losing weight cause I was so sick with my
vomiting and that didn't quit until she, I was
6 months pregnant, and I was kinda complaining
to gramma about it and she was like "You've got
it easy these days if you were pregnant when I
was delivering babies you would never make it"..
She used to make me feel really bad cause I was
so wimpy...(Interview 5:1997).

One of the most amazing narratives I heard was from one woman who
recalled the story of her own birth. Born in 1935 in the Old Village of
Masset, she was a premature baby and with no doctors to help them, her
grandmother and great aunt, both midwives, placed the tiny infant into a
shoebox with a hotwater bottle, simulating the warmth of the womb. They
laid her arms straight by her sides and covered her underdeveloped skin
with oolichan grease to try and keep it moist. She was too small and
weak to feed and since at that time children were breastfed only, her
mother expressed milk and carefully dripped it into her mouth from a
milk-soaked piece of cloth. Later, a visiting nurse gave her mother an
eyedropper to feed her with but most of her relatives felt that she
would not survive (Interview 2:1997). Many infants died during that time
but miraculously she lived to hear the tale of her birth and then relate
it to me.

71

4.1.2 Women as Midwives

The birth stories women told did not stop at the birth of their
own children but grew to include their own experiences of delivering
other babies either as midwives or as circumstances prevailed,

the only

available person.
For one woman the realization that the last child she had
delivered was now married with children of her own, made her laugh
lightheartedly about her age. More recently however, a Tlingit Elder
whose own births were attended by her mother-in-law recalled how
accidentally she was able to deliver her first grandchild:

Yeah, I, ah, delivered my first grandchild
because my daughter-in-law and my, my son
they were with us, we were away from downtown
and there was no doctor in town, so we were out
in the mining camp and she got sick, right there,
and when she got sick we got everything ready and
we, I delivered my first grandchild (Interview 4:1997).

The line between a woman's own birth stories a.id those she has
attended became blurred when in one Elder's narrative she was left to
deliver her own baby alone while the entire community was at church:
Another time I h a d ------- , we were living in
a cabin over there and uhr everybody went to
church and here I had my baby here all by
myself I...All by myself. I was ready to cut the
cord when my sister-in-law came back...(Interview
7:1997).

When asked whether or not this was a frightening experience, she replied
using a story she had heard from other women about birthing alone:

I wasn't scared. I knew what to do with a
baby. There was no choice. I would say.
One elderly woman, she was my mother-in-law's
sister, she went out to set her traps in the
morning and she had her baby in the bush, packing
her baby back (Interview 7:1997).

72

It is t his p a s s i n g o n o f k n o w l e d g e ,
r e i n f o r c e m e n t o f the

inherently natural

a b i l i t y to b i r t h u n a i d e d

experience

process

and positive

of b i r t h

and woman's

if n e c e s s a r y w h i c h h e l p e d t his w o m a n

through

her delivery.
In a n o t h e r
woman,
side,

instance,

the e l d e s t o f m y p a r t i c i p a n t s ,

t o l d m e of a b i r t h s h e a t t e n d e d alone.
sh e h e l p e d the women,

who

laboured

Lying

for 2 d a y s

a Tahltan

the w o m a n o n h e r
in t h e bush,

to

d e l i v e r a child. A l t h o u g h s h e s p o k e o f o n l y o n e d e l i v e r y w i t h w h i c h she
h elped,

h e r ag e a n d i n f o r m a t i o n

from her younger woman

b e l i e v e s h e h a d d e l i v e r e d m a n y c h i l d r e n bu t
s t u c k ou t

in h e r m i n d

(Interview

that

f r i e n d le d m e

this o n e

to

i n s t a n c e h ad

1:1997).

Important to recognize however, is that this was not a chosen
method of birth. Women who birthed alone, did so because of
uncontrollable circumstances, there being no other choice. Therefore,
one unchallenged aspect of all of these stories is that women preferred
to be attended in birth by women, even during the transition to hospital
births. This reflects the description of Burtch's Traditional Birth
Culture (1994a) which developed in the more rural and remote early
Canadian communities of the West. The continuity of care and support
systems shown in the Elders stories gives rise to the belief that women
unattended in birth were considered to have had an extra ordinary
experience.

4.1.3 Unique Instances

Several unique stories of childbirth arose which were not taken
from the participant's direct personal experience but from the larger
knowledge base of stories passed orally from women to women when the
subject of birthing was discussed.
The first hospital on Haida Gwaii was located in Queen Charlotte
City and for pregnant women in Masset, it was a 70 mile tauci ride to

73

deliver a child. Not surprisingly, a number of babies can claim the back
seat of a taxi as their birth place. One Haida Elder's nephew is an
example :
When my late sister was having her baby,
one of her babies, she had 7 boys, anyway
she, the last one, I think it was, the
hospital is 70 miles away from Masset,
at that time, and that was at Queen Charlotte
City...you had to take a taxi, they had two
taxi outfits in Masset...anyway, when a
woman, when my sister started going into
labour, they started, they got the cab and
they started off and they're rushing, rush,
rush, rush, but the baby was born anyway in
the car!! (Interview 6:1997).

Although the place of birth and the lack of help during birth are
two birth events that are memorable in women's minds, the breech birth
must also be included in this discussion of unusual birth experiences.
Breech births, as with the above story, have a way of becoming part of
the wider experience of childbirth, with women using stories told to
them and not taken

from their own experience. Midwivesusually tried

turn breech babies

before the woman went into labour,and

could

to

do so

easily if it was detected before the sixth or seventh month. The greatgranddaughter of one Wet'suwet'en midwife recalls how her great­
grandmother delivered a very difficult breech birth:
Well, she was trying to turn the baby around
but the mother was in too much pain, the mother
was being really rough with her, wouldn't let her,
it was really hard work trying to turn the baby
(Interview 5:1997).

In another story, first told to her by her mother-in-law and then
to me in an interview last fall, one woman graphically described how a
Tlingit midwife was able to avert major complications during a breech
birth only with extreme measures:
There was one woman there, she had only
one daughter and her daughter was going to
have a baby and she was sitting there, she

74

was going to deliver the baby for her
daughter and she found out that the feet
started coming first., and they said Oh!!
She had an awful time, it was, she was,
her daughter was in, in labour already but
she still had to try to turn it around..and
when the baby was going to be born, when she
was turning it around, I guess, see the baby's
arms are like this (elbows ini, you know,
but when she was turning it around, I guess it
spread all over and she said trying to push
this arm through she had to break one arm of
the baby. But the baby was born and then they
fix the arm (Interview 4:1997).

4.1.4 Maternal and Infant Deaths
Like most women, I date many of the happenings
in my life from the times when my children
were born and like most women, I do not forget
the dates when my children were lost to me
(Mary John in Moran 1988:76)
Even chough the discourse surrounding childbirth and birthing
systems revolves around the action, socially and physically, of bringing
a new life into this world, it is not without its dangers, risks and
sometimes deaths. Both mothers and newborns are victims of early
mortality from childbirth-related complications and these tragic events
can happen both at home or in the assumed safety of a hospital centre.
The participants coupled their own personal and triumphant birthing
stories with often more tragic ones, where children and/or mothers were
lost.
Most women either experienced or knew of women who had lost
children in birth or in early childhood. Along side of this, several of
the women I talked to had lost their own mothers due to complications in
childbirth. One Carrier woman lost both her mother and sibling:
M: It's just like my mother, my mother in 1934
died of childbirth....Her husband died, in
February, I think and then she was very
pregnant when her husband died.— but anyway,
my brother was 14 years old, the oldest
boy and I was married already and then she, they
were going to get some hay for the horses, you
know, when she put on the hay rack, it was

75

quite heavy, on a sieign, ca hitch up^ a team of
horses and go to the meadow and get some hay for
the horses, that's what she was doing
with the help of my brother who was not very big
either, so that's when she hurt herself and she
started bleedin, no doctor, so she uh, bled for
about a month, finally her time came and then
the women, all the women were helping, the baby
was dead, they got the baby out and she died
about 1/2 an hour later..
K: Oh no.
M: So, complications like that, you know,
the women, no matter how hard they try to help still happens
(Interview 7:1997).
Another woman's mother also died of complications in childbirth
however, she was in hospital at the time:
. ------- , that's my mom, when she had all
the childbirth, and uh, she got sick, and it
was her
stomach, something wrong with her stomach
and uh, they just kept her in the hospital and uh
she got
worse and then she passed away...1948,
yeah, 1948 that's w h e n -------was b o m . .. .1 was 9
or 10 years old, that's why my Grandma raised us

(interview 5:1997).
The death of women in childbirth although a very tragic reality
was paralleled only by the loss of infants and children. The stories of
children dying due to childbirth complications and illness in early
infancy were unfortunately part of the personal narratives the women
shared with me. One participant recalled vividly the stories her
grandmother, a Wet'suwet'en community midwife, told to her about
delivering on the trapline (in camp on the trapline):

She walked for three days and uh, the woman was
so strong in that way that she didn't want to be
left behind on the trapline, so she'd walk go walk
forever
and she didn't think she was going to
deliver it and she had a premature baby, she went
out on the trapline and Gramma had to walk for
three days to get out there, her husband came
back and grabbed Gramma and Gramma was in Moricetown
or here, I can't remember if she was here or in
Moricetown. But she, the father walked all the
way back cause she wanted her to deliver the baby
and since she walked all the way out there in
the bush and for three days it took her
to get there to deliver the baby. Oh, the baby
had all kinds Of complications, I thihk it even

76

died. Yeah, cause it was born too early and it
had to be incubated and we didn't have that way
in the bush in the cabin. They buried it right
out there (Interview 5:1997).

The degree of loss was unimaginable to me as First Nations women,
in the mid 20th century lost upwards of five children in a lifetime from
a variety of complications and newly introduced European diseases. The
midwife from the story above was no exception. Her granddaughter and
great-granddaughter remember with sadness how their grandmother would
cry whenever she spoke of her and her daughter's losses:
E: Most of the babies were born out on the trapline.
Like uhummm, my other sisters and brothers they, uh
were all born on the trapline. I can't remember the
name but it's up towards Smithers.
G: We still have property up there and my grandmother
(great)..How many babies are buried on that property?
Two, three, I thought there was three?
E: There's quite a few, there's my Mom's first five
kids and then, no four kids, one was buried in
Hagwilgit and then four is buried out there. Then
Gramma's first five that she had, they're out
there and they all died out there, they're all
buried out there....
G: Fever, some kind of fever....Their fever just
went skyrocketing. I remember Gramma (great)
talking about it eind she would cry when ever she
talked about her babies dying and she would cry
everytime she would talk about them and many times
if there was someone who was pregnant around her it
would bring it up and back to her and she
would start talking about deliveries and her
babies, and how hard it was and how she thought
she was going to go crazy everytime she lost
a baby (Interview 5:1997).

The residential school experience for one participant, as well as
the death of her parents early in her childhood,

left her with little

traditional knowledge to help her birth and raise her own children when
she was a young adult:
S: Yeah. We never even seen a doctor through our
pregnancy. Hazelton only hospital and then they
send us to school in the 20's, 1925 I went to
Lejac residential school......
T: You never lost any babies?
S: I lost lots. I l o s t
, I lost
,----and
. Four I think, eleven alive....

77

S: Uh huh. I have eleven alive, I lost four.
The first one I lost because I was too young and
I didn't know how to look after baby, couldn't poop,
if somebody told me I'd use an enema, nobody to
help me. Well, I have no parents, nothing. I lost
when I was a baby, 10 months old. I don't know
my Mom and Dad. Gramma I know. Gramma
raised us. My mother's mother (Interview 3:1997).
Fortunately, this Carrier woman relearned her cultural beliefs and
practices and is now a respected Elder recognized for her unique and
sacred traditional knowledge. This was the case for several of the women
I talked with. One Tlingit Elder remembers having to learn everything
over again after her long stay at Lejac residential school:
A: I been to school. I been to Lejac school, I
was there til I was eighteen then I went home
and when I got back to Atlin, I didn't even know
how to ah, ah, be like an Indian, you know, because
I was so much in school and I was with the sisters
and what not, you know, lost my language and
everything.
K : Uhhuh.
A: But it took me quite awhile, about a year, to
get it back again, lost my language but I could
talk again.
K:

Oh

good.

A: And I learned everything the Indian way, didn't
take long to do it (Interview 4:1997).

Death occurred previous to contact for the First Nations, but as
was outlined in Chapter's One and Two, the colonial experience, such as
the residential schools, caused a generational gap in the knowledge
base, a disenchantment and loss of cultural traditions and language. As
well the implications of colonization on midwifery practices led to
greater numbers of infant deaths and a significant rise in infant
mortality rates. Therefore, together these events can be seen as
contributing factors in the evolving nature of First Nations traditional
birthing systems and women's personal stories.
It is in these personal stories that the silenced voices of the
Aboriginal Nations and communities are found. These oral discourses shed
light on First Nations parturition practices and beliefs, opening up new

78

possibilities for alternative and cross-cultural perspectives to broaden
both the medical and feminist-revisionist models of birth.

