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DECOLONIZING MOTHERHOOD: EXAMPINING BIRTHING EXPERIENCES
OF URBAN INDIGENOUS WOMEN IN NOVA SCOTIA
by
Kayla Rose McCarney
Thesis
submitted in partial fulfillment of the requirements for
the Degree of Master of Arts (Sociology)
Acadia University
Spring Convocation 2019
© by Kayla Rose McCarney, 2019
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I, Kayla Rose McCarney, grant permission to the University Librarian at Acadia University
to reproduce, loan or distribute copies of my thesis in microform, paper or electronic formats
on a non-profit basis. I, however, retain the copyright in my thesis.
_________________________________
Author
_________________________________
Supervisor
_________________________________
Date
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Table of Contents
ABSTRACT ................................................................................................................................. VII
GLOSSARY ................................................................................................................................ VIII
ACKNOWLEDGEMENTS .......................................................................................................... IX
CHAPTER 1: INTRODUCTION .................................................................................................. 1
THESIS OVERVIEW ................................................................................................................... 5
CHAPTER 2: LITERATURE REVIEW ...................................................................................... 9
PRECOLONIAL ........................................................................................................................... 9
COLONIALISM, MOTHERHOOD AND OUTCOMES OF CULTURAL ASSIMILATION.. 10
Medicalization and Medical Dominance ................................................................................ 12
Medicalization and Resistance ............................................................................................... 16
Cultural Hegemony of Health and Healthcare ....................................................................... 19
The Residential School System ............................................................................................... 21
Transracial Adoption Patterns ............................................................................................... 24
The Sterilization of Indigenous Women in Canada ................................................................ 26
CONTEMPORARY COLONIAL .............................................................................................. 30
Health Disparities ................................................................................................................... 30
Indigeneity, Motherhood and Birth ........................................................................................ 33
CHAPTER 3: THEORETICAL AND METHODOLOGICAL PERSPECTIVES ................ 41
TWO-EYED SEEING ................................................................................................................. 41
POSTCOLONIAL THEORY ...................................................................................................... 44
INDIGENOUS FEMINISMS ...................................................................................................... 46
METHODOLOGY ...................................................................................................................... 50
Relationality ............................................................................................................................ 53
Relationships of Trust and Gratitude...................................................................................... 54
Research as Resisting Oppression, Reclaiming Knowledge ................................................... 54
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Negotiating Settler Identity and Privilege .............................................................................. 55
METHODS.................................................................................................................................. 56
Talking Circle ......................................................................................................................... 56
Interviews ................................................................................................................................ 59
Participant Demographics ...................................................................................................... 60
Ethics ...................................................................................................................................... 61
Analysis ................................................................................................................................... 62
CHAPTER 4: RESULTS .............................................................................................................. 64
CONTEXT OF CONTINUAL COLONIZATION ..................................................................... 64
Intergenerational Trauma and the Legacy of Residential Schools......................................... 65
Institutions and Feelings of Discrimination ........................................................................... 67
Indigeneity and Struggling with Identity ................................................................................ 70
THE TREATMENT OF INDIGENOUS MOTHERS IN HOSPTIAL SETTINGS .................... 72
Challenges to Using Indigenous Birthing Practices in Hospital ............................................ 72
Interactions with Hospital Care Providers ............................................................................. 75
Negligent Care ........................................................................................................................ 76
Institutional Pressures, Conditional Offers and Consent ....................................................... 78
CULTURAL PRACTICES OF INDIGENOUS BIRTH ............................................................. 83
The Medicine Wheel................................................................................................................ 83
Smudging ................................................................................................................................ 84
Indigenous Medicines ............................................................................................................. 86
Status as a Mother .................................................................................................................. 86
MIDWIFERY CARE FOR THE DECOLONIZATION OF BIRTH .......................................... 87
Empowering Women ............................................................................................................... 88
Comprehensive care ............................................................................................................... 90
Touch ...................................................................................................................................... 92
Culture .................................................................................................................................... 93
Decolonized Birth ................................................................................................................... 95
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CHAPTER 5: DISCUSSION AND CONCLUSION .................................................................. 98
Continual Colonization ........................................................................................................... 98
Treatment of Indigenous People in Hospital Settings .......................................................... 100
Midwifery Care as a Model of Addressing ‘Decolonized Birth’ .......................................... 101
Conclusion ............................................................................................................................ 103
Limitations ............................................................................................................................ 110
Recommendations for Future Research ................................................................................ 112
REFERENCES ............................................................................................................................ 114
APPENDIX: RESEARCH TOOLS ........................................................................................... 125
Mi’kmaw Ethics Watch Certificate ....................................................................................... 125
Acadia REB Ethics Approval ................................................................................................ 126
Interview Schedule ................................................................................................................ 127
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Abstract
While much as been written about how colonization has been accomplished through
the disruption of motherhood, less is known about how Indigenous women’s birthing
experiences have been shaped by continual colonization, or how birthing is, or can be part of
the decolonizing movement. This thesis, while focusing broadly on the relationship between
motherhood, health, and the effects of colonization, explores urban Indigenous women’s
birthing experiences in Nova Scotia. This inquiry was framed by the Indigenous theoretical
concept of Two-Eyed Seeing that is used to examine pressing health and social problems
experienced by Indigenous people, as well as postcolonial and Indigenous feminist theory.
Employing an Indigenous informed methodology, a talking circle with ten self-identified
urban Indigenous mothers was held in a community gathering space in Halifax, Nova Scotia.
In addition, seven qualitative interviews were conducted with mothers that attended the
talking circle in order to determine their perceptions and experiences of birth in hospital
settings. The results show that mothers experienced individual and institutional
discrimination, and that Indigenous birthing practices were desired, yet unrealized due to
structural barriers. This thesis argues that the current healthcare system in Nova Scotia fails
to meet the needs of urban Indigenous mothers during the birthing experience because it fails
to embrace culturally informed birthing knowledges. The incorporation of Indigenous birth
knowledges into practice can address these shortcomings, redefine how we come to
understand birth, and better support women of all cultural backgrounds in hospital. This
thesis also argues that Indigenous informed midwifery care is the pathway best suited for
decolonizing birth.
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Glossary
AFN: Assembly of First Nations
TRC: Truth and Reconciliation Commission, or Truth and Reconciliation Report
WOC: Women of Colour
TAP: Transracial Adoption Patterns
NACM: National Aboriginal Council of Midwives
BWHBC: Boston Women’s Health Book Collective
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Acknowledgements
First and foremost, I would like to sincerely thank all of the mothers who told me
their stories, dedicated their time, and allowed me to share their space. I am grateful for your
trust and respect, and am humbled by your acceptance. I would also like to thank, in
particular, the Elder that conducted the talking circle, and the coordinator of the centre where
the circle was held. This project would not be where it is today without your support,
knowledge, and willingness to help me conduct this research properly.
I would also like to thank the tireless efforts of my supervisor, Dr. Lesley Frank. You
have been instrumental in the development of this project, and have always been a source of
support. Thank you for your honesty, humour and gentle approach to criticism that allowed
me to complete this research without [many] stress induced panic attacks. Thank you to those
who have taken the time to listen to my ideas, strengthen my knowledge through literature,
and have provided insightful feedback: Dr. Sarah Rudrum, Dr. Claudine Bonner, Dr. Zelda
Abramson, Dr. Anthony Gracey, Karen Turner and Dr. Jim Brittain.
To Kate Ross, Caitlin Lawrence and Christine Moreau – I cannot thank you enough
for supporting me through this process and will always be grateful to have you in my life.
Finally, I wish to thank Ami McKay, because without reading The Birth House the summer
before I began my degree, this thesis would likely be an uninspired pile of garbage.
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CHAPTER 1: Introduction
“Calculated colonialism changed birthing. The western medicalization of birth
replaced our ceremony […] The birth of a child became something our
women had to endure alone rather than celebrated with the support of her
extended family and community. Women were medicated and hospitalized,
told that we could not give birth without the assistance of western medicine.
White doctors, who were “experts” on birth, replaced our midwives and
displaced our confidence in our bodies, [and] our reliance on our traditional
knowledge.”
- Leanne Simpson (2006:28)
Encroachment on Indigenous medical knowledge by European settlers, and the
subsequent dismantling of Indigenous knowledge systems over the course of Canada’s post –
contact history, is an example of what scholar Karen Stote has described as maternal cultural
genocide by the Canadian state (Stote 2015). Historically, maternal cultural genocide has
been achieved by processes that aim to disempower Indigenous women’s agency and bodily
autonomy through an assault on reproductive health, birthing, and parenting (Bent and
Haworth-Brockman n.d.; Grimshaw 1999; Lavell-Harvard and Corbiere Lavell 2006; Sinclair
2007; Stote 2015; Van Herk, Smith, and Andrew 2014). The Western management of
birthing was central to the colonial project of cultural genocide. For the purposes of this
research, colonization is defined as “the appropriation of sovereignty, lands, resources and
agency, and has included the imposition of western and Christian patriarchy on a peoples”
(St. Denis 2007:45). This thesis, while focusing broadly on the lasting effects of colonization
on health outcomes, specifically addresses the birthing experiences of urban Indigenous
women in the ancestral lands of Mi’kmaki, referred to in colonial settings as Nova Scotia.
This exploratory research addresses several questions in relation to contemporary birthing
experiences of urban Indigenous mothers in Nova Scotia, in order to interrogate maternity
2
care as a colonizing institution. This thesis also explores what decolonizing birthing might
look like from the perspective of Indigenous mothers. Decolonization takes on varying
definitions and various forms, and is considered both social, cultural and political processes
(Laenui 2000). For the purposes of this research, decolonization is a process best described
by Simpson (2006):
[…] in order for Indigenous Nations to liberate ourselves from the violence of
colonialism and to achieve a peaceful self-determining nationhood based on our own
culturally grounded visions, we must be prepared to liberate ourselves from the
ideological constraints of the colonial mentality that plagues present day Indigenous
political and governing structures and Indigenous thought. (P. 25)
The liberation of a colonized nation from the ideological framework of the colonizer involves
the insurrection of Indigenous cultural traditions and cultural knowledge. The main directive
of decolonization involves “undergoing a ‘re-traditionalization’ of thinking and of living
based on […] individual Indigenous cultural and intellectual descriptions” (Simpson
2006a:25).
This research was based on the assumption that the colonization of birth cannot be
separated from the broader project of state imposed cultural genocide via motherhood. State
undermining of Indigenous motherhood includes a legacy of measures aimed at interrupting
the reproduction of Indigenous culture. Methods of assimilation by the Canadian state were
strategically aimed at Indigenous mothers and children. The justification for this strategy was
twofold. First, mothers are the forbearers of the next generation, and the separation of
children from mothers separates children from traditional teaching, which in turn disrupts the
reproduction of Indigenous culture. Secondly, Indigenous children, in an effort to align with
the cultural hegemonic majority, might reject their own culture and cultural ways and adopt
‘colonialist’ attitudes, beliefs and behaviours. The disruption of Indigenous culture was most
3
notably with child apprehension to residential schools, the scoop1 of children from
Indigenous families by child welfare agencies, and subsequent transracial adoption patterns
outside of reserve communities. Yet the assault on Indigenous culture was also aimed at
biological reproduction, both in the involuntary sterilization of Indigenous women in
Western and Northern provinces, and in the colonization of birthing practices. This was
accomplished through a number of state processes that incentivized the reliance on western,
biomedical medicine for birthing through interfering with traditional practices and
ceremonies (Caroll and Benoit 2004). For example, there was forced separation of Elders and
community leaders from crucial roles as midwives and healers, and the criminalization of
Indigenous medical knowledges, ceremonies and practices that directly supported birthing
(Caroll and Benoit 2004). This was accomplished through the legal transferring of medical
responsibility of Indigenous people, including maternity care, to Federal and Provincial
governments (Simpson 2006).
We know that marginalized Indigenous communities, who have no self-determination
in healthcare delivery, have been found to experience negative effects of colonized healthcare
provisioning which fails to consider the cultural and identity harm that these systems may
cause (Adelson 2005; Van Herk, Smith and Andrew 2014). The colonizing of Indigenous
birthing practices is part of the colonization of healthcare, coinciding with the medicalization
of birth in Canada generally, which contextualized the experience of birth as a ‘medicalized
illness’ in need of ‘treatment’ (Johanson, Newburn, and Macfarlane 2002). The biological,
social, and cultural outcomes of the medicalization of birth has received much attention
1 Here, I refer to instances where Indigenous children are adopted out of their respective
communities. This pattern bears many names: sixties scoop, millennium scoop, and TAP. The
disproportionate removal of Indigenous children from their communities persists.
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within the discipline of sociology, yet the outcomes for Indigenous women less so. The
medicalization of maternity care, particularly for those who experience marginalization from
health services broadly, has the potential to produce harm to mothers in multiple contexts,
impacting accessibility and women’s right to care, but more broadly failing to respond to
knowledge systems of Indigenous health and the reproduction of Indigenous culture through
birthing.
The colonizing of Indigenous birthing practices also coincided with health disparities
of Indigenous populations as a result of colonization. Health disparities are both a direct and
indirect outcome of inequitable social, political, economic and cultural relations (Adelson
2005). Extensive literature details how the process of colonization has led to poor health
outcomes for Indigenous communities and peoples and, in particular, Indigenous maternal
outcomes. While there are differences in relation to demographical contexts (Reserve/Urban,
Status/Non Status Indian2, Geographic proximity to city centres), Indigenous women in
Canada are known to be at a higher risk of gestational diabetes, nutritional deficiencies,
experience lack of access to prenatal care, and experience increased incidences of sexual
violence, poverty, and drastically higher birth weight in infants (Hampton, Bourassa, and
Mckay-Mcnab 2004; Adelson 2005; Salmon 2010; Van Herk et al. 2014; Lavell-Harvard and
Corbiere Lavell 2006). Research has consistently linked poor health outcomes with the
negative effects of historical and contemporary colonization on Indigenous peoples in
Canada (Adelson 2005; Hampton et al. 2004).
This thesis grapples with the outcomes of colonization in the areas of health
disparities for Indigenous mothers that may position them to be in greater need of
2 While I do not personally endorse the term ‘Indian’ to describe Indigenous people in Canada, I
employ this term as it relates to the ‘legal’ term for whether or not an individual has the identity of ‘status’.
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medicalized birthing, while at the same time experiencing a form of maternity care that may
have the potential to further colonize. I draw upon interviews conducted with urban
Indigenous women about their birthing experiences in hospital. Participants were asked to
describe their experiences with prenatal, birthing, and postnatal care, and if/how their
experiences were informed by Indigenous knowledge and practices within the hospital. I
focused on the experiences of urban Indigenous women exclusively, as there is a lack of
research that addresses the relationship between urban Indigenous women and their self-
described relationship to cultural knowledges and traditions surrounding birth. While the
results of this study cannot be generalized to urban Indigenous populations in Nova Scotia,
this exploratory research uncovers themes related to birthing within a colonizing framework
that may be common for other groups and in other settings.
I argue that the current healthcare system in Nova Scotia is failing to meet the holistic
needs of urban Indigenous mothers’ in birth because it fails to embrace their culturally based
health and birthing knowledges. The incorporation of Indigenous knowledges concerning
birth can address these shortcomings, and redefine how we come to understand birth and,
subsequently, how we support birthing women. Finally, I argue that Indigenous informed
midwifery is the pathway best suited for decolonizing birth.
THESIS OVERVIEW
Chapter two is a review of the literature to situate the current study in relation to the
medicalization of childbirth, Indigenous motherhood, health inequities related to
colonialization, residential schools, transracial adoption patterns, and sterilization patterns of
Indigenous women in alignment with ‘eugenocidal’ ideology of assimilation.
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Chapter three provides detail on the theoretical and methodological perspectives informing
this research project, in order to situate the various perspectives that I drew upon to analyze
the participants narratives. Specifically, I discuss postcolonial theory, Indigenous feminist
theory, and two-eyed seeing as concepts that guided the research process. This chapter details
the research process employed, which was informed by both Indigenous methods and
traditional qualitative methods in an attempt to bridge both academic, Westernized inquiry
with Indigenous modes of knowledge. Chapter four presents the findings of the research,
detailing participants’ experiences of maternity care in hospital settings. Chapter five
discusses the results in relation to the theoretical perspectives that informed this research and
the contemporary Indigenous birthing movement. It also outlines strengths and limitations
concerning the research, and concludes with recommendation for decolonizing birth.
This research, in utilizing a two-eyed seeing approach, assumes that Indigenous and
Western knowledge and methods are not mutually exclusive or in stark contrast with each
other (Martin 2012), but must work towards a complimentary system that mutually enforce
one another to improve overall outcomes for Indigenous people and relations between
Indigenous patients and healthcare providers. Indigenous women have had minimal ability to
maintain control over their experiences of birthing, due in part to the unequal power relations
that govern the distribution of Indigenous influence within Eurocentric systems of power.
This research adds to the knowledge of what ‘decolonized’ birthing would look like from the
perspective of Indigenous mothers, and may help to empower Indigenous women, and non-
Indigenous women, to assert more control over their birthing experiences. The main purpose
of this research was to draw attention to the maternity care needs of Indigenous mothers, in
order to identify potential areas where ‘decolonizing’ practices and policy might be situated
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and to inform the work of healthcare providers in how to best support all mothers in their
care. It is hoped that this research will provide communities with the opportunity to
collaborate on advancing knowledge on this subject, with the goal of both ‘decolonizing’
birth and research.
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CHAPTER 2: Literature Review
This thesis asserts that cumulative efforts of assimilation have been disproportionally
felt by women and children in Indigenous communities in the context of the Canadian state.
This review of the literature focuses primarily on ‘attacks’ on Indigeneity through disruption
of motherhood. While I try to avoid making overgeneralizations about the experiences of
‘Indigenous’ motherhood, there is a claim that “despite the diversity of experiences of
Aboriginal motherhood, there is a shared reality of being different from the dominant
culture” (National Collaborating Centre for Aboriginal Health 2012:3). Indigenous women
are distinct, shaped by gender and status, as well as other political, social and cultural
experiences (Lavell-Harvard and Lavell 2006). While Indigenous experiences are diverse, it
is important to understand that colonization processes establish a common thread in birthing
narratives (Getty 2010; Lavell-Harvard and Lavell 2006).
PRECOLONIAL
While there is little written on precolonial birthing practices, sources have
documented that women in precolonial Indigenous societies were revered as the authoritative
experts on birth and childrearing. For example, Battiste (2011) claims that the traditional role
of Mi’kmaw women was to be the keepers of the past and the future, traditionally holding
roles as midwives, healers, and contributing to their societies through community education
and support. The gendered expectations of women in Mi’kmaw culture were geared towards
roles of mother, teacher, provider, and nurturer (Battiste 2011). Women’s bodies were
considered sacred, and carefully handled as they were sites of considerable spiritual power
(Battiste 2011). Leanne Simpson, a Nishnaabeg scholar, author and mother, contends that the
success of nations are contingent on the bodies of women, as they are “the first environment,
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that [the] babies inside of our bodies see through the mother’s eyes, and hear through the
mother’s ears” (Simpson 2006b). Mothering, then, becomes a crucial site of inculcation, as
children learn about themselves and their culture through the “way we nurture our children
with Indigenous interpretations of our teachings” (Simpson 2006b). As women birthed, they
insulated cultural longevity within their community contexts, and as such, nations in turn
supported mothers and children (Simpson 2006b).
Women who were not directly involved in biological reproduction still maintained
influence, and were often considered the primary support systems for birthing women in their
communities (Birch et al. 2009; Brown, Middleton, Fereday and Pincome 2016; Ireland et al.
2011; Mzinegiizhigo - kwe Bedard 2006; National Collaborating Centre for Aboriginal
Health 2012). Aunties, Elders and community members provided a safe, supportive place for
children to thrive, to learn, and to be. Midwifery care in Indigenous communities was
considered a commonplace practice, as colonial health models of medicalized childbirth did
not yet supersede Indigenous birthing practices. Overall, Indigenous parenting approaches
differed from that of Eurocentric parenting in that it incorporated community shared
childrearing, which included networks of extended family beyond biological ties, and
children’s behaviour was less restricted, punished and made to conform to notions of how a
child should behave (National Collaborating Centre for Aboriginal Health 2012).
COLONIALISM, MOTHERHOOD AND OUTCOMES OF CULTURAL ASSIMILATION
When colonization of the Canadian state began, settlers’ culture brought ideas about
birthing and childrearing that differed from those practices established by Indigenous
peoples. As the Canadian settler state expanded, so did the ideological strengthening of
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power over Indigenous ways of life. Euro-hegemonic power structures began impacting
indigenous communities, through the establishment of settler child welfare policies (Sinclair
2007) that have power to punish Indigenous parents for improper childrearing practices.
According to Simpson (2006):
Children are respected as spiritual beings, and are looked up to, because they have
knowledge that their parents, who live largely in the physical world, do not. That is a
very different way of positioning children in comparison to settler society. Children
are not viewed as helpless babies who need to be controlled. They are viewed as
independent spiritual beings, who have many things to teach their parents. Children
are gifts. They are leaders. They are gifts that require us to face our own conflicts,
faults and misgivings. (p. 26)
Indigenous approaches to parenting, which included “breastfeeding on cue rather than
schedule feeding, co-sleeping, baby wearing and gentle, positive, non-violent guidance,
discussion and empathy” (27), did not align with Eurocentric knowledge and protocols of
parenting. As the settler empire expanded, combined with dwindling Indigenous populations
and the pervasive ideology of Eurocentric superiority, Indigenous knowledge, ceremonies
and practices became punishable by settler law.3 This, along with other practices of cultural
assimilation, set the precedence for the imposition of Western models of motherhood as the
standard by which mothering became evaluated, which had severe consequences for the well-
being of Indigenous children, mothers, families and preservation of Indigenous cultural
practices, including traditional birthing.
3 Language, cultural and traditional ways of healing of Indigenous people were invalidated by the
colonizing collective, and as such, policies such as the British North America act of 1867 yielded control of
the governance of sociopolitical structures to the colonizers. Therefore, many Indigenous health
practitioners in pre-contact Indigenous societies were driven underground, as Indian agents assumed
medical authority. This, in tandem with the banning of traditional ceremonies such as the Potlach, the
dismissal of traditional medicines, among others, restricted the transmission of cultural knowledge in this
era.
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Through the processes of colonization, the imposition of Western models of
motherhood were mutually supported through religious and social institutions that aimed to
hinder the cultural and physical reproduction of Indigeneity from the 17th century and
onward. According to Bourassa et al (2005), “[c]ultural groups that have lived under
colonization experience a legacy of oppression that adds another level of threat to their
health” (24). The regulation of mothers was central to colonial mechanisms to disrupt
Indigeneity, accomplished through residential school and transracial adoptions policy, and
the banning of ceremonial practices and traditional medicines.
