Birth, Pregnancy & Postpartum Around the World Online Course(s) & Continuing Education

Since the formation of Canada in 1867, the Canadian government has systematically imposed a Euro-Western biomedical model of maternity care on Indigenous peoples. Colonialism and white supremacy rationalized the development of the Indian Residential School system with Christian organizations in attempts to “kill the Indian in the child.” Government goals were to civilize and assimilate Indigenous Peoples into a generic Canadian identity for the sake of nation building and colonial expansion. Eugenic ideologies underpinned the reduction of Indigenous populations through the forced, coercive, and covert sterilization of Indigenous women and girls. In Canada, two provinces had a Sexual Sterilization Act (Alberta and British Columbia), although it was practiced throughout the country. In the area of maternity care, Canadian healthcare systems have consistently failed Indigenous people and their children as evidenced by having highest IMR in Canada. Despite this, Indigenous midwifery and improved child and maternal health for Indigenous people, families, and communities can be realized. A return of birth to the land, recognition of Indigenous women’s and Two Spirit leadership in the provision of excellent culturally-informed, anti-colonial maternity care will contribute to the improved health and wellbeing of Indigenous Peoples.

16 million adolescents give birth in India annually which roughly translates to 100 percent of teenage pregnancies worldwide. The United Nations Population Fund (UNFPA) predicted “India will retain the biggest national adolescent girl population, with hardly any net change from 2010 to 2030 (93 million to 95 million)”. Birth Village, the natural birthing center, is the only free-standing natural birth center with midwife led care based currently in India.

In 2012 we formalized our second not for profit organization Birth for Change, and in conjunction with another NGO Dil se, have been successfully running Tejus, a home, the only one of its kind in India for young children who enter pregnancy primarily through violence. We provide a safe space where this section of vulnerable population obtain nourishment, childbirth education and exercise classes, facilitating supportive relationships, birth services and postpartum services. We have also expanded to provide an additional foundling space where the mothers can keep their babies. This presentation provides a look some of our research, including birth narratives recorded with consent, and provides a focused look at the midwifery care of adolescent pregnancies.

The cesarean delivery rate in America has increased steadily from 5% to 30-32% over the last 50 years, along with an increase in costs as well as short- and long-term maternal, neonatal and childhood complications. In Denmark, extensive teamwork between obstetricians and midwives has succeeded in reducing the cesarean section rate at the Hospital of Southern Jutland (SHS). Ten initiatives were implemented over eight years from 2010 to 2018. The department focused on natural childbirth, teamwork, vaginal breech birth, VBAC and only performing cesarean section (CS) when medically indicated.
After implementation of the initiatives at SHS the rate of elective CS decreased from 8% to 3%, emergency CS stable at 13%, and the overall CS rate decreased from 20% to 16% in 2021. In comparison the national rate went from 21% to 19%.
These reductions were made without any significant increase in birth complications such as instrumentation at vaginal delivery, low pH or low Apgar scores. One of the biggest changes at SHS is the rate of vaginal birth after previous cesarean section. The department has a team working to support women with fear of childbirth by making specific birthing plans. The department shares a belief that a good vaginal birth experience is better than an elective cesarean if the women feels safe.