4.2 KNOWLEDGE OF MIDWIFERY
The information given on Traditional Aboriginal midwifery
knowledge located births as entire community events and as central to
women's traditional roles. This becomes obvious in the descriptions of
the continuity of care practiced by both midwives and women's helpers
and the community at large with regards to the child's discipline. Also,
birth as a natural and normal event resurfaces as the foundation of the
discourse on birthing and as part of both these patterns, the teaching
of the younger generation becomes paramount.
All knowledge pertaining to midwifery and birthing: the
restrictions,

roles of the midwife, pregnancy and labour knowledge, as

well as breastfeeding can be seen as holistic in nature, connecting
together all of the information presented.
The

"don'ts" of pregnancy such as restrictions on diet, on

activities and on things the pregnant woman can experience were coupled
with the "do's", such as how pregnant women should act and take care of
themselves. Along with these, a number of more culturally specific
beliefs emerged from some of the interviewees and included methods to
make labour easier and how to prevent conception. On top of the
restrictions,

the women were very detailed in their descriptions of who

attended pregnant women, how many women attended, how these women
learned and what roles the midwives or women's helpers held within the
communities. Some of the participants had delivered children themselves
and most had delivered at least some of their children at home or in the
bush.
The knowledge surrounding pregnancy and labour was by far the
largest area of data and included information in the following topics:

i

79

I

medicines for pregnancy and labour, place of birth; including the
position during labour and birth and length of rest needed after birth
and finally the cleaning of the baby and mother, dealing with the
afterbirth and the significance of the cord. Finally, the discussion
surrounding breastfeeding dealt with when breastfeeding was initiated,
and for how long. A few women also discussed alternatives for women who
could not breastfeed.

4.2.1 Restrictions

Although many of the participants stated very firmly that
pregnancy was a natural event and that life went on as normal, further
discussion revealed that restrictions to certain foods and activities
were used to prevent future complications either in labour or in the
child's later life.
Tahltan and Haida participants mentioned the restriction of fresh
meat, either bear, salmon, oolichan or other fish (Interviews 1,2:1997).
These items were deemed too "heavy", or having too much oil. Berries
were also restricted, stated one Wet'suwet'en woman, both picking and
eating, especially raspberries since they were believed to cause
"raspberry" birthmarks,

red blotches found on newborns

(Preliminary

Interview 5:1997).
Other foods were restricted in this same way,

from fear of the

resulting repercussions. Often the repercussion was caused by the way in
which food was caught or killed. In the Carrier culture, rabbit snared
by the waist caused women to have hard labour but any animal snared by
the neck was fine (Interview 3:1997). Drowned beaver or duck could cause
the unborn child to choke after they were b o m yet if these animals were
shot first they were okay to eat (Interview 7:1997). it is important
that variations geographically and culturally with regards to main food

80

stuffs

be r e c o g n i z e d a n d that

interviews were part of
Like

th e

foods

the

individual

restricted

Nations'

activities

special

status" b y one Haida participant,

actions

up

baby's

F u rther,

Nisga'a

too q u i c k l y as
neck

this

(Focus G r o u p

while pregnant.

to j e o p a r d i z e
women had
caused

8:1997).

born

stuff

s h e said,

in t h e w o m b

"always on

womencould

her mother-in-law,

(Interview
in b e d a n d n ot

that

not

the

si t a r o u n d
that

e s p e c i a l l y walking,

t h e move",

to m o v e " .

a Tlingit midwife,

b a b y w o u l d g r o w too b i g a n d

of these

the p a r t i c i p a n t s

was

t h e c h i l d w o u l d be

(Interview 7:1997).

th e c h i l d w o u l d b e c o m e m i r e d in

and not be able

"woman's

t h e c o r d to w r a p i t s e l f a r o u n d
However,

or

from lifting

as all

to t u r n o v e r s l o w l y

"clean" stated one Carrier participant

Otherwise,

floors

the p r e g n a n c y

It w a s m a d e v e r y c l e a r b y a l l

If a w o m a n w a s

to m o t h e r

Deemed

wom e n were warn e d

w o r k i n g n o r m a l l y was n e c e s s a r y a n d exercise,
v e r y important.

danger

in s u c h a w a y .

bending over and sweeping wooden

have the p o t e n t i a l

2:1997).
get

also c a tegorized

in th e

beliefs.

for their p ot ential

child,

h e a v y ob j e c t s ,

were

food r e s t r i c t i o n s m e n t i o n e d

the

"white sticky

Another w o man was

told b y

if o n e d i d n ' t e x e r c i s e

th e c h i l d w o u l d b e

very difficult

deliver:

A: Well, a f t e r I g o t m a r r i e d , t h a t ' s
how I
l e a r n e d a n d m y m o t h e r - i n - l a w tell m e
alot
a b o u t t h a t c a u s e I w a s w i t h m y moth.er-in.-law
a n d t h e n fo r t e n y e a r s a f t e r w e g o t m a r r i e d
a n d s h e u s e d to, s h e u s e d t o t ake c a r e o f m e
r e a l l y g o o d a n d s h e t e l l s m e w h a t to d o a n d
e v e r y t h i n g . S h e a l w a y s u s e d to t e l l m e d o n ' t
s l e e p t o o m u c h w h e n y o u ' r e p r e g n a n t b e c a u s e th e
b a b y g r o w s to o m u c h . If y o u s l e e p t h a t w h e n
the b a b y g r o w s
A n d s h e u s e d to t e l l m e
w h a t to e a t a n d a l l that, y o u know, a n d s h e
l o o k s a f t e r m e r e a l l y g o o d a n d sh e t e l l s m e
d o n ' t s l e e p too m u c h t h a t ' s t he m a i n t h i n g she
u s e d to t e l l me, d o n ' t s l e e p too m u c h . . .

K: Stay active —
A: b e c a u s e s h e s a i d t h e b a b y h a v e a c h a n c e to
g r o w to o m u c h if y o u s l e e p t o o m u c h b u t i f yo u
m o v e around, keep busy, the b a b y d o n ' t h a v e a
c h a n c e t o g r o w to o m u c h ( I n t e r v i e w 4 : 1 9 9 7 ) .

to

the

81

In addition to exercising, throughout

my interviews Iheard

three

extremely similar stories regarding ways to

give birthing women

a quick

and easy delivery. Two involved the use of a live snake (garter), placed
through a pregnant woman's dress or belt once labour had started to
speed it up. One Carrier participant's aunt had this done to her by her
brothers at the onset of labour:
We used to do that with snakes. Yeah, my aunt
had that done to her, her brothers. She was
pregnant and she had a belt on her dress and
they put the snake down, down, you know, she'd
be having the pain and in her first contractions
and in, in, in 1/2 an hour she had that baby,
just slipped out (Interview 3:1997).

Another similar story came from a woman who lived on the coast and
in her story, a minnow was placed through the woman's baggy dress to
encourage fast delivery (Focus Group 8:1997).

it seems the

belief/methods were similar and only the object used, snake or minnow,
varied on geographical location.
I heard only two methods on how pregnancy was prevented and
although it was discussed candidly,

it was acknowledged by several

interviewees that preventing a natural event,

like pregnancy, was

frowned upon. In the Carrier tradition, women could use a beaver's tooth
to cut up the afterbirth of a previous child to stop future pregnancies
or could drink Kinnikinik tea to prevent conception:
M: They're really, like my aunt used to say,
women talked sometimes I listen to them, and
they used to say, they used to kinds, put down
a person, a woman who doesn't, whose childless.
You know, they think she's using, you know, doesn't
want to have childbirth and they used to really not
like that. And I heard at one time this woman she
had a child and after she had no children and then
they said a h
Oh yeah, afterbirth, they
do something with it. The beaver, beaver, they
use a beaver tooth, they tear it up with a beaver
tooth, if they don't want to have another child.
These are what you call it. Taboos (Interview 7:1997).

82

Again as part of their special status, women were discouraged from
looking at something too long as the belief was that the child would end
up resembling the object. This was especially true of frogs or dogs for
their not so beautiful appearance. One Haida Elder mentioned one woman
who held a beautiful doll in the mirror sc her child would take on its
characteristics :
And I knew, my Mom used to tell me about,
once in awhile she would say things like,
when a woman was pregnant she wouldn't look at
frogs or dogs or anything uhummm, any
pictures that were ugly and uhummm, she
mentioned the neighbour that was having a
baby and she got a real beautiful doll
and she used to hold it up to the mirror
(Interview 6:1997).

In the Tahltan culture, pregnant women were also shielded from
disturbing scenes such as bear kills for fear that it could pass on to
the unborn fetus (Interview 1:1997).
One Haida participant was told by the Elders that tight clothes
would give the child a flat nose (Interview 2:1997). Yet, due to the
soft nature of baby's bones when they are born, stated a Carrier
participant, you can shape their face and pull their noses out so they
will not be snubbed (Interview 7:1997). Further to this, how a baby is
first handled can effect its future life. One woman told me that if you
grab the child by the left hand they will be left handed and vice-versa
(Interview 3:1997). Similarly, parents were also known to rub an
infant's hands with the hair from a beaver's paws, while saying "Let it
be that he'll be just as busy as a beaver. He'll be like a busy beaver."
One Tlingit participant felt this had been done to her, since she was
always sewing:

That's what they do. I think they done that to me
because I am a good seamstress. I do a lot of sewing...
(Interview 4:1997).

83

Physical activities and visual objects weren't the only things
that women needed to avoid, but uncontrollable noise as well. One
participant recalled a story where her aunt, who was pregnant, had an
older midwife say to her "Hope you don't mind noise, cause the baby will
be born making that same noise", as she was exposing herself to a very
loud commotion (Interview 2:1997).
I heard one very interesting belief from a Haida woman on the
coast. She was told never to prepare for a child,

that preparation would

curse the pregnancy and the likelihood that the child would survive.
Nothing was made for the baby until after its birth including all the
baby's cloths (Interview 2:1997). Other participants however, described
in detail how to prepare for a child.
These beliefs come from the notion that all energies,

good and bad

can pass through the pregnant woman to the unborn child. Avoidance of
possible negative actions, sights or sounds is a protective mechanism
for the child and the mother. Conversely, all that is good should be
taken in, as was seen with the use of the beaver's paws to give children
drive. As mentioned previously, the Native Infant Education and Care
program at Malaspina College (1984) found that these energies, negative
and positive, encompass both the actions of the mother and father-to-be
and include more specific emotions such as anger, laziness and
depression. Therefore,

to have a healthy pregnancy and newborn, parents

are encouraged to live in a good way. It is important to recognize
however, that although the general philosophical base behind these
restrictions may have been similar throughout the Northwest, variations
across culture, nation and even community were noted.

4.2.2 Midwives's Roles

All the participants emphasized in some way that the elder women
in a community, some referred to them as midwives, were responsible for

84

instructing newly pregnant women on not only the aforementioned '‘do's
and don'ts" but on all aspects associated with pregnancy, labour and the
child's early life. These women were usually older "aunties" and had
gained their knowledge through the experience of their own births and by
attending others. It was these "women's helpers" who attended the woman
throughout the main stages of labour and delivery and stayed after to
aid the woman by making her medicine, looking after the children and
cleaning the house. Usually a group of as little as two to as many as
four or five were involved in a birth but many participants stated that
whoever wanted to help usually went, though it was always women.
Many participants mentioned that men and younger children were
sent away from the birthing woman. One Tahltan woman expressed it quite
firmly:
D: Yeah. Uhumm. Who was usually there when the
baby was born?
L: The midwives, and then the, whoever wanna
be there, your sister, your aunt or your folks
relatives or your friends.
D: The men were usually not allowed?
L: NO.
(Interview 1:1997).

For one Tlingit participant, separation of the birthing women,
their helpers and the midwives was achieved by the physical construction
of a tent outside the house

(Interview 4:1997). Variations across

nations and communities however,

result in differing opinions on whether

or not men were active participants at the birth or if their role,
although still important, lay outside the birth scene itself. Other
research has shown that men have been known to have delivered babies and
husbands have helped their wives in labour (Rattray 1997 Unpublished
Manuscript). However, these seem to be situations of special
significance where no other options were available.
Although almost all women could aid a pregncnt woman in labour and
many could deliver children, it seems that a second group of women with

85

specialized knowledge would be called in either at the delivery stage or
if complications arose during the birth. These women could be the
"aunties" or ocher relatives previously mentioned, yet some were not
related to the pregnant woman but known in the communities for their
unique knowledge of childbirth complications such as breech births and
hemorrhaging. Almost all the interviewees mentioned individuals by name
as specialists of birthing, or midwives. One Carrier participant
remembered one older midwife, who although having specialized knowledge,
had no children of her own:
and at that time, you know, when there was
complications there was an elderly woman
who was just, uh, very expert, in what, in
childbirth, you know, she had no children
herself, but she was a midwife (Interview
7:1997) .

It would seem then that two, sometimes overlapping, groups of
women attended births traditionally, the pregnant woman's relatives or
helpers and the community-known specialists or midwives.
All the women involved in attending women in labour and delivery
gained their knowledge through experience. Birth specialists or
midwives, were known to have apprenticed with the older women to learn
ways to deal with complications and their education was of an oral and
participatory nature where listening and watching were the main means of
instruction. Midwives used methods such as massage to feel for the
position of the bed)y and to turn a breech baby into the proper delivery
position. Breech babies could be turned around if they were caught
before the sixth or seventh month, claimed one Tlingit participant's
mother-in-law,

and whether the child was feet up or feet down could be

ascertained by the way it was kicking:

and that's the way they do it and that's
what my mother-in-law used to do and, ah,
she always used to ask me how the baby was
kick around, you know, inside (Interview 4:1997).

