For decades, Inuit women in northern Quebec had to travel south, far from family and support, to give birth. That changed in 1986 when the North’s first midwifery clinic opened in Puvirnituq
Retired midwives Akinisie Qumaluk, right, and Leah Qinuajuak in a photo from their early years working in the maternity clinic at the Inuulitsivik Health Centre. (Duncan McCue/CBC)
CBC News: Akinisie Qumaluk loves her small and skilful hands. Over her long career as an Inuk midwife in the North, they were the tools she needed to help babies find their way into the world.
“We always make sure that the baby’s head is down,” said Qumaluk.
“But if the baby’s head is up … I was taught to turn babies … gently, gently guiding that head down, down to where it is supposed to be.” The 65-year-old has delivered hundreds of babies over her 36-year career as a midwife in Puvirnituq, a small Inuit village of 2,100 people in the northern Quebec region of Nunavik.
In 1986, the community opened the first midwifery clinic in the North at the Inuulitsivik Health Centre, offering women the chance to give birth locally instead of flying south to bigger hospitals. Research shows the clinic has been a success, but the model has not been widely replicated and many pregnant women across the North must still make long journeys, often alone.
The first midwifery clinic in the North opened at Puvirnituq back in 1986, and now employs midwives like Nellie Iqiquq, bottom left, to provide care for locals who are expecting.
Puvirnituq is home to around 2,100 people. (Duncan McCue /CBC)
Qumaluk was one of the first to sign up for hands-on training in Puvirnituq in the late 1980s. Along the way, she learned the specific skill of turning a baby inside the womb when it’s in a breech position, known medically as external cephalic version.
“I always talk to the babies inside. ‘Hey, we’re going to turn your head down. You’re going to have to help me because you cannot be born this way,’” she told CBC Radio. “I know that the babies inside can hear my voice. They can listen.”
Her reward for that careful work was a profound one: the first cry of a newborn. “It’s beautiful to welcome the baby into the world — ‘Welcome to the whole world. You’re alive. You have a heart rate. That’s good, keep it up!’” she said. “I love those moments.”
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Safe and effective care
While women in Puvirnitiq now have the choice to remain in their community to give birth, expectant mothers have for decades been required to travel to hospitals in the south. The assumption was that childbirth there would be safer. The journey left many feeling vulnerable and isolated as they were surrounded by strangers and often faced a language barrier.
Vicki Van Wagner, a registered midwife, researcher and educator, has spent time working as a midwife in the North.
“If you’re in the community with a doctor or nurses who come in and out of the village, [and] don’t speak your language, you may be alienated from health care,” said Van Wagner, an associate professor in the Midwifery Education Program at Toronto Metropolitan University. “Having the midwives there, talking to people in the community from within culture and language, there’s no question that we do better.”
Van Wagner’s research has shown that the care provided at the Puvirnituq clinic is as safe and effective as care provided in the south.
Qumaluk retired for health reasons in 2022, but for almost 40 years she woke up at all hours and ventured out in all weather conditions to help the women in her community. She sees that work as providing vital care, but also addressing the harms of the past. “It can start to heal our own communities. It can open up women’s health. It can open up our own women in their own language,” she said.
Treated ‘like dogs’
Mina Tulugak was born in the 1950s, delivered by a traditional Inuit midwife who was aided by Mina’s grandmother, godmother and the woman who would eventually become her mother-in-law. They didn’t have doctors or modern technology, just knowledge that had been passed down through generations.
“It was natural, it was with family,” Mina said. “My mother was with women that she knew and it was OK. If anything was to go wrong, it goes wrong. But when it doesn’t, it’s something to celebrate.”
With the arrival of traders and missionaries from the south, nursing stations brought Western medicine to communities in the North. By the 1950s, pregnant women were expected to travel to hospitals in northern Ontario and even Montreal — each more than 1,000 kilometres away — to give birth.
Mina had her first baby in 1976. She was 17 at the time and travelled alone to Moose Factory, Ont. She remembers sleeping in a dorm with women from other northern villages. They got to know each other, but Mina said that when the time came, “they laboured by themselves.” “I just accepted that’s the way it was,” Mina said. “I had no other way of thinking, of how I had a say … in what I wanted.”
Mina said the care she was receiving often wasn’t explained to her. Moreover, medical staff in the south didn’t speak Inuktitut, which created a language barrier for many women.
In late August, a report published in the Canadian Medical Association Journal found that systemic racism is still a driving factor today in the health inequity and poorer outcomes experienced by Indigenous women.