Medicalization and Medical Dominance
For the purposes of this research, medicalization is described as “a process by which
nonmedical problems become defined and treated as medical problems, usually in in terms of
illnesses or disorders” (Conrad 1992:209). The medicalization of childbirth in Western
society coincided with major technological advancements in obstetrics and gynecology, and
occurred in tandem with the cultural modernization period of the capitalist, industrial
revolution of the early 19th century (Busfield 2017; Mitchinson 1986; Oakley 1986). While
many women in that time period embraced modern, medicalized birthing practices, the
dominance of medicalized birth lead to systematic discrediting of alternatives in childbirth,
including midwifery, as well as an erosion of women’s agency in birthing (Conrad 1992).
Medicalization has been theorized as a form of social control by Zola (1972), and he suggests
that medicalization is “nudging aside, if not incorporating, the more traditional institutions of
religion and law” (1972:489).
Oakley (2016) critiques the medicalization of childbirth, specifically medical control
of the labour process which utilizes medical intervention for the sake of institutional and
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practitioner convenience in managing birth. Examples of the effects of this include: “rates of
hospital confinement approaching 100%, centralization of care into large units, and rising
rates of Caesarian sections in birth” (Oakley 2016: 692). The concept of birthing ‘success’
has also been critiqued by sociologists. According to Illsley (1967) the narrow view of
medical ‘outcomes’ during birth has been described as “whether babies and mothers die or
are physically sick or impaired” (76), without considering the relationship between the rates
of medical intervention and the effects it may have on postpartum recovery.
Oakley suggests that women’s bodies are regulated like machinery within the
maternity ward. Oakley contends that the concept of childbirth has no hard or fast rules, but
is constructed socially and culturally (2016). Therefore, she presents the need for
practitioners to examine the cultural and social conceptions of birth as well as the physical
space in which the event occurs. Birthing falls into a precarious situation, as it is conceived
as “a social condition under the control of the medical profession” (Oakley 2016:692). As the
medical profession leaves little room for negotiating decision making in birth, Oakley
recommends midwifery for low risk pregnancies.
Critiques of the medicalization of reproduction originate predominantly from feminist
thought, which suggests that doctors maintain control over the way menstruation,
contraception, pregnancy, childbirth and abortion are perceived (Busfield 2017). As such, the
power relations that govern this social exchange are fundamentally unequal, and doctors are
capable of using medical knowledge to advance a social agenda against biological processes
exclusive to women’s bodies. This construction of power alienates women from their own
conceptions of their bodies and bodily processes.
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Women can experience the complicating effects of medicalized childbirth through the
amount of intervention required and how this intervention impacts their ability to provide
care for infants. Medical procedures relating to birth, such as Caesarian sections,
episiotomies, and epidurals can lengthen recovery time after giving birth. For example,
caesarian sections, a surgical procedure to remove the infant from the abdomen can create
post procedural outcomes that require extra attention, including ensuring the stitches remain
intact, that the incision wound is exceptionally clean, and ensuring the reduction of strenuous
activities, including bending and lifting objects (Rossi 1977). Episiotomies, or the surgical
incision from the vaginal opening to the perineum, require extra care for recovery, as the
proximity of the sutures to bacteria housed around the anus and vagina requires vigilance in
hygiene and increases the likelihood of infection (Oakley 1988). Birth interventions can lead
to further complications for women, but with success being measured only in the narrowest
of terms, a mother’s experiences both in labour and postpartum are increasingly overlooked
in favor of the perception that an absence of fetal injury and mortality means that the labour
was a success. Women, routinely written out of the narrative of birth, are conveyed as
passive recipients of an experience that can only be truly controlled by the hands of those
trained in the medical management of birth.
Busfield suggests that the concept of medicalization is still enduring and important, as
it exposes the monopolizing effect that it can have on the ways in which we come to
understand, conceptualize and treat illness (2017). However, Busfield (2017) also argues that,
because of a noted societal shift from moral to rhetorical authoritative frameworks, medical
consumers today are more aware of the systems of power that govern them, untrusting of
15
authority, more informed about their choices in healthcare, and given the right conditions, are
able to challenge them. 4
The medicalization of childbirth is concerning for all women; however it has
particular relevance to Indigenous women who inhabit different knowledge systems of
birthing and who may experience medical management of birth as necessary at times, yet
colonizing. This thesis presents the position that birthing is, with medicalization, a colonized
event for Indigenous women. Medicalization, or the imposition of predominantly Western
conceptions of medical dominance on Indigenous people coincides with the effects of
colonization, and can produce unfavorable outcomes for Indigenous mothers who give birth
in colonial institutions. In this way, I describe a double jeopardy: The reproductive health of
all women has been medicalized, but Indigenous women’s health is both medicalized and
colonized. The conceptual differences in relation to how childbirth must be managed in the
medical system versus within Indigenous communities creates a power imbalance that favors
systems of medicalized management of childbirth, and a rejection of other, equally valid and
culturally informed ways of managing low risk births.
Employing an intersectional feminist lens, the medicalization of childbirth runs
counter to the conception of childbirth as a social, natural and ceremonial process often
described by Indigenous scholars (Anderson 2006; Lavell-Harvard and Corbiere Lavell 2006;
Lavell-Harvard and Lavell 2006; Simpson 2006b; Whitty-Rodgers, Etowa, and Evans 2006).
The mandate that Indigenous women abide by largely western, biomedical conceptions of
4 I caution readers here to understand that assuming that individual consumers are wary of systems
of medicalized power in their lives, thus enables them to advocate for themselves in relation to health,
presupposes a privilege that suggests that an individual can access the literature surrounding health. This
assumes literacy, and access to resources that enable research to be conducted, and a basic comprehension
of health-related aspects of care.
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birth, including invasive procedures, the application of drugs and the underwhelming concern
for the delivering women’s emotional, mental and spiritual well-being, is yet another
extension of colonization. The interpretation of birth as a site of potential decolonization
comes first with a requirement that the healthcare system accepts and acknowledges the
potential for parallel knowledge systems to inform Indigenous women’s labour experiences,
each with, at a minimum, equal weight.
Medicalization and Resistance
In tandem with the second wave feminist movement of the 1960s-1970s, women
actively challenged the treatment they received from health professionals and demanded a
largescale shift in care. As Sobnosky (2013) describes:
Women began calling for changes in almost every aspect of health care. Women
questioned the way they were defined and treated by physicians, especially
obstetrician-gynecologists, and called for major changes in office procedures. Women
demanded more access to abortion and contraception in order to gain control over the
decision of whether and when to have children. Women also began to critique the
structure of the health care system and the ways it denigrated women through
involuntary sterilization, unnecessary surgery, and inadequately tested
pharmaceuticals. (P.218)
Resistance to the medicalization of women’s bodies was seen in consciousness raising efforts
which elevated collective stories of neglect, trauma, misinformation and abuse from
healthcare providers. The Boston Women’s Health Book Collective (BWHBC) was arguably
the most notable grassroots resistance to medicalization in North America, highlighting the
need for self-advocacy and education. The BWHBC began in 1969 during a women’s
liberation conference held in Boston, Massachusetts (Norsigian et al. 1999). In a workshop
titled “Women and their Bodies,” the women discovered that every person had a “doctor
story,” or an interaction with a medical professional that produced feelings of frustration and
anger. The tales were predominantly about male physicians who they considered sexist,
17
paternalistic, judgmental, or unable to provide correct, factual information that women
needed to make an informed decision about care (Norsigian et al. 1999). This workshop led
to the development of the benchmark health manual, Our Bodies, Ourselves and subsequent
pamphlets and published magazine articles to raise consciousness amongst other women with
similar medical experiences. These women encouraged others to share their stories,
encouraged self-examinations, pushed for more involvement with political activism, and
asked that women conduct their own research. By developing information and
communication networks, they were actively resisting medicalization of their bodies, and of
their births (Norsigian et al. 1999).
The critique of the women’s health movement is akin to those of white feminism:
Those who were developing this advocacy and education framework were predominantly
white, middle to upper class women. This homogenization of dissent has been critiqued for a
lack of understanding of the effects of the complex intersections of race and social inequities’
impact on health (Norsigian et al. 1999). While the BWHBC was an important starting point
for addressing the reprehensible treatment of women in medical spaces, more representation
in the movement was necessary.
Indigenous women who access mainstream health services experience the combined
effects of medicalization and colonization. To resist these forces, women in Indigenous
communities have advocated for models of culturally appropriate care through a resurgence
of Indigenous midwifery in Canada context addresses the unique care needs of Indigenous
women and is self-governed and informed by culture. According to the National Aboriginal
Council of Midwives:
An aboriginal midwife is a committed primary health care provider who has the skills
to care for pregnant women, babies, and their families throughout pregnancy and for
18
the first weeks in the postpartum. She is […] knowledgeable in all aspects of
women’s medicine and she provides education that helps keep the family and
community healthy. Midwives promote breastfeeding, nutrition, and parenting skills.
A midwife is the keeper of ceremonies for young people like puberty rites. She is a
leader and mentor, someone who passes on important values about health to the next
generation. (Olson 2016:3)
The National Aboriginal Council of Midwives promotes care excellence for Inuit,
First Nations, and Métis women, advocating for the reclaiming of traditional Indigenous
midwifery practice, the provision of midwifery services, and for choice in birthplace5. That
has similar visions in supporting traditional birth: centering culturally appropriate services,
providing collaborative care, improving Aboriginal maternal and infant health outcomes,
providing opportunities for home and community birth, among others. Additionally, there is a
resurgence of Indigenous doula services. These doulas provide cultural birth support,
advocate for women as they birth in hospital, and protect the sacredness of birth. According
to the First Nation’s Health Authority (2012):
A doula provides emotional, physical and spiritual support for expectant mothers and
their families during pregnancy, labour and the postpartum period. Building on the
role of the traditional Aunty, Aboriginal doulas can assist in honouring traditional and
spiritual practices and beliefs associated with maternity care and support the language
and cultural needs of the women and her family. (P.1)
The self-governance of indigenous midwifery and doula service outside of the current
medicalized birthing system is instrumental in addressing the effects of medicalization
and colonization simultaneously.
5 Currently, there are a number of Indigenous led midwifery practices in Canada. Inuulitsivik
Health Centre & Tulattavik Health Centre in Nunavik, Quebec; Rankin Inlet Birthing Centre & Cambridge
Bay Birth Centre in Nunavut; Fort Smith Health and Social Services Midwifery Program in the Northwest
Territories; Kinosao Sipi Midwifery Clinic in Manitoba; and in Ontario, Seventh Generations Midwives
Toronto; Six Nations Maternal and Child Centre; Kontinenhanónhnha Tsi Tkaha:nayen, Tyendinaga
Mohawk Territory; Neepeeshowan Midwives Arrawapiskat, among others.
19
Cultural Hegemony of Health and Healthcare
The theory of cultural hegemony is applicable to the discussion of the whitewashing
(Allen 2006) of healthcare provision and aids in the discussion of how we come to
understand contemporary hospital birthing as a medical event and as a colonized entity. For
the purposes of this research, cultural hegemony is defined as the supposition of the values,
beliefs, attitudes and culture of one dominant groups to the exclusion of other frameworks of
knowledge (Gramsci 1988). Historical documents demonstrate statewide evidence of the
assimilation project, through maintaining the hegemonic narrative that Indigenous people
were inherently inferior to European populations (Warry 2007). This narrative, which is still
persistent, is supported through the degradation of Indigeneity: stereotypical depictions of
Indigenous people as drunks, savages, or Indigenous women as squaws in need of Christian
reformation, and Indigenous culture as inherently primitive (Anderson and Robertson 2011).
These ideas were inculcated into Eurocentric society through rhetoric from religious
institutions, the education system, ‘scientific’ research and information from colonial
governments (Anderson and Robertson 2011). The rhetoric of Indigenous people as inferior
to Europeans established the basis on which the agenda of assimilation began and continues.
In order for society to justify the displacement of Indigenous people from their lands,
this ‘othering’ ideology was widely accepted and supported. Indigenous people were
subjected to the inculcation of attitudes, actions and beliefs of the Eurocentric ruling class
exclusively, which simultaneously pushed Indigeneity to the margins (St. Denis 2004).
Gramsci contends that power is exercised through state and civil society, through economic
and military forces, and through a hegemonic discourse that determines the ideological
dominance of a certain group (Gramsci 1999). Indigenous cultures were subjected to military
20
force through the colonization of their lands, and the hegemonic discourse of Indigenous
inferiority supported the assimilation conquest.
Thus, there is a clear hegemonic power dynamic at play in hospital settings. The
dominance of the biomedical framework of health care broadly, and birth care specifically,
provides a framework by which one can understand how totalizing and exclusionary
biomedical healthcare can be for those that do not embrace this hegemonic framework of
health. Indigenous people interact with a healthcare system that is reflective of a white,
middle class user experience. Within this, conceptions of health that align with a more
culturally relevant ideology of health are not considered a legitimate means of maintaining
health and addressing illness. Additionally, the attitudes of health practitioners and staff can
be largely informed by racist, stereotypical depictions of Indigenous people, and beliefs that
Indigenous knowledge and cultural practices are uninformed by medical fact. Culturally
competent care is starting to emerge as a priority in most healthcare spaces, yet cultural
awareness and sensitivity training in health practitioner education curriculum is not yet
mandatory (Birch et al. 2009). Without providing opportunities for healthcare practitioners to
learn about the importance of culturally sensitive approaches to health and healthcare, the
system itself is contingent on teaching exclusive Eurocentric, biomedical knowledge about
health. In relation to the birthing experiences of Indigenous women, the approach to birthing
that contends that birth is an illness requiring diagnosis, monitoring and treatment is a
westernized, biomedical conception of birth. Once inside the hospital, culture becomes less
relevant as biomedical management of birth addresses largely physical aspects of health. The
theory of cultural hegemony is useful in that it helps us to understand the totalizing effects of
21
the dominant ideology of biomedicine and the exclusion of alternative frameworks of
knowledge in health and healthcare which have coincided with other systems of colonization.
The Residential School System
The residential school system was an agent of colonization via the disruption of
family. Maternal cultural genocide occurred due to the persistent removal of children from
their community, placing them into the hands of the state for direct ‘care’ and cultural
assimilation. In the interest of furthering the colonizing initiative, Duncan Campbell Scott, a
prominent figure in the establishment of this school system, insisted on becoming
enthusiastically and unequivocally supportive of measures that aimed to eliminate the “Indian
question” (Neeganagwedgin 2014). The Indian Residential School System was a structural
mechanism to this end (Bombay, Matheson, and Anisman 2014; MacDonald and Hudson
2012; Neeganagwedgin 2014). It was implemented in the 1880s as a means to engender
assimilation, with cooperation from the colonial government and Eurocentric religious
institutions (Bombay et al. 2014; Smith, Varcoe, and Edwards 2005; Neeganagwedgin 2014).
Both the state and religious institutions involved in the implementation of this school system
were in agreement that assimilation processes must start as early as possible within the
child’s life (Neeganagwedgin 2014). Therefore, governments and school administrators
thought that removing children from the cultural influences of families and communities, into
the care of Christian educators, would likely expedite the assimilation process (Miller 1996;
Milloy 1999; Woods 2013).
Indigenous scholars often refer to the residential schools’ time period as the “stolen
generation” (MacDonald and Hudson 2012), as upwards of 100,000 children were affected
by systemic, racist policies geared towards cultural genocide (Smith et al. 2005)
22
accomplished through family disruption. The intent of residential schools was to ensure
attendees understood and practiced religion alongside vocational education. Indigenous
children were mandated by law to leave behind their cultures, communities and families to
live in schools that were specifically centralized around the notion of “kill[ing] the Indian in
the child” (Royal Comission on Aboriginal Peoples 1991).
The last operational residential school closed in the early 1990s. There were an
estimated 150,000 Indigenous children who attended schools throughout Canada, with
attendance compulsory for children between the ages of 5 and 15 (Barkan 2003). Included in
the curriculum was the preparation of children for manual and domestic labour, and lessons
for living in a proper way, including exclusively learning the English language and values
akin to settler society (Neeganagwedgin 2014; Woods 2013). Additionally, the conditions of
the residential schools posed health risks to the students in attendance. Poor housing quality
and overcrowding lead to disease and illness that were a normalized aspect of the residential
school experience (Smith et al. 2005; Woods 2013). High rates of malnutrition and lack of
medical care also impacted the health and wellbeing of students (Milloy 1999) and
contributed to mortality rates as high as 64% in some locations (RCAP 1991; Milloy 1999).
Residential school children were subjected to an array of assaults on their bodies,
their minds and their culture through abuses of power by staff. The intake process involved
the denigration of physical traces of Indigenous culture on the bodies of students as they were
separated from their siblings, their hair was cut to fit closely with Eurocentric standards of
presentation, and when they were subjected to corporal punishment for communicating in
their languages (Legacy of Hope Foundation 2014; Neeganagwedgin 2014; Woods 2013).
23
Many survivors have described situations in which they were subjected to sexual, emotional
and spiritual abuse in these schools (Smith et al. 2005; Neeganagwedgin 2014; Woods 2013).
While the Canadian state has not formally labelled the Residential School System as
genocidal in nature, the Harper Government issued a formal apology in June of 2008 on
behalf of the Government of Canada6 to address the transgressions enacted upon Indigenous
communities through the mechanism of residential schools. They recognized that the school
“[...] separated over 150,000 Aboriginal children from their families and communities”
(Harper 2008:1) and the Government of Canada apologized for “failing to protect [...]
forcibly removing children from their homes [...] [creating] a policy of assimilation [...] and
contribut[ing] to social problems that continue to exist” (Harper 2008:1 - 2). The Truth and
Reconciliation Commission’s report (Truth and Reconciliation Commission of Canada
2015), followed with recommendations on how to action reconciliation. While this is a good
first step, many argue that there is a long way to go in redressing colonial harms. Knockwood
(2015) argues that the state was too slow to respond in closing residential schools, despite
known harms, and that there is still a lack of recognition amongst governments for the
durability and permanency of the negative effects of the system. To mislead a nation and to
obscure the intrinsic role the state played in the longevity of residential schools is to ignore
the abuse faced by many survivors, and disrespects the memory of the children who perished
at the hands of institutional neglect.
6 A transcript of the full apology can be found on the Indigenous and Northern Affairs Canada
website: http://www.aadnc-aandc.gc.ca/eng/1100100015644/1100100015649
24
Transracial Adoption Patterns
In conjunction with the residential school system, transracial adoption patterns7 has
been identified as another site in which the overarching goal of colonial governments via
child welfare agencies, was to disrupt Indigenous culture by severing the tie between parent
and child and the connection to community and culture. Transracial adoption was another
process of cultural genocide enacted through and on Indigenous women and children, as the
opportunity to transmit cultural knowledge was disrupted by the forceful removal of
Indigenous children from care.
The estimated number of children removed from homes is difficult to determine,
however, it was suggested by Alston – O’Conor (2010) that one in four ‘status’ children were
removed, either in part or for the duration of their childhood, while rates for non-status and
Métis children were one in three. Rather than advocating for Indigenous sovereignty over
child welfare services, the Department of Indian Affairs “created agreements with the
provinces to take primary responsibility for children’s general welfare within their own
provincial agencies” (Armitage 1995 cited in Alston - O'Connor 2010:54).
Alston - O’Connor (2010) argues that residential schools were unable to fulfil the end
goals of assimilation, as many Indigenous children did not fully embrace the eurocentric
identity that these schools attempted to inculcate. Social welfare agencies, empowered by the
Canadian state, rapidly increased the rates of adoption from reserve communities as public
support for the residential school system began to rescind (Alston - O’Connor 2010). Under
the guise of acting in the best interests of the child, state agents could still remove children
7 This pattern has many names: sixties scoop, millennium scoop, etc. The argument for not calling
this pattern the ‘sixties’ scoop is to draw attention to the fact that this pattern persists to modern day. To
refer to this pattern as the ‘sixties’ scoop, according to some scholars, would imply that this is only specific
to the 1960 -1969 period of time.
25
from their families without having to physically send them to a school. Removing children
early enough from the home and community meant that they would not have an opportunity
to learn aspects of cultural knowledge and Indigenous identity. Children entering the system
had the possibility of being placed in distant communities, provinces or across borders, away
from community and culture. It had been later determined that an alarming number of
Indigenous children’s experiences of transracial adoption were subjected to physical,
emotional, verbal and sexual abuse (Hanson n.d). This approach to assimilation came at a
cost, as transracial adoption effects “fill the entire spectrum from deleterious outcomes that
include homelessness, addictions, incarceration, and suicide” (Sinclair 2007:4).
In 1959, it was recorded that only 1% of the youth state wards were of Indigenous
origin: by the 1960’s, 30 – 40% of all wards of the state were comprised of Indigenous
children (Alston-O’Connor 2010) leading to the labeling of this time period as the ‘Sixties
Scoop’ of Indigenous children by state authorities from their communities . The peak of the
adoption patterns took place from 1960 to 1970, however, from 1971 – 1981, the number of
‘status Indian’ adoptions in Canada was still high (Johnston 1983). Unfortunately, this is not
just a vestige of the colonial past – today, while Indigenous youth represent 5% of the total
youth population in Canada, nearly 50% of children currently in state care are of Indigenous
ancestry (Barker, Taiaiake, and Kerr 2014).
Scholars have noted that the knowledge vital to creating family situations of
competency, interconnectedness and capability had been severely damaged by institutions
that punished Indigenous families for not adhering to the ‘civilized’ way of childrearing
(Barker et al. 2014; Johnston 1983; Lavell-Harvard and Corbiere Lavell 2006; Simpson
2006b; Sinclair 2007). Social workers who had the power to remove children from homes but
26
lacked information concerning cultural differences in childrearing often made ill informed
decisions concerning the removal of Indigenous children. The social workers who practiced
at the time of the sixties scoop were unequipped with cultural information concerning
Indigenous ways of life, which led to gross misinterpretation: From an alternative way of
caring for children to what appeared to social workers to be a total lack of care (Fournier and
Crey 1997; Sinclair 2007). Kline (1994) demonstrates how interpretational difference of care
has severe consequences for the apprehension of children:
When social workers entered the homes of families subsisting on a traditional
Aboriginal diet of dried game, fish, and berries, and didn’t see fridges or cupboards
stocked in typical Euro – Canadian fashion, they assumed that the adults in the home
were not providing for their children. (Hanson n.d:1)
This particular example is a demonstration of how families who resisted pressures to
assimilate into ‘contemporary, modern’ society were subjected to state sanctions, and risked
the removal of children from their care. According to Kline (1994), childrearing was thought
to be the collective responsibility of the community within Indigenous cultures, contradicting
the Eurocentric idealization of the ‘nuclear family’ model. Shared approaches to care were
viewed as neglect and justification for child apprehension.
