Giving birth in a good way: co-designing culturally safe birthing services with Inuit from Nunavik and their service providers
Notice bibliographique
Résumé
BackgroundIndigenous Peoples in remote regions of Canada are routinely transferred outside of theircommunities for birth - a practice known as childbirth evacuation. Recent evidence linkschildbirth evacuation with negative health and social impacts. Evacuation affects Inuit inNunavik (Inuit territory in Northern Quebec), where at least 14% of people leave theircommunities for birth. Moreover, rapid population growth risks exceeding service capacity forlocal birthing in the region, recognized for its revitalization of Inuit midwifery and communitybirthing. With widening inequities in perinatal outcomes between Inuit and non-Indigenous inQuebec, there is a pressing need for culturally safe service re-design of childbirth evacuation,alongside support for continued local birthing in Nunavik.Objectives and methodsThis doctoral project engaged Inuit and their service providers in Montreal and Nunavik tosupport culturally safe Inuit birth in the context of evacuation and local birthing. Four objectivesguided the thesis by publication:Objective 1: Assess the factors and outcomes associated Indigenous childbirth evacuation inCanada as the foundation for stakeholder mobilization and engagement in service re-design,using a scoping review of the literature (addressed in Publication 1).Objective 2: Collate the visions of Inuit evacuated for childbirth and their Montreal serviceproviders about birth in a good way in the context of evacuation, using fuzzy cognitive mapping(FCM) (addressed in Publication 2).Objective 3: Develop a list of priority recommendations, implement, and evaluate these withservice providers and Indigenous patient partners at the McGill University Health Centre(Publication 3).Objective 4: Examine Inuit and Nunavik service providers’ perspectives on supporting perinatalwellness and birth in a good way in Nunavik, along with pathways for continued childbirth in theregion, using FCM (Publication 4).ResultsCollating the research on Indigenous childbirth evacuation, the scoping review illustratednumerous emotional, social, and cultural harms. It highlighted a need to re-evaluate childbirthevacuation, considering knowledge gaps regarding its long-term impacts on Indigenous perinataloutcomes (Publication 1). A local application of FCM with 8 Inuit and 24 service providers inMontreal generated 17 recommendations for culturally safer childbirth evacuation. Operator-independent weighting, based on Harris' discourse analysis helped collate stakeholderperspectives (Publication 2). A narrative description illustrated the implementation of four co-designed cultural safety interventions with Indigenous stakeholders and service providers. Testedagainst a modified theory of planned behaviour, an Indigenous-led cultural safety trainingdemonstrated positive influence on service provider knowledge and actions (Publication 3). FCMwith 16 Inuit and 9 service providers illustrated 13 protective factors of birth in a good way inNunavik. Well-equipped medical facilities, local birth centres, and Inuit perinatal traditions hadthe strongest influence. For Inuit youth, instrumental and emotional support for mothers andfamilies, along with health and self-care in pregnancy were the most influential factors forperinatal wellness. 21 Inuit and 7 providers identified 12 factors for continued communitybirthing in Nunavik, with local birth centres and well-equipped medical facilities being the mostinfluential (Publication 4).ConclusionInuit and their service providers have detailed knowledge of culturally safe birth in the contextsof evacuation and local birthing. FCM collated Inuit and service provider visions, refining amethod for stakeholder input and mobilisation in an area of shared concern. FCM illustrated aclear community vision for continued childbirth in Nunavik
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».