86

Massage was also used to help the placenta deliver itself right
after birth and as one participant remembers, to remove some of the
afterbirth that had been left inside her:

Mt: They would use herbs and stuff after to
make sure nothing was left behind.
M: Yeah, that was the worst thing. With me
after my first child, every evening
at sunset, it's like when you have puss or
something, you have this pain. Oh!! I used to
just, I was so sick and then this woman came
and a midwife came and she worked on me and
she gave me that tea, Kinnikinik tea, and
after that I had no more pain.
Mt: Cause that is the worse thing if things are
left behind.
M: In the, even if a little bit of the, something
left behind, you know, the afterbirth.
K: And she did massage?
M: She would just massage, like you know, like you..
M t : And she gave her the tea.
(Interview 7:1997).

As was previously outlined,

the negative side of childbirth was

discussed by participants and included miscarriage, infant deaths as
well as maternal deaths. Miscarriages were treated similar to a birth
with similar medicines made to aid the woman after delivery (Interview
3:1997). Afterbirth that was left inside a woman too long or if the
afterbirth was not delivered at all were two of the most common causes
for death among birthing women. One participant remembers two women
dying in the arms of the midwives from hemorrhaging:
T: Did you ever run into a time when a
kept on bleeding when she gave birth? Like
hemorrhaging?
S: Yeah, we had quite a bit, I think 2 died
from it.
T: Oh.
S: We couldn't help her. She had hard time to
give birth. She died. Yeah.
K: Ohhh.
S : In the hands of the midwife.
(Interview 3:1997).

87

The use of traditional medicines came up a number of times ia the
interviews. Although many women could make medicine for women to ease
the pains of childbirth, to induce the delivery of the placenta and to
stop post-partum bleeding some special medicines were prepared,

for

example, to help women who could not have children (Interview 3:1997).
The use of traditional remedies will be discussed further in the next
section.
Midwives roles did not end upon delivery of the child. After the
birth, when both mother and child were all right,

the family would bring

the child around to its relatives, the grandmothers and great­
grandmothers. In the Carrier tradition those that "handled the baby",
usually women of high rank, gave gifts to the infants (Interview
7:1997). In most instances it was these women, the relatives or aunties,
who were responsible for the disciplining and instruction of the young
children. For one Haida woman, it was the aunties who demonstrated the
duties a young girl would perform while the uncles were left to teach
the young men to hunt and fish:

C: And the auntie ah, her duty was to teach the
baby girl what life, what her duties as a female
were, that was the auntie's job, that would be the
great aunt eh.
K: Oh okay. So she had a role even after the birth
was over?
C: Yes, yes.
K: She would help that little girl to grow.
C: And the same for the boy, the uncle...the uncle's
job was to teach the boy how to provide for like,
fishing and trapping and hunting (Interview 6:1997).

This task did not fall solely on the aunties and uncles however,
it was all community members, especially the Elders, mentioned one
participant, who were responsible for the behaviour of the younger
generation:
M: Yeah, the extended family, mostly uncles and
aunts. They would be responsible like, eh,
to discipline the child...They would do that
right until the child was old enough to be

88

on their own, even then if the child's
behaviour is not very good, it's still the
responsibility, like uh, to discipline the...
even teenagers...
K: Even teenagers?
M: Even teenagers, even if they are married, like,
you know, there is no end to discipline, even
if they are married and grown up and still if
they see they are not doing right they have the
responsibility..if they are not doing right. Which
is very, very important.
J: So is that just the role of the aunties and
uncles?
M: No it's for anybody. Especially if you are
an Elder. If you see people not behaving it's
up to you to tell them, remind them of where they
came from. That is very important, they have to know
that (Interview 7:1997).

It is obvious that the role of the midwives, and more generally
the Elders in a community, was a strong one in terms of giving, teaching
and training the younger generation. These traditional birthing systems
allowed for this passing on of knowledge to occur, re-establishing
generation after generation,

the base philosophies of a particular

Nations' way of seeing.

4.2.3 Pregnancy and Labour
4.2.3a Medicines:

The Elders revealed quite a bit of information on medicines, both
herbal and cultural, spanning the entire course of pregnancy from
conception into the post-partum period. Herbal remedies came from a
number of participants, with one Carrier Elder in particular being known
to me before hand as a traditional healer:

We just help one another, that's all, there
were no doctors....we had our babies at home,
we just used our own medicine, there, you know,
the plants.... Long ago, they were the only doctors,
the women... (Interview 3:1997).

This participant is glad that the medicines have not been
forgotten and that the younger generation is interested in learning them

89

once again. Wild raspberry coupled with wild chokecherry boiled into a
tea was used to help give a woman back her strength after birth but also
eased the pain of labour:
S: They make these kinds (patting her plant display).
This one is Wild Raspberry, you mix it up with
chokecherries, this one you put 7 only
[bundles] and the other one, you use 4 bundles,
like this and you boil it up on the stove in
enamel pot, you don't use stainless steel because
it spoils the pot, inside it turns black
forever.
K: Ohhh!
S: It spoils, it leaves it black, acid or
something and then the, I use enamel pots,
the __ gallon size and I cook it for two hours,
this one..
K: This one?
S: And boil this for 2 hours and watch the time.
When I, two hours is up, I take it out, all the
bundles and let it sit and then I put it in the
fridge.
K: Oh okay.
S: And they take it, ah, 1/2 a cup twice a day,
this one, that's what I give.__
K: So would this help the woman then to uhummm_
S: To get back her strength...Yeah, she lose so
much blood, her blood will get back strong
(Interview 3:1997).

A coastal woman remembers pregnant women being given tea mixed
with either oolichan grease or butter to ease the delivery of the
placenta and to prevent women from hemorrhaging (Interview 2:1997). As
well, Kinnikinik tea, which was given to women for menstrual cramps and
helped keep

the menstrual blood flowing, was also used to induce

delivery of

the placenta, help stop post-partum bleeding and as a

contraceptive. One Carrier woman's grandmother used to joke with her
after she had so many children to "drink that Kinnikinik tea!"
(Interview 7:1997).
Although medicines could be given in smaller amounts to children,
often traditional healers and midwives had to make special medicines for
infants and children. As one Carrier woman stated it:

K: If a baby was sick would they have smaller,
sort of special plants for babies, or do they

90

just make smaller doses?
S: Yeah, there some plants for babies too....
this is good medicine for babies. Black,
Wildblack Current.
K: Oh okay.
S: You use it for when they cannot poop.
K: Oh?
S: You know babies they get trouble, this is
just like a laxative for them.
K: Oh?
S: And then it's good for them, them when they
got a cold.
K: And you would make it into a tea?
S: Wild Current, you give it to them, the babies
they cannot take it in big, little bit in bottle.
(Interview 3:1997).

4.2.3b Place, Preparation,

Positions of Birth:

Answers from the Elders who were interviewedvaried
with regards to the place, preparation and positionsduring

a greatdegree
delivery.

It

seems that differences in place, preparation and position of birth came
from both cultural beliefs unique to each nation and the very nature of
women's individual needs during birth.
Most women who had their children out of hospital delivered in
their homes, surrounded by relatives and women's helpers. In the Tlingit
culture birthing in the home was "bad luck" and in one woman's community
births took place in a tent constructed outside the house, specifically
for the birth:

When I am gonna have my baby they put up
a tent outside...and they branch it up,
they fix it all up and they make my bed
and have it ready and they put a fire and
a stove in there and they have it ready.
So when I am started to get, in pain, I go
in there. They don't have it inside the
house. They say it's bad luck to do that.
(Interview 4:1997).

Along with the home and a special tent, babies were born just
about anyplace. In the section Personal Stories, we heard of births in
taxi's, at fishing or hunting camps and on the trapline. Almost all the
women interviewed had at least one story of an unprecedented birth. This

91

goes hand in hand with the Elders' strong emphasis of birth as a natural
event and these stories become part of the larger knowledge of birthing
and traditional birthing systems. Although woman may have birthed in odd
(by today's standards)

and out of the way places, the First Nations

Elders were also very much aware of the risks of possible complications
that are attached to any pregnancy and stories of death in childbirth,
miscarriages and stillborn babies were also part of the personal
narratives.
Preparation for the newly born infants was similar for those born
in the home and those born in tents outside of the home. One Elder from
Kincolith recalls that hot stones were often buried under the branches
of the woman's bed when birth occurred outside (Focus Group 8:1997).
Women birthing at home also prepared beds, clothes, sterilized the
equipment needed for delivery and the cutting of the cord, sewed gowns
and prepared diapers with the aid of the women's helpers. In one Carrier
woman's words, everything in times past was natural, even the diapers,
yet with the advent of the forest industry these things are harder to
use today:

5: Natural.
K: Natural yeah.
S: And then they use, they don't use diapers,
they use moss.
T: That's good. They never had diaper rash
do they?
S: No baby rash at all and they use moss...
and then we used to pick it in the fall, dry it and
put it away. I did lots of work, lots of work to
find moss.
K: For the diapers...
S: It's hard to find on account of clear-cut.
K: It is? Oh.
S: That place that they used to make moss, big field.
They do away with all the moss and then after too
many, field— .It was the only place we used to
go to make it, now we have no...I never see any.
Everywhere I go I look for it and (laughs) couldn't see
any!! (Interview 3:1997).

92

The midwives, as was outlined in the section on Medicines, also
prepared the necessary medicines ahead of time and had them ready on the
stove.
As the place of birth varied across cultures and circumstance, so
did the common position for birth. A couple of standard positions were
talked about but the Elders also emphasized that labouring women could
chose the position most comfortable for them. Women were known to have
layed on their sides, supported by a pillow,

(Interview 1:1997) yet one

Tlingit Elder felt that this allowed the head to fall to the hip too
easily and prolonged labour (Interview 4:1997). Others kneeled down on
sheets, or by a chair in which two women helpers aided the labouring
woman :
and I would sit like this [sitting in chair]
and she [labouring woman] would hang onto
the chair or whatever I was sitting on and I'd
help her, she'd be turned into me and there'd be
one woman
down there [behind the chair],
seeing if
the baby's coming or if
the water
breaks. So that's how we had a child.
(Interview 7:1997).

As one Carrier Elder graciously pointed out, women kneeled both
for ease of labour and for modesty, covering themselves with a gown or
skirt to prevent exposing themselves. She felt it would be very
difficult for her to go to
which women lie

the doctor to have a baby due to theway in

prone with their legs spread. She alsofelt this may

be

a concern for the young women in her community today who come from this
very modest background (Interview 7:1997).
The other position mentioned was having the woman sit while
another woman watched for the baby. It would seem to be similar to the
above description only with the people's positions reversed (Interview
4:1997). The word "squat" was used a few times, usually in conjunction
with kneeling, again a possible position for women who found it most
comfortable.

93

Labour lasted anywhere from half an hour, as previously seen, to
three days. Each labour was different and its length depended greatly on
two things; how the woman helped herself and the nature of the birth,
including whether there were complications or not. One midwife put it
quite frankly:

Doesn't matter. When it will come, it will
come. It all depends on how they help themselves.
If they don't try to help themselves then the
labour is long. If you try then you have it
quick. If it gets worse then pretty soon it's
gonna come. That's all. They don't watch
time or anything. Let the baby come.
(Interview 3:1997).

4.2.3c Post-partum; Cleaning of the Infant, Mother, Afterbirth and Cord:

After the child is born a number of things must occur.

For all

participants, the child's eyes and mouth are either swiped clean with
the finger or a small cloth. This removes the mucus which could infect
the eyes or prevent the infant from breathing.
The delivery of the afterbirth was aided in many circumstances by
the use of medicines, as previously outlined, or by the midwife. The
midwives would slowly turn the baby

and gently helped theplacenta

dislodge itself, while the labouring woman lay on her side.

One Tlingit

woman remembers how, after the cord was cut, her mother-in-law assisted
the afterbirth to be expelled:
and then they wait again, you know, after
they cut the cord and they look after the baby
and you can feel it when the birth gonna be,
is gonna come, you can feel it cause you get a
slight pain, not as hard as labour pain, but a
slight pain...You can feel it, right there and
when you go "Oh, ah!!", like that, my mother-in-law,
she says, looks like the rest is going to come.
That's what she said and then she tell me if
its, if you go like that again, she said and
I'm going to help it to come because the cord
is out there...and when I started to get the pain,
slight pain, she help it. She pull the cord,
slowly, she don't jerk it..she help it to come out
(Interview 4:1997).

94

r received a diversity of answers to the question of how the
afterbirth was dealt with but they all revolved around the notion of
what the women deemed "cleanliness". While some women stated that the
afterbirth was "packed away", or "done away" with, others recalled the
placenta being hung in a tree to dry out, another method of cleansing:

Yeah, and then what they do with the afterbirth
they never just...someone would go in the bush
with it and hang it under a spruce tree way up
and it would get really dried up, that's how
they treated it. Everything too we cleanse it,
and nothing would ever bother it, or something
like that, they always hang it up on the tree.
That was very important, to put away the afterbirth
(Interview 7:1997).

Other groups hung the dried and packed up placenta on the child so
they wouldn't wander in life. However, some afterbirths were buried or
as one woman Tlingit recollected, burned up:
Yeah, and when it comes out, they wrap it up and
they don't throw it in the bush, they don't throw
it in the garbage, they don't throw it anyplace,
they make a big fire and they burn it up. They
don't throw it away, it's funny. Native people, I
know the white people don't understand, they the very
cleanest people you ever know or what they do about
their things...I never see any of the birth,
I don't even know what the birth looks like,
they don't even show it to me and I lay there
nursing my baby (Interview 4:1997) .

