Providing evidence to support Indigenous midwifery

Dr. Jennifer Leason’s, PhD, most recent research project, Reclaiming Indigenous Birth, was born out of a conversation she had while attending a national forum on the forced and coerced sterilization of Indigenous women in Ottawa in 2018, a gathering held in response to Amnesty International calling for action.

• Above image: From left: Shayla Claringbold, Majd Radhaa, Claire Dion Fletcher, Ava John-Baptiste, Liz Darling, Carol Couchie, Jennifer Leason, Evelyn Good Striker, Arielle Perrotta, Jessica Swain, Jennifer Murray

Indigenous midwives and co-chairs of the National Council of Indigenous Midwives (NCIM), Carol Couchie and Claire Dion Fletcher, approached Leason with an ask: they needed evidence that midwifery was better than sending Indigenous women to urban communities to have their babies.

“When advocating for funding and support, they are often asked to prove the cost effectiveness and health outcomes,” says Leason, the CIHR Tier 2 Canada Research Chair in Indigenous Maternal Child Wellness in the Department of Political Science in the Faculty of Arts. 

Indigenous women are at a higher risk for adverse outcomes in pregnancy and infant health because they lack access to culturally safe and community based perinatal healthcare. The solution, she says, is midwifery and supporting community based birthwork. 

Leason started working with NCIM and researchers from several universities and Indigenous groups to show that midwifery and community supports lead to better health outcomes for moms and babies, including safe continuity of care with higher breastfeeding rates, supports with social contexts, and reduced child apprehension.

Reclaiming Indigenous Birth studies the costs of “obstetric evacuation” and the social-cultural benefits of Indigenous midwives. The project was funded by the Canadian Institute of Health Research—$1.2 million over three years—just as the pandemic hit, which meant researchers were forced to make a few pivots. 

A series of powerful digital stories tell of the personal pain of leaving home to have a baby. “The cost of leaving the community is more than just money. The costs are social, intergenerational, it impacts healthy life trajectory, it impacts attachment,” says Leason. “We showcase stories about the importance of having access to community-based care, Indigenous midwifery, and the desire to give birth in their home communities.”

Federal data about birth evacuations wasn’t as robust as expected, so the researchers used GIS to map out Indigenous communities as well as hospitals, labs and maternity clinics to build economic cost models. “Then based on a systematic review we pulled together ways that we could try to estimate the costs of evacuation based on the differing contexts and locations of First Nations communities, specifically in Ontario,” says Leason.

Working with the Ontario Association of Midwives, the project received permission from 46 First Nations communities to access provincial perinatal health data to analyze birth outcomes and costs for travel for birth. Those results are expected this fall. 

The role of partner Pauktuutit Inuit Women of Canada led a two-day virtual seminar, the midwifery forum, resulting in two reports. “I'm really proud of this work because it's supporting community research, self-determination and advocacy for Inuit midwifery,” says Leason.

Leason is pleased with the research showing that community-based healthcare, specifically Indigenous midwifery has social, economic and health benefits and improved outcomes. 

“The success of this interdisciplinary project is largely attributed to Indigenous matriarchal wisdom and leadership. Our inclusive, relational governance created a beautiful ethical space resulting in transformative research that supported us to accomplish that which seemed impossible,” she says. “I truly hope this research can be the evidence needed to ensure a midwife for every community.”