**Birth on the Land: Memories of Inuit Elders and Traditional Midwives.** Edited by O'Brien B. Iqaluit, NU: Nunavut Arctic College; 2012. Softcover: 144 p. ISBN: 978-1-897568-10-1. Price: CAN$26.25. Available from: http://www.arcticcollege.ca/en/component/virtuemart/books/health-and-wellness-publications

The impact and consequences of European contact and settlement on Canada's first peoples, including the widespread harm caused by the practices and policies of assimilation, are well known to us through investigations such as the Royal Commission on Aboriginal Peoples and the Truth and Reconciliation Commission. Less well known, perhaps, is the specific disruption to traditional birth practices and resulting social harm, particularly among the Inuit peoples. Two interventions impacted the traditional Inuit experience of pregnancy and birth: in the 1950s nurses and English-trained midwives began providing maternity care in community nursing stations and in the 1970s pregnant women began being removed from their families and communities and sent to southern hospitals for labour and delivery [1]. The damage caused by these practices to Inuit family and community has been recognized and has prompted the documentation of traditional Inuit birthing practices and efforts to re-establish the primary role of Inuit midwives and maternity care providers for birth support in the community [2]. Beverley O'Brien's *Birth on the land: memories of Inuit elders and traditional midwives* contributes to this focus. O'Brien was a nurse practitioner in the early 1980s in what is now Nunavut and had first-hand experience providing maternity care in the increasingly rare context of Elder-supported birth. Now a trained midwife and nursing professor at the University of Alberta, O'Brien has been involved with the recent development of a midwifery training program at Nunavut Arctic College to prepare Inuit maternity care providers to support women to give birth in their own communities.

The focus of this book are the memories, stories, and recollections of Inuit Elders and midwives from a very specific time, during the transition from birthing practices "on the land" to institutionalized birth in nursing stations and far-away urban centres. The book is a re-telling of interviews O'Brien conducted, with the help of Inuktitut or Inuinnaqun translators, with Elders and traditional midwives in 10 communities in Nunavut in 2010 and 2011. O'Brien's introduction to the book places birth in Nunavut in its historical and geographical context and describes the methodology she used to gather Elders' memories. She also describes the recent Nunavut government initiative to reclaim birth within communities. This has resulted in a new program at Nunavut Arctic College to prepare maternity care workers and midwives to support birth by respecting and utilizing traditional values while meeting Canadian maternity care standards.

As O'Brien indicates in her introduction, the book is not a comprehensive review of the history of all maternity care practices among the Inuit in Nunavut, but rather a collection of “snapshots” from a particular time in the life of the Elders and traditional midwives who shared their memories. O'Brien presents these conversations in six chapters organized around the themes reflected by the Elders' memories: Memories of life on the land, Memories of being pregnant on the land, Memories of birth on the land, Memories of the transition from birth on the land to institutional birth, Memories of caring for babies and children on the land, and Memories of adoption on the land. The emphasis on land underscores the Inuit relationship with their geography and environment in every aspect of life, including birth. Throughout the book are verbatim passages from Elders that frame O'Brien's discussion of Inuit traditional birthing practices and the transitions to institutionalized and medicalized birth. Each chapter provides snapshots of the interviewees' experience, whether it was her own birth and childhood, the stories of her parents' births, the births that she had supported as midwife, or the births of her own children, especially when those births changed from within the community to the isolation of southern hospitals. The seventh and final chapter, Sharing memories with contemporary midwifery students, focuses on the Elders' desire to see birth return to the community and their consideration of their own role in passing on the traditional birthing ways to the new students.