The cord connecting the newly born infant to their mother was also
dealt with in a number of ways. Most women mentioned that scissors were
used to cut the cord, but in the "old days", a sharp object or knife may
have been used. One Haida woman was reminded of the times when "the cord
of a baby girl was cut with a knife that belonged to the mother and
naturally, the boy, the boy's cord was cut with the father's knife"
(Interview 6:1997). Sterilization occurred either by boiling the
scissors or pouring hot water over them. Yet, one Carrier Elder
remembers an older midwife's disbelief in sterilization, claiming that

95

with the use of traditional medicines and as long as the women kept
themselves clean no infections would occur

(Interview 3:1997).

Cut about two inches above the stomach of the infant, the cord was
usually tied on both ends with string, or white linen thread, braided to
make it stronger (Interviews 1,3:1997). Balsam bark crushed up and
burned helped stop any bleeding that occurred and after about 10 days,
having dried up, the cord usually fell off the infant. Wrapped up, like
the afterbirth,

in cloth or a skin pouch either beaded or embroidered,

the cord was sometimes kept with the child or given to the child at a
later date:
What's left of it with the string tied on, it falls
out in about a week or 10 days and when it falls out
we take little. • .skin or some kind of stuff and we
embroider or we bead it and then we put that cord
inside and we close it up because the cord is dry,
dry, dry by 10 days (Interview 4:1997).

In the Carrier tradition,

recalled one woman, the cord had to be hung up

outside only:

K: And what about the uhumm, cord ah, the baby's
cord? Was there a special way of putting medicine
on it?
S: Sometimes they clip it and then they use Indian
medicine on it.
K: Yeah.
S : They tie it up and then they cut it and they
put that, ah, the cord after it falls, they wrap
it up and hang it anywhere they want to.
K : Ohh.
S: Yeah, they don't burn it or anything. They just
hang it out.
K: In the house somewhere?
S : No, out somewhere.
K: Outside?
S: Yeah, anywhere, they hang it up.
(Interview 3:1997).
The midwives or women's helpers stayed after the birth to help the
new mother who was required to rest in bed from 4 to 10 days. New
mothers had to be very careful, especially with regards to their wombs,
which having been stretched, could fall and the woman would either lose

96

her shape or be unable to have future children. Referred to as binding,
several methods were used. A Carrier participant remembers the
following:

So your womb doesn't fall you had to bind
yourself, they made a little pillow for us
about the size of between the hips, yeah, and we
put that pillow in to keep our womb up eh, and then
put a real wide bandage like, we make it like, our
parents make it, out of a wide flannelette thing and
they'd bind you while you were laying down and they'd
pin it up.. (Interview 7:1997).

While one Tlingit woman's description differed slightly:

and she get me up for a little while after I have
the other children but she made, she sew and she
made a girdle for me....yeah as soon as right after
I had the baby she put that on and at the back there's
skin coming down like that and there's a lace up and
she put it on like that, herself, and she can tie it up
as hard as she can...and that way she said, you don't go
out of shape ...(Interview 4:1997).

Possibly binding began even while the women were pregnant as
numerous Elders spoke of a "belt" women would wear when with child,
right in the "pulse", below the mother's belly button. About eight
inches across, the belt supported firstly the fetus before birth and
secondly the uterus after birth. One Elder spoke of a midwife who could
reposition the uterus if it had fallen after birth:

And when the womb falls, sometimes it does that,
she was the one who, used to, who, uh, would put it
in the right position, she knew what to do (Interview
7:1997).

4.2.4 Breastfeeding

When I initially started this research and conducted my first
interview,

I had not included any specific questions with regards to

breastfeeding. However, it happened that a community member, Deet
Rattray, a former Dease Lake Pregnancy Outreach Counselor, attended the

97

first interview with me and had some questions of her
realizing that birth and traditional birthing

own to ask.

After

systems do not stop

upon

delivery of the child and continue well into the post-partum phase,

I

decided to include a section on the discussion of breastfeeding in
traditional First Nations communities. All of the participants agreed
that breastfeeding should begin right after birth, with no waiting
period. One Tlingit woman was astonished when

her newly born infant

latched and suckled right away:
It's surprising, as soon as the baby is born,
you put them there, their little faces and
A h!! It's funny how they know (Interview 4:1997).

The children were breastfeed for over two years and always on
demand but not all women could breastfeed. One Carrier participant
stated that she tried to breastfeed as much as possible with the help of
bottles but that after she got up from her 10 days of rest and started
working, she "dried up" (Interview 7:1997) . Another woman had an
overabundance of moisture and her mother-in-law sewed her a bra fitted
with cotton on the inside to prevent her from leaking. The amazing thing
about this, she found, was that her mother-in-law:

never knew such thing as a bra, she didn't know
nothing about it, but it looked exactly like the
bra they have today, only it's thick with cotton
(Interview 4:1997).

A Tahltan participant remembered that women would mash up rabbit's
brain and mix it with bear grease as either a breast milk substitute or
as early solid food to feed to the infants

(Interview 1:1997). Similar

to this, when babies were first weaned all their food was masticated for
them and when they were getting their first teeth, bacon rind was given
to them so they would get "their teeth fast" (Interview 3:1997) .
Although it has been recorded in many First Nations groups in British
Columbia that babies b o m with teeth are Elders reborn (see Mills and

98

Slobodin 1994), one Carrier Elder claimed that within her culture,
babies born with teeth were "poison" and that their parents usually
pulled them out immediately. The teeth (and all subsequent baby teeth
that fell out) were thrown "to the moon or the sun and they talk to it.
They tell it to have straight teeth" (Interview 3:199 7) .
To sum up, similar themes have surfaced throughout both the
women's personal stories and from their knowledge of midwifery and
traditional birthing practices. Like the woman's personal stories, birth
is deemed a natural and normal event, yet the possibility of
complications or even death are not forgotten. Both the community and
women specifically, hold important positions with regards to traditional
birthing systems outlined in the descriptions of the continuity of care
practiced by the both the midwives and women's helpers at birth and the
community at large with regards to the child's discipline. Also
filtering through the Elders' responses was the holistic nature of
traditional practices, as well as the foundation of the discourse on
birthing, that the passing on of cultural knowledge to the younger
generation was paramount. By reflecting and connecting to each other,
these social patterns are woven together to create the basis for
Traditional childbirthing systems.

4.3 CONTEMPORARY BIRTHING

When discussing the issues surrounding contemporary birthing in
the Northwest all participants gave individual and quite different
points of view on this controversial topic. Some women felt home
birthing was better while others agreed that hospitals were safer.
Nevertheless, no participant ever let go of the belief in birth as a
natural and normal event:

5: Just like everyday, natural.
K : Natural...yeah.
S: If it gets worse, then they pretty soon

99

gonna come. That's ail. They don't watch time
or anything. Let the bahy come___ They wanted me
to help at a workshop for that,
I tell them,
that's natural why? (Interview 3:1997) .
Women's concerns were centred around both women's comfort in
delivery and the safety of both mother and child. Coupled with these
were the recurring

dilemmas of travel and the separation of families. It

seems that only by

combining these two systems, the medical and

traditional,

solution be found.

can a

All the women had lived or continue to live in communities where
significant travel to hospital was necessary.

For example; Dease Lake to

Cassiar(~64 kms), Masset to Queen Charlotte City (-101 kms), Stoney
Creek to Prince George(-98 kms) or Vanderhoof
Horse

(~9kms), Atiin to White

(-135 kms) and Houston to Smithers (-64 kms). As has been

previously discussed,

the women who took part in the interviews had a

variety of personal birthing experiences. Each birth story was unique
and each system of birthing varied from woman to woman and nation to
nation. Some participants had all of their children at home or in the
bush, others had a mixture of home and hospital births while some had
experienced only hospital births. This range provided insight into the
traditional practices as well as into the transitional period of
childbirth where women delivered both at home and in hospital. This was
especially apparent in my afternoon with the three generations of
Wet'suwet'en women and their discussion of their (great-great, great)
grandmother.
Yet, the spectrum of answers expressed by the Elders did not
create a consensus on whether home or hospital birth was preferred. One
woman was firm in her belief that midwives should be used in communities
without hospitals (Interview 2:1997), yet, another participant was just
as certain that the Western medical system was the safest (Interview

100

6:1997). Two women felt that it didn't matter where you birthed, that
both their home births and hospital births were similar:
A: Yeah it's all the same. The only thing is they
have lots of other things too, I guess. There
[hospital] they know how to look after the baby
and everything, my mother-in-law she did pretty
good too you know (Interview 4:1997).

It is very important to recognize the controversial nature of this
topic and the host of factors influencing personal opinion on
contemporary birthing. Similar to the attempts to denounce midwifery and
women's healing powers in Europe as witchcraft, misinformation and
ignorance of the nature of First Nations midwifery care stems directly
from the centuries of public defacing of traditional knowledge and
Aboriginal culture since contact by Western colonial systems of power.
Although many people are firm in their belief that women need the
security of a hospital birth, others believe this can be achieved
without sacrificing the comfort of the birthing woman and her family.
The issue of choice came up for two participants who felt that women
should be able to choose with whom, where and how they birth. These
participants saw the benefits and shortcomings of both the Western and
the Aboriginal systems of birth. As one Elder stated:

K: Do you think that maybe young women today
should be having their babies at home?
S: If they want. Depends if they want to have
their babies at home, they could, their own
decision (Interview 3:1997).

Several participants noted there was "no choice" in the transition
to hospital births cuid fears not only of the hospital itself but of
repercussions from not delivering in hospital were also expressed. One
woman's fear stemmed from what she described as "when the doctors do
something to the women so they can't have any more children
[paraphrased]" (Focus Group 8:1997). The controversy over unauthorized

lOl

sterilization of First Nations women in the mid 20th century has been
recognized as both a childbirth health issue and a serious violation by
the Federal Government towards the Aboriginal population. This atrocity
has seen growing awareness from both Native and Non-Native groups. This
same participant's mistrust continues today towards certain types of
birthcontrol. Young girls, she says, get a "needle", or take a pill from
the doctor which stops them from having children (Focus Group 8:1997).
The issue of birthcontrol came up as a topic for several
participants and they expressed quite clearly the mistrust of
interfering with the body's natural system:

One thing I always talk about is, you know,
what I think now, a lot of our young people,
our women are using birth controls, like I
think it does something to your body and I
think, what I think mostly is, you know, maybe
that's why they have these cancers and stuff.
Like that, like I think about it and everything
has to come naturally, you have a baby and you
have milk and I don't know, everything is natural
and to do something like that I think is scary
(Interview 7:1997).

Fear also came from a lack of knowledge of how the birthing system
worked and how the law regarding birthing was changing,specifically
mandatory evacuation for delivery. One woman remembers that they had no
choice but to go to the hospital because several people told her that if
anything happened to the babies at home the parents would have to go to
court (Interview 1:1997). Ironically, many of the women had home births
after the introduction of hospitals due to the inability to travel the
distance to the hospital, the same reason mandatory evacuation was
introduced.
Personal experience and the conception of what a hospital birth
entailed varied in the responses from women. There was no simple
consensus on which system to use. One Tahltan woman felt that:

Everyone live in the Whiteman's way when I was
brought up. I don't know, my grandmother she didn't

102

say how they did it. I just...it's all I know it's
their new way of doing it, oh well, it's not a new
way, it's just ah, using the stuff from order, from
catalogue, that's all, that's the only thing different
(Interview 1:1997).

Her experience of the hospital, after having many of her children
at home was not an overtly negative one as the hospital where she
delivered was small and births were not overly medicalized:

No, it's about the same....Oh well when I had
------ in the hospital they all ready leave the
baby with you in the room. Already then, now they
uh, before they used to just, leave them in the
baby's room...the nursery and then they ah take
the babies in whenever they want to eat (Interview
1:1997).

However, the hospital birth experience previously described in the
section Personal Stories, where the woman was strapped down and not
allowed to see her child, speaks volumes about the differences, even
regionally, that women during similar time periods experienced within
the hospital system.
Concern over women having to leave their communities became
central to the discussion over the current system for a number of
participants. One interviewee felt that the use of traditional midwives
would be helpful for First Nations women, who would then be able to
birth in their home communities. She felt that the distance traveled to
deliver in hospital and the time spent in a strange place at such a
sensitive time held the greatest threat to women having positive
birthing experiences (Interview 2:1997). Another put it very concisely:

It doesn't matter where you are. You just have
to go through it quick. Home, home is good. I
like the home, I don't like the hospital (Interview
3:1997).

103

However, another participant although agreeing with the
difficulties associated with waiting in a foreign community still
preferred the hospital system for safety reasons:
C: I don't know, I don't think uhummm,
it's such a good idea to have a
midwife. I, I prefer the hospital.
K: Okay...for the safety reasons?
C: Uhhummm...... nowadays I notice
they send the mother to be over in Rupert
here and they put them up in a hotel sometimes,
I know this one young lady that waited for
over a month, in that hotel. Uhumm. That's an
awful long time (Interview 6:1997).
One woman wanted to know what we
were conducting the interview)

(myself and another woman who

thought about the contemporary situation

yet her thoughts touched upon the distance women must travel and the
separation from their young children:
L: I don't know... What do you girls think?
D: I think they have to make things easier for
women who go out.
L: Especially when they got little ones leave
behind eh? And they leave them, someone got to
take care of them for you.— and nowadays it
seems like nothing, I don't even think we noticed
before, where they put the kids, I don't know where
the elder ones go.
D: I think they usually leave them with other
relatives.. Some people are fortunate when
they go out, they have family where they go out..
(Interview 1:1997).

