From the Frontlines with Claire Dion Fletcher, NACM and Seventh Generation Midwives Toronto

Front the Frontlines with Claire Dion Fletcher, Indigenous Registered Midwife

Through her work as a midwife, an educator, and an advocate, Claire pushes for safe and accessible healthcare – keeping the patient and their family at the centre. 

Show Summary

Welcome to From the Frontlines, a special Healthcare Change Makers mini-series. Healthcare providers and support staff have been on the frontlines, fighting for Canadians since the start of this pandemic. In this series we’re handing the microphone over to some of those amazing individuals.  

Today, HIROC’s Michelle Holden and Philip De Souza sit down with Claire Dion Fletcher, Indigenous Registered Midwife and Co-Chair of the National Aboriginal Council of Midwives (NACM). Claire gives us an inside look at what midwifery and patient care look like in today’s new normal. 

She speaks about the important role that Indigenous midwifery plays in our healthcare system and what Canadians can do to better understand this relationship. 

For those looking to learn more about NACM and the role of midwives in our healthcare system, Claire leaves us with some salient takeaways. 

Key Takeaways

  • (1:05) Claire tells us about herself and her work
  • (2:18) The centering of clients and families in the care experience is crucial to providing good healthcare
  • (3:12) How midwives play a role in the revitalization of Indigenous knowledge and culture in healthcare
  • (4:16) What has changed and what has stayed the same in midwifery care since the start of the pandemic
  • (7:02) Talking to clients about the unknowns around being pregnant and delivering during the pandemic
  • (8:44) The day-to-day of a midwife
  • (10:03) NACM’s work around inequities in the healthcare system and the demand for better access to care provided by Indigenous midwives
  • (12:23) Claire’s work with the Midwifery Education Program at Ryerson
  • (13:06) One thing Canadians can do to better educate themselves and see the true value of midwives in society
  • (15:00) How the attention being drawn to racism today is interlinked with midwifery

Mentioned in this Episode


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.

Michelle Holden: Hey, podcasters. I'm Michelle Holden, Communications and Marketing Lead at HIROC. First, I wanted to thank you all for taking the time to listen and follow our podcast, Healthcare Change Makers. Over the past few months, we've seen how healthcare providers and support staff by being the driving force fighting for the health of Canadians. We've truly been inspired by your resiliency. And so we're handing the mic over to some of those very amazing individuals on the front lines. Today, we have Claire Dion Fletcher, an Indigenous Registered Midwife with Seventh Generation Midwives in Toronto and Co-Chair of the National Aboriginal Council of Midwives. 

Hi, Claire. Thanks for being with us today.

Claire Dion Fletcher: Thanks for having me.

Michelle Holden: Would you mind telling our listeners a little bit about yourself? 

Claire Dion Fletcher: Sure. So I am an Indigenous Registered Midwife working in Toronto. I'm Lenape Potawatomi and mixed settler, and I work at Seventh Generation Midwives Toronto. We're an Indigenous-focused midwifery practice, and I'm also Co-Chair of the National Aboriginal Council of Midwives along with Carol Couchie. And I am also an auntie of three. I have my two nephews and a niece who I try to spend as much time with as I can, but it has been harder to do in the pandemic because they don't live in the city.

Michelle Holden: That's great. It sounds like you're very passionate about family as well as midwifery.

Claire Dion Fletcher: I am. 

Michelle Holden: Can you tell us a little bit about what makes you so passionate?

Claire Dion Fletcher: Sure. I think there's a number of things that really make me passionate about midwifery. I think going to births and getting to be part of such an important moment in people's lives is really an extraordinary experience. And every time I go to a birth and I'm part of somebody's birth and labor, I always feel quite lucky, and it is I think new and exciting every time I do it. But I think one of the things that makes me most passionate about midwifery is really the centering of our clients and their families in their healthcare experience.

Being able to really provide clients the type of care that they want and that they need and clients really being able to be in control of their healthcare is extremely important to me and what really drew me to midwifery and keeps me in midwifery. I think that in midwifery and Indigenous midwifery particularly, we're often providing care to a population of people who have experienced or know people who have experienced racism in the healthcare setting and centering our clients and their families in their care, participating in the care that the client wants and directs is crucial I think to providing good healthcare.

