Bringing Birth Home: A Conversation with Dr. Karen Lawford, Canada Research Chair (Tier II) - Indigenous Midwifery

Dr. Karen Lawford is an Anishinaabe midwife from Lac Seul First Nation and was recently named a Canada Research Chair (CRC) - Indigenous Midwifery at McMaster University. We spoke with her about this recognition, her research on evacuation for birth and the future of Indigenous midwifery.

Congratulations on being named a Canada Research Chair - Indigenous Midwifery. What does this recognition mean for you personally and for the field of Indigenous midwifery research?

In the academic world, it is a huge accomplishment and honour to be awarded a Canada Research Chair. I am very honoured. What feels great for Indigenous midwifery is that my university nominated me and it sees Indigenous midwifery as important enough to have a high-level research position. I was quite surprised when it was brought to me that this was even a possibility, because there has never been a CRC in any midwifery, and the first one is allocated to Indigenous midwifery. I hope that it elevates Indigenous midwifery into a realm where people understand its importance.

You are the first Indigenous midwife in Canada to obtain a doctoral degree. What led you down this path?

When I was a Registered Midwife delivering babies, I was 100% surprised and incredibly disappointed that I was not able to work on reserves, which was the whole point of my becoming a midwife. I was told western midwifery would never be funded for on reserve services and that there was not a mechanism to navigate the very real jurisdictional challenges between federal and provincial spaces. I started to wonder about these reasons and wanted to understand why I could not work on reserves, and that is when I decided to go to university to do graduate work. After my master's degree, I asked my mom, Anita Olsen Harper, and my stepfather, Elijah Harper, what I should do. I asked if I should go into public service to try to make changes from inside the system. In conversation with Elijah, he asked me to do my PhD. So that is how I came to have a doctoral degree. I was asked to do it.

You have done research that examines Indigenous peoples’ responses to evacuation for birth. What have been some of your key findings?

My key finding is that Indigenous people who are impacted by the federal evacuation policy do not like it. It is a very disruptive federal policy to the family and it is very unsafe from Indigenous perspectives of safety. I often heard people say, “Well, people love traveling for birth because then they can go shopping,” which is such a deeply uninformed perspective. When Indigenous people travel for birth, they leave their homes and communities, and all their support systems. People who travel for any health care are completely dislocated and institutionalized; they are NOT going on holiday.

Further, when people are evacuated for birth, the process reinforces the idea that the land is dangerous, and this is not true. As Indigenous Peoples, our relationship with the land, animals and water is our defining identity. We need to be supported to live on the land with our people and all our relations in a way that brings us health and wellness.

Is bringing birth home one part of a bigger goal?

Yes. When birth is brought home, it is not just the pregnant person and a care provider working in community. It is about the family being there and being supportive. It is about people in the community who go hunting for you because they know you need a certain kind of soup after the baby is born. Bringing birth home is about building and weaving a web of relationships, so we understand and practice our relationality. It is a reminder of our relationship to each other and to the land. Bringing birth home is an opportunity to start this life in a good way. If we have an option to stay with our family and kin, isn't that beautiful? Bringing birth home is about the permission we give ourselves to begin to build these relationships in a good way. It has such beauty in it, and hope.

Your work also explores the resiliency of pregnant people who are evacuated for birth. Can you share more about that?

I think we are really tired of being resilient. It is exhausting always having to manage the racism, the contempt and the ignorance of health-care providers who mock Indigenous people, which still happens. I should not have to be resilient. There should be responsibilities and accountabilities that health-care providers have, and repercussions for being horrible, awful people. I am tired of being resilient. Indigenous people are deserving of uplifting, supportive spaces where we can thrive, including in our health care.

What progress has been made for Indigenous midwifery in Ontario?

Ontario is a very interesting jurisdiction because of the exemption clause in its legislation, which serves as an example to other Indigenous midwives in Canada and globally.

I am still trying to understand the benefits of the College of Midwives of Ontario registration for an Indigenous midwife because Indigenous midwives practising within the exemption clause in Ontario have access to liability insurance and provincial billing numbers, which facilitates inclusion of care services for those they serve. The authorities that set out the responsibilities and accountabilities are different for an Indigenous midwife practising within the exemption clause compared to an Indigenous Midwife who is practising as a Registered Midwife, and the scopes of practice may also differ. The widened scope of practice for an Indigenous midwife resonates with me as it facilitates the practice of our roles and responsibilities as Indigenous Peoples.

I think the idea of progress will only be known with time. I have lots of questions, but really, no solid answers at this moment. Really, we will need to hear from Indigenous midwives in order to understand concepts of progress.

What are the most significant barriers Indigenous midwives face in their communities?

I see and hear a lot of gatekeeping. I keep hearing about non-Indigenous registered midwives being unsupportive of Indigenous midwifery. I still hear about OBs not allowing any midwives, or an increase in the numbers of midwives, to have privileges in the hospital, yet we have been in a maternity care crisis for almost 25 years. How can we address barriers for Indigenous midwives in a meaningful manner when you still have individuals saying, "No, you can’t work in our hospital"? I feel really sad that certain individuals would rather maintain the maternity care crisis than work with any midwives, let alone Indigenous midwives. The gatekeeping of Indigenous midwifery by other health-care professionals—including non-Indigenous registered midwives—is a major barrier.

How can non-Indigenous midwives and health-care providers better support Indigenous midwifery?

Non-Indigenous midwives and health-care providers need to be supportive and stop trying to lead. This is not their space. I remember someone said, “if there are not enough chairs at the table, do not just bring more chairs; let's get rid of the table.” We hopefully all want the same thing, and it is more than a live baby and a live person at the end. It is about a joyous experience that shapes people’s lives forever. Indigenous midwifery reminds people there can be such beauty and community building, and I wish that for everybody.

What message would you like to share with Indigenous families and those working to bring birth home?

I hope that Indigenous midwives and Indigenous student midwives know that what they do matters, and that supporting dignity in care matters and makes a difference. We need to remember that Indigenous midwives are doing the work, and we need to uplift them as much as possible.

For Indigenous families, people should know they have options. People need to understand that they can say no. Unfortunately, we are in a time when we need to write things down. For example, if you asked for your partner to be in the room and they were kicked out, document it. Document if something was good, too. You can ask questions and you can also say no. Also, you can ask for Indigenous midwives when travelling for birth.

What advice would you give to young people who might be interested in becoming an Indigenous midwife?

Becoming and being a midwife is not easy. We walk that line between life and death, and that is a huge responsibility.

I think people should go for it. An Indigenous person at any age can become an Indigenous midwife. Follow your heart. Meet with Indigenous midwives and registered midwives, find out about their jobs, talk to them, be engaged. Even if you change your mind, maybe you want to be a second attendant or work in the midwifery field. It is not an all-or-nothing situation. I stopped being a practicing midwife, and I have a very successful career as an Anishinaabeg midwife who is registered and who does not deliver babies. There are lots of options.

I encourage all people to learn more about Indigenous midwifery and to support Indigenous midwifery students and Indigenous midwives.