Midwifery Care for Every Woman, Everywhere.

by Susanne Houd

To be born with a home

Women in Nunavik, Eritrea and Greenland want to give birth where they live. They want to give birth to midwives that understand their language and culture. Moreover, at the same time, they want midwives who have the knowledge of today’s midwifery care. They want their babies to be born with a home. This means to be born in your own culture, assisted by midwives from your own culture. Midwives from your culture. Midwives who understand the language, the food habits, and the words they need to say and not to. To be born without a home was for many years the case for women in Nunavik, North Quebec Canada. They sent them to the south to give birth alone and among strangers.

This changed in 1985, and birth was brought back to the north. The education of Inuit midwives began, honouring the culture. Today the care in Nunavik is an example for Nunavut and the Northwest Territories and the 10 Inuit midwives in Nunavik takes care of all the perinatal cases in the area. I was part of the return of birth to Inukjuak, a small village on the coast of the Hudson Bay, and we brought education to the students and the community and not the other way around. The health promotion results of this community based perinatal care are impressive and make you wonder why most of the western world wants to centralize perinatal care (1).

Eritrea has one of the world’s highest rates of maternal and child mortality. In this area, 998 out of every 100,000 women die in connection with pregnancy and birth and 134 out of every 1,000 children do not reach their fifth birthday. After 30 years of fighting for independence, they won in 1992 and the country is now re-building. Traditional midwives do 80% of the perinatal care. That is how the government has decided it should continue, based partly on the economy, partly on common sense and tradition.

The traditional midwives are educated where they live and are supported in continuing the kind of care they have always given. Now, with new knowledge and easy access to the established system, they form the backbone of the perinatal care system. They work against female circumcision, they educate the women and the women trust them. The care is decentralized and the education goes to the women and not the other way around.

I am part of a small team educating the midwives and nurses that train the traditional midwives. We use the concept of The House of Learning, which is based on the idea that to learn, is to want to change. It is change that is the hard part. We have trained almost 300 health professionals during the eight years we have been coming to this poor and unknown country. We work closely with Eritrean midwives and nurses and the Danish government supported us as one of the few Danish non-governmental organisations in the country. The first white man stepped on the east coast of Greenland a little more than 100 years ago.

Only 30 years ago people lived in primitive huts made of stone and earth. The heating was an open and hollow stone filled with seal oil. The Shamans had great power and even today people believe in ghosts and spirits underneath their thin Christian veneer. The Inuits are strong and intelligent, able to survive in a very harsh climate. There is an old tradition of Danish-educated midwives working side-by-side with traditional midwives. Today the system favours the centralised point of view. But, the fact that being away from the rest of Greenland, the women want to stay home and give birth – on the east coast in their villages (2).

The women give birth with the help of both Greenlandic and Danish midwives and they do it with power and strength. Birth is a part of daily life and they seldom show pain. The introduction of ideas from western society has created many problems – they now have a society with the world’s highest suicide rate, with violence, alcohol abuse and incest. In the middle of all this, birth becomes a very important event, linking the old traditions to the new times. Birth is hope – and we need hope in this society. Giving birth is a very social event.

There are many women at each birth, all offering their silent support, their warm hands and their cry of happiness when the baby is born. I feel very privileged to work in this vast area as the only Danish educated midwife, and I work closely with three Greenlandic midwives. The language is the key to the culture and I am challenged every day – and that is how it should be. Three very different places and yet there are similarities. In all three places, the perception of time is circular. Everything takes the time it takes, whether it is hunting a polar bear, getting the water from the well or being at birth. The difference in the experience of time by the white man and indigenous people is expressed by a Greenlandic elder:

“I think that the white man does not have any understanding of time. They cut it out in little pieces. Sleep a certain amount of time and wake up when the boss has told them to do. They ate at a certain time and were always together. They work the amount of time that their Nalagaq (boss) has decided. Just think if we had to live like them? When we hunt the nanok – the polar bear – we are not limited by time.

We are without time during the hunt. Does it take some few minutes or the whole day – it does not matter, for us it is only the bear and the hunting that exists.

We are never too late for a meal. We eat when we are hungry and until we have had enough food. Moreover, we sleep when we want and until we are not tired anymore. None of us would ever wake a person that is asleep.”

Acceptance of this notion, that things take the time they must take, is the lesson I have learned from Nunavik, Eritrea and Greenland. In all three places, the women want to stay close to their family and culture when giving birth and a midwife is an important person in the community. The three cultures are fragile, and threatened by our western cultural values. We must stop and learn and listen. As a midwife, I must make sure that every child is born with a home.

References:

• Houd S., Qiunuajuak J., Epoo B. The outcome of perinatal care in Inukjuak, Canada 1998-2002. International Journal of Circumpolar Health 2004;63 (Suppl. 2): 239-241.
• Bjerregaard P, et al. Inuit health in Greenland. A population survey of life style and disease in Greenland and among Inuit living in Denmark. International Journal of Circumpolar Health 2003;62 (suppl. 1):1-79.

© Birth International 2005