Culturally Safe, Positive, Empowering Birth

Saskatchewan mothers shaping research aimed at improving the birthing experiences of Indigenous women

Jessica Dieter and Dr. Angela Bowen (pictured left) are members of the research team, Bringing Birth Back: Improving Access to Culturally Safe Birth in Saskatchewan.They were presented the Excellence Award by Dr. Vivian Ramsden (right) for having the top SPROUT grant in the 2018 SHRF-SCPOR SPROUT grant competition. (Photo: Chris Plishka)

-By Farha Akhtar

Jessica Dieter will never forget the reassuring and beautiful words of the people in her community following the birth of her baby boy Lennox.

Lennox was born inside his amniotic sac. Known as a birth caul, it is extraordinarily rare with some estimates suggesting it occurs only once every 80,000 births. It happens when a piece of amniotic sac breaks away during gestation - or during the birthing process - and attaches to a baby’s head. Although harmless, a baby born inside their membrane is very unusual, even to experienced delivery room staff. As for parents, it can be distressing when anything out of the ordinary takes place during labor, as it did that day for Jessica and her partner.

It was when the family returned to their home that relatives and friends rejoiced by how lucky Lennox was to have been born this way. The feelings of reassurance and positivity were in stark contrast to the shock and confusion they experienced back in the delivery room. Kokums and aunties reassured Jessica and her partner that a birth caul was special because it was so rare. It was something to be celebrated, not feared in their culture.

When Jessica retells the story, she muses about how different her birthing experience would have been had one of these elder women been present during her labour. Jessica and her partner had originally planned to deliver Lennox at the Birthing Centre at All Nations’ Healing Hospital in Fort Qu’Appelle, Saskatchewan. She had previously delivered one of her children there with a mid-wife, and was pleased with the experience. Plans were forced to change when Lennox became over-due and Jessica had to deliver at a bigger birthing centre in Regina.

It’s not uncommon for Indigenous women in Saskatchewan who live in remote and rural communities to have to travel long distances to deliver outside of their community, often leaving behind those vital familial and cultural supports. As Jessica learned, having those supports make a huge difference, especially during childbirth.

“I am a rural mother. I live in a small town. It’s not close to a huge birthing unit,” Jessica explains.

“Yet I realize how worse off some of the women are who live in flown-in communities.”

“Sometimes they have to be brought in two weeks before their due date. They come in by themselves so they have no support from their partners because their partners are home taking care of other children or they can’t fly. These mothers may be in a city where, more often than not, they have no support at the most vulnerable time in their life. It is really shocking to me.”

“They may find themselves in a strange place for almost a month if there are complications. It’s so unfortunate.”

“This is supposed to be a special time for them,” she adds.

Jessica was motivated to help other mothers such as herself experience birth that was culturally secure, and positive. So she became part of an innovative research project spearheaded by the University of Saskatchewan’s Angela Bowen. The project is called Walking with Mothers: the journey to culturally secure birth in Saskatchewanand its aim is to improve birthing experiences for Indigenous mothers. As a patient-oriented research project, women like Jessica become mother advisors and help with research design, grant-writing, collecting and analyzing data, and sharing learnings in meaningful ways.

“We are always consulted,” Jessica says.

“We find out what is missing, how we can make the evaluation tool better. We are part of the data analysis and invited to attend those sessions.”

Jessica, who along with being a mother, is also a Community Research Assistant at All Nations’ Healing Hospital, says the engagement of mothers in the project was impressive.

“The research I was involved in prior to this would have community members involved, but we’re told even that is a rare thing.”

“It’s so great my voice and the voices are really heard in this project.”

What Jessica wants heard through this project are the voices of Indigenous mothers as they share their experiences and needs as it relates to culturally safe birthing.

“What do the mothers want? What are the traditions they want back?”

“Some of the research will reveal a lot of the knowledge of those people who delivered children and brought them into the world prior to the era of hospitalization,” explains Jessica.

“We know a lot about what our mothers do not like. Maybe they were discriminated against or maybe they felt they haven’t been heard.”

“It is a huge game of finding this balance of what can make our mothers feel safe and how we can help health care providers accommodate that.”

Jessica says the research team is looking at various ways to improve the birthing experiences of Indigenous mothers  including training more nurses to be birth companions, having birth centres in more Indigenous communities, or having a midwife that is shared among a few communities. Jessica points out the closest midwife training program is in Calgary. In an ideal world she says she would love to see a midwife program established in Saskatchewan, making sure an Indigenous perspective is implemented into the curriculum. Ultimately, she says changes can be either big or small so long as they make a positive difference for mothers.

 “It is about finding a happy middle as much as possible,” she explains.

As for her involvement in the project, Jessica describes it as being hugely satisfying.

“As I learned more about culturally safe and traditional birth teachings, it shaped my journey as a mother.”

“A lot of the knowledge, like the customs with the afterbirth, and the teachings of those people who delivered children and brought them into the world prior to hospitalization has been essentially taken away,” she explains.

 “I wanted to learn about the things we could bring back.”

Jessica is hopeful that the knowledge she and her research team produces will not only help to improve the birth experiences of Indigenous women, but other women who are seeking better birthing experiences including newcomers.

“We don’t know anything about how newcomers experience birth. Are they used to the older ladies delivering their babies, or is going to the hospital just the norm?”

“Overall we need to be learning more about how our children are actually brought into the world.”

-By Farha Akhtar