The Sterilization of Indigenous Women in Canada
Removing children from culture involved removing children from their families and
communities, through the implementation of the residential school system as well as
transracial adoption patterns. A disproportionate effect of assimilation process were enacted
upon Indigenous women as cultural reproducers. However, assimilation tactics also were
aimed at Indigenous women as biological reproducers through medical sterilization as a
means of population control, often conducted without adequate consent, under anesthesia, or
27
following childbirth. Sterilization was a measure to ensure that that the transmission of
traditional knowledge systems did not extend beyond the current generation.
Sterilization is a practice of eugenics, a term made popular by Francis Galton in 1883
(Black 2003; Haller 1963; Kevles 1985) and can best be described as a scientific method for
improving ‘traits’ associated with particular races, or encouraging the reproductive longevity
of those races with traits considered ‘best stock’ (Stote 2015c). Galton attributed traits
associated with the middle to upper classes – for example, intelligence, overall positive
health, and the accumulation of wealth – as not purely circumstantial privilege, but as
inheritable, and indicative of a more advanced evolutionary performance. Conversely, he
argued that traits ‘emblematic’ of the poor – such as poverty, precarious labour status, and
illness– were just as inheritable as those of ‘evolutionary advanced’ sections of society (Stote
2015c). Galton thus argued, to ensure that negative traits do not migrate into other, more
advanced populations within society, it is imperative to impose reproductive restriction on
those deemed ‘unfit’ to reproduce (Stote 2015b).
From a critical perspective, eugenics is best seen as a theoretical justification for
controlling and regulating the reproductive capabilities of women from marginalized races
and classes. This is especially concerning, considering sterilization was primarily enacted on
women who are deemed, by a hegemonic power structure that preferences certain racial and
economic attributes, as morally unfit, mentally incapable, or of lower socioeconomic status.
Mothers as the reproducer of ‘race’ biologically, and through their teaching of cultural
knowledge, were the target of eugenic practice (Stote 2015). Stote presents the theory of
eugenics as a racist ideology, as it “denies the humanity of those being oppressed, blame[s]
28
individuals for their miserable conditions, and divert[s] oppression away from those doing
the oppressing” (2015:11).
Trombley’s (1988) research on the eugenics movement in North America situated
medical sterilization as a eugenic practice, providing seven distinct guidelines that determine
if medical sterilization is coercive:
(1) Deception (sterilization during the course of another medical operations, or telling the
victim that the operation was for appendicitis or some other medical condition);
(2) Undue pressure (offering sterilization as a condition of parole or release from an
institution);
(3) Threats (withdrawal of social benefit);
(4) Violation of the principle of informed consent (sterilizing persons such as minors or
the mentally [deficient] who cannot give a legal informed consent);
(5) Lying about the procedure (telling the victim that is reversible);
(6) Failing to explain the procedure fully or in a language the patient understands;
(7) Pressing it upon someone who had not voluntarily sought it. (165)
Using these criteria, Trombley argues that the majority of medical sterilizations that
occurred in Indigenous populations was ‘coerced.’ Physicians utilized fabricated information
and deceit to obtain signatures for sterilization procedures (Pegoraro 2015). Pegorago (2015)
contended that sterilization was not just about racism, it also revealed institutional healthcare
practice rooted in patriarchal medical authority as many of those involved in the
maintenance, screening and regulation of sterilization cases rarely looked further than a
doctor’s signature for consent to sterilize women in their care.
The Sexual Sterilization Act was passed in British Columbia in 1933, and earlier a
comparative policy in Alberta in 1928, both of which afforded a legal route for principals of
29
residential schools to sanction the sterilization any Indigenous woman under their care
(Annett 2010). In Hidden No Longer, Rev. Kevin Annett contends that principals of these
schools were tasked, in the eyes of the state, as the legal guardians of the children in their
care and therefore were the decision-making authority. Thus, it was reported that Indigenous
female children could be sterilized as they reached reproductive age (Annett 2010).
Sterilizations were being committed in institutions complementary to the residential schools,
most notably in the ‘Provincial Training School for Mental Defectives’, later named the
Michener Centre, in Red Deer, Alberta and the Ponoka Mental Hospital in Ponoka, Alberta
(Stote 2015). In British Columbia, other facilities included Nanaimo Indian Hospital, WR
Large Memorial Hospital, and the King’s Daughters clinic (Stote 2015). The total population
of Indigenous people for the two provinces at the time of this legislation were between two
and three percent, yet, Indigenous women comprised six percent of all cases presented to the
Eugenics board (Grekul, Krahn, and Odynak 2004). Further, they were the largest population
of cases deemed ‘mentally defective’ by the medical staff recommending sterilization.
Grekul et al (2004) further states that out of every case of sterilization involving an
Indigenous woman presented to the Alberta Eugenics Board, 74% concluded with
sterilization approval. Annett also contends that there were an array of justifications for the
sterilization of Indigenous women, aside from communities that occupied resource rich
geographical areas (Stote 2015). These included Indigenous women who actively resisted
tactics of assimilation into Canadian society, those who did not attend church regularly, or
those who married ‘non-Christian’ Indigenous men.
The sterilization of Indigenous women as an act of maternal cultural genocide curtails
the physical reproduction of a peoples. The intentional targeting of Indigenous women for
30
sterilization, as opposed to men, is best explained by patriarchal medical authority and racist
attitudes about Indigenous women as unfit to reproduce and properly parent.
CONTEMPORARY COLONIAL
Health Disparities
Birthing is an act shaped by the endless violence perpetrated on women through
genocidal acts of unconsented sterilization, the removal of children from their family home,
the removal of children from homes and into residential schools. For many scholars who
reflect on the role of Indigenous motherhood, they reflect upon birthing as a site of
reclamation, Indigenous knowledge and cultural resurgence. Encompassing a battle on
multiple fronts, the resurgence of Indigenous cultural knowledge can be fought without
violence. Birth as a natural, traditional, cultural, and autonomous process, is in itself a
resistance to colonization. As more women claim ownership of their birthing experiences,
they reclaim traditional methods of birth, health and culture that with collaboration with
health care institutions, create the possibility to decolonize childbirth and provide alternative,
more culturally appropriate models of care.
The processes of colonization produces negative effects on both the physical and
mental health of those who are targeted. Indigenous people in Canada face an augmented rate
of health disparity when compared with settler populations. For the purposes of this research,
health disparities are defined as “indicators of a relative burden of disease on a particular
population [...] health disparities are directly and indirectly associated with or related to
social, economic, cultural and political inequities; the end result of which is a
disproportionate burden of ill health and social suffering [...]” (Adelson 2005:45).
31
In relation to physical health, Indigenous communities broadly face higher rates of
hypertension (Marrone 2007; Whitty-Rodgers et al. 2006), obesity (Stout, Kipling, and Stout
2001; Marrone 2007; Wahi et al. 2013), type 2 diabetes (Adelson 2005; Bourassa et al. 2005;
Stout et al. 2001; Marrone 2007; Wahi et al. 2013; Whitty-Rodgers et al. 2006),
cardiovascular disease (Bourassa et al. 2005; Marrone 2007; Wahi et al. 2013) and higher
rates of cancer (Bourassa et al. 2005; Marrone 2007). Indigenous people are also more likely
to experience poor mental health, such as elevated rates of depression (Adelson 2005;
Marrone 2007; National Collaborating Centre for Aboriginal Health 2010; Wahi et al. 2013)
and suicidal ideation (Adelson 2005; Bourassa et al. 2005; Marrone 2007). The multifaceted
physical, behavioral and mental health inequities result in life expectancy rates that are lower
than the national average, with Indigenous communities experiencing mortality rates that are
six times higher than the national average (Bourassa et al. 2005).
In relation to pregnancy, birth and motherhood, health disparities are also
considerable. In comparison to settler populations in Canada, these disparities include high
rates of teen pregnancy8 (Stout et al. 2001; Garnier, Guimond, and Senecal 2013; Van Herk
et al. 2014), fetal alcohol spectrum disorder (Salmon 2010; Van Herk et al. 2014), infant
mortality (Adelson 2005; M. Battiste 2011; Birch et al. 2009; Olson 2016b; Van Herk et al.
2014), sudden infant death syndrome (Birch et al. 2009; Van Herk et al. 2014) gestational
diabetes (Battiste 2011; Marrone 2007), as well as higher birth weights in newborns, which
places infants at risk during the delivery process (Adelson 2005; Battiste 2011; Marrone
2007).
8 While young pregnancy is not necessarily a disadvantage in Indigenous societies, the
socioeconomic disadvantages associated with having children at a young age proves difficult for young
women to contend with.
32
Research has shown that Indigenous communities are more likely to exist in
geographically remote spaces (Battiste 2011; Birch et al. 2009; Kornelsen et al. 2011;
Marrone 2007; National Collaborating Centre for Aboriginal Health 2010; National
Collaborating Centre for Aboriginal Health 2012; Olson 2016; Salmon 2010). Lack of
proximity to an urban centre reduces access to healthcare services, making health inequities
doubly burdensome (Stout et al. 2001; Marrone 2007; Olson 2016). In relation to birth, rural
and remote Indigenous women are forced to evacuate their homes and communities, to give
birth in locations in centralized hospitals. Often, these areas are a considerable distance from
their home communities.
Health inequities are directly influenced by socioeconomic status, and there is an
established link between poor health and poverty. For Indigenous communities, indicators of
poverty, such as substandard housing (Stout et al. 2001; Garnier et al. 2013; National
Collaborating Centre for Aboriginal Health 2010) unemployment, low income, and
precarious work situations (Adelson 2005; Battiste 2011; Garnier et al. 2013; National
Collaborating Centre for Aboriginal Health 2010; Whitty-Rodgers et al. 2006), and lack of
educational opportunities due to institutional discrimination (Adelson 2005; Garnier et al.
2013; National Collaborating Centre for Aboriginal Health 2010) which all foster conditions
in which poverty becomes a key factor in poor health outcomes. Social, cultural and political
conditions, brought upon by colonialism, create an environment of inequality, othering and
difference. This, in turn, allows for poverty to flourish, which has a profoundly negative
effect on health and wellbeing.
A gender lens reveals that Indigenous women tend to bear the brunt of socioeconomic
disadvantage and poor health outcomes compared to their male counterparts. As a result of
33
the combined effects of racism and sexism within a patriarchal society (Adelson 2005;
Bourassa et al. 2005; Lavell-Harvard and Lavell 2006; Van Herk et al. 2014), Indigenous
women face greater health disadvantages than men (Adelson 2005; Bourassa et al. 2005;
Stout et al. 2001; Van Herk et al. 2014). Research shows that Indigenous women experience
higher rates of poverty (Adelson 2005; Lavell-Harvard and Lavell 2006; National
Collaborating Centre for Aboriginal Health 2010). Additionally they are more likely to
experience sexual abuse and domestic violence (Adelson 2005; Battiste 2011; Bourassa et al.
2005, 2005; Salmon 2010; Wahi et al. 2013), with the mortality rate of fatal domestic
violence incidents being five times higher than the national average for non-Indigenous
women (Stout et al. 2001). Instead of understanding these outcomes as a part of a broader,
systemic experience, Indigenous women are often blamed for their own circumstances and
for engaging in high risk behaviours (Battiste 2011).
This legacy of trauma, and contemporary relations of gender and race, contributes to
conditions of health inequity for Indigenous mothers today. The link between colonialism
and poor health outcomes is vital to understanding the lived experiences of Indigenous
mothers in accessing health services, as they may require them more due to health inequity,
and as they are indicative of an ‘other’ in a system of whiteness and Eurocentric dominance.
Indigeneity, Motherhood and Birth
Contemporary continual colonial relations related to birthing are marked by
higher rates of child protection birth alerts in Indigenous populations in Canada compared
to non-Indigenous populations. Birth alerts are used as a means to notify relevant local
child protection agencies that a high-risk mother has delivered her child (Child Protection
Branch 2009) A birth alert calls into question the mother’s capabilities in caring for the
34
child, and she must then undergo an assessment to determine if she is considered capable
of parenting. Birth alerts are issued when the agency determines that there are legitimate
concerns regarding the woman’s ability to parent, and whether state action is required to
remove a child from potentially dangerous or unstable situation (Child Protection Branch
2009). Those who end up on this list are: Mothers who are under the age of majority,
mothers who have had previous interaction with child protection agencies, mothers who
have not sought out prenatal services, mothers with previous history of drug addiction,
and mothers who have experienced prior housing insecurity of homelessness (CBC News
2018). If a person has had a child apprehended in the past, any subsequent pregnancies
with be issued a birth alert.
Indigenous women’s concerns about birth alerts has received national attention in
the media recently in both radio (Canadian Broadcasting Corporation show The Current)
and print media (Macleans Magazine) highlighting the barrier to healthcare access such
alerts may cause9
Indigenous communities are experiencing sustained levels of interference from
Child Protection Services, and the use of birth alerts ensures that this begins at birth.
Currently, there are more Indigenous children in government care today than at the height
9 On CBC’s The Current, Anna Marie Tremonti interviewed a young Indigenous mother who
expressed concern with her unborn child being placed into care (Tremonti 2018). Her son was apprehended
when she was 16 years old – a time where her circumstances were different. The child’s father was in
trouble with the police, and they’ve since separated. She expressed concern that her past will be reason
enough to justify her unborn daughter to be taken from her shortly after birth (Tremonti 2018)
Maclean’s spoke with an indigenous mother who will deliver at home, unassisted, to ensure that
her newborn isn’t taken into care (Edwards 2018). Two years prior, her newborn daughter was taken away
from her. She had an open file with Child Protection Services, after leaving a violent relationship and living
in a homeless shelter until she was stable. She is convinced that her past will follow her, and by birthing
outside of the institution, she will not have to interact with Child Protective Services and risk her child
being taken into the system (Edwards 2018).
35
of the residential school system (Edwards 2018). Further, the systematic underfunding of
child, health and social services in indigenous communities exacerbates issues that affect
the ability for parenting supports to be available (Edwards 2018). Rather than taking an
approach that emphasizes early intervention and competency building with appropriate
supports, Child Protection Services are apprehending children and putting them in foster
care.
Birth alerts are carried out and facilitated by health care institution and in so hospitals
are a state apparatus of colonial social control. Allen (2006) documents how the
characteristics of white supremacy aligns with health care institutions, writing:
The ‘whiteness’ and class privilege of our heath care institutions are equally well
documented. Whether one looks and the internal hierarchies (which get whiter,
masculine and wealthier at the top), issues of access, quality of care within the
system’s current priorities (profitable intensive intervention instead of prevention and
public health), there is a remarkable consensus: Clinically and economically, the
healthcare system serves white, corporate interests, and nursing participates in and
benefits from this alignment. (P.72)
Several authors have stressed how the discriminatory attitudes of health practitioners have a
profound effect on the quality of healthcare Indigenous people access (Allen 2006; Birch et
al. 2009; Browne et al. 2005; Stout et al. 2001; Van Herk et al. 2014). It has been noted, both
in the Canadian and international contexts, that there is a distinct lack of culturally
appropriate, or Indigenous governed health services (Adelson 2005; Birch et al. 2009;
Bourassa et al. 2005; Stout et al. 2001; Kornelsen et al. 2011; National Collaborating Centre
for Aboriginal Health 2012; Olson 2016; Van Herk et al. 2014). Research has demonstrated
that mainstream health services often lack understanding of the sociopolitical and historical
contexts of Indigenous people, and fail to recognize communication barriers aligned with the
medical model of care (Adelson 2005; Birch et al. 2009; Browne et al. 2005; Stout et al.
2001; Marrone 2007; Van Herk et al. 2014). Differences in ideas concerning health, illness,
36
and treatment often produce situations in which Indigenous people feel scrutinized by health
professionals, as negative stereotypical depictions often inform health care practitioners’
ideas about Indigenous populations. This ill-informed, subtle racism borne by health
practitioners can produce harmful effects to individuals and communities alike. For example,
stereotypical associations of Indigenous people and alcohol abuse led to the death of a 34-
year-old man in Manitoba in 2008 at the hands of health practitioners who, instead of
processing him for a blocked catheter and a routine bladder infection, made him wait in
emergency for 34 hours because staff thought he was ‘sleeping it off’.10 Indigenous women
have had their health problems ignored or misdiagnosed, due to the symptomology being
close to what would be experienced through substance withdrawal (Kurtz 2011). Indigenous
women who access health services for their children face scrutiny by healthcare practitioners
because of the stereotypical depiction of Indigenous mothers as ‘bad mothers’ and ‘bad
parents’ (Battiste 2011; Lavell-Harvard and Lavell 2006; National Collaborating Centre for
Aboriginal Health 2012; Salmon 2010). The impact of ill-informed racist ideologies of
people in positions of power, including health practitioners can cost lives, can separate
families unnecessarily, and is crucial to address in the wake of decolonizing care institutions.
In response to colonial relations in hospital settings, health researchers, scholars
and health advocacy groups have made recommendations, including standards of culturally
competent and sensitive care. Among those recommendations is an emphasis on self-
governing processes of health for Indigenous communities, with a focus of reclaiming
traditional culture through the use of medicines, healing practices, ceremonies and a guiding
Indigenous ideology (Acoose et al. 2009; Adelson 2005; Stout et al. 2001; Kirkham and
10For more information on Brian Sinclair’s story: http://www.cbc.ca/news/canada/manitoba/brian-
sinclair-inquest-told-aboriginals-face-racism-in-ers-1.2670990
37
Anderson 2002; Kornelsen et al. 2011; Lavell-Harvard and Lavell 2006; Olson 2016;
Simpson 2006; Van Herk et al. 2014). In relation to using traditional practices, there is an
emphasis on using the medicine wheel as a means of understand and providing appropriate
health care. The teachings of the medicine wheel, while varying in definition according to the
users, had been a useful approach to addressing multiple quadrants of care. In Indigenous
culture, everything in life is interrelated. Regarding health, the medicine wheel suggests that
multiple quadrants of health have to be considered in order to address the full extent of health
and illness. Elaborating further:
The four directions of the wheel provide a framework for exploring assessment and
intervention from a holistic perspective. The medicine wheel can be used to illustrate
a life journey, as each person takes many turns around it. [...] (Clarke and Holtslander
2010:2)
Regarding birth, Battiste (2011) applied a human wholeness medicine wheel to frame her
participants narratives around birth. Specifically, she states:
The medicine wheel conceptual framework has been used by many First Nations
cultures in Canada as a means of obtaining culturally appropriate [...] organizations
frameworks for explaining issues in health and healing [...] The medicine wheel is
comprised of four quadrants within a circle; the circle representing the circle of life
and each quadrant equally contributes to a healthy balance. The four quadrants can
represent many things, seasons, life stages, earth elements, and human wholeness.
The medicine wheel is meant to show Indigenous worldview that organizes and
compartmentalizes themes without isolating them into separate quadrants. No matter
how they are applied, the four quadrants work together to create harmony in the mind,
body and spirit. [...] being balanced in all for quadrants of the medicine wheel is key
to maintaining a healthy lifestyle in First Nations culture. (19)
Human wholeness or balance includes the physical (reality, tangible, continuous). The
emotional (feelings, self-reflections, sensations, inner-most thoughts), the mental
(thoughts, teachings, lived experiences, beliefs, values) and the spiritual (intangible,
creator divinity, spirit, ideology) [...]. (Battiste 2011:20)
There are also recommendations that call for healthcare delivery to become more
sensitive and considerate of the distinctiveness of Indigenous peoples, including a formal
38
acknowledgement of historical oppressions (Adelson 2005; Allen 2006; Birch et al. 2009;
Stout et al. 2001; Kornelsen et al. 2011; Wasekeesikaw 2009), supplementing health
practitioner education with information concerning colonization (Allen 2006; Birch et al.
2009; Olson 2016b; Van Herk et al. 2014; Wasekeesikaw 2009; Woods 2013), a call for
reflexivity, respect for Indigenous cultures and an understanding of cultural difference and
unequal power relationships as healthcare providers (Allen 2006; Birch et al. 2009; Dion
Stout et al. 2001; Van Herk et al. 2014; Wasekeesikaw 2009). Finally, and perhaps the most
common recommendation in the literature is a focus on the amalgamation of western,
biomedical knowledge frameworks with Indigenous knowledge frameworks concerning
health (Acoose et al. 2009; Adelson 2005; Allen 2006; Battiste 2011; Birch et al. 2009; Stout
et al. 2001; Lavell-Harvard and Lavell 2006; Marrone 2007; National Collaborating Centre
for Aboriginal Health 2012; Olson 2016; Wasekeesikaw 2009). This recommendation further
suggests that multiple frameworks of knowledges are equally valid, applicable to the overall
promotion of health and wellness, and can compensate for when one framework is incapable
of addressing the complexities of a particular health issue.
Health is a multifaceted concept. Addressing health issues in marginalized
communities requires a firm understanding of the sociopolitical and historical contexts that
contributes directly to health outcomes. In relation to understanding birth experiences of
Indigenous women in contemporary hospitals, it is equally important to understand historical
effects of colonization specific to Indigenous mothers. The prior effects of colonization and
the residual effects largely felt today by Indigenous communities have obfuscated the process
of traditional birth and alienated it from the governance of Indigenous communities.
39
Indigenous women mostly give birth isolated from their communities, and within conditions
that may not be conducive to traditional Indigenous birthing practices.
40
41
CHAPTER 3: Theoretical and Methodological Perspectives
In this thesis explored urban Indigenous women’s birthing experiences in Nova
Scotia, and centered around specific research questions: What are the current experiences of
maternity care for Indigenous women living in urban Nova Scotia?; Do these arrangements
meet the needs of these women?; What are the successes and challenges that these women
face as a result of accessing and interacting within this context of care?; and, What would a
‘decolonized’ birthing experience look like? This inquiry was framed by the Indigenous
theoretical concept of two-eyed seeing that is used to examine pressing health and social
problems experienced by Indigenous people, as well as postcolonial and Indigenous feminist
theory. In this chapter, I outline the theoretical and methodological perspectives employed in
this thesis, as well as sociological and Indigenous theories used to understand women’s
birthing experiences. I also detail the research approach used for data collection and analysis.
TWO-EYED SEEING
Societal dialogue concerning birthing practices has been rife with disagreement on
how to best manage birth. One cannot deny the advantages presented by medical care during
birth: Women with high risk pregnancies can take advantage of highly trained practitioners
and specialized environments that allow lifesaving interventions to occur. Conversely, one
can recognize the inherent value associated with other frameworks of birthing knowledge and
practice that account for the physical, emotional, mental and spiritual well-being of both
mother and child, and are best suited for routine birthing. How, then, can multiple systems of
knowledge exist without residing in a constant state of competition for legitimacy?
