Nutaraqtaatitsijiit Nunavimmi Nunavik Midwives November Brenda Epoo

Transcription

1 Nutaraqtaatitsijiit Nunavimmi Nunavik Midwives November 2011 Brenda Epoo

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3 Opened since: Puvirnituq 1986 Inukjuak 1998 Salluit 2004

4 10 registered midwives 7 student midwives Puvirnituq 2 registered midwives, 1 student Inukjuak 3 registered midwives, 2 students

5 The Inuit registered midwives run the maternity and provide the midwifery care along with the student midwives *pre, peri and postnatal care *well woman clinic *family planning

6 Part of the role of the Inuit midwives is translating ideas from western medicine into practice in their own communities. This is far more difficult than translating words from one language to another, and is an invaluable skill which should be developed for the benefit of all Fletcher and O Neil 94 Royal Commission on Aboriginal Peoples

7 Community wellness *Prevention: Local Schools Local Radio Stations (FM) Community Based Activities *Core Group Members *Family House *Yearly Welcoming Newborns (National Child s Day Celebrations

8 Members of: Peri-natal Committee CMDPM Nunavik Midwifery Working Group Ordre des Sage Femmes de Quebec National Aboriginal Council of Midwives Canadian Association Of Midwives

9 Community training, Inuit women are able to get hands-on experience without leaving their community Midwifery training started in 1986 in Puvirnituq, 1994 in Inukjuak, and Salluit 2004 In August 2008, Inuulitsivik Midwifery Training Program was recognized

10 Inuit midwives trained on the job using traditional learning pathways Students are trained in both Inuktitut and second language Mentor midwives provide support for learning and formal training Training takes as long as needed - usually 4 years Inuit midwives and students employed by provincial government Credentials formally rencognized since competency based license equivalent to Quebec midwifery license...first time in the world that traditional pathways to learning are recognized along side a universty education

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12 The Nurses are a big part of our team especially during emergencies, *applying fast IVs while we take care of the woman *giving medication that we are not familiar with *extra pair of hands especially during birth *they learn about pre and postnatal visits, pap tests breast exams and births from the midwives and students. *nurses also consult with midwives from other villages concerning pre and postnatal, family

13 Members of PNC Consults: *medical problems in pregnancy *family planning *PAP tests (abnormal breast exams and vaginal) *emergencies Does one 1 St trimester visit and 2 months post partum visit (gives recommendations when needed)

14 Midwives and nurses work together while midwives are leading, Doctors on-call (on site or by phone) are sometimes involved in any emergency Midwives, nurses and doctors do teamwork on any emergencies

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16 I can understand that some of you may think that birth in remote areas is dangerous. And we have made it clear what it means for our women to birth in our communities. And you must know that a life without meaning is much more dangerous. Jusapie Padlayat Elder Inuulitsivik Health Directors Chair, Board of

17 9.4% analgesia (Entonox, epidural, narcotics) 75.7% intact perineum 1.2% episiotomy 22.5% 1st + 2nd degree tear 1.3% 3rd + 4th degree tear 8.1% induction 97.6% spontaneous vaginal birth 0.8% vacuum

18 15% transfer out of Nunavik 1388 Total Births 85% (1182) gave birth in Nunavik 56% (684) gave birth in their own village

19 Still births + néonatal deaths (6.5/100) Average birth weight at > 37 weeks : 3478 gms 1.2% IUGR 4.7% LBW (<2500 gms) 0.9% SGA, 3.7% LGA 10 Apgar < 7 at 5 minutes (0.7%) 8 neonatal infections (0.6%), 22 congenital anomalies (1.5%)

20 89.6 % women gave birth between weeks 28 births weeks 4 births weeks 101 births weeks Premature birth rate 10.4% 19 breech babies (1.4%; 11 SVD, 8CS) 9 sets of twins, 1 set of triplets

21 Conclusions/Policy Implications Supports premise that safe care can be provided away from C-Section capacity Supports midwifery as a model of care in remote communities Supports education of Inuit midwives as a strategy to improve perinatal outcomes in Inuit communities

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23 Nakurmiik!