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Nursing in Northern Canada

One of our Perinatal nurses just came back from 3 months working as a nurse in Northern Canada, in the Northwest Territories and Nunavut. While there she discovered a few big differences that might make you think.

Here is a Q&A with Brooke:

What are some of the biggest differences in practice/care for labour & birth between Northern and Southern Canada?

In the north, women often have no choice but to leave their home community and be flown to a larger city to give birth. This is known as “birth confinement”. It is disheartening at times because they are flown out at 36 weeks and if they don’t deliver until 40-41 weeks this means they are away from their community and families for up to 5 weeks at a time. They also don’t have the luxury of having extended family present with them as only 1 support person/escort is paid for by the government.

Another big difference is how many women have natural births! There is a much lower percentage of women who opt for an epidural, and an epidural is not always available! The C-Section rate is also tremendously lower, I think part of this is attributable to the hands-off approach to labour and the lower number of inductions!

What is the most challenging aspect of working as a nurse in the North?

Definitely the lack of resources! In the south, we have pretty much every single specialist, tool and resource imaginable, whereas, in a more remote setting, we don’t have nearly all of the testing or medical personnel.

In the health centres that I work in in Nunavut, everything must be flown in so if we run out of a particular medication then we must wait for the next plane to fly it in. If someone needs an ultrasound or CT, MRI or surgery, they must be flown out to a bigger city to have this done. There are no physicians in the community, so almost all of the care is managed by the Community Health Nurses.

In addition, there are other challenges such as poor weather. If a patient is very ill or injured and needs to be flown out but there is bad weather, sometimes the plane is unable to land and we must make do with the resources and personnel we do have until the plane can come in to retrieve the patient. When it comes to labour and delivery, if there is an emergency or need for a c-section, we must call in the Obstetrician and Anesthesiologist which can take up to 20-30 minutes.

What is the most rewarding part of working in the North?

Being immersed in the Indigenous culture is a privilege...the food, cultural practices and way of life differ a lot from the south. Northern Canada is also very beautiful, so having the chance to explore during my time off was a bonus. And of course, knowing that you have truly made a difference in the lives of others is rewarding. This feeling is more prevalent working in the north because oftentimes you are the only one available!

We have an expanded scope that allows us to assess, diagnose, prescribe, dispense and follow up with patients. It can be hard work, with long hours and challenging cases, but it has allowed me to grow as a nurse, and as a human being. And finally, in a small community, you can really get to know patients and their families, they really embrace their healthcare team and make them feel welcome.

What is a fun fact about how life differs as a parent in the North?

There are no strollers! Inuit mamas carry their babies in something called an “amauti”. This is a parka worn by Inuit women of the eastern area of Northern Canada where the baby nestles against the mother’s back in a built-in baby pouch just below the hood. Children are carried around in the amauti until they are about 2 years old. This keeps the child warm and safe from the wind and cold and helps develop bonding!

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