Heart work: Indigenous doulas responding to challenges of western systems and revitalizing Indigenous birthing care in Canada

Abstract

Background In Canada, there has been a significant increase in the training of Indigenous doulas, who provide continuous, culturally appropriate support to Indigenous birthing people during pregnancy, birth, and the postpartum period. The purpose of our project was to interview Indigenous doulas across Canada in order to document how they worked through the logistics of providing doula care and to discern their main challenges and innovations. Population/setting Our paper analyzes interviews conducted with members of five Indigenous doula collectives across Canada, from the provinces of British Columbia, Manitoba, Ontario, Quebec and Nova Scotia. Methods Semi-structured interviews were conducted with members of the five Indigenous doula collectives across Canada in 2020 as part of the project, “She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas.” Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. Results Our paper examines two themes that emerged in interviews: the main challenges Indigenous doulas describe confronting when working within western systems, and how they navigate and overcome these obstacles. Specifically, interview participants described tensions with the biomedical approach to maternal healthcare and conflicts with the practice of Indigenous infant apprehension. In response to these challenges, Indigenous doulas are working to develop Indigenous-specific doula training curricula, engaging in collective problem-solving, and advocating for the reformation of a grant program in order to fund more Indigenous doulas. Conclusions Both the biomedical model of maternal healthcare and the crisis of Indigenous infant apprehension renders Canadian hospitals unsafe and uncomfortable spaces for many Indigenous birthing people and their families. Indigenous doulas are continually navigating these challenges and creatively and concertedly working towards the revitalization of Indigenous birthing care. Indigenous doula care is critical to counter systemic, colonial barriers and issues that disproportionately impact Indigenous families, as well as recentering birth as the foundation of Indigenous sovereignty and community health.

Returning childbirth to Inuit communities in the Canadian Arctic

“…Alternative models have been implemented elsewhere to facilitate the entry of Indigenous providers into midwifery work. For examples, an Indigenous doula programme has been successfully implemented in Manitoba [ 69 , 70 ]. This approach might be considered as a lower threshold entry point into midwifery work for Inuit.…”

Dene, métis and inuvialuit peoples’ voices on the impact of Canada’s perinatal transport and non-medical escort policy in their communities: an outcome assessment approach and narrative literature review

“…There have been numerous groups created in the past few years across Canada/Alaska and in other circumpolar regions that aim to train Indigenous individuals in midwifery and doula care in the hopes of returning birthing to the community. This paper interviewed doulas from five Indigenous Doula collectives across Canada (British Columbia, Manitoba, Ontario, Quebec, and Nova Scotia) to understand the challenges and innovations they faced when providing Indigenous centred doula care [ 43 ]. As previously mentioned above, continuous support during labour has shown to lead to better outcomes overall, these results are also observed with doula presences at a birth as well.…”

“…As previously mentioned above, continuous support during labour has shown to lead to better outcomes overall, these results are also observed with doula presences at a birth as well. Doulas help women cope with the pain of labour and reduce their anxiety which can both shorten labour length and reduce interventions [ 43 ]. The main conflicts doulas faced in trying to provide Indigenous centred labour support included conflict with the western biomedical approach, challenges with infant and child apprehension, difficulty in accessing Indigenous specific doula training and spaces to problem solve with other Indigenous doulas as well as access to adequate compensation [ 43 ].…”

“…Doulas help women cope with the pain of labour and reduce their anxiety which can both shorten labour length and reduce interventions [ 43 ]. The main conflicts doulas faced in trying to provide Indigenous centred labour support included conflict with the western biomedical approach, challenges with infant and child apprehension, difficulty in accessing Indigenous specific doula training and spaces to problem solve with other Indigenous doulas as well as access to adequate compensation [ 43 ]. Not only are women faced by challenges when travelling for birth but Indigenous individuals attempting to provide doula care are also facing barriers.…”

The need for sustainable funding for Indigenous doula services in Canada

“…20 Specifically, Indigenous doulas play a critical role in countering medical racism in hospital and clinical settings and advancing the resurgence of Indigenous birthing sovereignty. 21 , 22 Indigenous doulas are rooted in cultural teachings and spiritual connections, and therefore, play an essential role in the re-establishment of self-determined Indigenous birthing practices. 23 – 25…”