Alienation and Resilience: The Dynamics of Birth Outside Their Community for Rural First Nations Women (original) (raw)
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The geography of belonging: The experience of birthing at home for First Nations women
Health & Place, 2010
The number of rural hospitals offering maternity care in British Columbia has significantly declined since 2000, mirroring trends of closures and service reductions across Canada. The impact on Aboriginal women is significant, contributing to negative maternal and newborn health and social outcomes. The present qualitative case study explored the importance of local birth for Aboriginal women from a remote BC community after the closure of local maternity services. Data collection consisted of 12 interviews and 55 completed surveys. The average participant age was 32 years old at the time of the study. From the perspective of losing local services, participants expressed the importance of local birth in reinforcing the attributes that contributed to their identities, including the importance of community and kinship ties and the strength of ties to their traditional territory.
aboriginal policy studies, 2015
It is not only remote Aboriginal communities in Canada that have poorer maternalinfant health status than Canadian averages; residents of First Nation communities located close to large urban centres also experience this health status gap. Alexander, Alexis, Enoch, and Paul First Nations are located within an hour of healthcare services in greater Edmonton. The narratives of 75 predominantly Cree and Stoney women from these communities were gathered through seven talking circles and five semi-structured interviews. The participants described their experiences of loss and separation as pregnancy care and childbirth moved out of the community and into the hospital over the last two generations. This shift was not only a geographic relocation; it also disconnected the childbirth experience from elders, family and community, traditional teachings, and spiritual meaning. Conversely, the participants' hospital experiences were characterized by a limited sense of cultural safety. Participants highlighted the urgent need to reintegrate culturally based community support and health perspectives into the childbirth experience. The implementation of such a culturally integrated healthcare model in all Aboriginal communities-remote, rural, suburban, and urban-may be the key finally to closing the gap between Aboriginal and non-Aboriginal maternal and infant health status in Canada.
2017
Indigenous women's experiences during pregnancy, birth and the early months of parenthood are important to understand their strengths, gaps, needs, priorities and barriers in order to address maternal and child health disparities. Despite clear evidence on how social determinants of health influence health, there is limited research that includes the perspectives and experiences of Indigenous women. The purpose of my research was to explore Indigenous women's maternity experiences. An interdisciplinary theoretical perspective that includes decolonized and Indigenous methodology, social determinants of health theory, critical medical anthropology, and feminist scholarship informs my research. I conducted an analysis of Indigenous women's (N=410) responses to the Canadian Maternity Experiences Survey (PHAC 2009), followed by ethnographic research with ten Indigenous mothers in the Okanagan Valley, BC. Individual in-depth interviews and participant-observations were analyze...
Midwifery, 2011
Objective: to investigate the beliefs and practices of Aboriginal women who decline transfer to urban hospitals and remain in their remote community to give birth. Design: an ethnographic approach was used which included: the collection of birth histories and narratives, observation and participation in the community for 24 months, field notes, training and employment of an Aboriginal co-researcher, and consultation with and advice from a local reference group. Setting: a remote Aboriginal community in the Northern Territory, Australia. Participants: narratives were collected from seven Aboriginal women and five family members. Findings: findings showed that women, through their previous experiences of standard care, appeared to make conscious decisions and choices about managing their subsequent pregnancies and births. Women took into account their health, the baby's health, the care of their other children, and designated men with a helping role. Key conclusions: narratives described a breakdown of traditional birthing practices and high levels of non-compliance with health-system-recommended care. Implication for practice: standard care provided for women relocating for birth must be improved, and the provision of a primary maternity service in this particular community may allow Aboriginal Women's Business roles and cultural obligations to be recognised and invigorated. International examples of primary birthing services in remote areas demonstrate that they can be safe alternatives to urban transfer for childbirth. A primary maternity service would provide a safer environment for the women who choose to avoid standard care.
2020
Background: For almost three decades, Waminda South Coast Women’s Health and Welfare Aboriginal Corporation has provided culturally safe and holistic wellbeing services to the Illawarra Shoalhaven region, New South Wales. Work towards “Birthing on Country” has been a longstanding part of the Waminda’s strategic direction. Method: Aboriginal ways of knowing and doing informed the multiple methods used. A desktop review of the grey literature and online public databases, then six community yarning circles were conducted in the region. Participants were mothers, grandmothers, community-controlled service providers, and government health providers. A thematic analysis was conducted by two researchers and a Waminda staff member. Results: Five broad themes were identified and informed the recommendations: (a) redesign maternity and child services, (b) establish a specific wellbeing and birthing place, (c) invest in a clinically and culturally exceptional workforce, (d) strengthen family...
