Episode 17: How Nathalie Pambrun, CAM President, Leads with Patience, Perspective and Understanding

Episode 17 with Nathalie Pambrun

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Nathalie Pambrun, CAM’s first Indigenous President, says being brought up in an environment that emphasizes a humanistic, relational approach is central to midwifery and her own leadership style.

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Nathalie Pambrun, President, Canadian Association of Midwives (CAM).

Although she has worked as a midwife in urban, rural and remote communities across Canada and internationally, and sat on both the NACM (Nation Aboriginal Council of Midwives) and CAM boards before becoming President, Nathalie Pambrun emphasizes that none of us is a born leader. Finding our voice means connecting with our passion and purpose – something Nathalie says comes naturally to midwives! For her, articulating a vision for healthcare that’s inclusive of all people means remembering where we come from and always being aware of the voices you’re not hearing.


Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to those leaders about the joys and challenges of driving change in our complex and demanding healthcare organizations.

Ellen Gardner: Good morning. I'm Ellen Gardner. I work in marketing communications at HIROC, and today on Healthcare Change Makers, we have the pleasure of talking with Nathalie Pambrun, who's the president of CAM, the Canadian Association of Midwives. Welcome, Nathalie.

Nathalie, you're the first Indigenous midwife to serve as President of CAM. Do you feel that puts a double burden of responsibility on you, not just to lead the organization but to continue to drive change for Indigenous midwives and the women they serve?

Nathalie P.: It's a good question. I think part of it is understanding some of the history of CAM and NACM. So, the history of the Canadian Association of Midwives and the National Aboriginal Council of Midwives, of which I am on both boards or leading core leaderships. I'm also the past president of the National Aboriginal Council of Midwives. I would say in about 2008, the National Aboriginal Council of Midwives officially and autonomously formed, but the Canadian Association of Midwives has offered administrative and financial support to the National Aboriginal Council of Midwives since 2006. So, prior to us kind of becoming more official.

Nathalie P.: And so, I think it's our collaborative relationship and the way that it's formed that really led me to continue to do the work with the Canadian Association of Midwives. What CAM and NACM do together is, it's rather unique from a health association perspective. We don't see this mirrored in nursing, with the physicians. It's this relationship of mutually supportive leadership where we acknowledge each other's strengths, and it's this continued commitment to work alongside each other.

Of course the Canadian Association of Midwives recognizes that the National Aboriginal Council of Midwives is the leading voice for Indigenous issues. But it's also that as allied midwives, we also recognize our responsibility and our way of working together. So in many ways, continuing my work with the Canadian Association of Midwives, being an Indigenous midwife has it allowed ... My lens has never changed in terms of how I see the world and midwifery. I just think that it has further strengthened that bilateral relationship.

Ellen Gardner: You've been one of the passionate midwives and facilitators who have played a key role in returning birth to Indigenous communities and in fact restoring Indigenous midwifery. What's been the most invigorating thing about seeing that happen, Nathalie, and being involved in it?

Nathalie P.: When I was the co-chair of the National Aboriginal Council of Midwives, we had received funding from the federal government. It was called the Aboriginal Health Human Resource Initiative, and this was an opportunity really to start to speak about midwifery, to talk, to open dialogue with communities and see where people were looking to create change in the reproductive health services that they were receiving. And I think also start to question the culture of birth and the culture that had been created around birth evacuation, and question those norms if you will, that had been put in place by these racist policies that were essentially removing capacity in the community and diminishing health outcomes.

Nathalie P.: It was an amazing opportunity to put a call out and say, "Who's interested in midwifery?" It was very difficult to choose which communities we would go into and work with. We chose to advance the ones that were the most advanced and where we could create more momentum. And so, we found ourselves in Akwesasne, which is a territory that bridges Quebec, New York, and Ontario. So you have a multi-jurisdictional complication there in terms of healthcare delivery, and really advancing the prospect of developing the type of Indigenous midwifery care that those communities wanted to see.

So we brought all sorts of stakeholders to the table, advancing discussions, identifying the barriers, looking at solutions. I feel like their vision of their maternity care and how it unfolded was really rooted in their traditions, and coming back to their creation story and using their creation story as a foundation for the creation and visioning of their reproductive healthcare that would be delivered by Indigenous midwives.

Nathalie P.: And so it was just ... it's very powerful and to see years later that there's funding in place and midwives are working and they're getting paid to work. That's not to say that there aren't still barriers and issues, but to see sort of that transformation and that change happen where the work is valued and the work is happening.

Ellen Gardner: You have talked about being a helper to your parents and grandparents, and watching your siblings and cousins, and you've said you were very affected by the loss of your grandmother at an early age. How has being connected to your roots helped you as a midwife and a leader?