Two-eyed seeing, an Indigenous theoretical framework conceived by Mi’kmaw
Elders Albert and Murdena Marshall, asks that we layer our knowledge of a particular topic
42
with “all of our understandings,” so as to not exclude the opportunity to strengthen our
knowledge of a subject with multiple informed perspectives (Martin 2012). Two-eyed seeing:
Adamantly, respectfully and passionately asks that we bring together our different
ways of knowing to motivate people, Aboriginal and non-Aboriginal alike, to use all
our understandings so that we can leave the world a better place and not compromise
the opportunities for our youth (in the sense of Seven Generations) through our own
inaction. (Martin 2012:11)
This framework embraces the contributions of both Western and Indigenous frameworks of
knowledge to understanding complex issues such as those related to health and wellness.
Proponents of two-eyed seeing contend that Indigenous ways of knowing are generally
discredited, and often excluded. Ways of knowing in relation to health broadly, and birthing
specifically in Western cultures have been dominated by biomedical science. Medicalized
knowledge presupposes a certain standard of rigor, associated with positivist assumptions
about what is considered a ‘scientific’ explanation of health. This standard is seen as
legitimate and supported through many institutional demands for reliable and duplicatable
evidence. As Martin describes, Indigenous health frameworks are critiqued in opposition to
medical science for lacking credibility due to their ‘unscientific’ nature (Martin 2012:25).
The tendency for individuals to rely solely on medical scientific knowledge makes it more
likely for alternative frameworks of health knowledge to be disregarded.
Health issues within Indigenous communities are increasingly complex, and largely a
result of social, political and economic relations, and as such, needs solutions beyond
medical ones. This framework asks us to think critically about how knowledge is created, and
who controls the ability to produce and access knowledge. Two-eyed seeing suggests that in
order to broach the multifaceted aspects of knowledge production, we need to first see
through both eyes. To elaborate, Martin (2012) suggest that:
43
Two-eyed seeing stresses the importance of being mindful of alternative ways of
knowing (multiple epistemologies) in order to constantly question and reflect on the
partiality of one’s perspective. It values difference and contradiction over the
integration or melding of diverse perspectives, which can result in the domination of
one perspective over the others. As a result, one “eye” is never subsumed or
dominated by the other; rather, each eye represents a way to see the world that is
always partial. When both eyes are used together, this does not mean that our view is
now complete and whole, but a new way of seeing the world has been created – one
that respects the differences that each other can offer. (P. 31)
A two-eyed seeing theoretical approach recognizes that knowledge is never a static entity,
but interrelated, and continually adjusting in response to how the world changes. Matter is in
a constant state of flux, and as such, our perspectives must adapt with this shift. Two-eyed
seeing offers a way to reshape our understanding of knowledge production and allows us to
look at social problems using multiple perspectives. It is acknowledged that while Western
and Indigenous thought are distinct epistemological frameworks, they each provide an
incomplete view on reality. When combined, these frameworks can offer a more complete
understanding of a variety of issues, and can produce new theoretical perspectives that could
not have been cultivated by looking through “one eye only” (Martin 2012). Two-eyed seeing
is the primary theoretical perspective employed in this research. It is employed to understand
Indigenous mothers’ experiences of birth within healthcare settings that are typified largely
by biomedical frameworks of maternity care management.
There are scholars who call into question the utility of the two-eyed seeing
framework. Those critical of two-eyed seeing contend that western, or mainstream modes
of inquiry are distinct systems that are perhaps too different to complement the mutual
learning process (Bartlett and Hogue 2014; Bartlett, Marshall, and Marshall 2012;
Hatcher et al. 2009) For example, Indigenous knowledges generally do not separate
physical and spiritual aspects in science. Critiques express concern with how this would
integrate into a western system that firmly embraces the distinction between science and
44
spirituality (Hatcher et al. 2009). Further, the idea of ‘equality’ in two-eyed seeing would
be difficult to achieve, as written material produced by this framework would either have
to be in English or Mi’kmaw language. The likelihood of these articles being written in
English means that while there is an integration of knowledge, there lacks a true equal
immersion of these concepts due to the inherent language/concept barriers (Bartlett et al.
2012). A two-eyed seeing framework does not exist in isolation, but in relation to funding
structures, timelines and expectations of ‘product’. Collaborations using a two-eyed
seeing framework would still, in theory, have to abide by the demands of a finished
product and a projected timeline, which may not fit in with Indigenous ideologies or
priorities (Bartlett and Hogue 2014). Finally, in relation to meaningful collaboration, both
sides must commit to undertaking the work necessary to learn about difference, and work
alongside individuals from different backgrounds and ideas. Often, the commitment to
this method is more than those involved are willing to undertake.
These critiques aside, two-eyed seeing is a solid theoretical perspective for this
research, while understanding the challenges in employing this theory, I contend that for
these women, the knowledges that we are collectively trying to bridge are not unfamiliar
to them as indigenous women who have undergone western schooling and interacted with
western systems. Using this theory acknowledges Indigenous culture and encourages the
understanding of culture as essential to the birthing process, while acknowledging that the
space in which it is contained is informed by western knowledges.
POSTCOLONIAL THEORY
This thesis also employed postcolonial theory to position this research as a critique
of racialized ideology in the Canadian context. Postcolonial theory has historically been used
45
to explain matters related to colonialism, identity, race, ethnicity and global structures of
inequality (Go 2013). Additionally, postcolonial theory is also defined as a body of literature
that provides a critique of the structures that sustain Western colonialism and its respective
effects on colonized populations (Go 2013). For the purposes of this research, postcolonial
theory is conceptualized as “a family of theories sharing a social, political and moral concern
about the history and legacy of colonialism – and how it continues to shape people’s lives,
well- being and life opportunities” (Young 2016 cited in Browne et al. 2005:19). A
postcolonial theoretical perspective maintains several fundamental requirements: to examine,
and remain cognizant of the experiences of colonialism and its effects in a contemporary
context, to provide a critical analysis of the experiences of colonialism and the multiple
realities faced by colonized populations, to purposefully undermine aspects of dominant
culture and incorporate marginalized views to become the initiation site for knowledge
creation, to expand upon the process by which ‘race’ becomes conceptualized within culture,
with attention being paid to how these concepts are constructed within historical and current
colonial realities (Gandhi 2003; Kirkham and Anderson 2002; McConaghy 2000).
Postcolonial theory, while attempting to explain the effects of colonialism on
Indigenous communities in Canada, is not absolved of criticism. One particularly strong
point of criticism stems from the assumption that postcolonial theory creates conceptions
based on a false binary, or an inherent and non-negotiable opposition. It is argued that this
leads to a false distinction between who is considered to be colonized and who is the
colonizer (Go 2013; Hall 1996; Narayan and Harding 1998), which has the ability to
eliminate important analytical identifiers such as social location, capacity for agency and
resistance, experience, diversity and distinction (Gandhi 2003; Hill Collins 2000). Browne,
46
Smye, and Varcoe (2005) argue that context must be taken into consideration when
employing a postcolonial framework, as there are “varying degrees of penalty and privilege,
depending on the context and situation” (Hill Collins cited in Browne et. al, 2005:24).
While taking critiques of postcolonial theory into consideration, there are inherent
strengths in employing this theoretical framework in this research. Spivak (1992) contends
that “we live in a postcolonial, neo – colonized world” – asserting firmly that the culture
implemented by settler colonialist ideology has persisted to modern day, and helps to sustain
an inequitable distribution of power within society (P.190). While recognizing, as critics
argue, that context matters in how colonial relations are experienced, a postcolonial
theoretical perspective allow for revealing structural determinants of colonial relations that
shape health experiences and outcomes. Utilizing postcolonial theory draws attention to the
inequities faced as a result of colonialism while simultaneously building a theoretical
structure capable of addressing “how health, healing and human suffering are woven into the
fabric of the socio – historical – political context” (Browne et al. 2005:19). I employed
postcolonial theory as a means to highlight the pervasive consequences of colonization to
colonized communities, and how this affects birthing as a particular aspect of the everyday.
INDIGENOUS FEMINISMS
This research also employs an Indigenous feminist theoretical lens to the topic of
decolonizing birth. I distinguish between capital F feminism11 and Indigenous feminism. I
contend that the mutually reinforcing patriarchal, colonial framework in which we, as
11 Here, I equate capital F feminism with the overarching, hegemonic discourses of white
feminism, or any conceptions of feminism that is not wholly inclusive of contributions and critiques from
WOC, transgendered women, among others.
47
inhabitants of Turtle Island,12 experience has built its foundations of power on intersecting
oppressions of race, gender and class. A theory of feminism that is truly intersectional, as
opposed to capital F feminism, is important for the framing of this thesis.
Indigenous feminism “[...] seeks an Aboriginal liberation that includes women,
and not just the conforming woman, but also the marginal and excluded women, and
especially the woman who had been excluded from her community by colonial legislation
and sociohistorical forces. [...] Aboriginal feminism is a theoretical engagement with history
and politics, as well as a practical engagement with contemporary social, economic, cultural
and political issues” and “[...] interrogates power structures and practices between and among
Aboriginal and dominant institutions” (Green 2007:25). Thus, I draw on Indigenous feminist
theory are employed in this thesis to highlight the multiple ways in which a patriarchal
society, or “the domination of males in positions of authority – political, economic, legal,
religious, educational, military and domestic” (Johnson 1997:5), affects all women, but in
ways particular to Indigenous women. Thus for the purposes of this research, the working
definition of colonization used is one that includes patriarchal relations, defined as “the
appropriation of sovereignty, lands, resources and agency, and has included the imposition of
western and Christian patriarchy on a peoples” (St. Denis 2007:45).
Women in Indigenous communities may be hesitant to prioritize issues of gender
inequality over the need for social, political and economic liberation from systems supported
by white supremacy. Many leaders of Indigenous communities view feminism as another
extension of colonial ideology, and, in embracing feminism, those who support it are
12 When I say Turtle Island, I am referring to the name that certain Indigenous groups use when
referring to Continental North America. For further reading on the origin story of Turtle Island, please refer
to http://www.manataka.org/page1302.html.
48
destroying the foundations of nations (hooks 2010; Maracle 1996; Smith 2007; St. Denis
2007). Other scholars mention the invisibility of Indigenous women under feminism, akin to
the experiences of women of colour (Green 2007b; Stewart - Harawira 2007). Other scholars
contend that the teachings of feminism contradict traditions that insulate gendered practices,
such as taboos concerning menstruation, or donning traditional skirts for ceremonial practices
(LaRocque 2007). Others say that feminist conceptions concerning gender roles fail to
account for the multiple explanations of gender in Indigenous communities (St. Denis 2007).
Some Indigenous scholars state that Indigenous cultures seek to maintain the uniqueness of
male and female bodies, as well as male and female roles. Therefore it is difficult to justify
fighting for equality when in their cultural context, they have already achieved it, or do not
exactly desire to achieve equality in the same way that mainstream feminist movements have
often defined it (Green 2007b). Also, the utility of feminism within Indigenous society is
questioned by the valorizing of maternalism and motherhood (St. Denis 2007:38). Due to the
role of motherhood being revered as a powerful position, as they are the “forbearers of the
next generation,” a feminism that assumes mothers as powerless is problematic (Simpson
2006b:26). Feminism, as has been evidenced by these critiques, has not concerned itself with
the work of carving a space for Indigenous women’s historical, cultural and contemporary
contexts.
Also argued is the necessity of feminism in the struggle against colonial practices
and, while problematic, feminism can be beneficial for Indigenous women in Indigenous
communities. St. Denis (2007) argues that the rhetoric concerning the pre-contact
canonization of women as powerful in Indigenous society can only be evoked in pre-contact
contexts. While traces of traditional thought concerning women’s revered positions are
49
evident, longstanding contact with settler society has inculcated toxic ideologies concerning
the devaluation of women in society. While women once exercised influence in Indigenous
systems of power, knowledge, and governance, the imposition of a Eurocentric patriarchal
framework reduced the ability for Indigenous women to maintain this status (St. Denis 2007).
As LaRoque (1996) states, “we cannot assume that all Indigenous traditions universally
respected and honoured women … it should not be assumed, even in those traditional
societies, that they were structured along matriarchal lines, and that matriarchies necessarily
prevented men from oppressing women” (14). Indigenous women endure marginalization
stemming from their own community, and the patterns of marginalization has been
increasingly patriarchal since the onset of colonialism. The disproportionate rates of violence
against women, the vulnerability of women within their own societies, demonstrates that
patriarchy “is so engrained in […] Indigenous communities that it is seen now as a traditional
trait” (Deerchild 2003 in St Denis 2007:41). According to Greene (2007b), Indigenous
women have often been shamed into silence by expressing their dissent with mainly
patriarchal aspects of everyday life – band politics, distribution of resources, violence against
women and children - through claims of their dissent being informed from ‘white, colonial’
approaches that betray the traditional, gendered aspects of Indigenous culture. In identifying
as feminists, their ‘authenticity’ as an Indigenous person has been challenged, and as a result,
are likened to colonizers in their own community.
Indigenous feminism, as identified by Indigenous feminists, combines anticolonial
practices and feminism to demonstrate exactly how Indigenous peoples are affected by
colonialism and patriarchy simultaneously (Green 2007; hooks 2010; LaRocque 2007;
Maracle 1996; Stewart - Harawira 2007). Indigenous feminism establishes a relationship with
50
critical political activism that traditionally addressed issues related to patriarchal oppression
of non-Indigenous women, as well as poverty, labour, and issues of social injustice in order
to provide a more complete analysis of oppression. I employ this theoretical perspective for
two reasons. First, I use Indigenous feminist theory to situate my own theorizing of
Indigenous motherhood within the actual lived experience of Indigenous women. As
previously outlined, one of the main purposes of this research is to incorporate Indigenous
knowledge into this research framework, and employing Indigenous feminist theory is a
means to stay true to this purpose. Secondly, this theory is used to draw linkages to the way
in which the intersections of gender and race specifically affect Indigenous women within
their everyday experiences of gender and race discrimination. Capital F feminism, while
useful, is not sufficient as a theoretical tool to aid in the analysis of the narratives collected in
this research, as it does not sufficiently situate the uniqueness of Indigenous women’s
experiences in relation to non-Indigenous women. This thesis will employ Indigenous
feminist theory as a means to contextualize experiences shaped by both a patriarchal and
postcolonial oriented society which health and maternity care are a part of.
METHODOLOGY
In keeping with the two-eyed seeing approach that attempts to bridge both
Indigenous and Western knowledge systems, this research blended an Indigenous informed
methodological approach with traditional methods of qualitative inquiry. The aim of paring
of these methodological approaches is to examine the contemporary birthing experiences of
urban Indigenous mothers in Nova Scotia, in order to interrogate maternity care as a
colonizing entity. In so doing, the narratives of participants were used to explore birthing as a
site of continual colonization, as well as a potential site of decolonization. I used this
51
approach to stay true to decolonizing research priorities, which emphasize Indigenous
methods, theories and knowledge (St. Denis 2007), and to acknowledge and account for how
my outsider perspective may shape the research process and analytical interpretations of the
findings. This chapter will describe this methodological framework, and how it informed my
research strategy.
Past experiences between Indigenous communities and objective, neutral
academic researchers have resulted in social and physical harms which call into question the
utility of academic research traditions within Indigenous communities (Battiste 1998; Coburn
et al. 2013; Foley 2003; Moreton-Robinson 2014; Rigney 1999; Smith 1999). Historically,
Western, academic research has been an area of colonial reproduction through the devaluing
and colonization of Indigenous thought (Battiste 1998; Coburn et al. 2013; Foley 2003;
Hoffman 2013; Moreton-Robinson 2014; Rigney 1999; Smith 1999; Steinhauer 2002).
Indigenous scholars have fought diligently for the right to exist within the academy, to
reclaim and forge legitimacy of their knowledge and research frameworks, and push for
inclusion.13
Academic researchers who work in collaboration with socially marginalized
communities must be mindful of the power imbalance between researcher and the subject. As
scholars who support the decolonization of the academy, we must actively engage in the
dismantling of this power dynamic through meaningful collaboration and the decentering of
academic traditions of research. This has been, to a large extent, a personal negotiation, as I
identify as an outsider to the community that is being researched. I have been mindful of my
13 Certain Universities in Canada have instituted Indigenous studies programs: Aboriginal Studies
at University of Ottawa, Native studies at University of Alberta, an MA in Indigenous Governance in
University of Winnipeg, among others. There is also a First Nations University of Canada, located in
Regina, Saskatchewan.
52
privilege and potential bias, in the context of both my academic and racialized position. My
role as an outsider challenged me to work diligently to establish relationships of trust and
reciprocity with participants. The methodology outlined in this thesis aimed to minimize
researcher bias by employing Indigenous standpoint theory which centers knowledge
production from the standpoints of the participants who have a unique experience of medical
dominance and colonization. I acknowledge that these standpoints embody intersections
which shape concepts of the self through multiple axes of race, class, gender, sexual
orientation, ethnicity, nationality and ability, among others (Crenshaw 1994).
Indigenous standpoint theorists understand that knowledge production has an inherent
bias, in relation to aspects of colonization and the delegitimizing of cultural or alternative
modes of inquiry (Coburn et al. 2013; Moreton-Robinson 2014; Wilson 2001). Indigenous
standpoint theory, in alignment with other structural based theories such as feminist
standpoint theory and black feminist standpoint (Hill Collins 2000; Smith 1972) utilizes
storytelling to build an Indigenous discourse, or Indigenous centered community narrative. I
used storytelling to explore narratives of birthing from an Indigenous standpoint.
Indigenous people have been conducting research since time immemorial (Coburn et
al. 2013). Distinct Indigenous modes of inquiry became the primary means of which
Indigenous cultures learned about themselves, their relationships to others, to the spiritual
realms, and to the land (Battiste 2011; Weber-Pillwax 2001; Wilson 2001). Within the global
colonization initiative, Indigenous modes of knowledge production and inquiry were
superseeded by European modes of scientific inquiry. The utilization of science, in relation to
the controversial study of the natural traits of race, has historically positioned people of
53
colour as inferior, which justified reprehensible treatment of Indigenous populations through
colonization (Coburn et al. 2013; LaRocque 1996; Rigney 1999).
Presently, there is a cultural shift underway that recognizes the homogenization and
monopolization of knowledge production systems, and a recognition that knowledge
produced from predominantly colonial and patriarchal systems denies the existence of
multiple epistemologies. This research aimed to aid in the decolonization of methodological
inquiry as well as the decolonization of knowledge production by employing Indigenous
methods.
I acknowledge that there is differences within Indigenous communities in Canada
and globally. There are a multitude of Indigenous cultures, and varied and complex
relationships between and amongst Indigenous people. There are cultural protocols, creation
stories, oral narratives and ways of doing that are distinct and unique. What is important to
acknowledge is that while aspects of colonization are not experienced equally, the totalizing
effect of colonization is shared and a relevant part of the experience of Indigeneity. Thus,
there are common threads for employing an Indigenous methodology that aims to decolonize
research: Relationality, Gratitude, Resistance to Oppression, and the Reclaiming of
Knowledge.
Relationality
Relationality presents the idea that life is cyclical and interrelated. Actions of
individuals are meaningful and can impact multiple actors within the past, present and future.
Scholars of Indigenous methodology place emphasis on the connection to earth and spirit
(Battiste 1998; Cardinal 2002; Coburn et al. 2013; Foley 2003; Hoffman 2013; Moreton-
Robinson 2014; Steinhauer 2002; Weber-Pillwax 2001), establishing and maintaining a
54
healthy relationship to self, and a connection of solidarity to other Indigenous peoples
globally (Moreton-Robinson 2014; Steinhauer 2002; Weber-Pillwax 2001). Moreover, in
relation to the research process, several scholars discuss the collectivity of knowledge
production. In stark contrast with academic principles which suggest that knowledge can be
owned, scholars of Indigenous methodological frameworks suggest that strengthening
relationality to others means that research must be a collective pursuit (Moreton-Robinson
2014; Weber-Pillwax 2001). Instead of stating that research can be owned, it is necessary to
share knowledge amongst community.
Relationships of Trust and Gratitude
Indigenous methodologies prioritize relationship building in tandem with data
collection (Cardinal 2002; Foley 2003; Hoffman 2013; Moreton-Robinson 2014; Steinhauer
2002; Weber-Pillwax 2001; Wilson 2001). This includes taking time to build meaningful
relationships with research participants and the broader community, while respecting the
necessity for community members to be consulted and/or involved with the decision-making
processes of research projects. This ties in with the idea of relationality within research, as it
is important to remain mindful that Indigenous research methodologies are focused on
maintaining community relationships and researching community issues, as opposed to
extraction and commodification of data (Weber-Pillwax 2001; Wilson 2001). As Weber-
Pillwax (2001) claims, if the research does nothing to promote action within community, it is
neither useful nor necessary.
Research as Resisting Oppression, Reclaiming Knowledge
Research in the academy has suppressed, obscured and devalued alternative
frameworks of knowledge in the interest of maintaining exclusive claim to power over the
55
tools of knowledge production. In response to this, Indigenous scholars have fought to have
Indigenous approaches integrated and accepted as credible research methodologies. For
example, academic institutions are making attempts to incorporate Indigenous knowledges
into curriculum, as an acknowledgement of the past and as a means of reconciliation (Truth
and Reconciliation Comission of Canada 2015). This means contending with the ways in
which unequal power relations and patterns of oppression through research can further
marginalize Indigenous peoples within Indigenous communities and in the academy (Battiste
1998; Moreton-Robinson 2014; Rigney 1999; Weber-Pillwax 2001). Indigenous research
priorities must be in alignment with community research needs, with the larger goal of
resisting oppression and decolonizing Indigenous knowledge (Battiste 1998; Moreton-
Robinson 2014; Rigney 1999).
Negotiating Settler Identity and Privilege
There are scholars who speak about the role that non-Indigenous researchers play in
bolstering the position of Indigenous methodology within the academy, with some arguing
that Indigenous methodology should exclusively be employed by Indigenous peoples
(Battiste 1998; Coburn et al. 2013; Foley 2003; Moreton-Robinson 2014, 2014; Steinhauer
2002; Weber-Pillwax 2001). As a non-Indigenous researcher, I respect the claims made by
these scholars. The idea of using an Indigenous methodology as a member outside of the
community and culture raises the questions of continual colonization. According to
Stienhauer:
If an Indigenous research methodology is about Indigenous identity, then how could
this methodology be used by anyone other than an Indigenous person? How could
anyone who is not Indigenous have the Indigenous knowledge that is required, and if
non-Indigenous people do participate, then will it not remain just as it was: research
conducted on Indigenous peoples? (2002:72–73)
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In respect for this idea, I cannot, and do not claim that I am using a strictly Indigenous
methodology within my thesis. As an outsider to the community, with no prior knowledge
concerning the cultural or spiritual implications of knowledge, I do not believe that I am
capable of understanding the full implications of employing an Indigenous methodology. I,
however, incorporate an Indigenous methodological framework—to the best of my ability—
to explore the research question guided by the wisdom of the two-eyed seeing framework
that allows individuals to broach strengths and insights from multiple knowledge frameworks
in understanding how an issue, in this case birthing, is understood and experienced, in the
interest of supporting the decolonization of birth. While I did not have the ability to fully
address my positioning as the outsider within this research process, I acknowledge and
maintain that challenging my bias and privilege in relation to my racial category was at the
forefront of every methodological and analytical decision I made concerning this research.
