Delivering truth in the name of Reconciliation
The birth of a new baby is supposed to be a joyous occasion and a time for celebration. For some Indigenous mothers, however, it can be a period of stress, isolation, and loneliness, particularly if they were forced to leave their communities to obtain prenatal care under a health care policy known as “out for confinement (OFC).”
This policy is being challenged by Wanda Phillips-Beck, Anishinaabe and a member of Hollow Water First Nation in Manitoba. She is currently Manitoba’s first Indigenous Research Chair in Nursing, an adjunct professor in the UM College of Nursing and works for the First Nation Health and Social Secretariat of Manitoba as a Seven Generations Scholar.
For her doctoral dissertation in the UM Faculty of Graduate Studies, she studied the experiences of women who left their homes to give birth away from their communities. As a community health nurse and in her role as manager of the Maternal Child Health Program, she had firsthand knowledge of the emotional, psychological, and the physiological effects that OFC has on babies and their mothers.
Phillips-Beck [MSc/10, PhD/22] says: “I was one of those health care providers that enforced this policy. I just knew there was something fundamentally wrong with telling a woman she had to leave the community. Some would cry and beg to stay a few days longer. Some would leave and come back. Many other nurses and I and doctors delivered many babies because the women either refused to leave or returned home.”
Partly in response to the Truth and Reconciliation Commission of Canada’s (TRC) Call to Action #19 to close the gap in maternal/child outcomes, Phillips-Beck’s dissertation provides a baseline for outcomes for women who are forcibly removed from their communities to give birth, a policy often called the Out for Confinement Policy (OFC) or Maternal Evacuation Policy. This policy has been in place for multiple generations and requires women living in rural and remote communities to leave home to give birth in urban hospitals at 36-38 weeks gestation.
She notes the policy has its origins in the increasing medicalization of childbirth and for the protection of the medical providers as opposed to the protection of the wellbeing of women and families. Until 2017, women were not able to take a significant other with them when they left home for birth unless they were underage or if there were exceptional circumstances.
“As you can imagine this was the source of immeasurable stress on the women, leaving the community and any source of support and celebration around birth. This policy resulted in the loss of important cultural knowledge, ceremony, celebration, and traditional practices around childbirth.”
Her work compared a low-risk cohort of women who are subject to the OFC policy and had to leave home to give birth, to a group of women who did not have to leave home until birth is imminent. Her findings demonstrated that OFC is harmful and is associated with increased odds of having inadequate prenatal care, lower odds of breastfeeding and higher odds of having a small baby. A quantification of results such as these had not been previously done.
In an earlier study, Phillips-Beck noted: “Theoretically, [an Indigenous woman] should be able to access prenatal support while she is in Winnipeg, but as the women have indicated they encounter many barriers, such as transportation, safety, lack of information about where to obtain the services and lack of communication between provincial and federal health systems.”
She adds: “Sending women away from their community, home and any system of support associated with lower odds of obtaining prenatal care, breastfeeding and higher odds of having a small baby has many other implications.”
Phillips-Beck learned that women in remote Indigenous communities will sometimes not get the care they need or conceal their pregnancies because they do not want to leave home. Knowledge Keepers have known for many generations that stress is harmful in pregnancies and many support practices were in place to help women feel less stress in pregnancy. In fact, she recommends that Knowledge Keepers and other Indigenous sources be part of all population health research and epidemiological studies involving Indigenous people.
“Applying an Indigenous methodology and using an Indigenous lens is entirely possible… working under the guidance of a Circle of Grandmothers and Knowledge Keepers who are Anishinaabe, Cree, Dakota and Anishininew,” she explains. “They informed my research from the beginning to the end, including the interpretation of the findings. This important Indigenous Knowledge will be included and cited in the publications as a source of legitimate Knowledge.”
Philips-Beck notes: “We know there are risks in delivering babies in the north, but we had many skilled traditional midwives who knew how to handle these complications. However, this practice of traditional midwifery has long disappeared or is disappearing, as the midwives have passed on. This knowledge was lost due to the overmedicalization of birth. We are glad that our institutions are training midwives once again, but the challenge is to implement these services in geographies where there are minimal secondary and tertiary health care supports.”
Phillips-Beck is supported in her research by doctoral student Stephanie Sinclair and Dr. Jaime Cidro who are advocating the return of traditional childbirth practices and knowledge in their work as a means of reclaiming Indigenous sovereignty over birth.
She says: “We recognize that you just do not change policies overnight and returning birth to every remote community is not possible. However, we can continue to support the work of the larger communities who wish to return birth to the community or move childbirth care closer to home. We can also work to influence changes within the health care system that create the space for traditional practices and knowledge.”
University of Manitoba Distinguished Dissertation Awards are given to graduating doctoral students who have been nominated by their faculty/college/school for a dissertation that represents a ground-breaking piece of original work. Each year, one award is offered in each of the following categories: applied sciences, health sciences, humanities, natural sciences, and social sciences. Awardees receive a $3,000 prize.