Alienation and Resilience: The Dynamics of Birth Outside Their Community for Rural First Nations Women
by Jude Kornelsen, Andrew Kotaska, Pauline Waterfall, Louisa Willie, and Dawn Wilson
Women in rural First Nations communities are often evacuated to give birth due to lack of local maternity services. Studies suggest that these women face significant social, cultural, and financial stress as a result.
Bella Bella/Waglisla: Women’s birth experiences
In the small community of Bella Bella/Waglisla in British Columbia, maternity services began to decline in the year 2000. In 2001, it was mandated that all pregnant women had to leave the community to give birth at a larger hospital. The authors surveyed women about their birth experiences before and after the loss of maternity services, and included those who gave birth locally and those who were evacuated to referral centres. Data were gathered through written surveys (55 participants) and in-depth interviews (12 participants) and qualitatively analyzed to identify themes:
- The decision-making process: Many women who chose to leave the community to give birth before the loss of services did so when local services began to decline. They described their decision in terms of safety and risk, and were usually strongly influenced by their physician and family, as well as their loss of confidence in local services as the number of health care providers declined.
- Isolating experience of birth in a referral community: When traveling to give birth, many women had to make compromises on transportation method, quality of accommodation, and choosing accompanying family members. The women often gave birth while separated from their other children and without the usual sense of community celebration.
- Travel concerns: The women expressed concerns about traveling during bad weather and being unable to return home. As a result, several chose less comfortable but more reliable methods of transportation (e.g., bus or boat vs. plane).
- The importance of family: About half of the women were able to have accompanying family members at the referral centres, which helped to reduce the sense of isolation. However, there was also a profound sense of sadness for the family members left behind.
- The desire to be home: Many of the women wanted to return home immediately after giving birth at the referral centre, despite the discomfort or need for continued medical attention. The desire for familiar routines and foods was strong.
- Understanding the change in service: Many women did not understand why maternity services were no longer available locally, and felt that the loss of these long-standing services was irrational.
Alienation and resilience
Many of the women felt a sense of isolation, alienation, and powerlessness as a result of having to give birth at a referral centre. However, most of the women showed resilience by proactively seeking answers about the decline in services, or trying to mitigate their feelings of isolation and estrangement at the referral centres (e.g., by bringing along family members and returning home as soon as possible).
Due to limited maternity service in small rural communities, local births for Aboriginal women are not always possible. In order to reduce negative outcomes, solutions are needed to reduce the stress of evacuation for birthing mothers and involve the affected women and communities in the decision-making process.