2018
BACKGROUND: The marginalization of Indigenous women in Canada has resulted in adverse pregnancy and infant health outcomes. While the epidemiological research focuses on statistical evidence, it fails to address the context and underlying causes, including social determinants of health. Despite clear evidence on how social determinants influence health, there is limited research on Indigenous women’s perspectives and experiences. Indigenous women’s narratives during pregnancy, birth and the early months of parenthood are critical to understand the underlying causes and proposed solutions. This research demonstrates how Indigenous women’s maternity experiences are embedded within their historical, social and cultural experiences, thus explaining the importance of addressing contexts related to social determinants of health. METHODS: Through an Indigenous and decolonized lens, maternity narratives from ten in-depth interviews were conducted with Indigenous birth mothers in British Co...
Reclaiming Birth, Health, and Community: Midwifery in the Inuit Villages of Nunavik, Canada
Journal of Midwifery Women S Health, 2007
This article describes the Inuulitsivik midwifery service and education program, an internationally recognized approach to returning childbirth to the remote Hudson coast communities of Nunavik, the Inuit region of Quebec, Canada. The service is seen as a model of community-based education of Aboriginal midwives, integrating both traditional and modern approaches to care and education. Developed in response to criticisms of the policy of evacuating women from the region in order to give birth in hospitals in southern Canada, the midwifery service is integrally linked to community development, cultural revival, and healing from the impacts of colonization. The midwifery-led collaborative model of care involves effective teamwork between midwives, physicians, and nurses working in the remote villages and at the regional and tertiary referral centers. Evaluative research has shown improved outcomes for this approach to returning birth to remote communities, and this article reports on recent data. Despite regional recognition and wide acknowledgement of their success in developing and sustaining a model for remote maternity care and aboriginal education for the past 20 years, the Nunavik midwives have not achieved formal recognition of their graduates under the Quebec Midwifery Act.
The Centre for Rural Health Research (CRHR) was formed in 2005 in response to the need for evidence to develop policies and inform decision making in the area of rural health. This mandate is based on an understanding of the known health inequities between rural and urban residents arising in part from the difference between their respective health needs and service delivery context. Under the direction of Drs Stefan Grzybowski (a rural family physician) and Jude Kornelsen (a medical sociologist who specializes in maternity care), the CRHR is supported by both the Vancouver Coastal Health Research Institute and the Department of Family Practice at the University of British Columbia, and receives project funding predominantly from the Canadian Institutes of Health Research (CIHR). To date the program of research has focused primarily on rural maternity care and developing strategic approaches to planning sustainable rural maternity services in British Columbia. Please see www.ruralmatresearch.net for a complete list of projects and recent publications.
Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada
Canadian Medical Association Journal, 2021
c cess to birth close to home, surrounded by loved ones, is taken for granted by most Canadians. The societal importance of family support during birthing has been highlighted during the severe acute respiratory syndrome and COVID-19 pandemics, despite the known and potentially fatal risks to hospital visitors, because people in labour have been one of the few patient groups exempt from visitor restrictions. 1,2 For residents living in rural areas of Canada, long-distance travel for birth is a reality that is becoming increasingly common in some regions because of closures of obstetrical services in smaller community hospitals. 3 This is only partially mitigated by the revital ization of rural midwifery practice. 4,5 Emerging evidence shows that the frequency of adverse medical events during labour and delivery for rural populations is similar for births that take place close to home and births for which people travel because of an absence of services close to home. 3,4,6 Less is known about the impacts of travel for birth on breastfeeding rates, maternal mental health and family functioning. Several studies have documented the negative impacts of birthing away from home with respect to maternal satisfaction and birth experience. 7-10 This evidence is particularly compelling for Indigenous populations for whom birthing on or near traditional territories in the presence of family and community is a long-standing practice of foundational cultural and social importance that contributes to well-being, cultural continuity and kinship. 7-12 The striking isolation, family disruption and racism experienced by Indigenous people who are forced to travel alone for RESEARCH HEALTH SERVICES