Why It Matters
Lena was nearly nine months pregnant when I joined her family in the Siberian arctic as they were preparing for their winter migration. As a Nenets woman, Lena lives nomadically with her family on the tundra, migrating seasonally with their reindeer herd as their people have done for centuries. Migration is physically demanding work that involves dissembling and packing the chums (traditional Nenets’ tents), herding the reindeer, and travelling by sledges pulled by reindeer through harsh arctic winds and freezing temperatures. Since the 1960’s Nenets women have been instructed by the Russian Federation to leave their tundra homes to give birth in a hospital. While the aim has been to reduce maternal and infant mortality and increase immunization coverage, the protocol has consequences which can put mothers and babies’ health at risk and fray social and cultural ties for families.
On the night when Lena’s birthing contractions began, her husband went by snowmobile to fetch the local midwife. It took several hours before he arrived back at the chum with the midwife. Once the midwife confirmed Lena’s labour pains, a helicopter was called with would take Lena to the nearest hospital, some several hundred miles away. When the helicopter arrived, Lena climbed on board taking her four year old daughter Christina with her. Lena’s husband could not accompany her. His duties lay with the care of the family’s herd, the livelihood on which they depend.
Lena’s birthing journey was an arduous one. After being admitted to the hospital, four year old Christina was separated from her mother, and stayed in a different department with other children. For five days, there was no communication between mother and daughter. Later Lena told me, “I arrived at the hospital alone, no one spoke my language. I felt anxiety and I was not allowed to have visitors”. Lena gave birth in a hospital surrounded by people she had never met before, who knew nothing of her culture and language. Language itself is a critical element in shaping a woman’s experience in hospital births. The absence of shared language and understanding can lead to difficult and even damaging results in the birthing process. Lena’s experience demonstrated this to me, and she later explained to me how her understanding of birth differed significantly from that of the Russian Hospital. She said, ”In Nenets culture women give a quiet birth, meaning they don’t shout, scream or talk during labour.” In the hospitals, nurses encourage women in labour to shout and scream – a practice Lena thought peculiar and was not comfortable with. The term “quiet birth” not only represents the birthing culture amongst Nenets women but also reflects other aspects of Nenets values and the way they coexist with their environment and animals.
After the birth, and all the check-ups and birth registrations had been completed, Lena was released from the hospital. Helicopter services are only provided on the way to give birth, so for the return journey, Lena had to find her own way back. Travelling alone with newborn baby Philip and Christina at her side, Lena made her way by taxi to the train station. At the station they waited for hours, cuing for security checks and registration protocols amid a blizzard. The train line is mainly used by the oil and gas industry workers to travel up to the Yamal peninsula, so the train could not take Lena the entire distance home. Eight hours after they boarded the train, Lena arrives exhausted with the children and is met by her husband. From there they make the final leg of the journey, traveling through the night for three hours by snowmobile.
The entire journey took over a day, and when Lena finally arrived home in the middle of the night she immediately began to prepare food for the family. Since men’s and women’s roles are distinct and each has duties that the other is not allowed to do, Lena’s husband had not been able to clean up and take care of their home. The chum was in chaos when Lena arrived, and she spent the next few hours putting things back in order, and caring for the well being of her family. Slowly, life in the Khundi family returns to the regular rhythms of life on the tundra, and three days later the winter migration finally takes place.
Supporting Birthing Rites:
Lena’s story is not unusual, in fact it is a reality for many indigenous women who live remotely with their families and communities. Her story and so many others like hers is the reason why Adventure Midwives was born. These kinds of barriers to accessing local, cultural safe healthcare can be the cause of trauma and poor outcomes for mothers and babies.
Through collaborating closely with indigenous communities and finding culturally safe ways to provide support for indigenous mothers and midwives, we hope to prevent and reduce damage and risks caused by:
- traveling long distances to access health/hospital services
- separation of women from their families and community support systems
- outside authority that does not recognize women’s birthing rites including rites to cultural acknowledgement and women’s agency over their own bodies
- institutionalized racism
Adventurous Midwives models of care provide integrated, holistic and culturally safe and respectful care for the ‘best start in life’. These models encompass the following:
- they are community based and governed
- support the work and role of indigenous midwives
- provide for inclusion of traditional practices
- – involve connections with land and country
- incorporate a holistic definition of health
- value indigenous knowledge, and ways of knowing and learning
- encompass risk assessment and service delivery
- acknowledge cultural systems
Through co-creating programs with communities that provide education on birth rites and navigating through outside medical systems and authority, advocacy, and additional resources we aim to impact women who have not come into contact with outside authority and medical systems as well as women like Lena, who have been exposed to these models, and are required to have hospital births.
Our programs aim to provide education, advocacy and resources that lead to the following outcomes for women/mothers:
- feeling empowered
- having autonomy over their bodies and birth choices
- having the rite to be accompanied by family, midwives or translators
- having the rite to have their customs observed Additionally our programs will prepare outside systems to adjust to, and be culturally sensitive to indigenous mothers who use these systems.
Following in the footsteps of previous models:
Adventure Midwives seeks to build on existing models that have been addressing these issues. Similar models for increasing mother and baby safety and providing cultural safe care have been introduced successfully with the Aborigines in Australia, and the Inuit in Canada.