title: Remote midwifery in Nunavik, Québec, Canada: outcomes of perinatal care for the Inuulitsivik health centre, 2000-2007.
abstract: BACKGROUND
  The Inuulitsivik midwifery service is a community-based, Inuit-led initiative serving the Hudson coast of the Nunavik region of northern Québec. This study of outcomes for the Inuulitsivik birth centers, aims to improve understanding of maternity services in remote communities.
  
  
  METHODS
  We used a retrospective review of perinatal outcome data collected at each birth at the Inuulitsivik birth centers to examine outcomes for 1,372 labors and 1,382 babies from 2000 to 2007. Data were incomplete for some indicators, particularly for transfers to Montreal.
  
  
  RESULTS
  Findings revealed low rates of intervention with safe outcomes in this young, largely multiparous "all risk" Inuit population. Ninety-seven percent of births were documented as spontaneous vaginal deliveries, and 85 percent of births were attended by midwives. Eighty-six percent of the labors occurred in Nunavik, whereas 13.7 percent occurred outside Nunavik. The preterm birth rate was found to be 10.6 percent. Postpartum hemorrhage was documented in 15.4 percent of women; of these cases, 6.9 percent had blood loss greater than 1,000 mL. Four fetal deaths (2.9 per 1,000) and five neonatal deaths (< 3.6 per 1,000) were documented. Nine percent (9%) of births involved urgent transfers of mother or baby. The most common reasons for medical evacuation were preterm labor and preeclampsia, and preterm birth was the most common reason for urgent neonatal transfer.
  
  
  CONCLUSIONS
  The success of the Innulitsivik midwifery service rests on the knowledge and skills of the Inuit midwives, and support of an interprofessional health team. Our study points to the potential for safe, culturally competent local care in remote communities without cesarean section capacity. Our findings support recommendations for integration of midwifery services and Aboriginal midwifery education programs in remote communities.
authors.affiliation: Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada.
authors.forename: Vicki
authors.initials: V
authors.lastname: Van Wagner
authors.forename: Claire
authors.initials: C
authors.lastname: Osepchook
authors.forename: Evelyn
authors.initials: E
authors.lastname: Harney
authors.forename: Colleen
authors.initials: C
authors.lastname: Crosbie
authors.forename: Mina
authors.initials: M
authors.lastname: Tulugak
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D004930:Inuit; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration; D008880:Midwifery / Q000379:methods / Q000706:statistics & numerical data; D009321:Natural Childbirth / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration; D011225:Pre-Eclampsia / Q000208:ethnology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000208:ethnology; D011792:Quebec / Q000453:epidemiology; D019114:Remote Consultation / Q000379:methods*; D012189:Retrospective Studies