Historically in Aboriginal cultures, pregnancy and childbirth were regarded as sacred events that were part of the natural life cycle governed by the Creator. The birth of a child signified new life and the powerful balance between the spiritual and physical worlds. A women`s ability to give the life and raise children, therefore placed her in a highly esteemed, sacred, authoritative and respected role within Aboriginal cultures. "Reproductive roles were central to women`s claims to social prominence" (1), and the women who were successful in raising children and providing care became influential as family spokespersons. Aboriginal midwifery was considered a calling and thought to be the Creator's work. Traditionally, midwives played essential roles, facilitating the childbirth process and were highly involved in the knowledge of traditional value systems from one generation to the next. However, the respected traditional roles of women and Aboriginal midwives have been diminished through centuries of colonial influence and assimilation policies.
The traditional Aboriginal model of maternal health care was weakened during much of the twentieth century by laws that made midwifery illegal and punishable by law as a result of these practices, many traditional Aboriginal customs have been lost and midwives today struggle to pass on surviving indigenous knowledge to their people. The medicalization of birthing process served to redefine pregnancy as an illness and the practice of midwifery as incompetent. The institutionalization of the birthing process removed birth from Aboriginal communities and placed it in often distant hospitals; as a result many Aboriginal women are still evacuated from their communities to give birth in hospitals. The removal of birthing from Aboriginal communities is reported to have "profound spiritual and cultural consequences, which are difficult to quantify" (2) and that has affected entire Aboriginal communities in measures of health and well-being. Traditional forms of midwifery included pre-natal, ante-natal and post-natal care which included frequent monitoring and counselling by an Elder or traditional midwife, an appropriate diet, traditional medicines and physical fitness regimens. It is suggested that Aboriginal midwives were herbalists, gynaecologists, obstetricians, and nutritionists all rolled into one. Midwives were reported to be able to reduce the intensity and pain of labour, and save the lives of women and infants (3). In traditional Aboriginal cultures, pregnancy and childbirth is regarded as a sacred period in a women`s life, with several customs and practices to be adhered throughout. There are many instructions on what foods to eat and how to conduct oneself during this sacred time.
Breastfeeding was the best, is the best and will remain the best as far as infant feeding is concerned. Breast feeding is a rich traditional practice in Aboriginal society. Many social, moral, and mythological factors are attached to the practice of breast feeding. The Aboriginal mind has recognised breast milk as the best food for the child since antiquity. The standard practice for infant feeding was nursing from the breast as one elder stated ''in the old days you simply breastfed your children'' (4). The duration of lactation was several years, until they were able to eat solid food. Breast feeding was prolonged considering that fertility was very high for aboriginal women in the twentieth century and birth intervals very short. But in modern times, until recently the practice of breast feeding has been declining even in Aboriginal group. The lost of infant feeding traditions is one factor within the larger culture context, in which formula feeding became the norm for Native women. Mothers living on reservations during the 1950s and 1960s were breastfeeding, when most women in the rest of the country were formula feeding. Another contributing factor was that by the mid-1970s federal nutrition supplementation and formula distribution by the Women, Infants and Children program were available to most women. Today, although breastfeeding rates vary considerably from one reservation to another and from urban areas to rural areas, breastfeeding rates for Native women are much lower than rates of the general population. The change away from traditional infant feeding practices towards manufactured formulas was a result of historical and social events unique to Native women, as well as the tremendous pressure caused by the manufacturing sector and medical establishment as they pushed artificial infant feeding for all women. However, breast milk now again is recognised as the most suited food for the baby. This has resulted in activities for increasing awareness and promotion of breast feeding.
The postpartum period, refers to the 6-to-8-week period after delivery. The newborn child was also immediately prepared for the world. Most Indians immersed children at birth, the water temperature notwithstanding. Other customary rituals included ear piercing, hanging wampum or other ornaments around the baby`s neck, and feeding the little one oil or grease. It was common to name a child at birth, possibly from a supply of names available to the clan, or in response to an event or the appearance of the child, or after an animate or inanimate object (an eagle, the wind). Nursing went on for several years. Many women resumed their normal activities within a week and were expected to care for their babies as well as other family members, and women often turned to their mothers for advice after birth. Children were given much love and affection by both parents. No preference was given to either male or female children as both sexes were seen as a gift from nature.
Younger generations display a movement away from cultural birthing practices and towards a more standardized approach to labor and delivery. The birth of a child is usually celebrated by the entire family. As women opt for more modern healthcare, they are often flown from remote areas two weeks before their dates to urban hospitals. They are only allowed to bring one support person which further contributes to the disruption of family involvement. In contrast, women who are living an urban existence but still subscribe to native ways, may not have traditional options available to them.
Because so many different tribes exist within the Native culture, childbearing practices vary greatly. Generally, Natives view pregnancy as a normal, natural process; for this reason, prenatal care is often not started until late in pregnancy. Maintaining a harmonious, stress free prenatal period and remaining active during pregnancy are considered crucial for a happy, healthy baby. The Native women usually prefer a female birth attendant, such as a midwife, although her husband or mother may assist with the birth. Birth is a family affair, and the woman may want her entire family present. Herbs are often used throughout labor and delivery and the postpartum period to promote uterine activity, stop bleeding or increase the flow of breast milk.
The traditional art of midwifery was learned from mother and grandmother. Today modern medicine and doctors have taken over. The use of and respect for midwives declined dramatically in the first half of the 20th century. The public grew to believe that midwife-attended births were unsafe. The decline was further accelerated by the development of anaesthetics. Doctors successfully fought for the right of all women to have access to anaesthetics, but they could be provided by doctors in hospitals. This change in attitude inevitably affected Aboriginal health care. The removal of births from many Aboriginal communities has had profound spiritual and cultural consequences. The loss of traditional birthing practices has been linked to the loss of cultural identity. Canada is currently facing a shortage of maternity care providers that grows more acute every year (5). The shortage is felt most acutely in rural and remote communities and has fostered an increased acceptance of midwives as appropriate care providers for low risk pregnancies. For Aboriginal communities, this development provides opportunities for the restoration of midwifery and community births. The re-establishment of maternity care in communities, and the recruitment of Aboriginal women into the profession of midwifery, has the potential to improve birthing outcomes for Aboriginal women. As the diversity and complexity of childbearing families increase, healthcare professionals as a team need to effectively assimilate the differences they encounter into their care. The development of cultural competence requires that healthcare professionals engage in ongoing cultural self-assessment and overcome any ethnocentric tendencies. The core of healthcare lies in our interactions with patients and families as we hone our ability to listen with a sensitive ear to gain an awareness of what makes people unique individuals. We should engage in ongoing dialogues with ourselves about the differences culture exerts on health outcomes, our own attitudes toward cultural differences and our ability to objectively understand descriptions of cultural behaviors. Competent, holistic nursing results from incorporating this awareness into the care we give to our patients. Culturally diverse childbearing families present themselves to prenatal healthcare providers with the same needs and desires of culturally mainstream families. They need to be given the respect and welcome shown to all families; be assured a birth experience that benefits from the highest quality of care; have their religious, ethnic and cultural values respected and integrated into their care; and have their physical and educational needs met in a way that respects spiritual beliefs and individuality.
