Today is the International Day of the Midwife. All over the world and from the very beginnings of human communities there have been people who were drawn to the work of supporting and caring for birthing people. Many midwives describe it as a “calling”. What follows is a story of three very different midwives who have responded to this call in very different ways. The common thread of these unique journeys is a strongly held passion for safe and respectful care for all birthing people.
Kerstin Helen was born in Sweden where midwifery care is the default. All pregnant people are cared for by midwives in most of the world. It is expected that the midwife will sort out which clients may need to have any additional medical care beyond what midwives can provide. Kerstin completed the mandatory schooling and chose to follow that with nursing training. As a student in a nursing program she was excited to have an opportunity to attend a cesarean section birth. For Kerstin this was the pivotal moment, the moment when she knew that she would become a midwife. Midwifery in Sweden, and in much of the world, is a specialty of nursing. Kerstin needed to finish her nursing education and work for at least 18 months before she would be eligible to apply for the specialty of her choice.
Along the way Kerstin met and married a Canadian. She left the midwifery education program and moved to Canada (Barrie, Ontario) where she worked for years as a nurse in a birthing unit. The call to midwifery never left her heart so in 1991 she returned to Sweden and completed the Midwifery specialty, graduating in 1992 and becoming a Registered Nurse-Midwife. Not long after completing her midwifery education Kerstin returned to Canada. Ontario was the first Canadian province to regulate the profession of midwifery and Kerstin was part of the first group of foreign trained midwives to have their credentials assessed for equivalency to the educational requirements for midwives in Ontario. Kerstin became a registered midwife in Ontario in 1997 and began to practice in Durham. By this time she had already attended many home births with other midwives in Ontario in the role of second birth attendant. In 1998 Kerstin joined Midwives Grey Simcoe in Barrie.
Kerstin was very active in the ongoing work of developing the midwifery program in Ontario. She often worked with students of the midwifery education programs. She became certified to teach neonatal resuscitation and emergency skills for midwives. Kerstin continues to contribute to midwifery associations, here in the Northwest Territories, back in Ontario and at the national level with the Canadian Association of Midwives (CAM).
In 2017 as part of CAM’s global programs Kerstin travelled to Tanzania where she had the opportunity to contribute to the Midwives Save Lives campaigns through teaching emergency skills and supporting local capacity building. In 2018 she returned to her roots and practiced midwifery in Sweden for a couple of years. By this time Kerstin’s first-born daughter, Mimmi Thompson, had become a doctor who was doing locum placements in Yellowknife. With the help of her daughter Kerstin managed to meet up with one of Yellowknife’s long-term Obstetricians when he was teaching vaginal breech birth workshops in Sweden. These two doctors can be credited with planting the seed which drew Kerstin to the Northwest Territories. The nurse-midwifery training provided Kerstin with the flexibility to come to Yellowknife and begin to work here before our midwifery expansion plans had reached the point of recruiting midwives. After a year of work in in the obstetric unit at Stanton Territorial Hospital in a nursing position Kerstin was recruited for the position of Territorial Specialist, Midwifery. Her experience at Stanton has contributed enormously to the integration of midwives in primary care in Yellowknife. Currently Kerstin keeps a workstation at the hospital where she provides hospitalist services as the primary care provider to all mother/baby pairs from Monday to Friday. Recently Kerstin’s job has become even more robust as she is now performing the role of first assistant at the scheduled cesarean section births. In this role she has an opportunity to meet the pregnant person before the birth and perform the newborn examination soon after the birth. She continues to provide primary care to the infant and supportive care including assistance with breastfeeding and contraceptive counselling until the pair are discharged from the hospital.
The people of Yellowknife and the Northwest Territories are very blessed to have this amazing mother/daughter (midwife/doctor) pair living and working in Yellowknife. Kerstin’s other daughter, Lina Thompson, is one of our favourite regular locum nurses on the Obstetric unit and her son, Erik Thompson, recently joined the team of expert outdoor enthusiasts at Yellowknife’s Overlander Sports.
Photo Credit: WHO/Christine McNab. Used with permission.
Heather Heinrichs was 9 years old when she read the historical fiction novel called The Midwife’s Apprentice. In this story a young homeless orphan girl finds her way to becoming someone with work and worth in the world through service to the mentor midwife and the birthing families. Heather has fond memories of childhood games of pretend with her friends which frequently featured pregnancy and childbirth. Although she was clearly inspired by the book, as a child she understood that midwifery was a thing of the past and it did not occur to her to pursue midwifery as a career.
