Alienation and Resilience: The Dynamics of Birth Outside Their Community for Rural First Nations Women

  • Jude Kornelsen Department of Family Practice, University of British Columbia; Centre for Rural Health Research, Vancouver, British Columbia
  • Andrew Kotaska Department of Obstetrics and Gynaecology, Stanton Territorial Hospital, Yellowknife, Northwest Territories
  • Pauline Waterfall Heiltsuk College, Bella Bella, British Columbia
  • Louisa Willie Health Services, Hailika’as Heiltsuk Health Centre, Bella Bella, British Columbia
  • Dawn Wilson Hailika’as Heiltsuk Health Centre, Bella Bella, British Columbia
Keywords: Rural maternity care, First Nations maternity care, low resource environments, qualitative research interviewing


Bella Bella/Waglisla is a small community of 1,250 First Nations residents on British Columbia’s Central Coast that has enjoyed a long history of birth within the community. This ended in 2000 when services began to decline, forcing women to travel to distant referral centres before starting labour. This qualitative investigation documents the experiences of First Nations women who gave birth away from their communities. Data were collected through a written survey of women’s experiences of birth, locally or away, and through in-depth exploratory interviews of women’s stories of their experiences. A community-based research advisory committee guided the study and ethical approval was obtained from both the community band council and the appropriate university research ethics board. Themes from the interviews included the influence of care providers in decision-making, the isolating experience of birth in a referral community, the stress of traveling to access care, the value of emotional and practical support from family and community, and community confusion regarding the decision to close local maternity services. Participants in this study had divergent experiences of childbirth outside of their community; the natures of the experience influenced whether or not they chose or were required to leave after services closed. The experience of leaving the community was difficult for most of the women, precipitating a sense of alienation. For many, the alienation experienced was mitigated by their strong sense of resilience.