Nathalie P.: It's been very grounding for me to remain connected to those parts of myself. When I think about who am most influenced by or my mentors, it's often my family. They're very basic skills and capacities that I feel really contribute to that humanistic, relational kind of approach that I think is quite central to midwifery and central to my leadership style.

Ellen Gardner: That strong family connection you have and your personality as a caring person, was that really the thing that drew you to being a midwife

Nathalie P.: I actually had an experience when I was quite young that led me to know that midwifery was my path. I would have been about eight years old and a good friend of mine called me up and said, "Oh, hey, you want to play?" And I walked over to her house. When I walked in the house, she was like, "Oh, my mom just had a baby. Do you want to come and see it?" And I was like, "What?" So, it was four hours post the birth. This would have been about the fourth child in this family of my friend's, and I walked upstairs and when I walked in that room, people were just sitting around. It was very calm, and the vibe in the room was like something I had never felt or experienced before. Immediately, I thought and could feel in myself, I wasn't born this way. Somehow I knew that, or I don't know, it was just a very profound knowing in that moment, and watching everybody care for my friend's mom, and meeting that baby.

Nathalie P.: I can remember leaving her house and thinking to myself, "Is there something more amazing that happens on this planet other than the fact that we reproduce like other humans?" And I thought, if I can be a part of that ... I felt very humbled by that thought and that idea, but also very drawn to the mystery of that experience. And so, I was sort of called at a young age... At the exact same time as I had that sort of sense of calling, I remembered having this as I was walking home, what appeared to me to be this random thought around water. And I was thinking to myself, "I wonder if one day my kids are going to drink bottled water?" And I started to think about the sacredness of water.

Nathalie P.: All of human life is made of water, right? It's an essential part of our bodies. It's inside the womb. It helps life grow and it protects it. And so for millennia, Indigenous life givers have honoured that sacred relationship with water. And I think that for me, that must have been in what we call my blood memory. It's like a teaching or knowledge that came from myself or my genes of my ancestors who carried that knowledge before me. And so that miracle of birth, that connection to land and water sort of launched me into this very specific path of reproductive justice, environmental justice.

Ellen Gardner: Getting that calling to being a midwife at a very young age was a wonderful thing for you, and I'm sure it's actually played out in a way that has been very satisfying. I just wanted to ask you about your practice life, because I know you've worked in urban communities, you have gone into remote and rural areas, and you have had international experience, too. So, maybe you can talk a little bit about your practice life and really what environment has had the greatest impact on you.

Nathalie P.: I've been practicing for 15 years and I am based in Winnipeg. I work in a community-based practice. That means we're not located in hospitals or institutions. I work out of a community health clinic with multiple other midwives, but also other care providers like dentistry, social work, doctors, nurse practitioners, in sort of a hub, like a one stop shop hub of healthcare access. My primary focus is working with teens.

My experience as a practicing midwife has been very diverse. I've had the opportunity to work internationally as well. I've worked with Doctors Without Borders, working in Chad on the Chad and Sudanese border in 2007, and that was ... I mean, seeing maternal and child health on another continent, in another country where there's such vast discrepancies, it's amazing because you need a whole new set of clinical skills and the kind of things that you encounter – because there's no preventative care – are just completely different than here at home.

Ellen Gardner: CAM has a national presence. You are coast-to-coast across the country. How do you, Nathalie, make sure that you're hearing the voices of midwives across the country? How do you keep everybody engaged when it's such a large and diverse population?

Nathalie P.: Essentially how we engage, I think it starts at the board level. Our board composition has the president of each provincial and territorial association there and present. So, it’s a bit like a federation. We also have the National Aboriginal Council of Midwives. We have a student representative, which is the Student Midwives Association of Canada. And then we have our executive board, so we have a very large board, but we really get the bird's eye view of the issues as they unfold, the themes, the trends that we see that are developing that we need to pay attention to and be responsive to. You have the weekly newsletter, updating our members on opportunities to participate on the work that we're doing. It might be through surveys or research opportunities, webinars. Of course, we host our annual conference in AGM.

Nathalie P.: The most important thing, though, that I think, is sometimes you have to reach out because you have to be aware of the voices that you're not hearing. So whether it's smaller jurisdictions or smaller practices that are challenged by their day-to-day work, who can't lift up their heads to say, "Hey, we need help over here," or marginalized groups. And so, how do we ensure that those voices get equal opportunity for advocacy, for being represented, for being visible?

Ellen Gardner: You are a busy person, Nathalie. We know you have young children and you're really making huge strides with CAM and the work that you're doing, and your vision for the organization. What keeps you motivated? How do you re-energize yourself?