METHODS
As mentioned, my research process was informed by an exploratory qualitative
approach to inquiry, informed by Indigenous standpoint theory to unpack the notion of
decolonized birthing. This section will detail the methods used to conduct this research, along
with a personal account of the collection and analysis of the data.
Talking Circle
Aligning with the principles of Indigenous methodology that aims to decolonize
research, I conducted a talking circle with the help of an Indigenous child development centre
coordinator (though a previously established research relationship with my supervisor) and
an Elder that I had established a research relationship with prior to this project. The research
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coordinator was instrumental in organizing the talking circle, through recruitment of
interested mothers, providing space, and childcare.
The circle was largely facilitated by an Elder. This was an intentional methodological
decision, in that I aimed to disrupt the academic tradition of putting the settler first in
research and obscured the power relationship between the researcher and the researched.
Previous research has demonstrated that academically rooted research methods – and the
rigor associated with them— can have the potential to misinterpret the narrative of
marginalized participants, by using eurocentricity as a benchmark to interpret the narratives.
The talking circle provided a space for the decolonizing power of storytelling to uncover
birthing narratives from an Indigenous perspective without predetermined researcher
questions.
Within the months leading up to the talking circle, I had established a relationship
with an Elder from a local Mi’kmaw community and had spent time seeking guidance on
how to conduct this circle with respect to cultural protocols. I had a lot to learn about process
and I was also challenged to think about how to reconcile the importance of process and my
own ideas of what constitutes as data. For example, the Elder maintained that a talking circle
was meant to be sacred, and as such, should not be recorded. This clashed with the ways of
doing research in the academy. I then suggested that, as I would not be leading the talking
circle, I could take detailed fieldnotes to suffice as enough evidence to ensure academic
standards. The Elder then explained that, according to how she conceptualizes talking circles,
fieldnotes would also prove problematic. Elaborating further, she explained that talking
fieldnotes would detract from the requirement to be present and pay full attention to the
stories shared by the women while in the circle. In this situation, I felt as though I was
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encased in two worlds: one world where the priority was ensuring that Indigenous
knowledge, methods and narrative was at the forefront of the research framework, and one
where I was required to conform to academic research traditions. This was an exercise in
building relationships of trust, and also in compromise. Upon consulting with the Elder, as
well as my thesis advisor, I came to see the talking circle as an introduction to the community
and as an opportunity to build trust, share stories and foster a sense of community.
The talking circle took place in May 2017 at the Indigenous-centered child
development centre in Halifax, Nova Scotia. In total, 10 participants took part in the circle
and two babies were present. The circle commenced with the elder smudging themselves,
followed by my sharing of the context of the research project. A sacred feather was used to
signify the person who was talking, and we went around the circle once, with the mothers
sharing their experiences of birth, and centering them in relation to their identity as
Indigenous peoples. The participants were all respectful of time. Some participants
elaborated on the stories of other speakers, and one participant in the circle chose not to
speak, but listen. The talking circle lasted for approximately one hour and finished with a
drum song. After the circle was finished, we had tea, coffee and food. During this time,
participants were invited to participate in a semi-structured interview at a later date. All of
the mothers indicated an interest in being contacted for an interview, and I placed a sign-up
sheet by the drinks and food. While the talking circle in itself revealed reoccurring themes
concerning colonialized birthing, fear, and resistance, the talking circle was more importantly
a way to connect with the community, while building trust within the circle. In alignment
with oral traditions in Indigenous cultures, the talking circle was a way to create space for
these stories to be shared across generations.
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Interviews
I conduced seven semi-structured interviews from May to September 2017 in order to
collect detailed stories and fulfil the requirement for ‘data’ akin to academic traditions. Semi-
structured interviews are defined as “[A] scheduled activity [...] open ended, but follows a
general script and covers a list of topics” (Bernard 2011:156). The interviews varied between
forty minutes to over two hours, as semi-structured interviews accommodate varied depths of
narrative. Interviews allowed each participant more time to articulate their own narratives
without the additional pressure of a time constrained group setting, and allowed for a
dialogue between the mothers and myself that complimented the stories shared during the
talking circle. The interviews helped to build my relationships with the mothers one-on-one
and they shared their experiences with me in an open and candid way. As storytelling is one
of the means by which Indigenous teachings are transported from one person to another
(Muin’iskw and Crowfeather 2007), the interview structure produced rich narratives
surrounding the experiences of childbirth.
The interview process began with an open-ended question: Can you tell me about
your birthing experience? The first question was intentional to the research design as it
allowed for a participant centered storytelling whereby each participant could begin where
they wanted. I probed for stories about the full process, including prenatal, pregnancy,
labour, and postpartum. From there, other probing areas included experiences of medical
intervention and postpartum effects, adjustment to motherhood. Then, the participants were
asked to reflect on the concept of decolonizing birthing, recalling their birthing experiences
in hospital, and the importance of their own cultural contexts within their birth experience.
The mothers interviewed were also asked to reflect on the talking circle in terms of process
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and content. All of the interviews were audio recorded with consent, and took place at
locations chosen by participants – in an effort to create an environment in which they were
most comfortable. All interviews were conducted in person and were later transcribed.
Participant Demographics
The participants in this study were mothers who self-identified as Indigenous, lived in
an urban area, and had gone through a birthing experience in a hospital setting. As these
interviews were conducted at an Indigenous child development centre, the coordinator of the
program informed me that the participants varied in Indigenous identity. The centre
welcomes women from all Indigenous communities: Mi’kmaq Maliseet, Innu, Inuit,
Mohawk, Cree, Ojibway, Salteaux and many more. While this study was originally designed
to encapsulate the experience of Mi’kmaw mothers exclusively, when I was confronted with
this diversity in participants, and on the advice of the coordinator, I included all women who
self-identified as Indigenous, recognizing that while variations of identity may influence
experience, colonialist practices are a shared experience. I will briefly describe my
participants here.
Nina is a 34-year-old woman from Labrador and was involved in the centre as a
teacher. At the time of our interview, she had two children, ages 13 and 15. Both of her
children were born in the IWK, with a doula/close friend assisting both deliveries.
Paige is a 31-year-old woman who lives in Dartmouth, and worked as a counselor for
adults with intellectual challenges. She had three children, aged 4, 2 and 13 months. Her first
delivery involved a traumatic experience that also affected her postnatal recovery. While she
delivered in hospital for all three, her second and third child were born with the help of
midwives.
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Penelope is a 31-year-old woman who lives in Dartmouth. She works as an RN for a
local hospital and had a one year old at the time of our interview. She birthed in hospital with
the help of a midwife.
Shauna is a 30-year-old woman who lived in Chester. She had three children, and all
three of her births were at the urban maternity hospital with an obstetrician managing the
care.
Janelle is a 31-year-old woman who lives in Halifax. She had 5 boys and was
pregnant with her sixth at the time of our interview. Her first two children were born in a
hospital in urban Sydney, the third was in a rural hospital in Antigonish, her fourth was in the
urban maternity hospital in Halifax, her fifth was an unexpected homebirth, and for her sixth,
she is hoping to access midwifery care.
Leann is a 57-year-old woman who lives in the Annapolis Valley, near Kentville. She
works for the Native Women’s Council of Nova Scotia. She had three children, and all were
born in a rural hospital in Middleton. She was present at the births of her grandchildren.
Fiona is a 37-year-old woman who lives in Shubenacadie with her father, sister and
son. She has one child who was born at the urban maternity hospital.
Ethics
This research project was approved by the Acadia University Research Ethics Board
(REB #1672) and by Mi’kmaw Ethics Watch, a third-party ethics committee from Unama’ki
College, Cape Breton University. All efforts were made to maintain confidentiality of those
participating in the talking circle and interviewees. In the specific case of the talking circle,
consent forms were not signed as this was not considered to be data collection. However,
participants were asked to refrain from sharing any information that they heard to those
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outside of the circle. Concerning the interviews, all efforts were made to ensure
confidentiality by stripping the transcripts of identifiers, using pseudonyms, and restricting
access to data to just my supervisor and I. The interview participants were recruited
exclusively from the talking circle, where I had a chance to introduce myself to the
participants, engage in relationship building, and foster trust through sharing stories in the
talking circle. I argue that, while not representative of the broader community, this sample
provides insight into the experience of urban Indigenous women in the local community,
which is, historically, an underrepresented group in maternal health research.
Analysis
Before analyzing the data, I transcribed each interview verbatim, excluding irrelevant
speech patterns (Ahs, Ums). Once all the interviews were transcribed, the transcripts were
inductively analyzed with the aid of the qualitative software QRS INVIVO 11. I began by
conducting open coding line by line which resulted in establishing themes in and across the
interview transcripts. According to Esterberg (2002), open coding is a method that involves
“work[ing] intensively with your data, line by line, identifying themes and categories that
seem of interest” (158). The goal of the open coding process was to gather a sense of what
this data conveyed conceptually, without imposing categories that asks the data to conform to
my preconceived notions of the topic. The open coding process helped to identifying
overarching themes, which guided a second focused coding step whereby I read the data for
these reoccurring themes. Prior to focused coding I ranked the overarching themes according
to the frequency of mentioned instances amongst the interviews. Ranking helped to
determine the most frequently discussed ideas from the perspective of the mothers, which is
how I came to determine what was important in the data. Thus, the establishment of ranked
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frequency of themes helped organize this second stage of focused coding. Focused coding,
similar to open coding, “entails going through [...] data line by line, but this time [...]
focus[ing] on the key themes [...] identified during open coding” (Esterberg 2002:158).
Chapter four presents the data organized by these themes, namely continual colonization, the
treatment of Indigenous mother in hospital setting, cultural practices of Indigenous birth, and
midwifery care and alternative birthing models.
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CHAPTER 4: Results
This chapter presents Indigenous women’s experiences of maternity care and their
perspectives on what a ‘decolonized’ birthing experience looks like. The research findings
are organized and presented by four main themes derived from the qualitative analysis of
seven interviews, namely: Context of Continual Colonization; The Treatment of Indigenous
Mothers in Hospital Setting; Cultural Practices of Indigenous Birth; and Midwifery Care and
Alternative Birthing Models. Overall the findings draw attention to the ways in which the
social consequences of continual colonization informs the mothers’ perspectives and
experiences concerning birthing. The findings also illustrate how a two-eyed seeing approach
to maternity care has the potential to address the entrenched institutional barriers to
Indigenous birthing practices experienced by mothers in urban Nova Scotia.
CONTEXT OF CONTINUAL COLONIZATION
The combined effects of the residential school system, transracial adoption
patterns, increased scrutiny from state and child welfare services, targeted sterilization of
Indigenous women, among others, produces a particular social and political context of
inequity in which birth occurs for Indigenous women. The following presents the data
concerning the effects of this colonial history on Indigenous birthing, showing that
colonization continues to frame present day experiences of birth for Indigenous women in
Nova Scotia through intergenerational trauma, the legacy of the residential school systems,
and the struggle to relate to Indigenous identities.
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Intergenerational Trauma and the Legacy of Residential Schools
How participants navigated their lives while living with the intergenerational trauma
brought on by past assimilative violence was a prominent theme in the stories. While I
acknowledge that there are other elements of assimilation that cause trauma, mothers most
frequently mentioned the Indian Residential School System as eroding culture and inducing
trauma. In Nova Scotia, the only residential school in the province was located in
Shubenacadie, approximately 35 kilometers outside of Truro. Leann offers her theory on the
relationship between residential schools and the erosion of culture:
So, it was gradual, and I think residential schools had a major role in that. Because
women were still at that point of having babies on reserve, as close to culture as they
possibly could have.
Here, Leann suggests that the removal of children from their homes and communities
removes the power of women’s influences in childrearing practices because of the lack of
opportunity for women to teach about culture. Residential schools inculcated European
knowledge concerning appropriate conduct, behavior and viewpoints, and for many of the
children in these school, was the sole means of attaining an education. When asked about
residential schools, Penelope recalls traumas recounted from relatives:
The residential schools [...] the priests who would rape these women and when they
had the babies, they would put them in the fires. And they say at the residential schools
that you can see the spirits of the little babies coming out of the chimney, because that’s
what they did.
Stories about the atrocities of residential schools have been circulating in Indigenous
communities since the inception of this system. Penelope identified the intergenerational
effects of this system, passed through storytelling and she highlights priests as abusers. Nina
specifically questioned the assimilation effects on Indigenous spirituality. In terms of the
lasting effects of Christianity in Indigenous communities, Nina had this to say:
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[...] and the stigma about how those traditions are bad, and native spirituality is bad
[...] even today’s society and our communities, they know the effects of residential
schools, and they know the effects of the churches, and this cultural genocide that was
implemented upon us. And even now I think like, for me, my native spirituality is
enough: I smudge, I pray to the creator, like, that’s enough for me. And it hurts my
heart that there’s people that have been so engrained with settler’s culture that they
don’t think that’s enough, that they need to go to church too.
Nina identifies the role of the church in perpetuating the cultural genocide enacted by the
residential school system. She also identifies the pressure that Indigenous people feel in
continuing with the religious traditions that they learned through these school and the
inculcation of European religious superiority. While it is impossible to account for the ways
in which things may have gone differently, the removal of children from their communities
and into a space where Judeo-Christian values were upheld and enforced had a lasting impact
on religious traditions.
The participants discussed intergenerational effects of residential schools in general
and within their own individual social contexts. Shauna, when speaking about her situation,
said:
And the things that I face from day to day, I have to watch my kids. Their
grandmother was in a residential school, you know? You have to ... and that’s held
on. We don’t know, mentally, what we’re treating. Cause you don’t know where
that’s coming from. It’s passed down.
Here, she is referring to the prevalence of mental, emotional and spiritual unrest caused by
the influence of residential schools in her culture. She expresses a fear that her children
would be affected by the intergenerational trauma enacted by the systems of oppression that
her cultural group has faced in the previous generation, and expresses anxiety over what
could have been passed down through the generations. Nina highlights this anxiety about the
generational effects of residential schools as well through her narrative:
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[...] And people have to acknowledge the effects of residential schools and what it
looks like on your society today, because it may not look like it did then but there’s
definitely still negative effects from it, right?
While she makes the distinction between the effects experienced by individuals that interact
with this system and the generations following, she maintains that there are real, tangible
effects that are distributed intergenerationally.
Intergenerational trauma was also discussed during the talking circle, and Paige
reflected on the talking circle during her interview, saying:
I’m pretty well versed in the education, trauma and history, genocide and oppressions
of First Nations people, so I was saddened more than shocked to learn that there is a
commonality, intergenerationally and still today from the 50’s, 60’s and 70’s.
Paige identifies that the talking circle illustrated effects of trauma on birthing across three
generations and how this is part of the oppression of First Nations people broadly. This is not
to suggest that Indigenous people in Canada all feel the effects of intergenerational trauma
equally or at all. However, Paige’s narrative demonstrates that there is a common experience
of trauma stemming from residential schools and other assimilative aspects of settler
colonialism, and that participants in this research identify the experiences of living through
this trauma and trying to mother despite the fear of intergenerational trauma.
Institutions and Feelings of Discrimination
The participants’ stories show that the effects of institutional mediated colonial
practices live on, not only in intergenerational trauma, but also in experiences of everyday
discrimination felt in schooling, and other interactions with state services. Describing her
experiences of post-secondary education, Penelope recounts discomfort with curriculum and
the need to teach others about Indigenous realities:
[...] It’s like being in university and speaking up in class and things like that.
Schooling people. And I used to do it all the time, and people would get so slapped in
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the face and repulsed, because like I said, I don’t visibly look it, but when I open my
mouth, it’s obvious. And I’m like “I have my status card, but I’m not going to pull it
out because you’re not going to get that out of me. I don’t have to prove anything.
Nina recounted her feelings of isolation and experience of being bullied due to her
race when moving to an urban school in North End Dartmouth.
Because in [Indigenous Community] where I’m from, I grew up with a population of
300. I was running the streets, saying hi to my cousins, and just having my world all
around me, I could just do what I wanted when I wanted, coming and going. And then
from that to moving down here, and being cut off from all of my family, all of my
friends, and growing up in Dartmouth, where I was predominantly the only non –
Caucasian student there, and like, having my nickname being ‘Chinese girl’ for years,
like, it’s just ... it was really hard. It was a really hard upbringing.
As a result of feeling like an outsider in predominately white institutions, Nina was schooled
by an Elder in how to maintain yet conceal her Indigeneity. She recalls a lesson that she
learned about how to conceal Indigenous health practices:
They took our medicines [...] We were making ornaments one time when we went
away for Aboriginal Headstart training, like, network training. And they were
Christmas balls, and they had four medicines in them, and the leather tied in them.
My first thought was I didn’t like the thought of the medicines being captured in there
and put on display, but what the elder that was teaching us how to make them taught
us that when she was little, they learned techniques like that to hide their medicines
around the house and they would look at it as a Christmas ornament rather than that’s
their medicine, keeping them strong.
Nina story reflects on a time period in when colonizing tactics of assimilation meant that any
Indigenous ceremonies, knowledges and medicines were banned from public consumption
(Caroll and Benoit 2001)(Caroll and Benoit 2004). The banning of cultural practices meant
that those who chose to practice had to do it in a secretive way, which hindered the
transferring of information from one generation to the next. This poignant demonstration of
adaptation and ingenuity in the face of state repercussion for possessing ‘traditional’
medicines demonstrates the resiliency and pervasiveness of culture, and the risk involved in
keeping culture alive.
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Feelings of discrimination are based on the construction of Indigenous people as the
‘other.’ The othering on marginalized groups creates a climate in which negative
stereotypical depictions of Indigenous people tend to flourish. The mothers identified
everyday examples of discrimination that they faced, and often communicated an almost
‘hypervigilant awareness’ of discrimination. Participants recounted experiences where they
would often second guess their initial evaluation of a situation as discrimination. In relation
to a visit by a public health nurse after the birth of her first child, Leann stated:
Yeah, and I often wondered about that. Was it because I was Aboriginal? And those
questions ... you never know. And sometimes you have to follow your gut. But I don’t
think it was that. I think it’s because I was just a new mom, but I didn’t know about
this happening. I was unaware.
Leann describes a situation in which she felt unsure about whether or not to evaluate a
spontaneous visit by a public health nurse shortly after giving birth as a byproduct of race
discrimination. This highlights the constant state of awareness that, by virtue of being an
Indigenous person, you are more likely to contend with racism and scrutiny by various state,
governmental and institutional forces. Whether or not the intent was due to discrimination,
Leann found herself asking if this experience had to do with her race, which is the
normalization of the expectation that she has, and will continue to encounter discrimination
on the basis of race. Shauna echoes a similar sentiment, and describes techniques she uses to
uncover motives:
And there’s always things in my life where I think, “Is that because of, or is it not
because of?” But I’ll never know really ... it’s like you gain survival techniques –
What questions to ask, to try to pinpoint the motive behind it. So, you never really
know, and it leaves you with a lot of wishy washy feelings because you don’t know if
that person’s just evil, or ...
Discrimination is a prominent aspect of the social context of these women, and their
experiences are an example of how they navigate their lives as Indigenous in multiple arenas
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including education, mothering, and health services. Remaining skeptical, hyperaware, and
vigilant for evil individuals is an adaptive tool, used to assess others’ motives and to ready
them to handle potential discrimination.
Indigeneity and Struggling with Identity
Continual colonialization as theme was also found in the interview data concerning
mothers’ sense of loss, struggles with identity, and loss of voice as Indigenous people.
Identity struggles varied from those related to ‘loss’ of culture brought on by assimilation,
loss of opportunity for the transmission of culture to children from parents and community,
and returning to community to strengthen aspects of culture through mothering. As Fiona
identified, “A lot of people lost their culture, Lost their voice, don’t know how to speak up
about it.” Leann recounts a story that highlights how a sense of loss pervaded her thought
process during the talking circle:
I felt, [...] that there was a sense of loss. I felt that it wasn’t spoken that there was a
loss, it was a feeling that I had. As the women spoke, there was a sense of loss, that
there was something missing. Culturally. Because I think all the ladies knew we were
there on the level of learning and exploring that knowledge that you were going to
take with you, and I think that that’s the feeling I had, because it was based on culture
that wasn’t there.
Leann also struggled with her identity as a Mi’kmaw mother, saying:
So, as a Mi’kmaw woman, it was difficult, because at the time of having my first
baby, I had a label of non – status, and I really didn’t fit in. I was struggling with my
identity, as a Mi’kmaw person, and I didn’t know where I fit it. So, thank goodness
for my mom, because she always kept me grounded as far as that went.
Here, Leann speaks about her struggles in forming her identity as a Mi’kmaw woman, and
also cites her mother as an invaluable resource for establishing her identity and understanding
her own culture. This quote speaks to the importance of close family members teaching
younger generations about cultural knowledge.
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Jenelle describes a different struggle with motherhood, identity and attachment to
Indigeneity, caused by moving from reserve land, into a predominantly white community.
When asked about the importance of culture during birthing she said:
I moved from the reserve when I was little. [...] I lived in the states for 15 years, so I
didn’t care to be native I guess. I never didn’t anything ... we never did anything. We
were the only people who had brown skin there, so yeah, I grew up very white [...]
my mom is not traditional. I didn’t have my grandparents. My grandparents are
traditional, but we stopped going to them after my father passed away. So, like I said,
I didn’t care to. And then even now, I probably still wouldn’t. Not because I don’t
want my child to know that they’re native, but I just don’t see the point. As long as
I’m feeling comfortable and supported, I feel like I’m doing okay.
This quote demonstrates that Jenelle’s attachments to Indigenous identity was disrupted by
moving leading to a loss of community and family relationships. This experience impacted
how she perceived the importance of cultural practices in birth. Here, Jenelle expressed that a
lack of proximity to culture, as well as a lack of traditional teachings of cultural practices
meant that her attachment to Indigenous identity was considered less important to her during
the birthing experience. It is crucial to acknowledge that the importance of culture varies
according to individual attachment and experiences.
