Bringing midwifery back to a northern Canadian community

World Health Organization
Feb 6 · 5 min read

Year of the Nurse and the Midwife 2020

Image credit: WHO/Christine McNab

Heather Heinrichs is a midwife working in remote Hay River in Canada’s Northwest Territories — a sub-arctic town of 3,500 nestled on the south bank of Great Slave Lake. Until five years ago, women from Hay River who wanted to give birth had to fly or drive around the huge expanse of lake to deliver in Yellowknife, the Territorial capital, or travel hundreds of kilometres south to larger centres.

Now, pregnant women can have all of their antenatal care in Hay River. They can choose to deliver there in the birthing room that Heather and another midwife colleague manage at the Hay River Regional Health Centre. The midwives check in on newborns for six weeks after they are born and provide continued services to women for one year.

Shorter visits with the doctor

Image credit: WHO/Christine McNab

“Before we set up the midwifery services here, women might see different doctors and nurses during their antenatal visits,” says Heather. That’s because Hay River, like many northern Canadian communities, relies a lot on ‘locum’ doctors — who travel to stay in the community for a few weeks at a time while the territory searches to fill a position, or the regular doctor is on leave.

“Before it was hard — I had to tell each doctor or nurse the same thing, every time I had a check-up,” remembers Brandy Buggins, who has had four pregnancies in Hay River — most recently with her new baby Chloe. “When the midwives came, we got to know each other. This made me feel so secure. Being cared for by Heather has been awesome.”

A deeper connection

Image credit: WHO/Christine McNab

Heather identifies as Métis, tracing the descent of her family to the Métis Nation, one of the three distinct groups of Indigenous peoples in Canada. When she completed her four-year midwifery degree, she began work with a midwifery service focused on care for Indigenous people in downtown Toronto.

She was struck by the gaps in access to health care for Canada’s Indigenous people, and about the unfair judgements that could result in poorer health outcomes. She saw the potential to improve those outcomes by incorporating the strengths of culture and the long history of Indigenous women giving birth in their own communities, attended by experienced local women.

“I learned about how to help people connect with their families — to call up their aunty, or mother or grandmother — and to learn from them. I learned how to treat birth as a ceremony, to cherish it as sacred.”

New babies born in Hay River

Image credit: WHO/Christine McNab

About half of Hay River’s residents identify as Indigenous — whether First Nations, Métis or Inuit.

Before the midwifery service opened, women had to get to Yellowknife or another community with birthing services by 37 weeks of pregnancy. “They may have gone alone, having to figure out who would look after their kids or elderly parents in Hay River,” says Heather.

Now, Heather and her colleague deliver anything between five and 25 babies each year. If a pregnancy is higher risk, Heather will counsel the woman to deliver in Yellowknife.

A first-hand view

Image credit: WHO/Christine McNab

Natasha Cleary sits with Heather Heinrichs in her clinic office. She has come in for an antenatal check from Enterprise, a small community about 30 kilometres south of Hay River. Heather has booked Natasha for an hour –to give plenty of time for an examination, and to discuss any questions Natasha might have.

During the exam, Heather talks to Natasha about how she’s feeling; draws blood for the laboratory; measures fetal growth and listens to its heartbeat. At first the heartbeat sounds fast — so Heather counsels Natasha to sit and relax for a moment and drink a glass of water. After fifteen minutes or so Heather listens again to the fetal heartbeat. This time it’s completely normal. And there’s still plenty of time to talk about breastfeeding, breast pumping, natural ways to relieve discomfort, and any other questions on Natasha’s mind.

Heather will continue to monitor Natasha’s pregnancy in the few weeks remaining. “I’m really hoping to stay here in Hay River to give birth,” says Natasha. “It’s so much better. I don’t have to worry about what to do with my three kids or how my husband will find extra time off work.”

Future challenges and opportunities

Image credit: WHO/Christine McNab

Heather loves her job. She and her colleagues have built beloved, comprehensive professional midwifery services where there were none before. Heather sees a world of expanding possibilities for women and families in the region, and even deeper bonds in the community.

“I love midwifery because of the connections we make with clients. I love getting to know them and making a plan that will work for them. Through midwifery I can support people through a really challenging time and help them come through all the stronger for it.”

Image credit: WHO/Christine McNab

World Health Organization

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Official Medium channel of the World Health Organization, the United Nations' health agency

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