What are the Prenatal and Birth Experiences of Metis Women in Northern Manitoba,
Canada?
7th International Meeting on Indigenous Child HealthDenver, Colorado – April 1, 2017
Sanguins , J., Carter, S., Chartrand, A.F., Mayer, J., Kosowan, L., Lagimodiere, J., & Mehta, P.
Metis Health Knowledge Authority In Manitoba
Faculty/Presenter Disclosure
• Julianne Sanguins has no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity
• Julianne Sanguins does intend to discuss an unapproved/investigative use of a commercial product/device in this presentation
Where is Manitoba?
Who are the Metis?
• Culture arose from Blending of First Nations and European cultures (fur traders and other settlers)
• Children developed unique values, traditions and language
Where are Metis in
Manitoba?
2012 Populations:Metis 73,753All Other Manitobans 1,165,791
Metis Self‐Government through the Manitoba Metis Federation
• Citizenship: – Self–identify as Metis– Show an ancestral connection to the historic Metis Community– Be accepted by the contemporary Metis Community
• The Federation: 7 Regions; 179+ Locals
• President is elected by all Metis voters
• Governing body –1) President 2) 21 Metis Leaders (VP & Directors from 7 Regions) 3) 1 representative of Metis Women
Health Status Study
• First of its type in Canada• Higher rates of teen
pregnancy in Metis compared to all other Manitobans (70.2 vs. 46.4 per 1000)
• At a provincial level similar complete immunization rate compared to all other Manitoban children (72.0% vs. 71.2%, NS)
• Martens, Bartlett et al. (2010) REB #2007:069 (HIPC #2007/08 –01)
Infant Mortality Study
•Infant Mortality rate amongst Metis infants (under 365 days) not significantly different than all other Manitoban infants (p>0.05)
•Leading causes of death included congenital anomalies (26.56%); maternal and perinatal complications (9.38%); prematurity and/or low birth weight (9.38%); sudden infant death syndrome (SIDS) (9.38% vs 6.64%)
Sanguins, J., Bartlett, J.G., Carter, S., Mehta, P., Bassily, M., & Hoeppner, N. (2013). A study of infant mortality and birth profiles in Metis in Manitoba. Winnipeg, MB: Manitoba Metis Federation. REB H2011:257 (HIPC # 2011/2012‐14).
Reclaiming Birth: Understanding access to maternity services and supports for Metis women in Manitoba
Methods
• Study conducted by MMF and UM
• Funded by MB NEAHR (CIHR)
• Involved The Pas MMF and Thompson MMF Regions
• Involved Metis women aged 19+ and health service providers
Objectives of the Study
• To identify existing programs and services for pre‐ and post‐natal care
• To identify supports and environments that are needed
• To identify governance structures needed to support wellness during pregnancy and post–partum for Metis women
Metis Women Told Us –Positive Life Event
Pregnancy for many was ahappy time
“I was happy I was pregnantand I still am. I loved it. I amhappier than I was before Ihad a baby, and I loved beingpregnant and I enjoyed thenine months of beingpregnant.”
“It just seemed that’s what Iam here for, to just make thebest things!”
Metis Women Told Us –Positive Life Event
Pregnancy was often seen as a ‘rebirth’ the mother
“I would say that it changed my life for the better because I know if I didn't have kids I probably wouldn't be here right now, given the path I was going down.”
Metis Women Told Us –Importance of Support of Family and Other Women
• “I rely on my husband for my support”.
• “I found myself communicating more with mothers.”
• “Yeah I talked mostly to my grandmas, my friends. I wasn’t really in any groups or anything.”
• “I have my sister; she is a reliable confidante for the last couple of years and pregnancies.”
• “My dad was there, he always helped me and to put my head on a shoulder, he'd be there”.
Metis Women Told Us –Quality Maternal‐Child Health Programs
• Metis women spoke of the importance of prenatal classes
• Maternal‐child health programs that provided them with support
Metis Women Told Us –Good Experiences with Midwives
Many women spoke of midwifery offering a more holistic birth experience
They felt they learned more about what to expect
Few midwives available in the North (<5)
“I went to see the midwife here and she was so nice and made me feel welcome and made the second pregnancy feel different, learning more what to expect and it’s just different.”
Metis Women Told Us –Valuing of Metis Identity
• Metis identity was an important support for Metis women during pregnancy and birth
• “Like the way I am I have experienced a lot where the Metis people came from and what they are going through. I like being Metis and I like reading the history of it and it’s pretty awesome, it is!”
Metis Women Spoke About –Emotional Impact of Pregnancy
• “Well my first pregnancy I was young, naïve, and alone. I lived with my mom and the father was nowhere to be found or unheard of so I felt that I was not doing right by my baby and I should not have been pregnant and I felt stressed ‐ and I felt stressed and hurt.”
Metis Women Spoke About –Financial Stress
• Most of the participants experienced financial stress during pregnancy and post‐partum.
• “I am still waiting for it [EI] and my kid is four months old.”
“My pregnancy would have been better if I had more help in transportation to get to [Community X] and to Winnipeg ‘cause it’s hard to try to pay your own way, especially when you have to pay your own way and you don't get that much income.”
Metis Women Spoke About –Change to Support Systems
“…and even with everyone, like even within my own family and all those relationships just stopped.”
“…Like nobody, wanted to, well you find out who your true friends were, like who stayed with you.”
Metis women experienced changes in social networks during pregnancy and as new mothers
Metis Women Spoke About –Ageism
• “[For] me the reaction I got from my last baby I had was ‘What? How old are you?’ ”
• “I have never experienced that myself but other people have said things like ‘She is too young to be pregnant’ or ‘She is too old to be pregnant’. I have never experienced it myself but being around people who do talk about others.”
Metis Women Spoke About –Intimate Partner Relationships
Several women spoke of physical, emotional, financial violence in their lives before, during, and after their pregnancies
Few services in communities to address this
“…he was choking me out and I blacked out and thank goodness my mom was there, I don’t know what the HELL would have happened. Like it was scary. When I started to see the black I thought ‘Oh my God’, I’m like dying’. And I was like ‘I don’t even know who’s gonna take care of my son.’ ”
Metis Women Spoke About –Hope for the Future
“I can honestly say we are strong women…inside we are strong, like we are still standing and we keep our babies strong.”
Recommendations for Change
• More formal health and social system supports are needed– ‘Women need someone to
talk to’
• Supports for protecting women and their children against violence are needed – ‘Women need somewhere to
go when things are getting bad’
• Health Centre for Prenatal/Postpartum Care
• Transportation
• More health care staff– More midwives are needed– More hospital nurses– Doctors focussing on
maternal health care– Ideally, providers familiar
with communities
Acknowledgements
• Commitment of MMF Board• Leadership and strong support from our Health
Minister and Deputy Minister• Commitment and support from MMF Region
Vice‐Presidents as they lead their region Knowledge Networks
• Champions for health & wellness in Manitoba: Regional Health Authorities
• MB NEAHR (CIHR) for funding• Metis citizens in Manitoba who allow us to
serve them in our vision of ‘A Well MetisCommunity’
Come and visit sometime!
