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ARVIAT - With the departure of its only midwife last month, Arviat women again have no choice but to leave their families and community behind to have babies.

The hamlet's long-awaited birthing centre, expected to open months ago, was never completed, and only one maternity care position is currently filled at the local health centre.

"We've had no indication to give us hope, and this is something this community has gone after since day one," said Shirley Tagalik, a member of the hamlet's health committee. "There was supposed to be at least two midwives, and the last one left this summer - and at any given time we have 45 pregnant women in the community."

Arviat, with a population of close to 2,000, consistently has the highest birth rate in the territory. In most cases, women must travel to Winnipeg up to a month before their due date to deliver in a regional hospital.

In 2005/'06, federal funding was made available through the Territorial Health Access Fund for Nunavut Arctic College to train midwives and maternity care workers, and for the creation of some new positions.

One maternity care worker was trained in Arviat. Funding to renovate Arviat's old health centre into a birthing facility was allocated in 2006/'07, and a contract tendered by the Department of Community and Government Services.

But while the first midwife was hired over a year ago, the renovations were never completed. The midwives were given clinic space in the regular health centre.

"When we were approached we wanted to make sure it would work. We'd been asking for it for at least 20 years, and we want a birthing centre that will work well. We asked for a stand-alone facility - a place of wellness not a place of sickness," Tagalik said.

The recent departure of the community's midwife was mainly due to professional burnout, according to Chris Siksik, a midwife at the Rankin birthing centre.

"It really came down to the fact that we were only able to recruit one midwife. The health centre is a very small building with a lot of nurses and very little room. There really wasn't room for them, but in one extremely hot, small space where they shared their clinic space and office. The centre itself has been very long in coming, and it still wasn't there," she said. "The midwife was also always on call, with a very antiquated call system where the calls get forwarded to their home. It's fine if you're only on call one night out of five, but she had to be available all the time."

The community enjoyed about three successful local births, but the working situation became "intolerable," according to Siksik.

According to a GN representative, the renovations to the birthing facility are now complete with the exception of the installation of the telephone system, which is still in progress.

"Right now they're planning to put at least two midwives there," Siksik said. "Midwifery services will resume ... as soon as we have enough staff."

The Rankin birthing centre, on the other hand, has enjoyed a great deal of success over the last few years, according to Siksik.

With three midwives and a number of maternity care workers, 52 babies were delivered there last year, "and we're pretty much on track to do the same at least, if not more, this year," she said. "We've got stability ... we're really lucky because we have three midwives all the time, as well as two very capable senior students from the Nunavut Arctic College. We are able to get time off."

Over half the new mothers come from Kivalliq communities outside of Rankin Inlet.

The centre is separate from the hamlet's other health facilities, with two clinic rooms and birthing rooms.

"That's the ideal situation," Siksik said.

According to a GN representative, the Department of Health and Social Services is currently working on a strategy for birthing centres based on Rankin's model.

Nunavut Arctic College will offer its maternity care worker program this year in Cambridge Bay, while students continue their midwifery studies in Iqaluit.

There has long been support for this type of care in the Kivalliq region, according to Joe Karetak, an Arviat resident who has assisted researchers on the subject.

"It was often the elders that promoted the idea to the health committee. They felt that if you were a healthy woman, with no complications, is it really necessary to spend four to five weeks down south? They have been concerned with a strain on the relationships and families," Karetak explained.

In traditional Inuit culture, a number of ceremonies take place immediately upon the birth of a child.

"Once the midwives deliver the baby, there was always an elder invited in to do the initial blessing, which would include a brief history of their namesake which they inherited and their expectations," Karetak said.

"The elders were concerned this was lost when the baby was born somewhere else, far from their community."