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Health Studies
Denis Maxwell

HLTC02 WINTER 2013 Week # 7: “Midwife Preferred”: Maternity Care in Outpost Nursing Stations in Northern Canada by Judith Bender Zelmanovits Introduction  Expansion of nursing stations in Northern Ontario because of concern over infant mortality rates which were supposedly disproportionately higher in the North vs. the South Canada  First, government recognized the need to provide obstetrical services to northern communities but its intentions were consistently undermined by its inefficiencies in staffing the nursing stations with appropriate, sufficient qualified personnel  Second issue – nurses had an opportunity to expand their skills in maternity care in an environment whether they had greater autonomy and professional authority than their southern Canadian counterparts  Many of the settlements in the North are present only by plane and by season  Majority of the residents are Aboriginal people but there are also non-aboriginal people  Nurses provided health care and regular visits to small surrounding settlements that did not have a nurse  Nursing stations – nurses lived and worked included beds for short term live in patients, such as parturient women  Major factor that differentiates their experience from that of nurses in Southern Canada is the geographic and social isolation of the communities they served  Greater responsibility was significant, they were forced to make diagnostic and prescriptive decisions often without benefit of advice from colleagues, perform procedures outside of scope because of the limited trained personnel and emergency and resource-limited setting  Transport not easy to nearest hospital, little supervision  Government acknowledged a moral but not legal or treaty responsibility to provide health services  State medical service to Inuit communities developed much more slowly than that provided to Indian communities  Most important and least defined of newly minted nurses – maternal care o Had training to give some perinatal care but not deliveries, that was usually the prerogative of the doctors but in the North with limited doctors, that task fell to them  Nurses occupied an “alegal” space moonlighting as midwives and fulfilled many of the cultural norms and obligations of the communities they were serving  Maternity service in the nursing stations was divided into three stages – antenatal, perinatal, and postnatal care  Duties: pregnancy test confirmation, took a history, complete physical, urinalysis, abdominal examination, pap smear, examination of STDs, monitored blood pressure, hemoglobin, weight, fetal heart rate, confinement, prescribed vitamins and iron, offered support, allowed to stay overnight at the nursing station if there were any unusual symptoms, prenatal talks on pregnancy, childbirth, diet and budget, post natal visit, feeding baby advice, providing information on birth control and immunization,  WHAT IS CONFINEMENT? Such an odd word  I would not wanna be “confined” during pregnancy  Hiring nurses for northern nursing stations was advantageous in 3 ways o Economic benefits – cheaper to have nurses than doctors o Trying to deal with the high infant mortality rate HLTC02 WINTER 2013 o Few doctors widely spread out in the North so now they could only visit once or twice because a nurse was at least out there o Nursing stations saved money as transport in and out isolated settlements was by air and therefore expensive  Such a dearth or lack of nurses or rather nurses with midwifery training that many were “imported” in from other commonwealth nations such as England and Australia, Canadian nurses were barely being trained in this subspecialty  Department of National Health and Welfare were of the opinion that hiring of nurse- midwi
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