Indigenous Obstetric Evacuation: Harmful but Risky to Resist

Kim Dreaddy analyzes the policy of mandatory obstetric evacuation in Indigenous communities within the context of the history of colonization.

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In 1945 an Inuit woman gave birth to a healthy daughter in a tent on Inuit land in the Canadian Arctic. She was aided by an indigenous midwife and surrounded by her mother and other community women. In 1966, that daughter gave birth in her Inuit community with the prenatal, birthing, and postnatal care of a midwife. In 1986, that granddaughter, experiencing a low-risk pregnancy, was flown to a non-Indigenous southern hospital hundreds of miles away at 38 weeks gestation to deliver her baby.

In 2019 most Inuit women and First Nations women living on-reserve in Canada are required to deliver their babies away from home in non-Indigenous hospitals. Since the late 1970s, according to Health Canada’s clinical practice guidelines, such women must be “transferred to hospitals at 36-38 weeks gestational age according to regional policy (sooner if a high-risk pregnancy)”.

What has led to this significant shift away from traditional birthing practice? What might prevent the likelihood that a great-granddaughter would feel safe to resist this Health Canada mandated policy of obstetric evacuation? The practice is said to cause significant psychosocial, physical, and financial hardship for pregnant women and their families, including isolation, depression, anxiety, poor nutrition, and the removal of community supports and traditional childbirth practices. Despite these damaging effects, few women resist or refuse to leave their communities.

Photo Credit: Association of Ontario Midwives. Image Description: A Signboard of K’Tigaaning midwifery practice in Nipissing First Nation.

The medicalization of Indigenous childbirth began with the Indian Act (1876), which afforded the Federal Government of Canada unparalleled power to control the bodies of Indigenous peoples. Shortly after the ratification of the Indian Act, the Federal Government assigned physicians to Indigenous communities.

During that same period, Indigenous peoples in Canada were experiencing the effects of colonization riddled with government-sanctioned, regulated, and monitored processes of child removal from Indigenous communities. The century-long residential school system, the sixties scoop, and the overrepresentation of Inuit and First Nations children in protective custody and the foster care system are all examples of forced assimilation fueled by racism.

The intergenerational trauma caused by colonization and the victim-blaming inherent in decades of child removal from Indigenous communities have contributed to the fear of resisting obstetric evacuation. With the medicalization of childbirth came a significant shift in power over Indigenous health and with that power came surveillance. Surveillance, with the repercussions of child removal, has led to self-surveillance that manifests itself in fear.

As a woman, I try to imagine myself in the place of these women experiencing obstetric evacuation. What would I think and feel? If I refused to go south to have my child I would be seen as a bad mother; I would lose my children. Would I risk it? The answer is no. Though as a white settler, I offer this discussion unable to share the personal experience of being colonized. During this time of reconciliation, social justice and human-rights require us to be aware of this colonizing practice and to lend our voices to the call for change.

Today, with the support of National Indigenous groups and the establishment of self-government within some provincial and territorial jurisdictions, there is an emergence of community-based Indigenous birthing centres in Inuit Nunangat and in a First Nations community in Ontario. Women in these communities are delivering their babies with a continuum of prenatal, postnatal, and birthing care, and the health outcomes are excellent. These communities have found a way to integrate traditional birthing practice with biomedical support.

To truly live in a time of reconciliation and decolonization, all Indigenous women in Canada must have childbirth choices that are free of the fear of child removal.

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Kim Dreaddy is a Ph.D. student in the Division of Community Health and Humanities, Faculty of Medicine, Memorial University. @Kimberl01520867