For many First Nations women in the North the extended family and
larger community are still an important support system for pregnant
women. Some women are lucky to be able to spend their time waiting for
delivery with relatives when in urban centres.
Expanding on the concerns raised in the above discussions, one
Elder brought a new light on the subject, claiming that woman should
take advantage of the two different systems but always remembering that
birth is a normal and natural event:

K: Do you think it's a wise move?

104

M: I think so. Everything is so modern now,
it's like ray grandchildren tell me, "it's the
nineties gramma!"...! think so, I think so. Yeah.
Mt: If we had to go back to
Che ol d ways we could,

if we had too...

M: Yeah, if we had to, if they had no hospitals,
suppose they bomb the hospitals, what can we do?
Wouldn't be the end of the world. Still get help
(Interview 7:1997).

When all of the responses are placed together I saw that although
a number of opinions and concerns are expressed with regards to both
hospital births and homebirths,

the issue over safety and comfort of

both woman and child is a dilemma which has no easy answers.

Ironically,

some of the same issues which women discuss as affecting their birth
experiences, like having to travel great distances and the uncertainty
of weather and road conditions, are the same issues which stand in the
way of safe home births from taking place in their communities. It seems
that neither a radical switch to midwife attended homebirths or staying
with the status quo would solve this problem. In each situation
something must be sacrificed; the comfort of a birth at home with the
support of relatives when women are evacuated or the reliable access to
hospital safety systems if a homebirth were to have complications. Co­
operation and collaboration between the Western medical system and
traditional Aboriginal midwifery and its birthing practices may be the
only answer. Opting for the best of both, the Indigenous system and the
medical system, echoes the responses of the women interviewed.

4.4 CONCLUSION

Although First Nations women's knowledge and stories about
traditional Aboriginal midwifery and birthing cultures vary across the
Nations and communities of the North, similar themes arose from the data
gathered. The Elders stories reiterated that women see birth as a normal
and natural event. This reemerging theme cannot be disputed. The

105

necessity for the community to be involved, both as helpers in birth and
as participants in the child's life, stem from First Nations kin based
society and from traditional birthing's holistic nature and practice of
continuity of care. Women want to be attended during birth by women who
were traditionally the holders of sacred and important reproductive
knowledge. Unique or unprecedented birthing situations were captured in
a directory of birthing information and used in the passing on of
knowledge orally,

from generation to generation.

Birthing stories, with all of their celebrations of life also
included images and instances of pain and sometimes death. Infant and
maternal mortality in pre-contact times was seen, as birth itself, as a
natural part of the cycle of life. First Nations beliefs in traditional
healing powers included communication with animals and non-physical
beings, the compelling of the will of another and the stealing and
storing of souls. These beliefs were subsequently persecuted as
witchcraft and this label was internalized by Aboriginal people
themselves

(Gunn Allen 1986:23). As stated by one participant;

S: Don't call me medicine man. I'm not, I tell
them. I just use, they think I'm bad or something.
— I tell them I don't know anything about that. I
just try to help people....Yeah, some medicines are
good, they just don't work. They think I
am bad. I tell them I can make medicine for
them and try to help them out (Interview 3:1997).
Further, the colonial experience, with its introduction of
European diseases, the move from traditional lifestyles to sedentary
reservations, residential schooling which tore children from their
families and instilled hatred of their own culture, has culminated in
growing cultural loss and social dysfunction. Traditional midwifery and
birthing systems were forced physically and ideologically to go
underground or were abandoned altogether.
The social determinants of health greatly effect health status and
with the legacy of colonization and genocide, it is no wonder that

106

infant mortality rates have remained twice as high for First Nations
communities when compared to the general Canadian population. Until the
basis for this is addressed and culture is included in program design,
little change can occur.
Despite the break from tradition, women want both the benefits of
a birth in one's community, the security and support of relatives, as
well as the safety offered by Western hospitals. A complete return to
Traditional Aboriginal midwifery and First Nations birthing systems
would be difficult to implement immediately in any of the outlying
communities of the Northwest. However, the philosophies or the base
themes of birth as natural, that women attend women in birth, that birth
is a community event and that knowledge is passed down to the younger
generation orally through storytelling can all be incorporated into
making the existing system more holistic for First Nations mothers and
their families. As one woman stated:
They've come along way. You can have a
natural, I had all of mine in the hospital
naturally. You can if you so chose to do all
that. I think you can have the best of both
worlds now, cause you have the safety if you
do have a problem but you can create your
own atmosphere, you know, it's entirely up to
the mother and father if they want to...
(Interview 7:1997).

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CHAPTER FIVE: MOVING TOWARDS THE FUTURE
5.1 DISCUSSION OF FINDINGS AND RELATED THEMES

When the themes that the Elders revealed are tied together, their
experiences and stories bring to light the inherent contradictions found
between the current Western discourses on birthing,

the medical and the

natural, and the wants and needs of First Nations women and their
families birthing in the North.
The literature review illustrated that culture, specifically First
Nations voices, were absent in the current discourses surrounding birth.
On

the European side, the

vilification of

midwifery

rise of the medical discourse created a
based on a professional/nonprofessional

dichotomy. The rise of the feminist revisionist narrative in opposition
to

this brought in the issue of gender,

of

the birthing scene was

that medical science's take over

an act of oppression of women as well. The

colonial movement in North America continued this vilification of
midwifery knowledge as witchcraft and led to the denouncing of
traditional Aboriginal healing and birthing practices. Forced
underground or abandoned altogether,

this knowledge must be used to

create a new narrative, one in which culture is seen as a relevant
aspect to birthing knowledge.
The narrative themes presented by the Elders are that birth is a
natural, normal, community and family event. These themes reflect the
traditional perspective of holism. All things are related and birth and
the knowledge surrounding birth cannot be separated from everyday
experience. The stories, both personal and unique, are used as teaching
tools to pass information on to the next generation.

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5.1.1 Contradictions and Complexities

The contradictions that become apparent are focused on the
transitional period between community based midwife attended births and
hospital births. The move was forced both ideologically with the
colonial vilification of traditional knowledge and physically with
mandatory evacuations and government policy. When women lost the power
to use their traditional birthing systems, a dependence arose on the
Western medical model. As Benoit and Carroll

(1995) have pointed out,

recent evidence suggests that rates of mortality and morbidity for
mothers and infants in pre-contact Aboriginal Nations was lower than
after colonial impact (1995:235). So although the move to hospital
births subsequently lowered infant mortality rates,

it was the process

of colonization and the introduction of disease which had caused
excellerated rates initially. O'Neil (1990b) states this in the
following way:

For governmental and medical authorities, a
reduction in infant mortality from the "traditional"
(i.e. pre-settlement) period is the justification
for all the changes which have been made in
obstetric care in the Keewatin [the North].
For the Inuit, the belief that "traditional"
(i.e. pre-contact) birth was safe is basic to
their demand for control over childbirth. The
distinction between pre-contact and pre-settlement
is an imposed one, for the current discourse
blends both, periods and reconstructs historical
memory to fit ideological needs (O'Neil 1990b:56-57).

However,

there is difficulty in assessing pre-contact Infant

Mortality Rates, creating problems in the need to see pre-contact
society as better than post-contact. To add to the complexity of the
issues, even with this lowering of IMRs in both the Native and Non­
native communities. First Nations IMRs continue to be twice that of the
national average.

109

As presented in Chapter Two, the Native IMRs continue to be high
due to the current status of the social determinants of health in First
Nations communities. As Young (1994) describes, simply providing better
access to Western services will not change the social determinants for
Aboriginal peoples. The social inequities facing First Nations
communities such as poverty and poor socio-economic status, are direct
repercussions of colonization. Therefore, only in addressing these
issues in a process of decolonization will Infant Mortality Rates, Low
Birth Weight Rates and Teen Pregnancy Rates change to reflect improved
health status for the Aboriginal population. At the same time,
culturally specific and relevant perinatal services must be implemented.
These services, in combination with the larger processes of
decolonization, can help to lower Infant Mortality Rates,

Low Birth

Weight Rates and Teen Pregnancy Rates and subsequently improve the
overall well being of First Nations peoples.

5.1.2 Contemporary Dilemmas

With much traditional knowledge gone, the move to hospital births
presented in the Elders' responses reflected the need for these women to
have safe and secure birthing experiences. However, the dilemma which
arises is how to create a positive contemporauzy birthing experience
where culture is not overshadowed by the medical technology-oriented
narrative or the feminist-revisionist one. More specifically, we are
faced with the problem of addressing how the Elders' responses and the
revitalization of traditional midwifery knowledge can impact the
practical health problems facing communities today.
Firstly, one must address how the revitalization of traditional
knowledge can effect the social determinants of health. The Elders'
experiences,

stories and knowledge about traditional birthing practices

110

show that traditional birthing systems did exist and that they were
deeply embedded in an entire way of being. For First Nations
communities, recognizing their own cultural heritage and reversing the
internalization of colonization can re-instill a sense of self worth,
self-esteem and cultural pride. Creating positive feelings about ones
self, community and nation is a first step in changing the way one
reacts to their environment. Women and their families could begin a
child's life in a positive way, by acknowledging and following
traditional teachings, changing not only their life experiences but
those of their children.
Secondly, in combination with these larger processes of
decolonization, the Elders' knowledge and revitalization of traditional
midwifery can be used in a practical sense by integrating it into
current perinatal services for First Nations women. In the interviews,
the Elders emphasized this need for women to have a choice between
traditional homebirths and delivery in hospital. Seeing the benefits in
both, the Elders also discussed the possibilities of combining the two
systems. This revitalization as well as public acknowledgment and
integration of traditional midwifery and childbirthing knowledge into
the current birthing practices will create alternative options which
fulfill both the need to ensure safety and the need to give women a
positive birthing experience reflective of their culture, community and
way of being.
The contradictions which arise from the findings are complex.
Initially, First Nations voices were absent in the current discourses on
birthing. This is partially due to the vilification of midwifery carried
over from Europe by the colonizers and placed onto First Nations
traditional birthing knowledge. As IMRs rose, the internalization of
this vilification resulted in a growing dépendance on the Western
medical system and Aboriginal women began to choose hospital births for

Ill

safety reasons. As two sides of the same coin, the move to hospital
births impacted First Nations as their cultural traditions were lost or
set aside, yet benefited them by lowering alarmingly high post-contact
Infant Mortality Rates.
Although initially lowering IMRs, the use of and access co Western
medical technology has not evened out the disproportionate rates of
infant deaths in First Nations communities as compared to the rest of
Canada. Without addressing the social inequities created by
colonization, IMRs, LBWs and TPRs will remain higher than average. The
revitalization of traditional midwifery knowledge, expressed in the
Elders' stories, can both instill a sense of self and cultural worth and
be used practically in current services to change these statistics and
subsequently improve First Nations health status and general well-being.
5.2 REVITALIZATION OF TRADITIONAL HEALING STRATEGIES
Re-traditionalization, in all its forms, is
part of a general ferment of ideas now contributing
to the renewal of Aboriginal cultures (RCAP 1996:352).

The benefits of traditional healing and the revitalization of
traditional practices are multifold for First Nations peoples. They have
the power to renew communities in the current process of decolonization
at work in Canada. The majority
ago

of traditional healers were forced long

to renounce their practices or to practice covertly because of

persecution by Canadian governments and Christian churches and contempt
on the part of bio-medical practitioners for their ceremonies, herbal
treatments and other practices (RCAP 1996:212). Yet traditional
practices,

including Aboriginal midwifery and traditional birthing

systems never faded away completely.
The reimplementation of traditional practices into or along with
the current health care system must be community and culturally based
with an emphasis on equity and the philosophy of holism. If such actions

112

are taken, the possibilities of a return to Aboriginal midwifery's
birthing practices and philosophies seems feasible. By describing
contemporary examples of communities who have successfully returned to
traditional birthing systems and by reviewing the newly legalized status
of midwifery in B.C., there is the possibility of a new combination of
traditional and western practices that can enhance and positively change
contemporary birthing experiences for Aboriginal people in the
Northwest.
As previously outlined, in almost all areas of health Aboriginal
peoples are suffering rates of illness and social dysfunction that
exceed Canadian norms (RCAP 1996:223). Co-operation between traditional
and mainstream practitioners has been outlined as a recommended action
for change by the Royal Commission on Aboriginal Peoples for the areas
of health care and general well-being. Its investigations have shown
that any new, revitalized or co-operative Aboriginal health and healing
system should embody four essential characteristics: the pursuit of
equity, the inclusion of holism, the movement towards autonomy and be
both culturally and community based.
The pursuit of equity in access to health and healing services and
in health status outcomes is paramount as an initial intervention
method. Along with raising life expectancy rates and lowering infant
mortality rates, new health strategies must also work at evening out
inequalities within the Aboriginal population itself by reaching out to
Non-Status, Off Reserve and Metis populations (RCAP 1996:203). The
inclusion of holism in approaches to health and well-being is reflected
by acknowledging the interconnectedness between the four areas of self,
the mind, body, heart and spirit as well as the individual, family,
community, nation and future generations (RCAP 1996:205).
Although Aboriginal authority and control over health systems has
begun to take place with Health Transfer agreements in many Aboriginal

113

communities, the transfers continue to work, within the original design
and world view of the Western model and need to be reorganized to
reflect new community priorities

(RCAP 1996:208). With this in mind,

the

need for culturally based programs must also reflect a diversity in the
design of systems and services that accommodates not only the
differences in culture across Canada but also of community realities.
Examples of culturally based healing initiatives involve direct
collective community participation in ceremonies, one to one client
consultation with Elders and other healers and the participation of
traditional Elders and healers in new program designs

(RCAP 1996:350):

It is often pointed out that much of the concent
of Aboriginal cultures has been lost and that the
dominant Non-Aboriginal culture has been absorbed by
Aboriginal people. This is true, but to exaggerate this
point is to miss one of the central facts of Aboriginal
existence: Inuit, First Nations and Metis peoples of
Canada are unique peoples and they are determined to
remain so. Traditional norms and values, though changed
and constantly changing, retain much of their power (RCAP
1996:209).

