What makes Inuulitsivik midwifery successful and sustainable? How an Inuit-led care model brought birth back to our remote arctic communities
Bibliographic record
Abstract
Nunavik (Québec, Canada) has been inhabited by Inuit for over 4,000 years. Inuit midwives assisted in childbirth for centuries before colonization removed birth from our communities. In the 1980s, after years of evacuation for birth to southern hospitals, local women and Inuit leaders brought birth back to our remote Hudson Coast and Hudson Strait villages. As Inuit midwives, we have continuously offered local midwifery care to the population since that time, supported by southern midwives and an interprofessional team. Our midwifery service is nationally and internationally recognized as a model for returning childbirth to remote communities and reclaiming Indigenous midwifery. Inuulitsivik midwifery demonstrates that birth services and midwifery education can be integrated into health care systems in remote communities with safe outcomes. To understand the factors that contribute to our success and sustainability, we brought together experienced midwives and student midwives and met in person, by teleconference and online. Themes that emerged include Inuit values and language; Inuit leadership; local midwifery education; an adapted role for midwives in remote communities; flexibility in the organization and implementation of practice; midwifery-led interdisciplinary care and strategic collaboration with southern Canadian and international allies. We explore these themes and use common frameworks for policy analysis to consider effectiveness; impacts on the experience of pregnant women and families; health equity and access to services; costs; feasibility and acceptability. Our local midwifery service makes an important contribution to meeting the calls to Action of the Truth and Reconciliation Commission of Canada.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.024 | 0.014 |
| Scholarly communication | 0.015 | 0.007 |
| Open science | 0.003 | 0.012 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".