A Report on Best Practices for Returning Birth to Rural and Remote Aboriginal Communities

BackgroundDuring the last four decades, policies and practices based on modern obstetrical techniques and knowledge have replaced traditional practices in many rural and remote Aboriginal communities. As most of these communities do not have obstetrical facilities or staff, women often have to leave their communities to give birth.ObjectiveTo review policies currently in place in Aboriginal communities that recommend evacuation of all pregnant women at 36 to 37 weeks' gestation to deliver in a Level 2 hospital.OptionsAllowing Aboriginal women, their families, and their communities to decide whether it is safe and practical for women to deliver close to home.OutcomesIncreased opportunities for Aboriginal women in remote and rural communities to deliver within their own communities or closer to home in a familiar environment.EvidencePubMed was searched for articles on subjects related to birth in Aboriginal communities, birth in rural and remote communities, and midwifery in Aboriginal and remote communities. The web sites and libraries of the National Aboriginal Health Organization, The First Nations and Inuit Health Branch, and Health Canada were also searched for relevant documents.In addition, the authors visited three communities that have trained local midwives and that support deliveries within the community to observe and participate in their programs.BenefitsIt is hoped that improved communication between health institutions and remote and rural communities and changes in policies and procedures concerning the care of pregnant women in these communities will contribute to reductions in perinatal morbidity and mortality.SponsorsFirst Nations and Inuit Health Branch (FNIHB), Health Canada.