And as midwives, not only do we work towards this, but we also participate. We have the ability to participate in the revitalization of Indigenous knowledge and culture in healthcare. So being at births and participating in prenatal care and postpartum care where clients are surrounded by their family, where Indigenous knowledge and practices is respected and incorporated into healthcare and where babies are being born into a loving and respectful environment surrounded by their family, I think is what makes me most passionate about being a midwife.

Michelle Holden: Thank you for that. Yeah, it seems very kind of ingrained in what you do and the way you talk. We can tell that you're very passionate about it. One thing that I know Indigenous midwifery for it has a long history, but I did want to talk a little bit about the pandemic and what may have changed now since then in midwifery generally, as well as in the work that you're doing. So I was wondering if you could speak to that.

Claire Dion Fletcher: So I think a lot has changed and also very little has changed as well. I think we have made a lot of adjustments to the way that we provide our prenatal care and postpartum and intrapartum care in thinking about what we can do as midwives and as healthcare providers to help prevent the spread of COVID-19, to make sure our clients are staying safe and as healthy as possible. And as healthcare providers, we know all of these things are extremely important, and we want to lessen the spread of the pandemic, especially for midwives who are working with clients who don't have as equitable access to healthcare.

It's really important to ensure that our clients stay healthy, but I think these changes also make midwifery care look different during the pandemic. So some of the things that we've been doing are we changed our visit schedule, so less in person visits, more visits over the phone or over different internet platforms. Partners and support people are able to be less involved or we have to think about different ways to involve them. We're wearing PPE at our visits and during birth and postpartum, which we know is extremely important, but it's also a barrier which makes your prenatal appointments and your birth feel a bit different when you can't see your midwife in the same way as you used to be able to.

So that we support people in birth, including family visits in birth and in the postpartum has become... We have to think about how to do this differently. Especially at the beginning of the pandemic, we are supporting people who are getting less in-person support, right? Like families weren't seeing each other as much. Oftentimes we're the one person who the pregnant person is still in contact with beyond their immediate family, and I think this was really hard on our clients and also hard for us as midwives.

But I think we as midwives really mobilize to ensure our clients are staying safe and to try to figure out how to still provide the midwifery care that we love and that we know and that our clients need while also keeping everybody safe.

Michelle Holden: Yeah. It sounds like while things have changed definitely, you and we here at HIROC have noticed that, that things are very consistent as well with midwives and the care is still there. It's all still about the client and the family and what you can do for them, so that's really nice to hear. I wanted to ask you a little bit about how you talk to patients and clients right now around some of the unknowns when it comes to being pregnant and delivering.

Claire Dion Fletcher: Yeah. I think this is actually one thing that as midwives we were already good at doing. So birth itself is unpredictable and you can have a plan and you can talk about how things normally progress and how you think they're going to progress, but there always has to be room for things to change. So I think that's a skill that a lot of midwives already have, and so just expanding that to include the changes that were happening during the pandemic and reassuring people that while things look different, we're still providing the same level of care. We know as midwives how to adapt. We're already set up to provide care in the community, right?

We already do things like risk screening and some check-ins, and we're used to doing all those things. So in a way, while things were quite different, some things still stayed the same. And I think we were in a good position to be able to talk about those things and to reassure our clients, "People are still having babies, and your birth is going to look different, but we're going to try to preserve as much of what you want as possible," which is just things we already did when plans change and when things become different.

Michelle Holden: What is the day-to-day kind of for you right now? I know you talked about the changes in the virtual care and potentially you're not always going into client's homes. But if you could walk us through what it is that you're doing on a day-to-day, that'd be amazing.

Claire Dion Fletcher: I think the day-to-day of midwife looks very, very different. You could be doing... You could be in clinic doing your clinic appointments. You could be on call, going to births, seeing your clients at home for a postpartum. And then those are the kind of like usual clinical things that we're doing. Everything is taking I think a bit more time. Well, you have to put on your PPE outside of people's house and being really careful about changing your clothes and changing in between seeing clients and making sure that we're doing as much as we can to reduce the spread of COVID. We do lots of online meetings, and we're not meeting with our colleagues in person as much anymore.