After completion of secondary school in her home province of Manitoba Heather took to wandering, working in various jobs and volunteering in community service. During her travels she learned that midwifery was beginning to enjoy a resurgence in Canada and that midwifery was something that she could pursue as a career. Heather’s awareness of the impact of policies of evacuation for childbirth on her own and other Indigenous communities fueled her desire to become a midwife and be part of the important work of supporting people to give birth where they live. Heather chose to apply to the midwifery education program at Laurentian University because of its tri-cultural (Indigenous/French/English) and rural/remote community focus. During her senior year of this 4-year Bachelor of Health Science Degree program Heather had the opportunity to work with Seventh Generations Midwives Toronto - a midwifery practice group with a focus on providing culturally skilled care to urban Indigenous families. She never intended to stay so long in the city of Toronto but the opportunity to work with these midwives and later to contribute to the establishment of the Toronto Birth Centre kept her there from her senior student year until 2014. When she finally said goodbye to life in inner city Toronto she made her way to Hay River, NT.
Heather was one of two midwives who worked to establish the midwifery practice in Hay River. There had not been any planned community births in Hay River for at least 15 years as the family doctors found themselves unable to maintain the services required. The community was very ready to embrace the chance to give birth with midwives in Hay River and the midwives worked hard to increase the skills and knowledge of other health care providers so that they could once again be comfortable attending childbirth. The midwives led workshops and taught the skills of neonatal resuscitation and management of childbirth emergencies to nurses and physicians in Hay River.
After 7 years of practice in Hay River Heather decided to take a break from the all-consuming nature of the work of being one of two midwives in a community in order to engage fully in the creative work of film making. Heather moved to Yellowknife in early 2021 and just this year in February she joined the team of midwives in Yellowknife on a part time basis. Currently Heather is providing primary midwifery care services to residents of Tlicho who attend for prenatal and postpartum care in Behchoko. Heather works collaboratively with the Community Health Nurses in Behchoko, and in consultation with Yellowknife physicians, to ensure continuous high-quality care for these birthing families. The community is very excited to have the specialized perinatal services offered by midwives. Historically prenatal and postpartum care has been provided by an ever-changing nursing staff with varying levels of expertise and interest in pregnancy.
Heather’s current film making project is the creation of a short film called “nihtâkwikihew/She Gives Birth”. The script follows a pregnant Metis woman preparing for the birth of her child and confronting racism within the healthcare system juxtaposed against the incredible power of traditional childbirth practices.
Another exciting creative project that Heather is currently engaged in is the development of eLearning modules for nurses and other health care providers on breast/chest feeding. This Department of Health initiative is designed to meet the World Health Organization (WHO) competency-based framework for education of direct health care providers to meet the requirements of the Baby Friendly Initiative (BFI). Heather is excited to have the opportunity to ensure that the modules centre local and traditional knowledge of breast/chest feeding and principles of respectful trauma-informed care.
The communities of the Northwest Territories are blessed to have this amazing creative modern day Indigenous midwife as part of the midwifery work force.
Lesley Paulette began her journey into the world of midwifery in the early 1980’s. Inspired by the work and writings of an Indigenous (Mohawk) midwife, Katsi Cook, Lesley realized the power of midwifery in Indigenous communities for the restoration of community birth alongside other traditional healing practices. Lesley had been considering a career in medicine but found that the pull towards midwifery was stronger. At that time there was no clear path anywhere in Canada to become a midwife. Lesley had the opportunity in the very early days of the Six Nations Birthing Centre (the home of Lesley’s family of origin) to enter the developing Aboriginal Midwifery Training Program. As luck would have it, Lesley met and fell in love with a Dene man from the Northwest Territories. Lesley followed her heart, married her Dene sweetheart and made her home in the Fort Smith area where the path to becoming a midwife was one that she would have to create for herself.
In 1982 Lesley started to connect with Elders in NWT communities who had been Traditional Midwives. Together with community members Lesley explored the huge disconnect between what the midwives knew was important for the health of families and the experiences of young women giving birth alone in hospitals far from home. In Lesley’s mind it was becoming ever more clear that the path to reconciling this disconnection needed midwives. She built her own education program, taking correspondence (pre online learning) courses from American schools and finding clinical midwifery education opportunities in the US on the Mexican border at the Casa De Nacimiento Birth Centre. Lesley also worked closely and studied midwifery with other pre-legislation midwives in Edmonton.
At the time of her first pregnancy there still were doctors attending births in Fort Smith although this service was soon to be suspended - a move which meant that all birthing people would be required to leave their home and their families to give birth alone. But Lesley was determined to have a midwife attended birth so she went to Edmonton. For her second birth she decided to stay home. A midwife was planning to come and stay with her to await the birth but her second baby made a different choice. He was born at home attended only by his mother and father about 10 days before his due date and just a few days prior to the planned arrival of the Edmonton midwife. Finally, for her third and last birth Lesley had the midwife attended home birth she had always wanted.
