Background: During the last four decades, policies and practices based on modern obstetrical techniques and knowledge have replaced traditional practices in many rural and remote Aboriginal communities. As most of these communities do not have obstetrical facilities or staff, women often have to leave their communities to give birth.
Objective: To review policies currently in place in Aboriginal communities that recommend evacuation of all pregnant women at 36 to 37 weeks' gestation to deliver in a Level 2 hospital.
Options: Allowing Aboriginal women, their families, and their communities to decide whether it is safe and practical for women to deliver close to home.
Outcomes: Increased opportunities for Aboriginal women in remote and rural communities to deliver within their own communities or closer to home in a familiar environment.
Evidence: PubMed was searched for articles on subjects related to birth in Aboriginal communities, birth in rural and remote communities, and midwifery in Aboriginal and remote communities. The web sites and libraries of the National Aboriginal Health Organization, The First Nations and Inuit Health Branch, and Health Canada were also searched for relevant documents. In addition, the authors visited three communities that have trained local midwives and that support deliveries within the community to observe and participate in their programs.
Benefits: It is hoped that improved communication between health institutions and remote and rural communities and changes in policies and procedures concerning the care of pregnant women in these communities will contribute to reductions in perinatal morbidity and mortality.
Sponsors: First Nations and Inuit Health Branch (FNIHB), Health Canada.
Recommendations: 1. Physicians, nurses, hospital administrators, and funding agencies (both government and non-government) should ensure that they are well informed about the health needs of First Nations, Inuit, and Métis people and the broader determinants of health. 2. Aboriginal communities and health institutions must work together to change existing maternity programs. 3. Plans for maternal and child health care in Aboriginal communities should include a "healing map" that outlines the determinants of health. 4. Midwifery care and midwifery training should be an integral part of changes in maternity care for rural and remote Aboriginal communities. 5. Protocols for emergency and non-emergency clinical care in Aboriginal communities should be developed in conjunction with midwifery programs in those communities. 6. Midwives working in rural and remote communities should be seen as primary caregivers for all pregnant women in the community.