By enlisting the support of the mainstream system, more effective
responses to health care for Aboriginal peoples will be achieved by
bridging the cultural gaps through cross-cultural awareness, cross
cultural input and by renewing the balance of power between our two
worlds.
5.3 COLLABORATION/COOPERATION: CONTEMPORARY EXAMPLES

Several contemporary communities can be seen as excellent examples
of women reclaiming their positions as the caretakers of the birth
process through the integration of traditional midwifery practices in
their health systems. The Sioux Lookout Zone Hospital in Northwestern
Ontario, the newly opened Birthing Centre on the Six Nations Reserve in
Ontario and the long standing Inuulitsivik Maternity Centre in
Puvirnituq are three such organizations.

114

In the Sioux Lookout Hospital, although, no actual labour coaching
or home birthing is allowed, traditional midwives are able to help the
expectant mother through much of her pregnancy term. The hospital has
set up a self-help program aimed at collaboration between Native women
and the professional medical community. The goal of this program is to
make the existing health care system more responsive to community
members and create better liaisons between the community and health care
workers

(Malloch 1989:112).

Traditional healers may practice in the hospital if it is
requested by the patient and the midwife can give prenatal and post­
natal counseling to the mothers. This mutual co-operation of existing
health care and traditional health methods reflects the belief that
Native people deserve the right to practice their own medicine with
their own people.
This has also recently taken shape for the First Nations of the
Six Nations Reserve in Ontario. The newly opened centre officially
called Tsi Non:we Lonnakeratstha (The Place They Will Be Born) is the
first Native-only birthing centre in Ontario:

The goal is to provide a space where women
with normal low-risk, pregnancies can prepare,
labour and deliver combining elements of traditional
rites and ceremonies with modern medical procedures
and know-how (Nolan 1996:July 3).

With a friendly, homey atmosphere, traditional ceremonies such as
smudging and sweetgrass purification are used. Women and their families
can also bring gifts of tobacco to the sacred fire burning outside the
centre. Tsi Non:we Lonnakeratstha was built in response to a community
health survey which indicated that Native women wanted to incorporate
these traditional elements into their birth plans and to have their
babies on Native Land. As Katsy Cook, a registered midwife from
Akwesasne Reserve near Cornwall states:

115

The medical profession doesn't have to believe
the way we believe, but our belief systems are an
integral part of our culture and to think that we
can have children without them is absurd (Nolan
1996:July 31.
Funded by the province until 1999 the centre is staffed by several
Six Nations women who have been trained as Traditional Birthing
Assistants,

two additional First Nations midwives from Hamilton, and one

from the Akwesasne Reserve near Cornwall Ontario. There are classrooms
for prenatal activities and a kitchen for nutrition teachings.
Breastfeeding is encouraged and mothers-to-be can birth in one of three
birthing rooms,

in hospital or in their homes.

The movement to bring birthing back to the Inuit communities in
the Eastern portion of the Northwest Territories and Northern Quebec
began in 1982 with the opening of The Inuulitsivik Health Centre in
Puvirnituq (Tuluguk 1993:239). Initiated at the same time.

The Maternlcy

Project, brought together the efforts of the Native Women's Association
and the seven surrounding villages. Public meetings, consultations with
local organizations, surveys, questionnaires and interviews with Elders
were used to get an understanding of the maternal needs in the Nunavik
region. The goal of this project was to promote quality health care at
the community level,

to revitalize community knowledge including all

aspects relevant to women and reproductive health, bring deliveries back
to the North and to give the Inuit people control over their own health
(Tuluguk 1993:239, Stonier 1990:63, see also O'Neil 1991 and 1990a&b for
similar studies conducted in the Keewatin district of the NWT).
The Inuulitsivik Maternity opened in 1986 as an annex to the
Health Centre with four macernity beds. Inuit midwife apprentices were
nominated by the community and have been trained locally on the job as
they work towards becoming the women's primary caregivers. One third of
all deliveries are conducted with local staff and most communication

116

occurs in tJie Inutituk language (Stonier 1990:65, Tuluguk 1993:240). A
perinatal committee chaired by a midwife meets weekly to review prenatal
files and, along with risk grading, determines Che place of birth and
perinatal careplan for the pregnant women in these communities

(Tuluguk

1993:239). Seven hundred and seventy-five in-community deliveries have
occurred from 1986-93 and one Inuit midwife has completed the required
training to achieve full privileges at the health centre (Tuluguk
1993:240, Gallagher 1997).
Stonier (1990), in her article "The Inuulitisivik Maternity",
discusses the positive aspects of the maternity as allowing women care
in her own language and culture by her own people. Although women in the
surrounding communities must travel to Puvirnituq,
than traveling south,

the stay is shorter

they can stay with relatives and their partners

and families can be present. Stonier sums up her discussion by stating
that "it is from within the culture and community that real positive
changes in the health of a people begins" (1990:77). The Inuulitisivik
Maternity is now 11 years strong and presently 80* of all births from
the surrounding areas are performed at the maternity. Birthing has once
again become an important part of the Inuit identity as a family and
community event (Gallagher 1997:52).
As we have seen in these innovative examples, both the movement to
include traditional midwifery knowledge and birthing practices into the
current system and the move to bring births back into remote
communities, are part of a larger process of decolonization for First
Nations peoples. By returning birth to the hands of the midwives and
communities. First Nations groups are taking control over their lives;
socially, mentally, emotionally and spiritually with the inclusion of
traditional birthing's holistic perspective in the contest of the best
western medical assistance to decrease the high IMRs.

117

5.4 ABORIGINAL MIDWIFERY IN BRITISH COLUMBIA TODAY
Midwifery's growing acceptance in Canada has lead to its
legalization in Alberta and Ontario in the early 1990's and more
recently in the province of British Columbia. The benefits of midwifery
and alternative birthing movements include lower hospital and medical
costs, lower rates of caesarean sections and other medical interventions
achieved thorough the reduced use of technology and pharmaceuticals as
well as with the implementation of low cost birthing centres and home
deliveries.
The B.C. provincial government's recognition of midwifery as a
self-regulating profession was the result of lobbying from The Midwifery
Association of British Columbia (MABCl and B.C. Midwifery Taskforce as
well as consumer concern and the Royal Commission on Health Care and
Costs recommendation to legalize midwifery (Benoit and Carroll
1995:226).
The British Columbia College of Midwives was formally acknowledged
in 1995 and is comprised of nine people; three public and six
professional and these members set the standards of practice, the code
of ethics and review public complaints

(Author Unknown 1995:02).

Although the Midwives Association of B.C. took the first step by
applying to the Health Professions Council to have midwifery recognized
as a legitimate, self-governing profession, the government still plays a
role as it appoints the public members of the College,

requires the

submission of annual reports and has final approval of College bylaws
(Author Unknown 1995:01).
The professionalization of midwifery can be seen as a major part
of the midwifery movement in Canada as medicalized birth has reached a
near hegemonic state with 99» of births taking place in hospitals
(Burtch 1994a:05). Previous to this legislation, midwifery was not only
marginalized but illegal and Section 72 of the Medical Practitioner's

118

Act restricted the performance of midwifery to members of the College of
Physicians and Surgeons. However,

independant, community and Aboriginal

midwives have been practicing in the province for a long time and up to
the present when evacuation to hospitals was not possible (Benoit and
Carroll 1995:225).
Although historically Aboriginal midwifery has been ignored in the
official discourses of birth, it is making itself heard in the new
movements to legalize midwifery in Canada. In B.C., the Committee on
Aboriginal Midwifery was established to determine the specific place
that Aboriginal midwifery will hold in the larger scheme of legalized
midwifery and to ensure that,

ideologically and legislatively,

it will

not become overshadowed in the process of professionalization and
entrenchment into the Western medical system.
This Committee will guide the development of additional
registration requirements and standards of practice for the First
Nations populations. These additions will include the honouring of
Native cultural and spiritual customs as well as the use of traditional
herbal remedies and healing practices (Author Unknown 1995:03). The
recognition of and rejuvenation of Aboriginal midwifery is part of a
larger health promotion and illness prevention movement taking place in
First Nations communities across British Columbia.Focus on
care and traditional ties will

perinatal

help address issuessuch as infant

mortality, low birth weight, malnutrition, Fetal Alcohol Syndrome,
parenting skills and community

support by ensuring that the knowledge of

the Elders is retained (Author Unknown 1995:03).
Some see traditional healing as an adjunct treatment service;
others insist on it remaining an alternative service, completely
separate from Western style medicine and social services. However, the
possibility for real healing to take place revolves around the notion of
collaboration and full partnership with Western medical science. Having

119

community Eiders provide personal birth stories. Knowledge of midwifery
and traditional birthing practices as well as information on traditional
health and the traditional roles of men during the prenatal period could
enhance existing programs. The revitalization of cultural beliefs, even
within the context of the Western health care system,

is a method of

empowerment for First Nations women and their families. Further, the
exploration of existing alternative birthing options and the use of
traditional midwifery knowledge in birthing centres, a reality for other
Northern areas, could lead future research initiatives.
As previously mentioned, several Aboriginal communities have
already begun this process with culturally based community birthing
centres and Aboriginal midwives. With the recent acceptance of midwifery
as a profession in British Columbia and the recognition of a separate
committee on Aboriginal Midwifery, British Columbia has begun to empower
Aboriginal women birthing in the North.

5.5 CONCLUSION

Traditional healing methods and therapies can
make two sorts of contributions; they are valuable
in their own right for their direct efficacy in
treatment and they contain ideas that can be adapted
to solve difficult problems in restoring whole
health to Aboriginal people (RCAP 1996:211).

Midwifery in Europe originally was a community based activity. Its
move to church and then state control led to the denunciation of the
traditional women healers who were the caretakers of the birthing scene.
From this decline of midwifery in Europe one can trace the rise of two
culturally constructed official discourses of birth, the medicaltechnology based narrative and the feminist-revisionist narrative.
However, neither gives voice to cultural difference in their discussions
and they have silenced alternative birthing systems, including First
Nations traditional midwifery knowledge and birthing practices.

120

Alchough centuries of colonization, denunciation of culture,
abuse, genocide and oppression have obscured Aboriginal voices in the
discussion of both healing and birthing, traditional practices have
survived. Upon contact the introduction of European diseases, warfare
and assimilatory government policies caused a cultural lapse, where
ideologically and physically.

First Nations peoples were forced to

renounce their traditional and cultural beliefs. This movement is
similar to the European movement to vilify midwifery, women healers and
their power in the birthing scene. Accused of witchcraft, European and
Aboriginal midwives were cast out of their traditional spheres of
healing with the threat of damnation. After centuries of suppression in
Europe, midwifery and women's healing knowledge eventually gained a
secure footing. In the "New World", this same suppression of traditional
healing practices has caused them largely to go underground. Yet the
depth of the knowledge the Elders gave shows that it had not completely
disappeared despite the growing dependence on Western society, its
governments, educational and health care systems.
Colonization has left a legacy of social illness within the First
Nations populations of Canada. Centuries of persecution have resulted in
loss of cultural knowledge, generational gaps, low self-esteem and lack
of self worth and nations, communities and individuals continue to
suffer today from these effects. The social determinants of health, such
as socio-economic status, low levels of education attainment and
political marginalization, have resulted in an extremely poor health
status for Canada's Aboriginal peoples. As the health care system fails
to improve First Nations well being to the national standard, we see
alarming discrepancy in health status indicators.
The North has a unique history as First Nations peoples' birthing
cultures not only survived but were practiced up until relatively
recently. Obstetrical policy and misrepresentation of traditional

121

birthing practices led to the mandatory evacuation policies which First
Nations across the North are seeking to change. Northwestern B.C. is no
exception. With higher than average regional rates of infant mortality,
low birth weight and teen pregnancy, coupled with the highest percentage
of First Nations population in B.C., health care access and delivery for
Aboriginal peoples must be challenged. Only by addressing the history of
oppression, genocide and assimilation, and the subsequent effects on the
social determinants of health, will change occur. Promoting the
revitalization and use of traditional healing practices as well as
including Indigenous philosophies in the current health care system are
ways to encourage positive health status change in Aboriginal
communities.
Traditional knowledge must be protected and promoted. When I asked
the question. What traditional knowledge is available about midwifery
and birthing practices in the Northwest?,

it was the Elders who answered

with enormous amounts of information about their personal experiences,
specific healing knowledge and feelings on the contemporary birthing
scene. Again and again the same thoughts were expressed,
normal and natural,

that birth is

to be celebrated as a holistic, family and community

centred event. The Elders see these aspects of traditional birthing as
essential to conducting healthy births today, be they in hospital or at
home. By incorporating the base philosophies of Aboriginal midwifery and
traditional birthing practices into the contemporary birthing system,
women may be able to attain the best of both worlds.
Since prenatal education and care is a right of all prospective
parents in Canada, making prenatal care for First Nations peoples not
only accessible but culturally sensitive is paramount
Association of Canada (ANAC)

(Aboriginal Nurses

1996:14). The socio-economic barriers which

hinder specifically First Nations women must be considered in any
program and should include one on one counseling, possibly in the home.