Nathalie P.: What keeps me motivated as a midwife I think is seeing families heal from intergenerational trauma, learning how to parent again, even though they weren't parented themselves because of our histories of residential schools, and the separation of our families through child protection, and seeing what an impact midwifery can make. It starts at that individual level. And when you experience that as a practitioner, you think there has to be system changes that can be made or policy changes that can reflect bigger changes that we could see ripple out beyond me as a clinician directly to providing care to families.

Ellen Gardner: When you assumed the leadership of CAM, your mentor, Carol Couchie, an Indigenous midwife of Nipissing First Nation, told you not to be scared of making mistakes and to stay invested in the community. How has that advice helped you in your first year as president?

Nathalie P.: Again, it's that concept of grounding. Grounding myself, especially when you look at the sociopolitical context of what's happening nowadays nationally, but also globally. We are missing so many opportunities to show true leadership in our country, to have these important nuanced conversations about the history of racism in our country. Canadians are capable of that, you know? And it's not about demonizing any particular person. I find it truly challenging and so it helps me focus on, okay, how can I nuance the conversations that we're having about healthcare and move it forward? And so, it is in remembering where we've come from and where we're going that I think can help inform us and create a vision that's more inclusive, and that ultimately I think will be to the benefit of all, to the health and wellness of all peoples.

Ellen Gardner: Being a leader and saying the difficult and sometimes dangerous things takes courage. When you've see leaders not doing it, does it make you probably, yes, a little more fired up to actually get up and say those things?

Nathalie P.: Yeah, absolutely. I mean, and it's interesting, and I think as Indigenous people, it's less difficult for us to do that. And so when we work within organizations where sometimes there isn't that way of looking back and then looking forward. Sometimes people think, "Oh, it's not important to bring that up," or, "Why is that being brought up again?" and it's like, well, let's remind us about how we got here, right? And how this system that we're in is shaping the way that we're acting and how we can shift it and how we can change it. Because I think there's a lot of collective willingness to change.

Ellen Gardner: Nathalie, what does the partnership with HIROC mean to you and midwives across the country?

Nathalie P.: I think the partnership with HIROC has been ongoing for many years. HIROC's been a leading partner of the Canadian Association of Midwives, of our conference for instance. They've been constantly growing in support but also in participation. I think the gift in that relationship has been HIROC wanting to seek midwives' input in their own risk management, and contributing your perspective as an insurer. We've often had a great dialogue and risk discussions at our conferences, creating tools and webinars that can really support midwives. I also feel like the cooperative model also speaks to the progressive way in which midwives think and believe. And so, there's a lot of allyship philosophically between our organizations.

Ellen Gardner: We've heard you speak many times across the country and your voice and your message and the way you deliver it has true power. You have a charisma and just a way of connecting with your audience that when we've heard you, we think, "Wow, who is that person?!" And we want to hear more. So, what is it that you can say to other midwives that would help them raise their voices and just be heard in a way that you've made it a point of being part of your character and the way you present yourself?

Nathalie P.: I think the teaching for me is, none of us is born leaders. But what midwives have is passion and we all have a unique passion for a specific part of our work or the lens through which we see the work that we do every day. And so, part of it is connecting to that passion. We're connected to it. It's having that authenticity of being able to articulate your passion, relating it to sort of the bigger picture and why it's important. I think taking the time to really get engaged in things.

I can remember when I joined all of these boards, I felt like, "Oh my goodness, I don't know anything. These people know so much." We're constantly learning as leaders. We're constantly allowing ourselves to grow through our experiences. And so, I think it's about having that humility of bringing yourself to the table.

Nathalie P.: We're so enriched by being able to occupy and share these spaces. I think ultimately for me, what association work has done for me is it's pulled me out of my day-to-day challenges and struggles and it's given them a voice and a venue on a larger scale that has really given me perspective and patience and understanding, but also, it's allowed me to put my angry, feisty side to something constructive, like policy changes or creating programs that can help shift the culture. And so I think this ... I really invite everybody to have that, to know that you have a space and a unique voice and something to contribute.

Nathalie P.: I had a bumper sticker on my car ... Well, I’ve had many, but one of them was, “The world is run by those who show up”. It's like, you just have to show up. I hope that our members know that CAM is a safe place to be having some of these difficult conversations, to be exploring these topics together, to be represented. And so, the more people step up and step out, the more we can benefit from each other's diversity.

Ellen Gardner: That's great advice, Nathalie. Having an angry, feisty side can actually work in your favour a lot of time, as you know. So, thank you again for sharing your thoughts and your perspective, and your passion. It's been great talking to you today.

Nathalie P.: Likewise. Thank you very much.

Thank you for listening. You can hear more of our interview on our website, HIROC.com. Follow us on Twitter at @HIROCgroup or email us at Communications@HIROC.com. Healthcare Change Makers is recorded by Ellen Gardner and Philip de Souza and produced by Podfly productions for HIROC.com. Please rate us on iTunes.