Nina recounted her experiences with strengthening her attachment to an Indigenous
identity. When she recalled the story of being ‘othered’ as a ‘Chinese girl’ after moving from
a smaller, remote community to a city, she explains how she strengthened her attachment to
her identity through finding a new sense of community:
It wasn’t until I found [community centre] that I actually grounded myself and said
“Okay, this is where my community is.” And I think that’s why it means so much to
me to work for the Aboriginal community too, because I saw the benefits my family
and I got from it, and we’re healthier because of it. And that’s what I want from other
family members.
Nina solidified her Indigenous identity thorough accessing community centers that fostered
solidarity among Indigenous peoples. Nina also raised an interesting point about the
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importance of Indigenous centered childcare that incorporates cultural elements into
teachings and care. She said:
And I think too, with doing the drumming and dancing and the language, that some of
the parents have disconnected from, but see, it rekindled in their children makes
them ... pushes them to get immersed in the culture and want to pass it onto their kid
so they’ll learn it on their own.
Providing childcare that incorporates aspects of culture, including dancing, drumming and
learning the language, has the potential to engage with parents and other family members to
strengthen their own ties to culture.
THE TREATMENT OF INDIGENOUS MOTHERS IN HOSPTIAL SETTINGS
The stories showed that the current arrangement of hospital-based birthing can be
experienced as a site of continual colonization in that it fails to accommodate Indigenous
birthing practices. Specifically, the stories highlighted challenges to the use of cultural
practices in hospitals, and perceived poor treatment from hospital staff, including neglect,
pressure, mistrust, and medical intervention without consent.
Challenges to Using Indigenous Birthing Practices in Hospital
Participants identified barriers that prevented them from practicing culture during
their birth experience. Leann, Shauna, Nina, Fiona and Penelope discussed the challenges of
integrating Indigenous birth practices within hospital settings:
My two daughters had their children there [regional hospital] and there was never
that option. Like, if we could use medicine. It was never ... and to tell you the truth, I
don’t think we would have been able to get there with medicine. (Leann)
Yeah, they weren’t receptive at all [...] I wish I could burn some medicines while I’m
giving birth, but I can’t. (Leann)
I think, you know, now maybe it would have crossed my mind to, but when you think
of the hospital you don’t think about having those opportunities available to you. So, I
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guess it never crossed my mind to push for those things, at the time. But I think it
should definitely go in that direction, and that’s important. (Nina)
Everyone was like no. They didn’t want anything to do with our native medicine. I
just don’t understand that. To me, they should be able to accommodate it. They
accommodate to other medicines, I’m pretty sure of it. They must. Why not
accommodate ours? And it’s not like we’re trying to kill ourselves or anything with it.
It’s blessing ourselves, that’s what we’re trying to do, and they won’t let us do
it….It’s important because I grew up the Mi’kmaw way. It’s instilled in me [...] and if
my baby can’t be smudged in the hospital, it’s wrong. (Fiona)
As for the facility, I mean, they try to be inclusive, and I think they’re trying to
change things for the better, but, you can’t smudge, you can’t have sacred medicines
burning, things like that. (Penelope)
Six out of seven participants identified a strong desire to use Indigenous medicines as
a part of their birthing experiences, but each identified that hospital policy made it impossible
for these traditions to be practiced. Just as the federal government banned traditional
medicines and ceremonies from open practice beginning in 1885 (Cole and Chaikin 1990),
today Indigenous women face barriers in exercising their right to use their medicine in the
hospital. Such institutional barriers have historical roots in assimilation. A failure to allow for
Indigenous birthing practices today in hospitals illustrates continual colonialism by way of
institutional discrimination that is simultaneously a by-product of biomedical hegemony of
birthing that excludes alternative practices.
Shauna discussed how cultural practices concerning health can be seen as neglectful.
Speaking about the difficulty of reviving cultural practices, Shauna said:
[...] Our cultural practices have been lost. So, to bring back cultural practices ... it’s
really hard because there are cultural practices that are lost because the colonizers
have taken control. If I choose to not take my kids to the hospital, what would happen
to me? And they found out? Children’s aid would knock on my door and take my kid.
Shauna details the difficulty of incorporating Indigenous cultural practices into mothering
when there are hegemonic cultural practices and ideologies supporting them. Even if Shauna
used traditional methods for healing, rather than going to the hospital, she is doing so
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knowing that she is exposing herself to the potential of being construed as a negligent mother
and she acknowledges the risk of having her children apprehended by state authorities. The
interaction of dominant and marginalized cultures often produces negative consequences for
those on the margins, as different practices in relation to culture can be misinterpreted as
neglectful, and thus subject to state control.
Paige spoke about the importance of fostering cultural sensitivity within hospital
settings using the experiences of one of her family members, who is employed by the health
authority:
And for me, my [family member] is an RN, through her nursing practice, she was
able to draw upon her own relevance with culture. But otherwise, there’s nothing in
the medical books that are going to teach you how to be culturally sensitive. And she
still is oppressed and has problems at work. Like on her team, she has had to talk to
her supervisor about diversity training for people because a lot of her clients are First
Nations, because our health complications are at a greater percentage than non, so she
faces that in the healthcare front, even as a professional and not a client.
Seconding the call for cultural sensitivity training, Nina speaks about her ideal cultural
training scenario:
[...] And even if everybody had a basic understanding, and knowledge and respect,
and you have one specific person that could actually get in depth on helping and
knowing the culture to assist the culture to assist that mother.
Additionally, Nina recounted a story about her mother experiencing resistance to her chosen
birth position and how she wished hospitals were more accommodating:
I was there for my mother’s birth, and I helped her [...] I was supporting her on one
side and [friend] was on the other. She didn’t want to sit down, she didn’t want to lay
down, she was just like “Ohh!” And then it was freaking the nurses out, because they
were like “You’re ready to deliver soon, you need to get on the bed.” She didn’t want
to get on the bed, but they didn’t have anything equipped for her to not do it on the
bed. So, there she is, ten centimeters dilated and standing up, and they’re making her
lay down to give birth. It reminded me of what I was taught about Canadian History,
and it’s still that settler’s mindset of “what we’re doing is best” and that was inflicted
even on my mother in this day and age.
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Here, Nina demonstrates how routine hospital management of birthing denies birthing
alternatives, and she likens this to the ‘settler mindset’ akin to biomedical hegemony.
Historically, Indigenous women, and women in many cultural backgrounds, chose to stand or
squat to give birth. To not allow reasonable accommodation of birth position in the hospital
is denying women the ability to exercise their choice in birth. While understanding that some
hospital policies are flexible and some are non – negotiable, there must be a way to either
allow these practices to happen under careful supervision, or provide a space where
practitioners are better equipped to accommodate.
Interactions with Hospital Care Providers
Mothers expressed a considerable amount of complaint concerning treatment from
hospital care providers during their births. There were perceptions that the staff did not listen,
did not care, did not want to respect birth plans, and did not provide adequate supports for
breastfeeding. They also identified that not all staff they encountered treated them poorly,
rather treatment was specific to individuals. However, the quotes below show that the
majority of the mothers had negative experiences.
Yes, it was a bit difficult with a few of the nurses. Not all of them, they’re all
different and have different experiences. (Nina)
They didn’t care. They were like “Yeah, we know. Yeah, we know”, that’s what they
would do. That’s what the nurses would tell me all the time [...] and it got to the point
where we were fighting with the hospital staff because they didn’t want to do
anything ... they never listened to anything, and I’m sorry, but like, why go through
that? It was horrible…..Depending on which doctor was on. You would get some that
ignored you. Totally ignored you. And if you needed something, or something
happened, they didn’t care. (Fiona)
It’s unfortunate that we have so many judgy people in the medical field. It breaks my
heart as a [health practitioner], that there’s still really judgy, really shitty nurses that
people have such different experiences within the facility, and it’s horrible. It breaks
my heart. (Penelope)
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I guess I had a mixture of both. I can’t even remember which child, which birth, but
yeah, I had both, there are nurses and doctors that shouldn’t be nurses, and then there
are nurses that really go above and beyond and help you. (Jenelle)
Um, just that the hospital staff were – again, overworked and busy and very non-
compassionate – like you said, a production factory. “okay, the baby is out, she’s
okay, she’s not dying, baby isn’t dying, shift her to the next room and away we go.” It
was very like, “You’re fine, move on.” (Paige)
The mothers collectively felt that some staff were inattentive, yet not all. Participants
described how it was routine to receive care from multiple nurses, attendants and doctors
during labour and delivery. The nature of shiftwork and long labours means negotiating
relationships with multiple teams attending births, who may have limited knowledge about a
patients birthing needs. A lack of continuity of care in hospital settings increases the
likelihood of interacting with insensitive and unaccommodating staff.
Negligent Care
The mothers described situations in which they described their own, or family
members experiences of medical and emotional neglect. Shauna described a situation when
she felt neglected by her care providers when they left her on her own:
My last birth ... I wouldn’t say it was a bad experience. It wasn’t horrific, but I mean,
they left me in the shower. They put me in the shower and left me there. [It was like]
the woman was pregnant, and I just stayed in the shower. I was hooked up to an IV,
and they were like “Press a button if you need help.”
When asked if there was any justification for being left in the shower, she said:
Oh no, it was just like ‘You’ve done this before.’ Yeah, I’ve done this before, but it
hurts.
Jenelle described being separated from her baby the night she gave birth due to her
high blood pressure. She was isolated from friends and family members and was left in a
dark room. She felt neglected and sad, saying:
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So, my blood pressure was so high that I had to stay in the room, by myself, like, in
the dark. [...] And then I finally had the baby, and they took the baby out [...] I
couldn’t see them until the next day. I wasn’t allowed. Like, my mom had to leave
right after. I had to stay in the room, the birthing room all night by myself cause my
blood pressure still wouldn’t go down. And the next day they were like “Okay, it
seems like it went down a little, but not a lot” and they were like “How was your
sleep?” and I was like “I heard a kid crying all night, no, my sleep was not great.”.
And they were like “That baby was yours” [...] So I met him the next day, which was
sad.
The opportunity for her to bond with her child in those crucial hours after birthing was
denied. This is a stark example of neglect by staff: Neglect for the wishes of the mother to be
with her child around other family members, and a failure to foster an environment that was
conducive to lowering her blood pressure.
Fiona describes a situation in which she felt negligent care occurred after her baby
was born:
No one came in to check on [child]. So [sister] stayed with me. She got fed up and
went out and she stopped to bath him. She gave him his first bath in the hospital
because he wasn’t cleaned up. They don’t need to be ... they neglect to watch you or
check on you. And then they just shove you off, like “Yeah, whatever.”
Apart from feeling uncared for in labour and delivery, and in the support she needed in caring
for her baby, Fiona spoke of several other instances where she felt that she was not
adequately cared for by hospital staff, including not receiving a visit from a lactation
consultant, being denied food, and not being provided with babycare supplies. She describes
her time in the hospital as “a rough week, hardest week in the world.”
Paige spoke about her experiences with neglect:
I couldn’t feel anything, because I had the epidural. They told me to watch the
numbers go up on the monitor as you contract, and just push when you see the
numbers accelerate [...] I was like ‘cool, I got this’, and the nurse was calling me her
champion pusher. She was a good nurse, the one [...] that delivered my baby. Because
there were no doctors, there were no doctors at all. It was so busy ... like, my doctor
wasn’t there, she was on vacation. So, every time the numbers went up, I pushed. I
gave’r, I gave’r and 15 – 20 minutes of pushing, she was out.
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She then describes the immediate aftermath of the champion pushing:
I tore fourth degree and I didn’t know because I didn’t feel anything... I just pushed
like they told me to when the numbers went up. I ended up having a running stitch, so
it was like inside and out. I was like “Okay, you’ve been down there for a while, how
many stitches do I have, what’s the damage?” I thought a couple [...] they were like
“Uh, we don’t count after so many ... it’s just called a running stitch. You have it
inside and out, and it’s a fourth-degree tear” [...] it was like a c – section out of my
vagina, basically [...] but it was because of the way I pushed ... the [...] lack of
directives I was given.
Discussing further, Paige identifies the long-term effects of this:
[...] I was like, “I’m never having a baby again, like ever. Never ever.” It took a year
to heal. I didn’t have intercourse for over a year, it was just so damaged down there.
And inside, I had scar tissue granulations and I had to have them burnt off [...] I
couldn’t even sit straight. I had to lay or sit sideways, and like, I used the step stool to
get on and off my bed for months [...] he (doctor) offered me a c section if I ever
wanted to give birth again because of how much of a mess it was down there.
Paige discussed the birth as a traumatic event that caused lasting physical harm. This
experience, and the others raised by the mothers, demonstrate that the mothers felt
inadequately cared for during their birthing experiences. The feelings call into question the
hospital as a safe space for birth. It is difficult to know what lead to the events that caused
these feelings. For example, it is not known whether it was individual attributes of staff
approaches to care, or institutional arrangements, such a lack of material and human
resources, or hospital protocols, that hinder emotional and physical support during the labour
process.
Institutional Pressures, Conditional Offers and Consent
Within the hospital setting, participants identified feeling pressured to undergo
medical interventions during their birthing experiences, such as to either use or abstain from
using drugs, interventions, and influence women to consent to procedures without adequate
explanation. Describing her daughter being pressured to get an epidural, Leann said:
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So, when she (daughter) is having a difficult time, she’s going through it, and the
nurses came in and interrupted that and said “Here are your options, you can ... I want
you to know what you’re still at a place to get the epidural” and Denise is looking at
me like “What’s going on? Do they want me to?” They pushed it. And I don’t say
anything but I’m looking at her like, “Make the right decision” and she did. She
didn’t go with it. But looking back, we talked about it in depth and she said “Mom,
they pushed it on me” and she said, “Anybody else who didn’t have support may have
done that.”
This experience highlights problems concerning the pressure to make decisions with little
information. The benefits and potential risks of the epidural were not explained and Leann’s
daughter was left confused about what the right decision was and who to trust.
Nina and Penelope also discussed dilemmas of decision making that coincide with
feelings of powerlessness. They said:
And a vulnerable mother in labour is going to take advice of a person standing over
them, right? And if they don’t have ... if they’re [hospital staff] not equipped with
techniques to do before you have to fully have a C – section or intervene with
drugs ... (Nina)
When you’re in there, they’re all like “are you sure?” and it’s like, you’re so
vulnerable, you almost could be persuaded either way. You’re either really focused
on it, and I was – and I was because I knew what to expect already – they tried to
persuade me to do it natural and to not take the drugs and I was like “No, you fucking
listen to me, I told you and my mind hasn’t changed,” and like ... after a while of just
waiting, the waiting is like ... “I’m not going to make it, I’m going to have to push
this baby out with no drugs.” (Penelope)
I remember them coming and asking me the same stupid question that they did to my
sister, even though it was like a tease for her because she didn’t end up with it, but
they were like “Are you sure?” and I was like “Yes, I’m fucking sure.” It’s on my
birth plan and I certainly haven’t changed my mind, and especially since my
contractions are nutso. I still want the epidural, like, get it here. I’m like I gave you
plenty of notice that, it shouldn’t be too late for me, so get it. (Penelope)
Penelope highlighted that feeling of vulnerability and power imbalances can lead to letting
others make decisions that go against your birth plan. Mothers who lack the ability to
advocate for themselves or lack a support network are at risk of having an unsupported birth.
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A few mothers stressed that the biggest issue with decision making was the pressure
to decide quickly as interventions were often a time sensitive offer. They had to decide
without adequate time to understand and weigh the consequences of interventions. For
example, Paige said, “I ended up having an epidural because they kind of told me it was now
or never.” Alternatively, other interventions were forced because they ‘had been ordered’
taking away the agency of the mother. For Jenelle, a morphine injection and an epidural were
ordered by a physician:
So, I got an epidural for that birth and I was like “No, I don’t want it’ and they were
like “Well, you have to have it, because it’s going to keep the blood pressure down”
and I’m like “okay”….I had false labour a week before I had actual labour, so I went
to [City] the hour drive, and they were like “Well, you need to have a shot of
Morphine” and I’m like, “I don’t really feel comfortable taking Morphine, because
I’m scared I’m going to become a drug addict”, but they were like “Well, it was
ordered, so you need to take it” and I’m like ... “okay.”
Janelle did not want to use drugs during the birth experience. As she said:
My whole family is drug addicted. I’m the only person in the family that’s never
done drugs, I’m like “I don’t really feel comfortable, taking drugs. I don’t want to do
drugs. And if I can do anything without taking drugs, I will.”
Substance abuse is one of the recognizable intergenerational ill health effects of
colonialism. It is understandable that there may be potential trauma experienced by people
who have connections to addictions, through family members and the broader community,
that might lead to fear of the often-encouraged chemical management of pain in labour in
hospitals. Shauna also described how a narcotic was ‘ordered’ and how this intervention was
offered as “now or never.” She said:
And I even had someone offer me pain medication. And I said, “I don’t take pills,
you’re lucky to get me to take a Tylenol.” She said, “Well, I’m only offering you this
now. Once I take it back, you can’t get it anymore” …Yeah, it’s oxycodone. And I’m
like, “What are you doing? I don’t want that. It’s a narcotic.” Oh well, yeah but ... she
tried to tell me it wasn’t. And I was like, “I know it’s a narcotic, why are you telling
me I can only get it now?” If it wasn’t a narcotic you could administer that at any
time. “Here, take it now or don’t take it at all.”
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Penelope also described the pressure of decision making at times when she felt vulnerable,
despite that she had a plan:
Yeah, it’s really like a cat and mouse game, it’s just like “What is this? Why are they
asking 3 – 4 times?” ... and it’s almost like I said, you’re at your most vulnerable
point, where you either are like “No, you’re right, I probably shouldn’t take the
drugs” or you’re like “Get me the drugs or I’ll kill you.” It’s one or the other. It’s a
really horrible feeling. They second guess you. You have a plan ....
The timed pressures create situations in which women are forced to make decisions about
interventions without adequate time for considering if the intervention is appropriate for their
situation. While some interventions might be time sensitive due to their effectiveness for
particular stages of labour, such as epidurals, earlier discussions (at the time when mothers
are not enduring the most pain and feeling the most vulnerable) on the possibilities and
effects of interventions might prevent feeling of pressure and lack of agency.
In another case, interventions occurred without the option of decision making.
Procedures were conducted without adequate explanation and consent. Leann describes the
use of forceps used during her birthing experience:
So, when I’m trying to zone in on this, letting my body do the work and I thought I
was doing great, but then they brought out these things that were like great big claws
and mental, and I had no idea what they were. So, I was ... everything stopped, like
my focus stopped. And now I have to think about something else and I’m like “Oh,
you can’t touch my baby with those things, because that’ll hurt his eyes or
something.” So, they said “No no, trust me, it won’t hurt.” So, I said “Ok, well,
alright.”
Leann described the ‘zone’ that she had to leave in order to interact with the doctor
concerning an intervention she was not expecting and had no knowledge of. Being in a
heightened stage of pain, Leann consented to the procedure, but with little information about
what was happening. Leann claimed that the forceps were just “sprung” on her, and that she
“[...] wasn’t prepared for” making a decision about forceps use. Similarly, Shauna described
interventions being sprung on her and her reluctance to consent:
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I asked for nothing. I didn’t want to do it, [I wanted to be] totally natural, and I
bounced on a ball and stuff, and then the woman, they ended up forcing me to break
my water, cause they said “Your uterus is going to get too tired” [...] I was really kind
of against that. I didn’t really want to do that at all, and I kind of felt like I had to do
it, so I did it. Because they were doing it. And I kept trying to put it off and they were
like “No, no, no, you have to.” So, we did it. And then I hemorrhaged. And so, that
was really scary.
Shauna claimed that “they don’t really educate you or tell you any different,” which makes it
difficult to advocate for yourselves in those times, knowing that there might be resistance and
pressure from hospital staff. Paige described her experiences of lack of informed consent:
I went two weeks overdue, so I had to get a gel induction, which was awful. I knew
nothing about it, I just knew when the IWK called me to go in because the Dr. said so,
but nothing was formally explained to me, what could or couldn’t happen. That it
might not work the first time, depending on ... you only give birth when your body is
ready. Otherwise it can cause serious trauma [...]
Paige made it clear that she did not want to be induced. She understood that she would
deliver when she was ready. When met with the possibility of an induction, there was no
explanation of the procedure, or the reasoning why it was ordered. Instead, she was left to
deal with the consequences without adequate support.
I had asked the participants to speak about why they did not speak up about the
feelings they had about having drugs and procedures being ordered for them. They indicated
that they lacked energy to argue at the time of labour, that they felt as though they lacked the
education and resources to effectively argue against health professionals, and in the specific
case of cultural practices, that they had no faith they would be respected. Speaking on that
last point, Shauna had this to say:
Cause you’re so worried about what’s next, what else are they going to try and scare
me into? [...] but it’s also like you eliminate it [that fear] because they’re not going to
respect your wishes, they’re just going to do whatever. They’re in that role.
Informed consent is necessary for empowering women in their birthing experiences
and ensuring that women are encouraged to be active participants in birth. Undermining the
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ability for women to be able to consent to procedures, along with making offers time
sensitive, and invalidating their decisions to either consume or abstain from labour drugs is
not conducive to empowering women in their labour experiences. These women spoke about
the hospital as a place where when lack of autonomy and informed consent is routine,
impacting the likelihood of acceptance of cultural practices. These circumstances can be
argued as an extending of the unequal power relations emblematic of colonization.
CULTURAL PRACTICES OF INDIGENOUS BIRTH
Without a definitive and clear consensus, the mothers mentioned a variety of cultural
practices that they considered to be relevant to birth. The participants often spoke of barriers
in place that prevented them from following their cultural practices and identified that the
hospital was not a space that was conducive to supporting a culturally informed birth
experience.
The Medicine Wheel
When speaking about the ways in which they managed their health, the mothers
spoke about the importance on the medicine wheel. The medicine wheel is a philosophy of
care that expands beyond accounting for purely physical aspects. The medicine wheel is
divided into four distinct quadrants and represent the balances in health and wellness
involving four processes: Mental, physical, emotional and spiritual. It is an intentional shape,
as the circle represents the universality and interconnectedness of health. Mothers referred to
the medicine wheel to describe how they managed their health during labour, demonstrating
the importance of incorporating culture into care.
Paige described how she incorporated the medicine wheel into her birthing
experiences:
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[...] the medicine wheel and trying to keep myself centered and balanced with
emotional, spiritual and have those aspects all intact, and like, we live in a modern
society, so you have to also [...] keep in mind the boundaries. [...] If you really want
to keep in touch with your culture, you have to rely on those things you use. Whether
it’s the smudging or medicine wheel that you use to keep a centered balance for your
life.
