This research was funded by Health Canada, First Nations and Inuit Health Branch, Ottawa, Ontario, with contributions from Inuulitsivik Health Centre, Puvirinituq, Quebec, and Ryerson University, Toronto, Ontario, Canada. The study sponsors had no role in the design of the study, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication. The authors’ work was independent of the funders.
Remote Midwifery in Nunavik, Québec, Canada: Outcomes of Perinatal Care for the Inuulitsivik Health Centre, 2000–2007
Article first published online: 29 JUN 2012
© 2012, Copyright the Authors, Journal compilation © 2012, Wiley Periodicals, Inc.
Volume 39, Issue 3, pages 230–237, September 2012
How to Cite
Van Wagner, V., Osepchook, C., Harney, E., Crosbie, C. and Tulugak, M. (2012), Remote Midwifery in Nunavik, Québec, Canada: Outcomes of Perinatal Care for the Inuulitsivik Health Centre, 2000–2007. Birth, 39: 230–237. doi: 10.1111/j.1523-536X.2012.00552.x
- Issue published online: 29 AUG 2012
- Article first published online: 29 JUN 2012
- Manuscript Accepted: 16 NOV 2011
- Health Canada, First Nations and Inuit Health Branch
- maternity care;
- perinatal outcomes;
- remote health services
The Inuulitsivik midwifery service is a community-based, Inuit-led initiative serving the Hudson coast of the Nunavik region of northern Québec. This study of outcomes for the Inuulitsivik birth centers, aims to improve understanding of maternity services in remote communities.
We used a retrospective review of perinatal outcome data collected at each birth at the Inuulitsivik birth centers to examine outcomes for 1,372 labors and 1,382 babies from 2000 to 2007. Data were incomplete for some indicators, particularly for transfers to Montreal.
Findings revealed low rates of intervention with safe outcomes in this young, largely multiparous “all risk” Inuit population. Ninety-seven percent of births were documented as spontaneous vaginal deliveries, and 85 percent of births were attended by midwives. Eighty-six percent of the labors occurred in Nunavik, whereas 13.7 percent occurred outside Nunavik. The preterm birth rate was found to be 10.6 percent. Postpartum hemorrhage was documented in 15.4 percent of women; of these cases, 6.9 percent had blood loss greater than 1,000 mL. Four fetal deaths (2.9 per 1,000) and five neonatal deaths (< 3.6 per 1,000) were documented. Nine percent (9%) of births involved urgent transfers of mother or baby. The most common reasons for medical evacuation were preterm labor and preeclampsia, and preterm birth was the most common reason for urgent neonatal transfer.
The success of the Innulitsivik midwifery service rests on the knowledge and skills of the Inuit midwives, and support of an interprofessional health team. Our study points to the potential for safe, culturally competent local care in remote communities without cesarean section capacity. Our findings support recommendations for integration of midwifery services and Aboriginal midwifery education programs in remote communities. (BIRTH 39:3 September 2012)