Self-determination is the key to improved outcomes in midwifery care within Toronto’s Indigenous community

“If our community asks for it, then I will do it.”

This is commitment. The commitment Métis midwife Cheryllee Bourgeois has made to the Indigenous community.

Indigenous midwives, up until the medicalization of birth in the 1950s, had been providing care to pregnant people and catching babies in Indigenous communities since the beginning of time. Despite the silencing of their voices and suppression of their work by government and health-care policy across Ontario, in 1996 Tsi Non:we Ionnnakeratstha Ona:grahsta’: The Place They Will Be Born, the first community-governed Indigenous birth centre, opened its doors in the heart of the Ongwehon:we community at Six Nations of the Grand River in Ontario.   

Fast forward to 2018 when Seventh Generation Midwives Toronto (SGMT) received funding through the Ministry of Health’s Indigenous Midwifery Program (IMP) for an exemption Aboriginal Midwife (section 8.3.a of the Midwifery Act 1991 of Ontario) and a hospitalist midwife.

Cheryllee Bourgeois resigned her registration with the College of Midwives of Ontario, where she had been a member since 2007, to continue her work with SGMT as an exemption Aboriginal Midwife, regulated by the urban Indigenous community. A huge leap of faith for some, but not for this Métis midwife. 

Initially, she found the limitations of practice under the exemption clause challenging, as she had to problem solve with SGMT midwives to find ways to order labs and ultrasounds. (To date, exemption Aboriginal Midwives have not been assigned the billing numbers required to order tests, screening and ultrasounds and to access test results within Ontario’s health-care system, although the Ministry of Health has committed to provide these in the most recent midwifery funding agreement.) Strong relationships with her practice partners, the hospitalist midwife at Sunnybrook and community partnerships helped in smoothing her path and making the transition a little easier, including providing in-hospital support when required.  

Born on the West Coast and raised in Steveston, BC, a small fishing village and suburb of Richmond, Cheryllee grew up in a family of four brothers, three of whom were much older with a younger brother named Luke. Laughingly, she shares that she was always on standby to take care of the cuts and bruises suffered by her overly adventurous and rambunctious little brother on his daily escapades—jumping ditches and picking up anything and everything, dangerous or not. Experiences such as these in her younger life helped shape her and prepare her for her work as a midwife. Her resourcefulness is a skill she uses daily in her work providing care in Toronto’s Indigenous community, a skill she credits Luke with helping her to develop.

“Indigenous clients have lots of unmet health needs in terms of the broader system.  Midwives are very well positioned to actually attend to some of those needs. [Providing excellent care] is about creating systems, or ways that people can actually ask for what they need.”

Indigenous community members call many parts of the city of Toronto home. Cheryllee moves easily between her practice space at SGMT to people’s homes, in addition to working with those with no fixed address and who may be living in a variety of circumstances including local encampments, shelters or the transitional housing dotted around the city. Cheryllee works within the full spectrum of the primary practice of Indigenous midwifery, providing access to sexual and reproductive health-care services to the Indigenous community in Toronto.

Call Auntie

When COVID-19 hit, Cheryllee and the Indigenous community birth workers at SGMT’s Baby Bundle Program knew they had to act fast to provide a service that would effectively reach many Indigenous community members within the Greater Toronto Area (GTA). Knowing there was potential for many to become extremely ill with the virus, they put their heads together and came up with the Call Auntie phone line. 

Why “Call Auntie?” Who do you call when you are overwhelmed and you don’t know where to turn? Very simply, you call Auntie. A phone line was easily accessible and the name was chosen to appeal to every Indigenous ‘cousin’ in the city. The team  pooled all their resources and skills in supporting community members to navigate sexual and reproductive health care and added COVID-19 to the list. Cheryllee reflects, “we were already [providing care] for folks who are pregnant, expecting or those who are looking for a termination or don’t know what to do when they are pregnant.” Since initiating the service, the staff have begun offering an access point to Call Auntie via Facebook and have further expanded the service through the interdisciplinary Call Auntie Clinic, which operates every Wednesday afternoon out of SGMT at the Toronto Birth Centre, with regular appointments and walk-in services available. Through the service, community members can access culturally safe care that includes sexual and reproductive health care, primary health care with an Indigenous physician, referrals to mental health supports, pandemic-related information and support, as well as advocacy services.

“I feel very privileged to be doing this work—being responsive to the needs of the people in the community. It feels like a good purpose for me.”

“Indigenous clients have lots of unmet health needs in terms of the broader system.  Midwives are very well positioned to actually attend to some of those needs. [Providing excellent care] is about creating systems, or ways that people can actually ask for what they need.” When a service is filling that need, Cheryllee observes, people respond. “Many times, it is simply problem solving. It is helping clients draw the line from point ‘a’ to point ‘b.’” The approach involves respect for the individual and self-determination at its core, understanding that clients hold the answers. She adds, “the service provides care to clients who may not have received care— where care was non-existent or very low level. It may not totally look like a regular midwifery course of care, but it is contributing to better outcomes.” 

Good purpose and better outcomes

Cheryllee is extremely proud of the work of the Baby Bundle Program and Call Auntie. The commitment to providing the care that the community asks for and providing culturally safe sexual and reproductive health care is paying off. This commitment is resulting in better outcomes for her clients, which is key to changing the narrative for Indigenous families in the GTA. At a time when there are more and more reports of Indigenous people suffering racist attacks and discrimination within the health-care system in Canada, building trust and maintaining that trust takes not only reliability and dedication to the community, but hard work.

Cheryllee asserts that it is important for communities to define what midwifery is to them. Funding through the Indigenous Midwifery Program has allowed more freedom in the delivery of services and for her to create models that fit the needs of the people. She shared, “I feel very privileged to be doing this work—being responsive to the needs of the people in the community. It feels like a good purpose for me.”