Paige described the way that she uses the medicine wheel to exercise an aspect of her culture,
as well as keep in balance with other, often neglected aspect of birthing. Paige uses the
medicine wheel to understand what is most important to her, and to retain strength and
resiliency through the birthing experience. Penelope also made reference to the medicine
wheel as important to birth, saying:
[...] the whole medicine approach, the holistic view, and a more spiritual thing that
birth should really be focused upon, because it’s so powerful. If that was the main
focus, things pushed on you, not the induction gels, the extra drugs.
Framing birth in a way that respects the multiple quadrants of health, Penelope describes the
function of the medicine wheel as a tool of empowerment, which can offset the demand for
intervention and drug therapies during pregnancy. This shift in focus allows for birth to be
reframed as a healthy, normal and routine happening that incorporates multiple quadrants of
health and wellness.
Smudging
Participants described their desire to practice smudging in the hospital setting. As
Shauna indicated, “I always smudge.” Smudging is described as a burning of various
materials including sage, cedar, sweetgrass and tobacco, and is done for blessing individuals,
rooms, as an offering to the spirit world (Muin’iskw and Crowfeather 2007). Penelope
described smudging as “a purification process, and a cleansing ceremony, that you can pray
for a good journey.” However, as mentioned previously, there are institutional barriers in
place that makes it difficult for individuals to use this cultural practice within hospitals. Any
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type of ‘smoke’ in a hospital setting is typically prohibited according to the facilities Smoke
Free policies. Although it is distinct from the detrimental effects of cigarette smoke, this
ceremonial practice is still treated as a toxin and thus not encouraged. In the specific case of
the central urban birthing hospital, there is a clause that states that it can be allowed so long
as it has been cleared by the Fire Safety Officer in advance of the labour. While this policy
may claim to make exceptions for First Nations people, no participants claimed that they
were allowed to smudge in the facility during their labour experiences. Instead mothers
discussed the barriers to smudging:
I think smudging in the hospital would be a wonderful opportunity. If we could
manage to do that, that would be great, but realistically, I find it hard [...]. (Nina)
You either already know you’re going to get shut down. Like the whole smudging
thing, or you got to take it outside, or they can’t just shut the sprinklers off for a
moment or two, when you know it’s a full out possibility, it just doesn’t happen. The
efforts aren’t made. (Penelope)
You can’t burn sweet grass, or you can’t have a smudge bowl burning. Which is
really there to create a Zen, bring clarity and carry prayers [...] cause we smudge a lot
in my place. (Paige)
When dad came in to see him ... the grandfather gives your child his native name. He
was not allowed to smudge [son]. He was not allowed to light the pipe. He was not
allowed to do nothing, he couldn’t do it. They wouldn’t let him use any type of
smudging or anything [...] So, he didn’t get smudged until he got home – and we
didn’t get released right away because I had a C-section, so a few days. So, he had to
wait until he was four days old before he was able to get smudged. (Fiona)
The participants identify the distinction between smudging as a purification process and
‘harmful’ smoke and identify the institutional barriers in place that makes it difficult to
participate in meaningful, ceremonial practices like smudging. It is perceived by the mothers
that the hospital is unwilling to make accommodations for these practices.
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Indigenous Medicines
When asked about using Indigenous medicinal knowledges in general, Leann said:
No, no. Even though it was there, because my grandmother would handpick
medicine. My mother always had some in the cupboards. I just never used ... well
maybe I did in teas and stuff, but as we were growing up and we were getting ill, we
would go to the doctor. And we would get medicine from the doctor. So, our
medicines kind of went on the wayside, but looking back and redoing it, I would rely
on medicines that I know are out there.
Mothers also acknowledged that Indigenous medicines are not accommodated in the hospital
facility. Penelope described not having the option to use Indigenous medicines saying:
I liked to smudge and use my medicines and things like that. But it wasn’t an option
inside a facility. So that’s kind of a big thing for me.
There was only one account of medicines being accepted into the hospital and utilized in
conjunction with other medicines. Janelle shared that approximately two years prior:
[a family member] was on life support at [the urban hospital]. He was on life support
there, and we were able to do smudging ceremonies for him... They gave him
traditional medicine for him, and gave it to him, rubbed it on his feet and did stuff for
him. [...]The only think they requested was to know every ingredient in the medicine
[...] I don’t know if they made an exception of him because they knew that he was
just about to die, because this was when we took him off life support. So, I don’t
know if it’s just an exception.
Janelle’s account describes a situation in which the facility granted permission for the
application of medicines and smudging during death. That fact that the hospital was willing
to allow practices to be conducted in sensitive, emotionally difficult situations during death
demonstrates the possibility that the same can be accommodated for birth.
Status as a Mother
Despite the lack of cultural birthing practices being used in the hospital, the
participants described the importance of the role of mothers in Indigenous societies and the
importance of mothers to the well-being of communities and nations. According to the
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mothers, women are powerful beings, who assert their power through the experiences of
motherhood. Leann confirmed the role of women and the cyclical nature of mother earth:
Yeah, and if you go back to, and I think this relates, if you go back to speak about
how women were looked at in the Mi’kmaw culture, was related to as mother earth –
put on the same type of level, because women were life givers, you know? So, they
held a different status. So, when ... for an example, if a woman was on her moon time
[period], she couldn’t be around certain ceremonies, so that’s how the cycle of life
was respected.
For Penelope, becoming a mother was that most important aspect of culture during birth, as
she said:
For First Nations women, and me being Mi’kmaw, being about to have the gift ... to
bear life within you is so powerful. It’s the most precious gift of all, and that’s why
women are so sacred, because we have the ability to do that.
These participants describe their ideas about the role of motherhood in their societies, and the
meaning that this experience of motherhood has brought to their lives. They described this
role as powerful, and as sacred gifts that are to be respected.
MIDWIFERY CARE FOR THE DECOLONIZATION OF BIRTH
This section presents data on how mothers viewed midwifery care as an answer to
problem due to medically managed hospital birthing experiences. Contemporary midwives
are health practitioners who provide pre and postnatal care and support and are able to
facilitate a delivery in instances of uncomplicated labour (Caroll and Benoit 2004). The
midwifery model of care diverges from the medical model of childbirth in several
fundamental ways. Midwives, when properly supported in either a hospital or private practice
model, can provide emotional support alongside the physical management of pregnancy and
birth. They provide primary care for as long is required by the patient, collaborate with other
healthcare professionals to support the health and wellness of the patient, provide postpartum
care, including home visits for up to six weeks after birth, support informed choice and full
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participation in pregnancy, including time for discussion about procedures, expectations and
plans, and where possible, provide choice in location of birth (Bourgeault, Benoit, and Davis
- Floyd 2004)
Conversations about midwifery care were prominent in the interview data of two
mothers who had experienced midwifery care. These mothers discussed midwifery as a
model that provides empowering, consensual, detailed care, orientated to touch, and attuned
to culture. While outside of the scope of this thesis to sufficiently address, the lack of
participants experiencing midwifery care is likely as a result of the lack of opportunity to be
seen by a midwife in the local area. In Nova Scotia at the time of data collection, midwifery
care had been poorly implemented and subsequently underfunded within the urban birthing
hospital. Further, at the time of this study, only 5 midwives were practicing in the local
birthing hospital; two of which were practicing on a part-time basis. The regulation of
midwifery in Nova Scotia has been historically referred to as restrictive, and a lack of
provincewide programming has left many rural women without access to midwifery care for
their births (Daniels 1997; Morrison 2014; Taylor 2013). While only two of the participants
experienced midwifery care, the narrative from these two experiences resonated strongly
with support for cultural practices.
Empowering Women
I asked Paige about her experiences with midwifery care. The first thing she
mentioned was the way in which they addressed her anxieties stemming from her past
traumatic birthing experience:
[...] And they went into detail. They told me what they could do to prevent the
tearing. They never ever said “we won’t let it happen” or “it can’t happen”. They said
it’s always a possibility where it happened the first time, that it can happen again. But
we’ll do our best and this is what we can do, and these are the techniques that we
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have to stop that from happening. And let me tell you, they did everything they told
me that they were going to do. And it was the best birth I ever had, out of the three.
The overwhelmingly positive experience that Paige described was predicated on the way that
the midwives addressed prior birth related trauma. Paige had expressed a fear of tearing
again, as her experiences had left her with injuries that affected her long-term postpartum
recovery. Rather than maintaining that she would not tear, the midwives empowered her to
overcome her fear by understanding the approaches that they were going to take to prevent
the trauma from reoccurring. Setting the expectation that tearing was a distinct possibility
while properly informing Paige about what they will do to prevent this from happening
fostered a care relationship built on realistic expectations, trust and consent.
Paige also described that her second pregnancy experience left her feeling validated,
listened to, and fully in control of her own body and abilities:
They never lied to me, they never took their sweet time, they didn’t disbelieve in me.
Like, if I said “Oh my god, this hurts, like I can’t do this” they were like “Yes you
can, you’ve done it before. I know it was traumatic, this time is going to be different.”
It was all positive and upbeat. “Whenever you’re ready, we’re here for you.”
In describing differences between birth under the medicalized and midwifery model, Paige
said:
Well my [...] baby was quick and better, and because of the midwives, they allowed
me to stay more in touch with my body [...] They allow you to listen to your natural
instincts, whereas the medical and hospital settings and the OB/GYN didn’t.
Everything was pushed on me, and pulled away from me, and very fast paced and
unexplained, and awful. And where I had a totally different experience with my
second time, I went back with my third.
In comparing the midwife’s management of using an epidural with her previous experience
under the care of an obstetrician, Paige said:
I couldn’t move my legs for hours the first time. [But] After the birth of my son, I
only had an epidural so I could still feel the contractions, so I knew when, naturally,
to push. They turned the monitor away from me [...] and they clamped the IV and
stopped it right after he was out. So that I wasn’t going to continue to be frozen, it
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was going to wear off quickly. They stayed with me, allowed me to clean up and
bathe before taking me up to the birth unit.
By allowing the time for detailed care that was centered on bodily control and
autonomy, for listening and validating her fears about labour trauma, and by tailoring the
amount of epidural to allow for postnatal mobility, a sense of competency and a reduced
sense of anxiety and fear resulted. Support in this way helped Paige to gain a sense of control
in the direction of her labour, and a sense of competency through the support of the
midwives. Similarly, Penelope described the way in which the midwives validated her own
experiences of labour, by not questioning her birthing plan, and through advocating for her in
the hospital:
The doula’s and midwives play critical roles. I feel like they are the reason why ... I
feel like without them all of these things that you speak of would have likely been
pushed on me [...] And if you request something, you have these midwives put in
place and you have a birth plan that says give me all the drugs, and like, don’t
question me about it.
Through advocating between health professionals, and supporting women’s decisions
in birth, midwives empowered the mothers in their births. Rather than expecting mothers to
be passive recipients of care, the midwives took active steps to empower these women to
make their own decisions with factual information.
Comprehensive care
Participant described the care that they received from the midwives as detailed, and
comprehensive. In describing her care, Paige had this to say:
Everything was so detailed and fantastic, and there were three midwives per team and
they have two teams, so somebody is always there, and they share info between teams
in case there no one available on the specific team you’re assigned to. So, somebody
is there and you meet them all. Your team, you take turns having appointments with
each in their own office, and it’s amazing.
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Comprehensive care can reduce feelings of uncertainty going into the birth experience. Paige
also spoke about the attention paid to the birth plan and consent process:
And went over everything, from the vitamin K shot to the ointment that they put on
the baby’s eyes for when the baby comes out to prevent infection from anything not
sterile, they tell you step by step what happens. “Do you want this? Are you okay
with this?” and have you sign off on things. Like, I was never asked anything my first
time, at all. They just take they baby and did whatever. I heard her cry and they told
me they give her a needle and I didn’t what the needle was and like, all kinds of stuff.
But with the midwife, closer to your due date they go over every single thing
possible. And give you the option. They don’t just say “You have to do this.”
Informed consent had a profound effect on the birthing experience, as Paige felt as though
she was in control of her care and was able to choose her plan, with the midwives providing
advice, clinical information, as well as explaining what to expect in the hospital setting.
Moreover, according to Paige, the midwives did not invalidate her choices, or impose a
particular view. Instead, they allowed Paige to make her own choices, helping her to feel
validated and confident.
Comprehensive care also means that there is room for situational accommodation. An
advantage of the midwifery model is that midwives are able to travel to their client’s homes
for prenatal, birth and postnatal care. Paige detailed her experiences of the midwives at
home:
They come to your house when your labour starts, to assess you and check you out.
And if you’re scared, or feel like you should be assessed again, they’ll come back to
you. They don’t make you go to them, they don’t make you go to the hospital unless
they feel it’s necessary or that’s where you want to be. They knew all my fears, they
knew why, so like, they were really great with me, and very compassionate and
considerate and they never once refused me [...] So yeah, the birthing was a lot better
with the midwives, like they came to the house, and when I was ready to go to the
hospital they met me right at the door.
Describing the care that she received postnatally, Paige said:
Even post care, the follow up. Bring your baby back in 6 months [in reference to the
hospital]. Nope, the midwives come a couple of days after you’re home, weigh the
baby, check the baby, check you. LOOK at you, physically touch you, check things
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out, and then they do weekly check ins, and then at 4 – 5 weeks, you go to them. But
until you're able to, they come to you. In the privacy and space ... your own comfort. I
could barely walk the first-time afterwards.
Penelope also spoke about accommodating interactions with the midwives:
I get to the hospital and they midwives meet you there, like you call them, and you
check it and they’re on call and they meet you there.
Comprehensive and continuous care, providing detailed explanations about
procedures, and the ability to do in home visits for prenatal, birth and postnatal experiences is
how the participants described their care as detailed and supportive. In contrast, the medical
model required that mothers travel to staff, experience appointments that lacked the time
necessary for addressing concerns or explain procedures, and be treated in hospital by staff
that are routinely unknown to them.
Touch
Midwives were described as care providers that use bodily touch to facilitate birth and
relieve pain, and encouraged patients to use touch to understand their own labour
experiences. Paige described the difference in touch between midwifery care and medical
care:
They were hands on, and they massaged your shoulders. [with medical care] I was
made to get out of the bathtub, which is my comfort zone when I labored the first
time, like ‘you can’t stay in the tub, we’re too busy, we can’t keep coming to check
up on you, you need to stay in the bed, especially once you have your epidural, you
can’t move.
Through labouring in the tub, Paige speaks about the manner of the midwives:
[...] I went and got in the tub and they came and sat of the floor, continued to put
warm water in the tub, it didn’t matter that was floating around in there. Bodily fluids,
nothing. They were so hands on, and so mentally and positively reinforcing.
In relation to using touch to prevent trauma she said:
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Yes, I wanted an epidural. It was in my birth plan because I was so traumatized from
the first time. I was like “I’m not doing this without an epidural, you can’t take that
from me, it’s my right”. But they really are au naturel, like they want you to deliver
naturally, and they did everything no matter if I had an epidural or not. Hot
compresses, and perennial stretching, massaging my vagina, the area, to make the
head coming more smooth and the area was relaxed and more elastic. Everything, hot
compresses, touch. They encouraged me to take part, to touch myself, to feel the baby
crowning. It was really odd, it was such a smooth labour transition for me and having
the epidural, the sac was bulging, they water sac, it didn’t break. So, they were just
like “Do you want to rupture your own sac, break your own water?” It was just like,
phenomenal birthing experience. They weren’t like “No, we’re the doctors, we’re
going to do it.” They let me take a part in every aspect possible.
Aspects of touch are important during the labour experiences and are often
overlooked when birth is managed through obstetric care. Paige had experienced a traumatic
birth prior to her second child, and described how the management of birth through being
encouraged to participate through touch was an empowering experience that allowed her to
be in touch with her own body which she also described as culturally relevant, saying:
Because of the midwives, they allowed me to stay more in touch with my body,
which is also culturally relevant because, in the Mi’kmaw culture and heritage, you
are intuitive with your own body [...] our culture encourages us to be in tune with our
bodies and the midwives really follow that. They allow you to listen to your natural
instincts, whereas the medical and hospital settings and the OB/GYN didn’t. (Paige)
The midwives encouraged her to take an active role in her labour, encouraging her to rely on
her body and fosters a sense of competency and self-efficacy, as opposed to being fearful and
encouraged to relinquish control. This is especially important for Paige as she had
experienced trauma in the hospitals, and the setting had the potential for re-traumatizing her.
Culture
The participants identified the hospital as not typically a place that prioritizes the
importance of culture within health and is not a conducive environment to supporting cultural
practices during birth. As mentioned, mothers often identified barriers to Indigenous
practices during birth, and often did not ask because of feelings of discrimination and
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potential resistance. Paige, like Penelope and Leann mentioned above, also acknowledged the
cultural relevance of motherhood, and she pointed out that her midwives were not only in
tune with this, but made her identity as an Indigenous mother central to the care they
provided her. She said:
Yeah, and they were really interested in me being Mi’kmaw and like, how I felt about
our ancestors, and how you are a giver of life and how important the female body is
to our culture, and that we’re held in high regard and our bodies should be respected,
and it’s like a sanctuary [...] it’s a matriarchal society and the women are the decision
makers and they’re held in high respect and are usually at the forefront of most
things.
Penelope similarly described her attachment to culture, justifying her use of midwifery care:
I feel like midwifery care stems from my people. I feel like that is an Indigenous
profession. It’s rooted that way, and it feels that way. It’s like a very motherly,
women power kind of thing. Outside the facility everything seems to be your way and
acknowledged, the cultural components. If you expose to them that you’re First
Nations, your beliefs and what you’d like to have, it seems to be all inclusive until
you get inside those walls. Medical, white coat kind of stud. The whole task, the
whole focus changes and it’s ... it’s unfortunate, because it’s something that really
should be a holistic approach versus a westernized, medical approach. It seems like
everything except for the physical component is lost.
The necessity for having access to a model of care that is more culturally appropriate
is of paramount importance. As described by participants, the hospital setting, while
important to access for high risk pregnancies, fails to address the unique needs of urban
Indigenous mothers. This thesis aimed to facilitate a discussion of exactly what, according to
the participants, would be a step forward in the decolonization of birth. Although only two of
the seven participants in this sample accessed midwifery care, their insights suggest that
midwifery care is more effective in addressing the needs of this distinct population. The key
elements distinct from the medical model include: Addressing and providing support for
prior traumas, using the midwives’ knowledge to inform themselves and feel comfortable
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with their decision making, advocacy when dealing with other health professionals, detailed
care and adapting care location options to include prenatal, birth and postnatal care at home.
Decolonized Birth
The mothers were asked what they thought needed to happen to improve their
birthing experiences as Indigenous women. It was hoped that their recommendations might
help inform a pathway to decolonizing birthing. These participants provided multiple
suggestions in order to facilitate decolonized birth, however, they converged on three
subthemes: the desire and ability to express culture while birthing, incorporate multiple
worldviews in birthing care, and receive less medical intervention while birthing.
There were multiple expressions of the desire of a culturally centered birthing
experience. Leann stated that a decolonized birth would mean that “It would be to explore the
culture” and similarly Nina said, “It definitely would be having cultural components
available to you.” Paige explained that it would mean, “the comfort of being in the company
of my own people. My tribe, my family, my friends, whoever I want present. That would be
ideal [...] a very Zen environment, with my cultural things there to guide me through.” For
Penelope it included a sense of reclaiming, saying it would mean, “To get our voice back and
to be able to practice your ways loud and proud, and not have a fearful component.”
The desire to incorporate culture into their birthing experience was highlighted by
four of the seven participants in this study. The desire for collaborative care that recognizes
the importance of culturally relevant, culturally safe maternity care was important for the
decolonization of birthing experiences. Decolonizing birthing also meant incorporating
multiple worldviews into maternity care. According to Paige and Penelope:
So, to take your own background and cultural heritage and experiences and put them
into play through pregnancy and labour and birth and delivery as well means a lot
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because you're taking your roots and passing them on right from birth to the next
generation, you know? So even mentally and spiritually, knowing that you’d be able
to do that is quite beneficial. (Paige)
Oh man, these health professionals to get their heads out of their asses. They really
have to be educated on the history and the genocide and the atrocities more than
anything, so that they can get to the root, because like you said, it’s all about the
women and children. And that’s where the healing needs to happen, first and
foremost, because we’re the primary caregivers, that’s the way it is. (Penelope)
These passages demonstrate the need for an awareness and understanding of historical
oppressions faced by marginalized populations within maternity care, as well as an
environment that allows for the incorporation of Indigenous conceptions of birth alongside
biomedical approaches to maternity care.
The mothers also expressed that decolonizing birth also depends on less medical
interventions during pregnancy, labour, and delivery. As articulated by Jenelle:
And I feel like, it would be in your own comfort settings. You wouldn’t be asked ‘Are
you breastfeeding?’ and you wouldn’t be asked if you need the drugs.
Shauna similarly said:
Not having as much medical intervention [...] for sure. We don’t have anything that
would be the colonizers way.
Decolonizing the birthing experience meant the desire for less medical intervention, the
freedom to incorporate an individually adequate amount of culture, and to incorporate
alternative worldviews into the traditionally medically dominant spheres. Data suggests that
the incorporation of midwifery care is a means to address all three.
The experiences and perceptions of these urban Nova Scotia Indigenous mothers are
important, as they can be used to evaluate the maternity care of marginalized populations
within Nova Scotia. While the findings were based on a small urban Indigenous sample in
Nova Scotia, these findings mirror the larger Canadian context of birthing care. The findings
demonstrate that the current model of medical based maternity care is not adequately
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supporting Indigenous mothers in their birthing needs. These findings draw attention to the
ways in which hegemonic narratives about health and birth further marginalize
underrepresented communities by administering healthcare as a ‘one size fits all’ experience.
I am hopeful that the results will make clear the issues in relation to culturally safe
healthcare, and aid in the decolonization and reconciliation of birthing experiences.
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CHAPTER 5: Discussion and Conclusion
This chapter discusses the mothers’ experiences and perceptions of birthing and
concludes that hospital birthing is a site of colonization, yet a two-eyed seeing approach to
maternity care that embraces Indigenous informed midwifery has the potential to decolonizes
birthing. While the previous chapter presented themes concerning birthing based on the
experience of mothers, the following discusses these experiences in relation to continual
colonization, the treatment of Indigenous peoples in hospital settings, and midwifery care as
a means for decolonizing birth. I will also discuss the ways in which the two-eyed seeing
framework for addressing issues can help us navigate birthing knowledge systems.
Continual Colonization
The process of continual colonization is a social reality for urban Indigenous mothers.