So lots of our meetings and things like that have become online and relying on online meetings and phone calls and email to communicate and attend the different meetings that we do.

Michelle Holden: I know aside from providing care, you're also working as Co-Chair, as you said, of NACM. Can you speak a little bit about that and kind of why it's important for you to give back in that way?

Claire Dion Fletcher: My role at NACM is important because I feel it's a way that I can really participate in supporting the growth of Indigenous midwifery. And I think one thing that the pandemic has really highlighted and is hopefully drawing attention to is inequities in the healthcare system. Especially at the beginning of the pandemic, we were very concerned, and we still are, but concerned about clients in the North, in rural places, on reserves, in smaller centers where there's less access to healthcare, we were very concerned about the spread of COVID.

I think what is really being drawn attention to is the need for midwifery and the need for Indigenous midwifery for more Indigenous midwives and the real demand for better access to healthcare. And I think that's one of the things that really motivates me about working at NACM and why I think it's important is the role that NACM plays in supporting the growth of Indigenous midwifery and really working to ensure that everybody has access to an Indigenous midwife. And Indigenous midwifery allows birth to stay closer to home and sometimes in your home.

The importance of that became very clear during the pandemic and what people needed to do to stay safe and to feel safe was to be closer to their home and to not have to travel into the urban centers and to not have to be exposing themselves more and more to other people. And the lack of midwifery, Indigenous midwives in some communities, was really highlighted.

Michelle Holden: I just want to transition a little bit and find out what you do in your spare time, what keeps you energized and motivated.

Claire Dion Fletcher: I really love to bake and cook and preserving. I got a whole bunch of raspberries this past weekend and made a bunch of different preserves. So those are some of the things I like to do that are non-midwifery. But I think one of the things that keeps me like most energized and motivated in addition to my work with NACM, which I've talked about is really I teach in the Midwifery Education Program at Ryerson and getting to see the incoming midwifery students and the Indigenous midwives who are coming up in the program and aspiring midwives. And all of the amazing things that they're doing for Indigenous midwifery is really what really motivates me.

Michelle Holden: It sounds like you're very busy. That's what I take from that. That's nice to hear though. Philip, did you have any other questions before we let Claire go?

Philip De Souza: One thing I did want to add, Claire, is just that how we as Canadians should be applauding midwives and supporting them. And if there's one thing that you think that any Canadian can do to better educate themselves about NACM, about just midwifery in general, what's one thing someone can do just to better educate themselves and to see the true value and importance midwives play in society?

Claire Dion Fletcher: That's a good question. I think I'm going to say like one easy thing to do would be to check out the NACM website. We have some really great information there, really great publications that talk about the importance of midwifery. We have a Twitter account. You can follow us on Twitter, but that will be... That's like one kind of easy thing to do to kind of learn more about midwifery.

Another thing would be if you wanted to go a little bit further, you could become a supportive member of NACM, which is funding that helps us do more of our projects and work our daily operations.

Philip De Souza: What you're saying really resonates about the access to care and having people in the community. And I think people often forget or people just don't know how pivotal the role of midwife is. And I think that sometimes, especially how the pandemic has shown us, is that community is so critical to happy people and to care that can be provided, like you said, right at home. So I think it's very important that people in general just kind of educate themselves, especially in the time we're in now with so many different social issues that are being pushed into the spotlight. I just want to make sure that HIROC is there to support any way we can.

Claire Dion Fletcher: Yeah, that's great. Yeah, I think the attention being drawn to racism in healthcare system, as well as the larger society and the role that that plays on people's health is being... There's attention being drawn to it during the pandemic, which I think is a really important, because it's something as like Indigenous healthcare providers we know exist and we know our clients. We see our clients face it. We see our colleagues face it, and we see it ourselves. But I think the attention being drawn to it in the pandemic is really important and will hopefully result in some changes to our systems.

Michelle Holden: Absolutely. Okay. Well, thank you so much, Claire, for taking the time today to talk to us. I know you're very busy, a lot of hats that you wear, so really appreciate it and we're excited to share your story with our listeners.

Claire Dion Fletcher: Yeah, thanks for having me. This was great. It's always great to have an opportunity to share what we do and some of our work. So thanks.

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