Surrey Indigenous women face mistreatment during childbirth: report

A national study found that two-thirds of Indigenous women report mistreatment during childbirth — a finding that Danette Jubinville, the executive officer of the Indigenous Midwives Council of British Columbia, said is extremely troubling, but not surprising. 

“Sadly, this isn’t new. Patterns of reproductive abuse against Indigenous people have been documented since the earliest days of settler colonialism,” she wrote in a statement to the Citizen. 

The study, which was led by UBC midwifery professor Saraswathi Vedam, collected 6,096 peoples’ experiences who had been pregnant or given birth in the past decade. Among the 309 Indigenous participants, 93 per cent reported at least one mistreatment during childbirth and nearly 75 per cent reported disrespect. 

Twenty-eight per cent of Indigenous women reported health-care providers shouting or scolding them, compared to 18 per cent reported by white women and 16 per cent by racialized women. The study also found that 31 per cent of Indigenous women experienced health-care providers withholding or forcing treatment onto them — 20 per cent of racialized women and 19 per cent of white women also reported this. 

Forty per cent of Indigenous participants reported feeling neglected by their health-care provider during childbirth. Women who live in northern or remote communities may also be forced to relocate to urban centres during childbirth, which can disrupt families and communities and lead to emotional disconnect, financial strain and dissatisfaction with health care. 

However, participants who had midwives rather than family physicians or obstetricians, reported significantly lower rates of mistreatment and disrespect. 

Jubinville explained that Indigenous midwifery appointments can take upwards of an hour and can allow for more questions and thorough answers, compared to shorter appointments with a family doctor.  

This extra time, Jubinville wrote, is where the real work happens and allows the provider to actually learn about the family’s cultural practices and what they hope to bring into the care — not just what’s written in a chart. 

“I really believe Indigenous models of health care, midwifery care in particular, are

groundbreaking for their focus on trust, relationship-building, and family-centredness.” 

Jubinville wrote this “should be the gold standard we’re investing in for Indigenous populations. And there’s so much everyone else can learn from this model of care too. As the survey shows, Indigenous people aren’t the only population experiencing mistreatment from health providers during childbirth.”

The Indigenous Midwives Council of B.C. is currently working on expanding the number of Indigenous midwives in the province from 17 to 200 over the next 20 years. 

This change will need to be a multi-faceted approach with investment in Indigenous midwifery services across urban, rural and remote communities, boosting recruitment and retention and broader education and awareness of Indigenous midwifery and the midwifery model of care generally. Jubinville noted that none of this can happen without sustained support from the provincial government.

Over the past decade working as a doula, Surrey’s Simone Carriere has witnessed women face this very type of neglect. Carriere worked as a registered nurse for eight years before deciding to transition to working as a doula, and now operates her own local practice. 

When working with Indigenous families, she noticed more often that health-care providers were slower to come, less receptive to concerns and families would be talked over. 

This is where Carriere said she may step-in, especially when mothers may not be able to advocate for themselves mid-labour. 

“I ask the questions, but I frame them in a way that it’s like, ‘Just wondering for the room, why are we doing this, or how come we consider this as an option?’ And asking more questions to see what their train of thought is.”

Sometimes it’s a matter of educating health staff.

“It’s not always a malicious thing. It’s more this is what we do, but maybe stopping [the health-care provider] in their track and being like, ‘Well, this might not be culturally safe or culturally competent in this regard. So, can you break down why you’re thinking this, and can we go from there?’” said Carriere. 

Clients can also discuss their birthing experience with Carriere afterwards and in some instances she has assisted in filing complaints. 

Other times, Carriere leans on cultural expertise, which may include different ceremonies like cleansing, smudging and sweat lodges to allow for healing.  

The ability to bring these types of cultural traditions into health care spaces could be a start in addressing some issues, said Carriere. Yet, incorporating these practices can be difficult when dealing with the current system. 

Carriere conducts smudging ceremonies, which include smoke, but she often does smokeless smudging because of hospital fire alarms. She recently gave a hospital a 24-hour notice of the ceremony and asked that the smoke detectors for her client’s room be shut off for a short period of time. 

The hospital said they could not do it and needed two days’ notice, which Carriere noted is difficult to do, as it’s hard to predict when someone may go into labour or need a ceremony. 

“Having the capacity to bring in their culture and then having the health-care providers being receptive and open to that,” she said. “I think on the health care side, [facilities need to be] a little bit more open and receptive to how we can all work collaboratively as a team.”

Across the country, Jubinville said Indigenous peoples have diverse understanding of what safe and culturally grounded care may look like — Indigenous-led midwifery care is informed through families and ancestors and rooted in connection to homelands. 

“Generally speaking, these models of care attend to both the spiritual and physical elements of health, and recognize that individual health can’t be separated from community health and the Environment,” she wrote. 

However, Jubinville said it’s time to stop using “softened language” like cultural safety, when even basic levels of care are not being met. 

“This research makes it plainly clear that health services for Indigenous people in this province, and across this country, are not reliably safe. No one should have to fear being mistreated during childbirth, full stop.”

The study also highlighted Canada’s affirmation of the calls to action outlined in the Truth and Reconciliation Commission (TRC) and United Nations Declaration on the Rights of Indigenous People (UNDRIP). TRC’s actions 18-24 are specifically about health and include addressing systemic racism and inequities in healthcare and restoring Indigenous health systems. There are similar calls to action in UNDRIP like article 24, which affirms the right to traditional medicines, maintaining health practices and equal ability to achieve the highest attainable standard of physical and mental health.  

Despite the health care system continuing to fail Indigenous people, Jubinville stressed the importance of living in a place of hope rather than fear. 

“What keeps me grounded in this work is knowing that, every day, Indigenous babies are taking their first breaths in spaces filled with love and culture, with our family members, our traditional medicines, songs, and languages present,” she wrote. 

“I hope we can work together to bring forward a paradigm shift in how we approach birth and postpartum care, one that ultimately improves the lives and wellbeing of Indigenous people, and all people, in B.C.”