Although a brief 144 pages, *Birth on the land: memories of Inuit elders and traditional midwives*, is an important source of primary material. The first-person accounts provide rich detail of traditional Inuit ways surrounding childbirth and the impact of the new ways introduced by colonization. O'Brien's work in gathering the stories and memories of Elders respects the Inuit tradition of oral transmission of ways of knowing and practice. Given the age of the Elders and traditional midwives, it is fortunate that the work was done now while they are here to tell the stories. The central message of the book reiterates the quote from Nowyah Williams, Manager, Maternal Care, Rankin Inlet Birth Centre: "...a birth is a birth is a birth" (p. 23). For the Inuit birth was commonplace, part of life and part of the community, to be welcomed with little fuss and with the loving support of family and Elders, as it had been done for generations. O'Brien does well in demonstrating the impact of this loss to the family and community when mothers are separated by great distance for long periods of time to give birth and when the traditional relationship with Elders and respect for their wisdom has been supplanted by southern caregivers.

Two purposes and audiences might be served by this book. The first, as O'Brien suggests, is to provide grounding in traditional birthing practices for the midwifery training program at Nunavut College and to inform maternity care providers of the impact and contribution
of the Elders and traditional midwives. The role of Elders and the traditional midwives is well documented throughout the book and anyone who reads it will come away with more understanding and deeper appreciation of the place of birth in Inuit culture and the important roles these women played in families and the community. Chapter 3, Memories of birth on the land, provides fascinating, detailed descriptions of traditional birthing methods shared by the Elders on labour management and birth positions. Photographs were taken of Elders and volunteers demonstrating these traditional birth and support positions, including the practice of fundal pressure application, a procedure O'Brien notes as controversial in other settings. The photographs could be larger and better quality, but the images and text effectively describe the purpose, procedure, and outcome for these birth practices and could be incorporated, as O'Brien suggests, into training that respects the traditional Inuit ways as well as midwifery standards. Midwifery and other health professions students will not only benefit from these descriptions but also the book as a whole is a guide to culturally appropriate care.

The book's secondary role is for audiences outside of the health sciences looking at the impact of colonization on Inuit traditions and subsequent reclamation of traditional practices. This purpose is especially served by Chapter 4, Memories of the transition from birth on the land to institutional birth. As a scholarly source this book has some shortcomings such as no index, a need for more editing, and a very brief reference list that could be strengthened with more resources pertaining to the impact of maternal health policies and the recent movement toward reclamation of traditional birth and returning birth to the land [3, 4]. Even with those gaps, the book's first-person accounts from the juncture of the entrenched practice of institutionalized birth and reclaiming of community birth contained are an important addition to our understanding of this era.

Any library that supports the study and teaching of midwifery, nursing, or obstetrics, especially where culturally competent care is part of the curriculum or Inuit or First Nations families are community clients, would do well to purchase this reasonably priced book. For other libraries, this book is a useful resource and addition to material exploring the traditional culture and subsequent impact of colonization and settlement on Canada's first peoples.

## References

1. Van Wagner V, Epoo B, Nastapoka J, Harney E. Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada. *J Midwifery Womens Health*. 2007; 52(4):384-91.

2. Couchie C, Sanderson S. Society of Obstetricians and Gynaecologists of Canada. A report on best practices for returning birth to rural and remote aboriginal communities. *J Obstet Gynaecol Can*. 2007;29(3):250-60.

3. O'Neil JD, Kaufert PA, Postl B, Binns B. A study of the impact of obstetric policy on Inuit women and their families in the Keewatin Region, NWT: final report, September 1990. Ottawa: Health and Welfare Canada; 1990. p. 58.

4. National Aboriginal Health Organization. Celebrating Birth – Aboriginal Midwifery in Canada. [Internet]. Ottawa: National Aboriginal Health Organization; 2008. [cited 18 November 2013]. p. 95. Available from: http://www.naho.ca/documents/naho/english/midwifery/celebratingBirth/Midwiferypaper_English.pdf

### Lisa Demczuk, MLS

Elizabeth Dafoe Library, University of Manitoba
Winnipeg MB R3T 2N2

E-mail: Lisa.Demczuk@umanitoba.ca