122

as well as culturally appropriate resource materials for Aboriginal
peoples.
One method for instituting change could be to provide information
and establish awareness throughout First Nations communities about the
practice and benefits of traditional midwifery. Emphasizing chat normal
birth is not a medical risk and that traditional childbirth was an
entire community event, deliveries could occur in communities by trained
and certified licensed midwives. However, there must remain a choice of
practitioner (ANAC 1996:31). In addition to these ideas, the possibility
of establishing child birthing centres, where identified by First
Nations communities as a useful community resource,

is also a viable

mode of action. With regards to community involvement; raising awareness
of community midwifery as a profession, providing information on
midwifery training and encouraging youth to consider midwifery as a
profession are other planning methods (ANAC 1996:31).
Other ideas for change include culturally based programs for First
Nations women and their families, reflective of the holistic and
community centred nature of traditional practices. These could be
established either in the southern centres where women must evacuate to
for delivery or in newly developed birthing centres in the North.
Cultural awareness in hospitals must be a priority and simple steps like
providing language interpreters,

cultural foods, medicines and

recognition of spiritual practices can make women birthing out of the
community more comfortable. Funding to allow partners to accompany
birthing women, and to cover transportation, accommodations and
childcare as well as the establishment of birthing group homes, where
women and their families can stay and interact with others in similar
situations, are two other methods to enhance birthing experiences for
Northern women.

123

Reimplemen ting the oral discourse of birth by having Eiders teach
workshops or participate in these programs is essential. Further, all
communities should be well informed on alternative birthing options and
successful First Nations attempts to bring traditional practices into
the birching scene such as the Inuulitsivik Maternity and Tsi Non ;we
Lonnakeratstha.
As with the Commission's finding on the general health and well­
being of the Aboriginal population, the goal for change in Aboriginal
prenatal and pregnancy health will not come from a complete replacement
of traditional birthing practices over the medical model but will
involve the combination of these two worlds for the optimal health of
First Nations mothers and their families to be met (RCAP 1996:137),
Along with ensuring the safety of Aboriginal mothers,

infants and

their families, any alternative must recognize the diversity of First
Nations traditional beliefs by being community initiated and community
based. The revitalization and reimplementation of Aboriginal midwifery
knowledge and traditional birthing systems must instill pride and self
worth into First Nations cultures and be part of the larger movement
towards decolonization at work in Canada today.
I have not always felt empowered by my role as a woman or by my
connection to the earth. Western society has made me feel ashamed of my
body, its cycles and gifts. This research has given me one very
important gift, the knowledge that being a woman is the most important
part of my life and it shapes my outlook and my experiences.
Like the beginning of this journey, the end will also be lost in a
host of memories, new endeavors, academic relationships and most
importantly friendships sown over the two year period of this process.
Now a new experience has entered my life, I have become pregnant with my
first child. Every moment has been joyous and I wonder if this thesis
was in preparation for this pregnancy and new role of motherhood.

124

Women are the givers and caretakers of life. They are the centre
of life and have an intimate connection to the Earth and all of
creation. Their gifts sustain the people on this earth and must be
honoured, celebrated and respected.

125

Bibliography

Aboriginal Nurses Association of Canada (ANAC)
1996 Healthy Children, Healthy Nations: A Framework Document to
Support the Well-Being of First Nations Children. Ottawa:
Aboriginal Nurses Association of Canada.
Author unknown
1995 "B.C.'s First College of Midwives Established." in Women's
Health Writes. 1(21:1-3
B.C. Ministry of Health and Ministry Respon^-ble for Seniors
1996a Selected Vital Statistics and Health Status Indicators:
Annual Report 1995. Victoria: Ministry of Health.
1996b A Report on the Health of British Columbians; Provincial
Health Officers Annual Report 1995.
1996c Health Status Indicators in British Columbia: Birth Related
and Mortality Statistics 1995.
1997 A Report on the Health of British Columbians: Provincial
Health Officers Annual Report 1996.
1998 A Report on the Health of British Columbians: Provincial
Health Officer's Report 1997.

B.C. Women's Hospital
1995 The Challenges Ahead for Women's Health. Vancouver: B.C.
Women's Hospital and Health Centre.
Beck Peggy V., Anna Lee Walters and Nia Francisco
1992 The Sacred Ways of Knowledge, Sources of Life. Arizona: Navajo
Community College Press.
Benoit Cecilia and Dena Carroll
1995 "Aboriginal Midwifery in British Columbia: A Narrative
Untold." in A Persistent Spirit: Towards Understanding Aboriginal
Health in British Columbia. Peter Stephenson et al. eds. Victoria:
Western Geographic Press University of Victoria.
Burning Times, The
1990 Dir. Donna Reed. Prod. Margaret Pettigrew. Ottawa; National
Film Board.

Burtch, Brian
1994a Trials of Labour: The Re-emergence of Midwifery in Canada.
Montreal: McGill University Press.

126

1994b "Medical Dominance and State Policies: The Midwifery Movement
in Canada." in Women, Medicine and Health. E. Singh Solaria and
Rosemary Solaria eds. Halifax: Fernwood Publishing, pp. 141-157.

Capyk, Stephanie
1997 Birthing Away from Home Guide.Unpublished Manuscript.
Dease Lake Pregnancy Outreach Program.
College of Midwives of British Columbia
1996 Code of Ethics Vancouver: College of Midwives of British
Columbia.
1997 Bylaws for the College of Midwives of British Columbia.

Cominsky, S.
1986 "Traditional Birth Practices and Pregnancy Avoidance in the
Americas." in The Potential of the Traditional Birth Attendant. A.
Managay Maglacas and John Simons eds. Geneva: World Health
Organization, pp. 75-90.

Gossett, Tess
1994 Women Writing Childbirth: Modern Discourses of Motherhood.
Manchester: University of Manchester Press.
Cruikshank, Julie with Angela Sidney, Kitty Smith and Annie Ned
1990 Life Lived Like A Story. Vancouver: University of British
Columbia Press.

Dze L K'ant Friendship Centre Society
1998 Houston Maternal Health Needs Study Final Report. Unpublished
Manuscript. Dze L K'ant Friendship Centre Society.

Elkins, Valmai Howe
1985 The Rights of the Pregnant Parent. Toronto: Lester and Orpen
Denny's Limited.
Equity Committee of the Interium Regulatory Council on Midwifery
1994 "Midwifery Care for Immigrant and Refugee Women in Ontario."
in Canadian Women's Studies. 14(03):83-86.

Erickson, K.L. and Associates
1996 Community Action Program for Children: Pregnancy Outreach
Program; In Our Hands: Comprehensive Program Evaluation Report.
Unpublished Manuscript. Dze L K'ant Friendship Centre Society.

Furniss, Elizabeth
1994 Victims of Benevolence: The Dark Legacy of the Williams Lake
Residential School. Vancouver: Arsenal Pulp Press.

Fuss, Diana

127

1989 Essentially Speaking: Feminism, Nature and Difference. New
York: Routledge.
Gallagher, Beth
1997 "Northern Babies." in Canadian Geographic. Jan/Feb.
117(01):50-56.

Graham-Cunning, G.
1967 "Health of the Original Canadians.'' in Medical Services
Journal Canada. XXXIII(02):115-166.

Gunn-Allen, Paula
1986 The Sacred Hoop: Rediscovering the Feminine in American Indian
Traditions. Boston: Beacon Press.

Health Canada
1995 A Report on the Health of First Nations in British Columbia.
Ottawa: Minister of Supply and Services Canada.

Indigeni: Native Women and Politics (video)
1994 Dir. and Prod. Renee Morriseau. Vancouver: Visual Motion.

Jeffrey Roger and Patricia Jeffrey
1993 " Traditional Birth Attendants in Rural North India: The
Social Organization of Childbirth." in Knowledge, Power and
Practice:The Anthropology of Medicine and Everyday Life. Shirley
Lindenbaum and Margaret Lock eds. Los Angeles: University of
California Press, pp. 7-31.

Katz-Rothman, Barbara
1986 "The Social Construction of Birth" in The American Way of
Birth. Pamela S. Eakins ed. Philadephia: Temple University Press,
pp. 104-118Kellehear, Allan
1993 The Unobstrusive Researcher: A Guide to Methods. Sydney: Allen
and Unwin Pty. Ltd.

King, Ursula
1989 Women and Spirituality: Voices of Protest and Promise.
Pennsylvania:The Pennsylvania University Press.

Kirby Sandra and Kate McKenna
1989 Experience, Research and Social Change; Methods from the
Margins. Toronto: Garmond Press.

Lang Jennifer and Elisabeth D. Elkin
1997 "A Study of the Beliefs and Birthing Practices of Traditional
Midwives in Rural Guatemala." in Journal of Nurse-Midwifery.
January/February 42(011:25-31.

128

Macaulay, Ann
1994 "Ethics of Research in Native Communities." in Canadian Family
Physician. 40:1888-1890.

Macaulay Ann, Nancy Hanusail and Janet E . Beauvais
1989 "Breastfeeding in the Mohawk Community of Kahnawake: Revisited
and Redefined." in Canadian Journal of Public Health. May/June
80:177-181.

Malloch, Leslie
1989 "Indian Medicine, Indian Health: A Study Between Red and
White Medicine." in Canadian Women's Studies. 10[G1&02]: 105-112.

Marron, Kevin
1986 Witches, Pagans and Magic in the New A g e . Toronto: McClellendBantam Ltd.
Mason, Jutta
1990 The Trouble with Licensing Midwives. Ottawa: CRIAW/ICREF.
McElmurray Beverly, Kathleen Norr and Randy Parker
1990 Women's Health and Development: A Global Challenge. Boston:
Jones and Barlett Publishers.

Medical Services Branch
1991 An Agenda for First Nations and Inuit Mental Health.
Vancouver: Pacific Medical Services.
Miller, J.R.
1996 Shingwauk's Vision. Toronto: University of Toronto Press.

Mills Antonia and Richard Slobodin eds.
1994 Amerindian Rebirth: Reincarnation Belief Among North American
Indians and Inuit. Toronto: University of Toronto Press.

Monture-Angus, Patricia
1995 Thunder in my Soul: A Mohawk Woman Speaks. Halifax: Femwood.

Moran, Bridget with Mary John
1988 Stoney Creek Woman: Sai'kuz Tseke: The Story of Mary John.
Vancouver: Tillacum Library.

Morrison, Lee G.
1996 "Health Transfer and Research Considerations." Nov. 19.
HHSC 604. UNBC.

129

Muz,yciika, Martha et ai
1996 Feminist Research Ethics; A Process. Ottawa; The Canadian
Research Institute for the Advancement of Women.

National Council of Welfare
1997 Healthy Parents, Healthy Babies: A Report by the National
Council of Welfare. Ottawa: Health Canada.

Native Infant Education and Care Program
1984 The Teachings of The Elders. Vancouver: Medical Services
Branch.

Neander Wendy and Janice M. Morse
1989 "Tradition and Change in the Northern Alberta Woodlands Cree
Implications for Infant Feeding Practices." in Canadian Journal of
Public Health. May/June. 80:190-194.
Niethammer, Carolyn
1977 Daughters of the Earth: The Lives and Legends of American
Indian Women. New York: MacMillian Publishing.

Nolan, May
1996 "Blending Children With Tradition: Birthing Centre First
for Ontario." Hamilton Spectator. July 3.

Northrup, Christine
1994 Women's Bodies, Women's Wisdom; Creating Physical and
Emotional Health and Healing. Toronto: Bantam Books.

Oakely Ann and Susanne Houd
1990 Helpers in Childbirth: Midwifery Today. New York: Hemisphere
Publishing Corporation.

O'Neil, John et al
1991 "Political Considerations in Health Related Participatory
Research in Northern Canada." in Anthropology, Public Policy and
Native Peoples in Canada. Noel Dyck, James Waldram eds.
Montreal: McGill Queens' University Press, pp. 215-232.
1990a "The Epidemiology of Obstetric Care in the Keewatin District:
Methodological Issues." in Childbirth in the Canadian North;
Epidemiological, Clinical and Cultural Perspectives. John O'Neil
and Penny Gilbert eds. Winnipeg: Northern Health Research Unit
University of Manitoba, pp. 5-11.
1990b "The Politics of Obstetric Care: The Inuit Experience." in
Births, Power, Social Change and the Politics of Reproduction.
San Francisco: Westview Press, pp. 53-68.

Paulette, A.
1990 " The Changing Experience of Childbirth in the
Western NWT." in Childbirth in the Canadian North:

130

Epidemiological, Clinical and Cultural Perspectives.
John O'Neil and Penny Gilbert eds. Winnipeg: Northern
Health Research University of Manitoba.
Rattray, David
1997 Appendix 2: First Nations Values, Beliefs and Attitudes and
Behaviours: Together with Cross Cultural Considerations.
Unpublished Manuscript. Dze L K'ant Friendship Centre Society.

Rorie Jo-Anna et al
1996 "Primary Care for Women: Cultural Competence in
Primary Service." in Journal of Nurse Midwifery. March/April.
41(02):92-100.