Lesley attended births in the Fort Smith Hospital throughout the 80’s in a supportive role (Doula). By the early 1990’s physician-attended childbirth services in Fort Smith were completely suspended as the family doctors found themselves unable to continue to provide this service. Lesley, with her strong belief in the importance of normal birth within the community began to offer full scope midwifery services and began to attend home births in Fort Smith. Midwifery was not yet regulated in the Northwest Territories. Prenatal care occurred in the home of the client or the home of the midwife in those days and midwives could only provide home birth services as they did not have registration and hospital privileges. Because of a strong belief that excellent maternity care was a fundamental right the midwives did not charge for their services and somehow managed to find the money to purchase supplies, buy gas and feed their families. Families sometimes gave them money, or baked goods, or firewood or wild harvested game meat and fish. In 1997 Lesley applied to a Prior Learning and Education Assessment (PLEA) program for midwives in Edmonton and in 1998 she became one of the first group of midwives to be registered in Alberta.
In response to the inability to recruit and retain physicians who were willing and able to attend childbirth Lesley applied for, and was awarded, a grant to perform a needs assessment. Focus groups of parents and community members, front-line health care providers and health care administrators were conducted and resulted in a report outlining three options. Option 1: no community births - continue the policy of evacuation of all pregnant women in late pregnancy. This was not the preferred option of the community members and carried the significant risk of de-skilling health care providers and rendering them less competent to manage unplanned community birth. Option 2: continue to try to recruit and retain doctors willing and able to provide birthing services. An acceptable option but it was clear that the modern family physician was a new breed and not like the old family doctor who was willing to be on call for their entire life, prioritizing patient needs over the needs of their own families. Option 3: Invest in midwives and embrace a midwifery led model of maternity care. The report recommended Option 3 but health care leadership was not ready for that. It seems that the belief that midwifery was a thing of the past and a lack of awareness of the resurgence of midwifery across Canada prevented health care leadership from acting on the recommendations.
Lesley was undeterred. She began to work with grassroots community organizations to raise funds to build a birth centre on the Alberta side of the border. As midwives registered in Alberta, she and her midwife partner were able to order and perform the necessary laboratory tests and receive the reports on the fax machine. They would appeal to the local Fort Smith physicians to order ultrasounds when they were deemed necessary. Funds were raised, plans were drawn, signs indicating “future site of the Nike”niya Birth Centre” were posted and land was cleared in preparation for the construction of a free standing birthing centre. It was at this point that a champion of midwifery came on the scene in the Department of Health and a meeting was held in the home of one of the Fort Smith midwives with government leadership who wanted to know what could be done to integrate midwives and get them regulated in NWT.
This was the ultimate goal of the midwives; to have integrated, collaborative, funded and accessible maternity care in the community. Lesley took a leadership role in the work of writing a Midwifery Act and Standards of Practice. Integration was not easy. Midwives insisted on incorporation of Indigenous knowledge and principles of trauma informed care way before the rest of the world even knew what that was. But it happened. By 2005 the Act regarding the regulation of midwifery came into force. Lesley and her partner midwife became registered in NWT and were employed by the Health Centre to provide primary maternity services as autonomous practitioners. Lesley continued to work full time as a Registered Midwife in the Fort Smith Health Centre for 12 years before accepting her current position as the Senior Midwifery Consultant for the Department of Health and Social Services in 2017 where she strives to support the expansion of midwifery services throughout the entire territory. She is still called upon to assist from time to time when a community birth becomes complicated such as with a recent case of a retained placenta. And she supports the learning needs of the younger midwives by assisting in the performance of point of care ultrasound.
There has always been great community support for expansion and integration of midwifery services. The progress of midwives has been driven by the community voice. We are blessed in the NWT to have midwives like Lesley Paulette relentlessly forging this path. We are also blessed to have Health Care Leadership who see the role for midwives in meeting the goals of the Truth and Reconciliation Commission (TRC), the National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG), the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and the Sustainable Development Goals of the World Health Organization (SDG-WHO) and who continue to provide the necessary supports for the ongoing expansion of midwifery in the Northwest Territories.
Are you a midwife looking for an exciting opportunity to continue to forge this path? Would you like to join our team and enjoy the benefits of working for a supportive government in the service of a unique and diverse population in one of the most beautiful places in the world? Your inquiries are always welcome at www.practicenwt.ca.