These women’s birthing experiences are situated within the broader context of social,
political and economic inequity perpetuated by systems aimed to assimilate Indigenous
culture (Adelson 2005; Birch et al. 2009; Bourassa et al. 2005; Browne and Fiske 2001;
Simpson 2006b). Participants described how their identities and outward expression as
Indigenous peoples would lead to experiences of discrimination within colonial institutions,
which mirrors in part the cultural assimilation of Indigenous people akin to the residential
school system (Bombay et al. 2014; Milloy 1999; Neeganagwedgin 2014). Conversely, the
participants in this sample who self-described as ‘white passing’ felt shielded from
discrimination, providing evidence for the prevalence of a hegemonic Eurocentric health
system (Allen 2006). Participants also identified that individual practitioners working within
these systems had a tendency to bring their own biases to the workplace, and thus the
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mothers were apprehensive to identify as Indigenous to hospital staff verbally and on intake
forms for that reason. The participants described experiencing discrimination in the hospital
settings and within their own broader contexts, including education facilities, community and
judicial systems, showing that Indigeneity is often discriminated against within an Euro-
dominant hegemonic social structure.
When asked about their desire or intent to use cultural birth practices in hospital
settings, the participants identified barriers from staff and from the facility, and often felt as if
their active challenging or resistance to the barriers was futile, as they had little decision
making power due to medical control of birth in general, and in using their medicines and
cultural practices in particular in the hospital. The fact that the mothers are preconditioned to
believe that their medicines are unwelcome in hospital settings shows the importance of a
two-eyed seeing approach to care in hospitals and in birthing, in order to restore balance to
the hegemonic, totalizing structure of medicalized health management. Participants
determined that overcoming the stigma related to Indigenous cultural practices meant
incorporating more Indigenous individuals into the hospital facility, fostering an environment
conducive to protocols of cultural safety, and the need to education healthcare providers
about colonialism and its effect on the Indigenous people.
Postcolonial theory can help situate health inequities in the broader context of
residual and contemporary colonialism (Browne and Fiske 2001) helping to explain why
Indigenous people accessing facilities, as a result of prior attempts of assimilation,
experience mistrust in state run institutions. Postcolonial theory explains colonization’s effect
on health and birth experiences as it helps us to see birthing as a part of a colonial past of
maternal cultural genocide. Without this theory guiding our understanding, it would be
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difficult to acknowledge the transition from overt colonialist practices and the form they take
currently. Participants voiced their understanding of traumas that occurred in the residential
school system, and how these traumas affected health outcomes of their communities, as well
as how there was hesitancy in fully trusting institutions meant to act in their best interests.
Akin to this is an identified feeling of struggling with identity, and a loss of culture.
Treatment of Indigenous People in Hospital Settings
The mothers described their experiences in the hospital and interactions with staff as
largely negative. They claimed that their desire to use cultural practices within their birthing
experiences were met with resistance from both the staff and the in-house institutional
policies that govern practice. The mothers recommended establishing a cultural space in
which ceremonial practices like smudging and burning medicines can occur in hospital. In
using two-eyed seeing as an approach to understanding and respecting difference, the current
healthcare system can better address the needs of multiple individuals, from multiple
perspectives.
In relation to the individual staff members, participants suggested that they had
negative experiences stemming from their perceived care during the birth experience.
Common experiences included receiving care from staff who were unconcerned with their
well-being, did not listen to them, and did not follow their birth plans. Participants did not
establish the link between these actions being racially motivated, but instead equated it with
the standard of care in the hospital setting. Within the neglectful care experiences,
participants described situations in which they felt pressure to conform to hospital
procedures, such as complying with orders to utilize drugs, complying with requests to
abstain from using pain medication, and the invalidation of their decisions about their birth
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experiences. Participants described interventions during births as lacking consent: In that
they were not adequately informed about intervention protocol, nor were they asked to
consent to these procedures. The participants claim that, by virtue of being in the hospital,
their unrelenting consent was implied.
Midwifery Care as a Model of Addressing ‘Decolonized Birth’
Two out of the seven participants experienced midwifery care during one of their
pregnancies. Although this is an underwhelming number in comparison to the majority, the
justification for the superiority of this care in addressing birth outside of the scope of the
medical model requires addressing. Participants identified the hospital as a place that is not
conducive to respecting birth or cultural or alternative knowledge systems. It was
acknowledged that once the participants entered the hospital, birth was managed according to
hospital protocol. Those who experienced midwifery care provided several justifications for
the midwifery model as a more appropriate model for culturally supported birth. Participants
described the care as detailed, with the individual midwife addressing prior traumas by using
their scope of practice to empower women. This type of care was cited by the participant as
one of the reasons why she expanded her family.
Within the discussion of midwifery care, the narratives converged on the
dissemination of knowledge and the negotiation of consent. The mothers evaluated the
opportunity to be informed of procedures and being asked to consent to these procedures as
vital to the empowerment of their birth experiences. They felt as though they were informed
about the purpose of the procedures, the potential benefits and the consequences, and were
allowed time to make a decision without feeling pressured, or constrained by time sensitive
requests. The midwives addressed the potential for procedures largely in advance of the
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actual birth, which would allow enough time for reflection on their choices and preparation
for decision making during the birth.
The scope of midwifery care extends beyond the birthing experience. The mothers
who have experienced midwifery care addressed the advocacy role midwives played in
relation to other healthcare practitioners. According to the mothers, the midwives advocated
for their choices and their birthing plans, and were able to articulate that support to other
health professionals that they interacted with. Lastly, the participants mentioned that the care
that they received under the midwives was adaptable: In the sense that it adapted to location,
to preference of care, and to the supporting of culturally informed birth experiences. This is a
distinct feature, as birth that is managed within hospitals require women to travel to
appointments and deliver on site. While neither of the participants who experienced
midwifery care opted for a home birth, they had received pre and postnatal care with the
midwives in their home setting. In this regard, the action of conducting care appointments at
home supports mothers and families, especially mothers with multiple children. Relating to
preference of care, midwives were equipped with the knowledge of practices and procedures
within the facility, but were also well versed with techniques related to managing non-
medical births, using touch, and attending to non-physical needs. Finally, the midwives
encouraged conversations about the utilization of cultural practices during birth. This is
perhaps the most important in justifying midwifery care as a strength for culturally
marginalized peoples. The mothers made it clear that the incorporation of culture was
important, so long as culture was important to the mother, and the midwives made sure to ask
what aspects of culture were important to incorporate in the labour experiences.
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Indigenous women in precolonial societies held the authoritative power on birthing
knowledge and managed birth accordingly. Looking at these stories through an Indigenous
feminist lens allows for an understanding that medicalized birthing has acted as a form of
social control of Indigenous women. Recounting the experiences of those who had delivered
in the hospital, the desire to incorporate culture was met with resistance from hospital staff,
who may have felt as though the incorporation of culture was not within the scope of care,
expertise, or relevant within a hospital setting. Through the model of care that guides
midwifery practice, there is a respect for the incorporation of culture, and a desire to
prioritize what is deemed important for the mothers. The desire to incorporate culture into the
labour experience is an important aspect of midwifery care, and strengthens the claims for
decolonizing the birthing experience.
Conclusion
This thesis documented contemporary experiences of urban Indigenous women in
Nova Scotia, in relation to their births in a hospital setting. Through conducting a talking
circle and seven semi-structured interviews with individuals from the urban Indigenous
community, mothers’ voices were heard and analyzed. This thesis addresses the lack of
qualitative research about the experiences of urban Indigenous women in birthing and is the
first of its kind to inquire about the potential for birthing as a site of decolonization, and for
reclaiming cultural protocols concerning birth, using the narrative experiences of urban
Indigenous women in a Nova Scotian context.
In this thesis, I argue that the imposition of medicalization on Indigenous
communities in Canada is an extension of colonization by way of the colonization of
biological and cultural reproduction. In a similar fashion of stripping families of culture that
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occurred with residential schools, transracial adoption patterns, and involuntary sterilization,
the medicalization and Westernization of childbirth shifted power away from women within
the communities and directly into the management of institutions that fail to recognize
distinctive Indigenous ideologies concerning the birthing process. Medicalization’s broader
reach into maternity care has had harmful effects for all women, but I argue that it has
harmed Indigenous women in specific ways that requires attention from an academic and
policy-based perspective. The medicalization of childbirth has provided many benefits in
terms of high-risk pregnancy and birth. However, the medical management of birth must also
attend to cultural safety within its scope of practice, in order to reduce trauma and
interventions that can come from culturally inappropriate and colonizing approaches to
birthing.
In this thesis, a two-eyed seeing theoretical approach was employed to situate the
potential of integrating biomedical approaches and Indigenous approaches of birthing as a
way to decolonize birth. Using a two-eyed seeing approach to birthing would be beneficial to
all mothers despite their individual cultural backgrounds. Using a perspective that
acknowledges all conceptualization and practices of health, birth, and care without
prioritizing one system over another makes the system better equipped to address diverse
health problems. Immigrant women and families, for example, could benefit from an
approach that incorporates cultural safety as a key component in pregnancy and birth
management. Equally, all women, regardless of race, socio-economic status, or religion, can
benefit from the incorporation of Indigenous care models— one of which being the medicine
wheel – that give equal importance to mental, physical, emotional and spiritual health.
Through a multilevel approach to birth care, women can experience care that supports
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multiple facets, and be supported in needs that are not usually addressed through the
exclusive use of the medical model.
This thesis also concludes with a recognition of the midwifery model of birth
management as a more suitable model for all women, but specifically Indigenous women that
are caught in the trap of potentially needing more medical intervention (due to the outcomes
of colonialism that lead to poorer maternal health outcomes) while such interventions may
lead to further trauma as part of the trauma legacy of colonial interruptions of motherhood.
Midwifery, with its principle of respect to cultural practices, commitment to a minimization
of medical intervention, and respect for autonomy and informed choice, maybe the pathway
to redressing trauma, advocating for appropriate intervention when needed, and allowing for
the reclaiming of traditional birthing practices. The midwifery model is concerned with the
empowering of women as decision makers, and as the authoritative figures of their birth
experience. Through implementing space for the incorporation of culture, for informed
choice and consent within the birthing process, midwifery care becomes an experience more
aligned with traditional ideas about the birthing process while allowing for the birth itself to
be managed medically, if desired or required. If midwifery is a complement of the medical
system rather than a replacement, and one that had equal status and power, urban Indigenous
women would have access to a two-eyed seeing birthing framework that meet their needs.
This is a conclusion well rooted in activist coalitions that are also exploring ideas
around the decolonization of the birth process. The contemporary movement towards a
decolonized approach to birth has been well documented in Quebec, Ontario and the
Northern Territories of Canada. The Innuulitsivik Health Centre in the northern Quebec
region services seven villages in the Hudson Bay area. This health centre provides maternity
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care for Inuit populations using relevant languages. There is also a collaboration between
Inuit and non-Indigenous midwifery practitioners, in an effort to birth children within
traditional territories (National Aboriginal Health Organization 2004). The Mohawk Nation
at Akwesasne is involved with a similar movement towards the reestablishing of traditional
birthing practices, using a birthing ideology focusing on education and empowerment
through Indigenous health practices. These programs encourage Mohawk women to utilize
traditions that relate to their culture. This program also trains Mohawk women to become
midwives within their own community context.
Concerning Indigenous midwifery practices, Ontario’s provincial legislature is
perhaps the closest in achieving a two-eyed seeing approach to maternity care. In the
implementation of midwifery practice in the province, the steering committee consulted with
Indigenous midwives, and Indigenous consumer groups and maintained the distinctiveness of
Indigenous cultural practices related to birth. As a result of meaningful consultation,
Indigenous midwives and the Indigenous midwifery program were exempt from the rules that
govern midwifery in hospital practices. This exemption allowed for a revitalization of
traditional healing practices, allowed women to give birth in their communities without
undue sanctions from protocols of non – Indigenous health authorities, ensuring the
responsibility of birth is transferred back to the communities (Bourgeault et al. 2004).
Despite the distinction between health authorities, it has been described as a positive step in
building relationships between Indigenous and non-Indigenous practitioners, in which
Indigenous midwives work in conjunction with nurse practitioners. In acknowledging the
necessity for autonomous governing in birthing experiences, the Six Nations Maternal and
Child Centre, or Tsi Non:we lonnakeratstha [the place they will be born] is a centre in
107
Ontario that is dedicated to providing a safe space for Indigenous women to exercise their
right to incorporate cultural protocol in birth. Through this centre, the midwifery program
lends support to the revitalization of traditional cultural knowledge, and encourages
Indigenous mothers, children, partners and families to take on a more active role within birth.
A goal of this centre is to encourage partners to be more active within the birth process, and
in doing so, enhancing family cohesion and partnership.
The Canadian territories have had a difficult time in implementing health services
broadly, and services for birth specifically. Both low and high-risk pregnancies require
evacuation from community to hospitals equipped to manage birth. Recent research has
suggested that community evacuation can produce an array of effects on the health of mother
and child (Bourgeault et al. 2004; Caroll and Benoit 2004; Munro, Kornelsen, and
Grzybowski 2013; National Aboriginal Health Organization 2004), and efforts are being
made to strengthen midwifery practices in regional centres in the north, with a pilot birth
centre in Rankin Inlet. In 1993, the Keewatin Regional Health centre was developed to
manage low risk pregnancies, in collaboration with the Manitoba Department of Health, the
government of Northwest Territories, and the Keewatin Regional Health board. Prior to the
establishment of this health centre, women were by default flown out of community to give
birth. From the pilot project to a full-scale program, midwives and their respective
apprentices take on an average of 70 to 80 patients annually.
The discussion of these facilities are important, as in contrast, there is a distinct lack
of services available in New Brunswick, Newfoundland and Labrador, and Nova Scotia.
Despite the volume of Indigenous communities in the Atlantic provinces, provisions have not
been made to provide maternity care that supports Indigenous birth. To effectively blend
108
traditional Indigenous knowledges concerning birth with biomedical perspectives comes with
an acknowledgement that the success is contingent on involvement from localized,
community-based health initiatives. The challenging task remains in overcoming the
cumulative effects of generations of assimilation, and the subsequent decline of traditional,
localized knowledges and belief systems. I caution readers to accept that incorporating
‘cultural competency’ in and of itself is the solution, as the institutionalization of birth, even
with culturally competent care, is still within the hospital and subject to hospital standards,
policies and procedures. Future research should look into whether the implementation of
cultural competency training would have an effect on the overall satisfaction of Indigenous
mothers in care.
This thesis addresses the need to decolonize aspects of the birthing experiences of
Indigenous women, for the benefits of the collective. The challenges faced by Indigenous
midwives are substantive. The standardization of midwifery services drastically reduces the
ability for autonomy and control if regulated by a medically dominated regulatory board.
Further, the normative education opportunities for Indigenous midwives are largely based on
a model of care that is biomedical. Therefore, a small number of Indigenous students enter
midwifery training programs in Canada, and fewer graduate (National Aboriginal Health
Organization 2004). I suggest a two-eyed seeing approach to decolonizing the birth
experience would help those in control of curriculum and maternity care provision realize
that distinctive means of managing birth in Indigenous communities could have a profoundly
positive effect on the health of all women. Therefore, allowing space for these knowledges to
be assessible in the healthcare system would allow for better outcomes in health, despite
109
cultural backgrounds. By restoring power to mothers, grandmothers and women as central to
the birthing experience, we move towards a truly decolonized approach to birth.
The medicine wheel, within its various cultural interpretations, hinges on a collective
premise: That health is not a singular entity, but comprises multiple, interrelated quadrants of
health (Battiste 2011; Clarke and Holtslander 2010). The health of a person is interconnected
with the health of a community, and the health of a nation. Therefore, it is imperative that
supports are in place for the multiple, interrelated quadrants of care: Physical, emotional,
social, mental and spiritual. Mainstream medical narratives tend to reject the idea that health
is a multifaceted, interrelated entity, and instead approaches health on the basis of treating
physical illness. Medical rituals, including standardized invasive care, the routine use of
medication to manage pain, and the exclusion of alternative narratives of care and
management makes it difficult for individuals with a diverging conception of health to feel
supported. The medicine wheel is applicable to the birthing experience, but inconsistent with
hospital protocol where birth is typically medically managed: An issue to be solved rather
than a celebration of motherhood and as a site of cultural reproduction. Therefore, while
efforts are made to be as accommodating as possible, the biomedical viewpoint of birth
further colonizes Indigenous women, as their experiences, informed by cultural influence, are
discredited in favor of a more medicalized approach.
Through the use of a two-eyed seeing approach that insists on seeing through both
eyes (Martin 2012) birthing can be transformed as a space in which the medical dominance
of birthing care is not the benchmark of how birth is treated. Instead, the incorporation of
Indigenous birthing practices can be absorbed into this broader system of maternity care,
quite like each piece of the medicine wheel is carved into place. This research has identified
110
inequities faced by Indigenous mothers within hospital settings, and the likelihood that
addressing singular pieces of the medicine wheel leaves women more likely to interface with
the health system as a result of experienced inequities. Through an approach to health care
that emphasizes the importance of cultural relevance, we begin to untangle the effects of the
intensive suppression of cultural knowledge and forge a path towards decolonizing the
systems of continual colonization that persists to modern day.
Limitations
There were several limitations in relation to establishing research relationships,
collecting data and the subsequent analysis of the data. I started this research in the fall of
2016 and was not able to speak with any mother of this community until May of 2017. This
gap in time is a demonstration of the difficulty in accessing participants, as well as
establishing credibility as a researcher looking to engage with Indigenous communities. The
first stage of this research project was developing relations of trust, which is essential for the
integrity of the research process but was at odds with the timeline of my graduate program.
As a result, the sample size is small, and a larger sample size may have revealed additional
important themes.
Throughout this research process, there were a number of barriers that prevented me
from conducting this research in the way that was originally planned. At the beginning of this
project, I was hoping to facilitate a conversation with both the on-reserve Indigenous
communities, as well as neonatal unit staff at hospitals. I wished to understand the story to
the fullest extent, as healthcare practitioners could reflect on their own experiences of
providing care, provide insight on why birthing experiences happened the way that they do,
and provide insight into the practices in the hospital.
111
The issue of interacting with participants on reserves in Nova Scotia is that often this
research was not aligned with the research priorities of the reserve communities that I spoke
with, as they did not see this research as a priority area within their own health initiatives. In
order for research to be decolonizing, it must be a research relationship in which the
community at hand view the subject as a priority, and beneficial. The communities I
contacted, or at least those speaking for the communities, did not see this subject as a
priority. Further, it was often difficult, as someone who is outside the reserve communities in
question, to interact with potential participants, and my racial and cultural background and
lack of past involvement within the community meant that I did not have an established
relationship of trust. Akin to my methodological framework, there has been a distinctly
negative relationship between Indigenous people and academic researchers. I respect the
boundaries that had been put up to prevent me from speaking with on reserve communities
but must identify it as a struggle that I had to overcome.
In terms of speaking with staff at neonatal units in the hospital, there were
institutional barriers from preventing me from doing so. Under the Nova Scotia Health
Authority, employees are prohibited from participating in research that discusses the terms of
their employment, without the research being approved by the NSHA Research Ethics Board.
In order to be approved by the NSHA for non-clinical research, there must be an employee of
this Health Authority acting as an investigator for the project. Due to a lack of time or desire
to have a third governing body on this research, I opted to address the experiences of urban
Indigenous women instead. This could be a future recommendation for those who are
wishing to pursue this further and are willing to take the time to prepare a third ethics
application.
112
Due to the fact that this research was exploratory, there was a limited amount of
midwifery experiences among the mothers. Had I known the impact of midwifery care on the
empowerment of Indigenous women’s birthing experiences, I would have used ‘accessing
midwifery care’ as a sample selection criteria. That being said, by using an open criteria, I
was able to explore a variety of birthing experiences. Future research for those interested in
how midwifery care can address decolonized birth would expand the findings of this
research.
Recommendations for Future Research
Research on the birthing experiences of urban Indigenous women as a current
colonized site and a potential for decolonization is important to consider in the current
climate of reconciliation (Truth and Reconciliation Commission of Canada 2015). This
research model could be extended to on reserve communities, as the narratives could be
different due to available health services on reserves, but also further distances to travel to
give birth in hospitals outside of reserve communities. Specific to the healthcare model, a
study based on the perceptions of Indigenous women’s care needs and the institutional and
personal barriers to addressing them would address gaps in relation to understanding the
maternity care context. By gauging the opinions of healthcare staff, in relation to the reported
experiences of marginalized individuals in hospital settings, the study of the experiences of
healthcare providers providing care to marginalized populations could further describe the
landscape of birthing, and provide insight into why these experiences and perceptions of
neglect are occurring.
Concerning methodology, an approach to research that aligns closely with a
participatory action research framework may improve data interpretation and actively engage
113
the community in addressing this issue. While this research focuses on the narrative
experiences of the mothers, there is no way to account for the accuracy of my interpretations
at this time, as they are filtered through my internal outsider biases. A participatory
framework would establish a relationship with the community in question that focuses on the
mutual benefit of each actor, encouraging meaningful participation in a de-escalation of
traditional power relationships, and focusing on drawing conclusions and creating an action
plan based on the outcomes of this research. This framework would account for the potential
of reconciliation of past research related harms and allow for their experiences and
contributions to have a substantial impact on the research process.
114
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Appendix: Research Tools
Mi’kmaw Ethics Watch Certificate
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Acadia REB Ethics Approval
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Interview Schedule
Name?
Age?
Place of birth?
How many children?
Where did you give birth?
Tell me about your birthing experience?
Recalling your birthing experience, is there anything that you would like to have gone
differently?
While you were pregnant, how would you say your access to prenatal care was?
Did you rely on ‘traditional’ Indigenous knowledge and practices during your pregnancy?
What are some of the birthing practices that you would say are unique to Indigenous culture?
Speaking about your identity as an Indigenous mother, can you describe how important
Indigenous birthing practices are to you? If not, then why not? If so, why is it important?
Recalling your birth experience(s), were there any challenges in practicing those methods?
How supportive was the environment to respecting your cultural practices?
Can you describe the care that you received from staff that attended your labour?
Can you describe the care that you received after you gave birth? Did you receive care
outside of a Provincial healthcare setting?
Specifically for the talking circle participants:
One of the themes that was discussed with the talking circle was about ‘fear’: What are the
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fears? What are the cultural fears? What would you say about the notion of ‘living in two
worlds’?
In the talking circle, we discussed what colonized birthing experiences look like. According
to your own context, what would ‘decolonized’ birth look like?
One of the themes that was discussed with the talking circle was about the power that
medical staff can have to dismiss alternative knowledges and a birthing woman’s own bodily
capabilities Do you think that there’s a dismissal of maternal knowledge in hospital settings?
If so, why? If not, why not?
During the talking circle and listening to other people’s stories, did anything stand out for
you about Indigenous women’s birthing experiences?
Was there anything that you think would be important to include in this interview? Was there
something that I forgot to address?