Roscoe, Will
1991 The Zuni Man-Woman. Albuquerque: University of New Mexico
Press.
Royal Commission on Aboriginal People (RCAP)
1993 Ethical Guidlines for Research. Ottawa: Canada Communications
Group.
1996 Final Report Volume Three: Gathering Strength.

Sakokwenonkwas
1989 "Pregnancies and Mohawk Tradition" in Canadian
Women's Studies. 1 0 (02&03):115-116.

Sanday, Peggy Reeves
1981 Female Power and Male Dominance: The Origins of Sexual
Inequality. Cambridge : Cambridge University Press.
Silman, Janet
1987 Enough is Enough: Aboriginal Women Speak Out. Toronto: Women's
Press.

St. Denis, Verna
1992 "Community Based Participatory Research: Aspects of the
Concepts Relevant for Practice." in Native Studies Review.
8 (02):51-74.

Stone, Merlin
1989 Ancient Mirrors of Womanhood: Our Goddess and Heroine
Heritage. New York: New Sibylline Books.

Stonier, Jennifer
1990 "Inuulitisivik Maternity." in Childbirth in the Canadian
North: Epidemiological, Clinical, and Cultural Perspectives. John
O'Neil and Penny Gilbert eds. Winnipeg: Northern Health
Research Unit University of Manitoba.

131

Terry Carol and Linda Calm-Wind
1994 "Do-Dis-Seem." in Canadian Women's Studies. Summer.
14(03):77-82.
The University of Northern British Columbia
1998 1998-1999 Calendar. Prince George: The University of Northern
British Columbia
Tulguk, Aani
1993 "The Inuulitisivik Health Centre and it's Maternity Project.'
in The Path to Healing. Ottawa: Canada Communications Group.

Voisey Eva, Annie Okalik, Maraim Brown and Annie Napayok
1990 "Cultural Perspectives on Pregnancy and Childbirth." in
Childbirth in the Canadian North: Epidemiological, Clinical and
Cultural Perspectives, pp. 37-42.

Young, T. Kue
1994 The Health of Native Americans: Towards a Biocultural
Epidemiology. New York: Oxford Press.

132

Figure #1
Map of First Nations of British Columbia
(source: htto://www.aaf.cov.bc.ca/aaf/fn/fn.html]

lbdaOeaa(Takon)

^^Cassàir

m

z B.C. First Nations Community Descriptions and Affiliated Tribal Councils
z B.C. R rst N ations Tribal C ouncils and Affiliated Communities
Ail information provided courtesy of the Government of Canada, Department of Indian Affairs and Northern Development

133

Figure #2
Infant Mortality Rates (IMR's) for Registered Indians, Inuit
amd Total Population
(source: Royal Commission on Aboriginal Peoples 1996:128)

Rate per 1,000
240

220
200
180

160
140
120
100
Total Populitian

1925

1955

1965

1975

1985

Source: Kue Young. 'Measuring the Health Sam s u f Canada's Aboriginal Population: a satistical
review and methodological commentary', research smdy prepared for RCAP (1994).

134

Figure #3
Map of British Columbia Health Regions
(source: Ministry of Health and Ministry Responsible for
Seniors 1996b:ix)

t

13
14

N

15

12

t1

11

0

100

200

300 i r o

am imm
11 Uppar WandlCanM Coast RHB
01 EMt Koaenay RHB
12 Cadboo RHB
02 WHt Kooenay Doundaiy RHB
13 Noitfi Wsat RHB
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05 Soutfi OkMwean a m ifcim n HB 14 Paaoa Uaid RHB
15 Noifliam Manor RKO
06 ThompMn RHB
16 Mncouwf HB
06 RaMT IMtay M B
17 Burnaby HB
07 SouBt Ftaaar VMay RHB
16 North Shorn HB
06 Simon Fiamar HB
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10 Canttai ^ n cwwar Wand RHB
20 Capital HB

Nota: Pmpead by: BtBsh Columbia VM Bananes A6aney(lOS6).
Map Boundaiy Souraa: Canbal Slansttea Blanch.

135

Figure #4
Map of British Colianbia Local Health Areas
(source: Ministry of Health and Ministry Responsible for
Seniors 1996b:viii)
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136

Figure #5
Infant Mortality
Status Indian vs. B.C., Both Genders
British Columbia, 1992
(source: Health Canada 1995:110)

Rate

-lO

. Status

IB.C.

inaian

Rate per 1000 Live Births
Sonrce: Vital Statistics

INFAar «ORTALITT

Sen

Indian/
B.C.

Age at Death
Early Neonatal
No.

Mel#
Female
. *To»l-

Rate

Heenatal
Me.

1

Pest Neonatal

Rate

Rate

Indian

27

3.26

36

4.35

Me.
95

B.C.

581

4.29

686

5.07

465

3.43

Indian

27

3.54

4.19

58

7.60

,*■;*;

B.C.

A22

3.27

3.82

302

2.34

India*

54

3.3»

32
493
• . ‘v 68

. ..t&27'i r-

T . :A 16Ï
■r.” 2ai r ;T''.i3-.89:

.1.003 .

3.79

\ 17»

4-.46V

V 'ISÎ
- 7*7

■-2.-90.

■.■■. V- T i » '

.B.C.

Total nabcr of live births In B.C. 1907-1992
Status Indian: 15 900
Provincial: 264 502
Source: Vital Statistics
^ For additional detailed statistics by year (1987*1992).

see Aooendix C: Panes 5. 6 and 7

V .A Mete. X

11.48

■-

15183 '

i\i5i:y

'8:30
it .v J t ilZ » '

Note: Early Neonatal: Age at death less than 7 days.
Neonatal: Age at death less than 28 days.
Post Neonatal : Age at death greater than 28 days to
under one year.
Infant: Age at death less than one year.
Rate per 1000 live births.

137

Appendix I

INTEBVIEff TABLE

Title

Participants

Nation

Date/Place

Interview #1

Tahltan

Sept. 24 1997,
Dease Lake, B.C.

Interview H2

Haida

Preliminary: Oct. 8 1997,
Prince Rupert, B.C.
Secondary: Oct. 9 1997,
Terrace, B.C.

Interview #3

Carrier

Oct. 28 1997,
Stoney Creek, B.C.

Interview #4

Tlingit

Nov. 8 1997,
Smithers, B.C.

Interview #5

Wet'suwet'en

Preliminary: Oct. 9 1997,
Terrace, B.C.
Secondary: Nov. 10 1997,
Houston, B.C.

Interview #6

Haida

Nov. 12 1997,
Prince Rupert, B.C.

Interview #7

Carrier

Dec. 4 1997,
Stoney Creek, B.C.

Nisga'a
Gitxsan
Haida

Nov. 13 1997,
Prince Rupert, B.C.

Focus Group #8

-8

138

Appendix 2

Letter of Intent:
Aboriginal Midwifery and Traditional Birthing Systems Revisited and Revitalized:
Interviews with First Nations Elders in the Northwest Region of British Columbia
This research will be conducted as part of the requirements for the First Nations
Studies Masters Program at the University of Northern British Columbia in Prince
George, B.C. 1 will be collaborating with the The Dze L K’ant Friendship Centre in
Smithers, B.C. which is initiating a similar study in the spring of 1999. As a separate but
complimentary part of it the Friendship Centre’s study, 1 have been asked to interview
Elders from the First Nations communities o f Northwestern British Columbia. This
gathering of traditional knowledge, personal experiences and perceptions on birthing
practices in combination with Dze L K ant’s research project would serve the following
purposes:
1) Record and preserve traditional knowledge from First Nations communities
2) Identify alternative birthing options and practices for women in the Northwest.
3) Create a knowledge base for new and current health programs in the Northwest
4) Secure First Nations voices in the discussion on birthing options in the Northwest
5) Ensure that my thesis research is both community based and recognized as a priority
area o f research in the Northwest.
The process for the selection of interview participants will be done in co­
operation with Louise Kilby, Director of Development at Dze L K'ant and key
community representatives from the Northwest region which the Friendship Centre
serves. The number of First Nations Groups in this region is extensive and each Nation as
well as each community are unique in their traditions, memories, experiences and needs.
1hope to conduct nine interviews at approximately 1-3 hours each. Again, this is only
part o f a larger study being undertaken by The Dze L K’ant Friendship Centre and
additional information and interviews may be used to expand the data I gather for the
Centre’s final report.
Some or all of these questions will be asked and some questions may be altered to
accommodate for the unique ancestry/nation of the interviewee, i.e. Aboriginal midwife
to Haida midwife and depending upon if the interviewee was a midwife or a relative of a
midwife, i.e. granddaughter. Audio and video taping of each interview would be ideal
and upon permission of each participant these recording techniques will be used.
Thank-you for your time and help.

Kimberly Ross

139

Interview Questions
Three themes:
1) Interviewee’s experience
2) Traditional Aboriginal Midwifery/Birthing Practices
3) Contemporary Birthing
Section #1
la) I am interested in hearing about your knowledge and experience in the area of
childbirth, traditional midwifery and birthing practices.
lb) How many babies have you delivered? How many births have you assisted?
Ic) When were you delivering babies, what years? Was there a hospital/clinic or a
nursing station in or near your community then? When did births begin taking place in
hospitals in your community? What was this transition like? Was your community aware
o f other birthing options before hospital births began?
Id) Do you have any specific experiences/stories you would like to tell?
le) Do you have children?
1f) Were any o f your children bom at home? What were your experiences? Were any
bom in the hospital? Which did you prefer?
Section #2
2a) What is your traditional word/term for a midwife? What does it mean?
2b) What were some of the traditional practices, ceremonies, beliefs surrounding
childbirth and the practice of midwifery?
2c)What was the role of the midwife leading up to the birth ?( prenatal care )
2d) ( supplementals ) What did/does the arrival o f a newbom baby mean in your
community?
What things did a woman do differently when she became pregnant? Was she looked
upon differently in the community? How did the woman prepare for having a baby?
2e) How did/does someone become a midwife?
2f) What were/are some o f the responsibilities o f a midwife in the community? What
types of skills did/does a midwife possess? How did/does a midwife pass on her skills?
2g) Csupplementals )How was/is a new midwife chosen? Were/are they always women?
Could/can a man be a midwife? How long was/is the training period for a new midwife?
What was/is involved in this training? Have you trained anyone?
2h) What was a traditional homebirth like? Who participated and Why?

140

2i>( supplementals ) What traditions were followed when the woman went into labour?
Where was the woman during labour? What was prepared? What were the positions for
birth?
2j) What was the role of the midwife after the baby was bom?
2k) ( supplementals ) What was done right after birth? ( tying of the cord
etc. ) What ceremonies were performed regarding the afterbirth? When did the mother
begin breastfeeding?
Section #3
3a) How do you feel about birthing today in your community? How do you view the
Health Care System and hospital births?
3b) What do you see as some o f the problems for women who must leave their
communities to give birth? What solutions do you suggest?
3c) What are your feelings on the use of traditional Aboriginal midwives or registered
midwives today, either for homebirths or in a hospital setting?
3d) Do you want to add anything else?

141

Appendix 3

Informed Consent
Aboriginal Midwifery and Traditional Birthing Systems Revisited and Revitalized:
Interviews with First Nations Elders in the Northwest Region of British Columbia
The purpose o f this study is to gather and record traditional aboriginal knowledge
on midwifery and birthing needs through interviews with First Nations Elders from
communities in Northwestern British Columbia. This study will benefit First Nations
communities by;
1) Preserving cultural knowledge.
2)
Ensuring First Nations perspectives in the establishment o f birthing options for
women in this region and when creating a knowledge base for new and current health
programs.
Agreement to Participate
I agree to participate in the interview and possible return visit for this study and I
have been properly informed of the following things:
- that I will be asked questions about my personal experience and knowledge
- that the information I give will be used in Kim Ross’ Masters Thesis for the
Department of First Nations Studies at UNBC and The Dze L K’ant Friendship Centre’s
Regional Study of Birthing Needs and Midwifery.
~ that I will remain anonymous in the study
~ that my participation is voluntary and that I may withdraw at any time
- of how I may access the data and results of this study
~ that the audio and video tapes of my interview will be confidentially stored
I have agreed to have this interview:
Audio taped________Videotaped______
If you have any questions feel free to contact Kim Ross, The Dze L’Kant
Friendship Centre or The Department of First Nations Studies at The University o f
Northern British Columbia.

Signature o f Particpant
___________________________ Date_
{ 1have received a copy of this letter }
Signature o f Principal Researcher
Date

142

Appendix 4

COMMUNITY ACCESS TO DATA/RESULTS
Each participant will be asked if they would like copies of the audio tapes, video
tapes and transcriptions of their interviews. Each participant will be offered a Community
Summary of the final thesis project and will have access to a complete copy of the final
thesis project to be housed at the Dze L K’ant Friendship Centre in Smithers, British
Columbia.
STATEMENT OF CONFIDENTIALITY
All participants in the study Aboriginal Midwifery and Traditional Birthing
Systems Revisited and Revitalized: Interviews with First Nations Elders in the Northwest
Region o f British Columbia will remain anonymous. The only persons who will listen to
or view tiie audio or video tapes will be myself and Dr. Antonia Mills at the University of
Northern British Columbia, supervisor to the thesis project. Community members
participating in the interviews, with permission o f the interviewee, may use the
information for other community purposes. All audio and video tapes will be stored in a
personal locked filing cabinet at the home of Kimberly A. Ross Leitenberger, primary
researcher.