Keynote speeches at the Brisbane Congress from Canada, Malawi, the UK and Australia: four renowned midwives gave inspirational addresses on the Congress themes of history, professionalisation, current ways of knowing and future pathways.

Monday, July 25--'History'

Participants at the first full day of the Congress heard a striking presentation called 'Bringing birth back to the community' from two midwives who work among the Inuit people in the far northeast of Canada: Julie Nastapoka, Community Midwife, Inuulitsivik Health Centre, Inukjuak, Quebec, and Vicki Van Wagner, who works at the Inuulitsivik Health Centre and at Ryerson University.

The 'History' theme was highly appropriate, as the Inuit peoples of Canada (population about 40,000), living in Nunavut, Nunavik (Quebec) and Nunatsiavut (Labrador), follow a traditional culture and way of life. They are part of the northern circumpolar peoples, living above the tree-line on the tundra, in coastal communities. Hunting and fishing is an important part of the subsistence economy.

However, Julie explained, they are living with the impact of colonialism and rapid cultural change over the past few decades. Among the Inuit, there is a strong history of, and pride in, midwifery and women's knowledge and skill about birth. There was therefore great dissatisfaction with the policy imposed on them of evacuation of pregnant women at 36 weeks or earlier to southern hospitals for birth. Evacuation has both social and medical risks; it is associated with loss of autonomy, poor diet, substance use, family stress, lack of information and lack of appropriate care and high rates of intervention. In Nunavik, taking birth out of the community is symbolic of disrespect and neglect.

A new midwifery service started in 1986 at Inuulitsivik Health Centre in Puvirnituq. This was inspired by the community itself, and set up through the efforts of Inuit women's organisations, linked with Inuit cultural revival: it is seen as part of the 'healing' from colonialism. The Inuulitsivik Health Centre is governed by an Inuit community board and is committed to education of Inuit health workers and to community development. Consultations are held with elders, childbearing women and young women to establish appropriate aspects of maternity care.

'On the job' education means that student midwives are also vital health workers. Traditional midwives and traditional knowledge about birth are part of the education programme. Nine midwives have graduated through the Inuulitsvik education process, and seven student midwives are currently learning.

There is still a need for more local transfer, as the women from smaller villages come to the birth centre at 37-8...