The Rankin Inlet Birthing Centre: community midwifery in the Inuit context.

OBJECTIVES To trace the historical development of the Rankin Inlet Birthing Centre since its inception in 1993 in the context of plans to make it the nucleus of a system of community birthing centres throughout Nunavut. STUDY DESIGN This is an analytical historical study using a combination of oral history interviews, government documents and existing literature. METHODS Oral history interviews with current and former employees of the Birthing Centre, founding organizers and women who gave birth there were combined with a review of the literature using MEDLINE, Anthropology PLUS, CINAHL and Historical Abstracts, as well as a search of the records of the Nunavut Government and the debates of the Nunavut Legislature and its predecessor, the NWT Legislature. Results. The Rankin Inlet Birthing Centre has been successful, but only marginally so. The majority of births for residents of this region still occur in southern hospitals, either in Churchill or Winnipeg. Although the long-term plan for the Centre is to train and employ Inuit midwives, thus far only two maternity care workers are employed at the Centre. All the midwives are from southern Canada and rotate through the Centre and the community on fixed terms. The Centre has been very successful at gaining and retaining support at the political level, with a strong official commitment to it from the Nunavut Legislature, and active support from the medical communities in the Kivalliq and in Manitoba through the Northern Health Unit at the University of Manitoba. Community support within Rankin Inlet is less apparent and has been halting. Plans to extend the model of the Centre to other communities are long-standing, but have been slow to come to fruition. DISCUSSION The Rankin Inlet Birthing Centre has remained an important, but peripheral, institution in Rankin Inlet. It is in many ways a southern institution located in the Arctic; for this reason, and due to the social networks present in Rankin Inlet itself, it has suffered from a lack of enthusiastic support from the community. However, the staff at the Birthing Centre are aware of its shortcomings and explicitly support more community-centred approaches in other communities. CONCLUSIONS The staff and clients of the Rankin Inlet Birthing Centre have broadly recognized the challenges it faces. Future expansion is likely to adapt to local traditions and requirements, leading to new birthing centres that will be integrated into their communities.