4 funerals and a wedding

And four births...this is the aptly named baby `Lucky'

Midwifery students in the equivalency program

Susan has her own baby, Peter Nanuq, on her back when she does the head-to-toe newborn exam on Teegan, age 1 hour.

These are the three rockstar midwifery students in Inukjuak. Between them, they've had 9 babies of their own. To be a trainee, they applied and were interviewed by staff at the health centre (I guess it formalizes it, since everyone knows everyone here). They are each at a different levels of their training, and carry varying responsibility for pregnant woman - all under the supervision of two Inuit midwives. Their training is all apprentice-based, and they keep a log book of cases, skills, and knowledge acquired. Once they've provided primary care for 40 women (throughout pregnancy, labour, birth and up to 6 weeks for the woman and baby) and have attended 100 deliveries - they 'defend' all their acquired skills before a panel of midwives...from there, they submit their application to the Ordre de sage-femmes de Quebec, the regulatory body of midwives in Quebec.

Working on caribou heart - learning how to infiltrate anesthetic into a wound...

And learning how to suture

Transport and referral from the north

Heading out the door at 430am - the start of 18 hours of daylight

Student Susan May, with her baby Peter 'Nanuq' - born at home with the midwives. (Peter is wearing his cool sealskin boots made by grandmother Eva).

One of two delivery rooms.

Transport equipment and supplies at the back door ready for medevac. There's a heater to the right that holds expired iv bags - used as hot water bottles to pack around the patient for the trip out.

But what about the 6 hour transport time on a good day and the inherent risk of giving birth. It seems that with good prenatal care, preventative measures, and referring at-risk women to deliver in PUV with a little extra technology available, or in Montreal with a lot of technology available, the outcomes are very good. And when something comes up quickly, you manage it and it resolves, or stabilize them and move them, or you stabilize them and then sit tight through the night until the skies clear.

The most recent data by Luo, up to 2000, found that there was no difference in perinatal mortality rates among infants born in the north, compared to aboriginal infants and non-aboriginal infants born in the south (Montreal). They did however find that infants born to Inuit mothers, when adjusted for infant's sex, parity, maternal age and education, and marital status, had 4x higher risk of postnatal infections and sudden infant death compared to non-aboriginal infants in the south. Limitations in the data did not permit the researchers to control for maternal smoking in pregnancy. And 99% of women here smoke in pregnancy, and presumably in the postpartum too - though in the last 10 years, there has been a very successful public health campaign to get people to smoke outside (yes, all year) if they have young children in the house.

What is somewhat hidden in this paper is that ~70% of all women in the north and aboriginal women in the south had <11 years of schooling, whereas ~10% of non-aboriginal women in the south had <11 years of schooling...and given that the Auditor General of Canada in 2004 estimated that if all things remain the same - this gap will take another 28 years to close...we likely won't see a change in these numbers for a generation, as maternal education is closely linked to both neonatal deaths (<28 days), and infant deaths (<1 year).

Meeting their great grand daughter, less than an hour after she was born