Giving birth in a good way: co-designing culturally safe birthing services with Inuit from Nunavik and their service providers
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".