Nellie Iqiquq is one of the midwives currently working in Puvirnituq, and a mother of eight children herself. She flew south for two of her deliveries, which were high risk.
During one of those deliveries, in Montreal, she felt herself going into early labour and tried to tell a nurse. “She said, ‘No, you are not in labour,’” Iqiquq said. “She was just looking at the machine, not my belly … she never checked me, how dilated I am.”
Iqiquq’s baby was already crowning by the time someone checked. She was rushed into the delivery room where her son was born premature at 34 weeks. Looking back, Mina thinks they were seen as not much more than the number on the tags the federal government issued to all Inuit in the 1970s.
“That’s how we were treated — like dogs.”
One ‘revolutionary’ act
In the mid-1980s, a woman named Anni Tulugak refused to travel south to give birth and instead stayed in Puvirnituq. Mina called that act “revolutionary” — and it prompted her and other community members to start conversations that would eventually lead to establishing Puvirnituq’s maternity clinic.
Those early discussions about “how we want to give birth [and] who we want to give birth with” were eye-opening and made her realize there was healing in taking back control, she said.
Midwifery wasn’t a common practice in Canada at the time. But its emphasis on natural childbirth, and supporting the needs of both mother and baby, appealed to Mina and her community. Mina would become one of the clinic’s midwives.
In the decades since, more than 3,000 babies have been born at the Puvirnitiq maternity centre. Rates of caesarean deliveries are two per cent, compared to the Canadian Institute for Health Information’s national rate of just under 32 per cent in 2021-22. The rate of late fetal and early newborn deaths is under one per cent, roughly the same as the Canadian average.
But like much of Canada’s health-care system, Puvirnituq’s maternity centre has a staffing problem.
Qumaluk’s retirement left the Puvirnituq clinic with three registered Inuit midwives. Though they are supported by some midwives in training, the workload is such that midwives still need to be brought up from the south. That southern staffing comes at a cost and complicates the Inuit-led maternity care originally envisioned.
Despite those challenges, almost four decades of local midwifery services have shifted the needle in Nunavik. Nearly nine out of 10 births now happen in the region. The clinic’s success has prompted three other communities in Nunavik to open their own maternity centres: Inukjuak, Salluit and Kuujjuaq.
Van Wagner, the Toronto-based researcher and midwife, travels north to Inukjuak for a few weeks every year to pitch in with local midwives and train new recruits. She said the Nunavik clinics are an important example of what’s possible and have been studied by other places with remote populations, such as Australia and Scandinavia.
But back in Canada, she said the model has not been widely and successfully replicated beyond Nunavik. That means people across many communities in Canada’s North must still travel south for maternity care.
Midwifery could “absolutely” be adopted in some of those regions, Van Wagner said, but there is skepticism that it can be safely practised so far from large medical centres and specialized care. She added there are also complex obstacles related to local northern economies, or resistance to systemic change.
“Every community is going to have its own nuances and different risk factors and different resources,” Van Wagner said. “I believe Inuit leadership and community buy-in is the … key factor.”
A light in the window
Last winter, in the dead of night, Liliane Aliqu went into labour. She rushed to Puvirnituq’s maternity centre, where a student midwife delivered baby Elisapee — at seven pounds, 15 ounces. The midwives announced the baby’s arrival with what’s become a tradition: they lit up a bright neon heart that hangs in the window, spreading a warm orange glow across the snow.
Caroline Ivillak, left, and Iqiquq care for Elisapee, who was born in Puvirnituq late last winter. (Duncan McCue/CBC)
Qumaluk may be retired but with 746 babies under her belt, she’s keen to encourage more women to become midwives. “Your hands need to be small and you need to be a light sleeper,” she said.
If that’s true for you, Qumaluk says “you’re meant to be a midwife.”
Credits
Editor: Jason Vermes | Lead Digital Producer: Padraig Moran | Senior Digital Producer: Brandie Weikle | Audio Documentary Producer: Duncan McCue, Alison Cook, John Chipman | Travel funding provided by the CBC Library Partnerships Program
About the Author
Padraig Moran
Padraig Moran is a writer and digital producer for CBC Radio’s The Current, taking great stories from the airwaves to our online audience. He started his journalism career in Ireland primarily covering arts and entertainment, then spent five years at The Times of London in the U.K., before joining the CBC when he moved to Toronto in 2017. You can reach him at padraig.moran@cbc.ca.