In the rec room of a midwifery clinic in Toronto’s east end, a group of women are talking about amusement parks and their favourite roller-coaster rides while sanding cedar frames for what will eventually become hand drums.
“I can’t ride those things,” says one, explaining that subjecting yourself to the more extreme rides — the loops, the inversions, the panicky feeling of weightlessness — feels like a total loss of control over your body, which, she notes, isn’t unlike being pregnant. And she’d know: like most of the women in this class at Seventh Generation Midwives of Toronto, she’s expecting a child.
The workshop leader, Kevin Myran, explains the Cree traditions behind the drum they’re making as he wipes completed frames with an oil-soaked rag. “Not so long ago, what we’re doing right now would have been illegal,” he says. The same would also have been true of traditional prenatal medicines and smudging ceremonies for birth — things that, since it opened in Toronto in 2006, Seventh Generation has helped facilitate for Indigenous clients who request them as part of their prenatal care.
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What’s different about the program this workshop is part of is its breadth and scope. The Baby Bundle Project, a collaboration between Seventh Generation Midwives, St. Michael’s Hospital, and Nishnawbe Homes, is a three-year study that’s following 50 Indigenous families from prenatal care to birth and through the first year of an infant’s life. Now in its second year, it’s modelled on an Australian program called Strong Families; it provides supports that go beyond standard prenatal health care, ones aimed at reducing the number of adverse birth outcomes linked to Indigenous families.
Statistics related to pregnancy and the years following a birth provide some of the most highly visible examples of the health and social inequities facing Indigenous people. In 2017, a Statistics Canada report found that the rate of poor birth outcomes, such as low birth weight, infant mortality, and Sudden Infant Death Syndrome, were generally higher for Indigenous-identified mothers.
“We also often hear about the deplorable conditions and health outcomes in remote communities and on reserves,” says Sara Wolfe, a co-founder of Seventh Generation Midwives and a lead researcher on the project. “What we know anecdotally on the ground is that the outcomes don’t get better when we move into the city.”
The project’s first phase, which wrapped up last summer, focused on identifying access barriers and care priorities among participants, says Wolfe. The second phase, currently underway, brings together social, housing, and health-care supports in a way that’s mindful of the fact that, for many Indigenous people, navigating all three systems involves deeply fraught histories, both individual and communal.
“Say you get pregnant,” Wolfe says by way of example. “Accessing a pregnancy test costs $20.” (If you’re living in a Canadian city under the poverty line, which is statistically more likely if you’re an Indigenous woman, this can be a barrier.) “So then you go to a primary-care physician to confirm your pregnancy,” she says. “People will typically go to a walk-in or health centre to get that test.” But not everyone feels comfortable doing so, she says, because they might have had previous negative experiences with other forms of institutionalized care. A lack of prenatal care can also create additional problems, as a number of preventable or treatable perinatal conditions are caught in the early stages of pregnancy.
Phase 2 care differs from client to client, says Callan Buckshot, who facilitates workshops as a program assistant for the project. As well as having regularly scheduled midwifery visits, clients meet once a week with a wellness worker. “Some people require more time than others or need more help setting up and reaching out to the different services they need,” she says. “But if they need it, they’ll go with them to prenatal appointments or screenings or go with them to other service providers if they want that extra emotional support.”
For Wolfe, midwifery offers an ideal avenue for exploring ways to improve Indigenous health. For one thing, the practice is rooted in the medical traditions of many First Nations, Inuit, and Métis communities. “It’s an opportunity for us to bring our ancestral knowledges and teachings into health care, and it has positive impacts across every different outcome measure,” says Wolfe, adding that those positive impacts can extend beyond just physical health.
“These aren’t highly complex technical interventions,” she says. “It’s about cultural safety and being with people and practices that see a person as a person.”