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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study

Authors: Richard T. Oster, Grant Bruno, Margaret Montour, Matilda Roasting, Rick Lightning, Patricia Rain, Bonny Graham, Maria J. Mayan, Ellen L. Toth, Rhonda C. Bell

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. Although there has been a call for improved prenatal care, examples are scarce. Therefore, we explored the characteristics of effective care with First Nations women from the perspective of prenatal healthcare providers (HCPs).

Methods

We conducted an ethnographic community-based participatory research study in collaboration with a large Cree First Nations community in Alberta, Canada. We carried out semi-structured interviews with 12 prenatal healthcare providers (HCPs) that were recorded, transcribed, and subjected to qualitative content analysis.

Results

According to the participants, relationships and trust, cultural understanding, and context-specific care were key features of effective prenatal care and challenge the typical healthcare model. HCPs that are able to foster sincere, non-judgmental, and enjoyable interactions with patients may be more effective in treating pregnant First Nations women, and better able to express empathy and understanding. Ongoing HCP cultural understanding specific to the community served is crucial to trusting relationships, and arises from real experiences and learning from patients over and above relying only on formal cultural sensitivity training. Consequently, HCPs report being better able to adapt a more flexible, all-inclusive, and accessible approach that meets specific needs of patients.

Conclusions

Aligned with the recommendations of the Truth and Reconciliation Commission of Canada, improving prenatal care for First Nations women needs to allow for genuine relationship building with patients, with enhanced and authentic cultural understanding by HCPs, and care approaches tailored to women’s needs, culture, and context.
Footnotes
1
In Canada, three types of Indigenous peoples (sometimes referred to as Aboriginal peoples) are constitutionally recognized: The First Nations, the Inuit, and the Métis peoples. Each group and each community is distinct in terms of their cultural identities, histories, languages, and so on. The Indigenous population represents approximately 4.3 % of the total Canadian population.
 
2
Residential schools were a federally funded policy whereby Indigenous children were removed from their homes, families, and culture, and forced into church-run schools aimed at assimilation into the dominant Canadian culture and society. The schools were in existence for over 100 years and have had a profound and continuing negative impact on Indigenous populations [34].
 
Literature
1.
2.
Shah PR, Zao J, Al-Wassia H, Shah V. Knowledge synthesis group on determinants of preterm/LBW births. Pregnancy and neonatal outcomes of aboriginal women: a systematic review and meta-analysis. Womens Health Issues. 2011;21(1):28–39. doi:10.​1016/​j.​whi.​2010.​08.​005.CrossRefPubMed
3.
4.
Oster RT, Toth EL. Stillbirth epidemiology and risk factors among first nations and non-first nations pregnancies in Alberta, Canada from 2000 to 2009. J Obstet Gynaecol Can. 2015;37(2):117–21.CrossRefPubMed
5.
Statistics Canada. Aboriginal peoples in Canada in 2006, 2006 census: First Nations people. Ottawa: Statistics Canada; 2006.
6.
7.
8.
Sokoloski EH. Canadian First Nations women’s beliefs about pregnancy and prenatal care. Can J Nurs Res. 1995;27(1):89–100.PubMed
9.
10.
Wiebe AD, Barton S, Auger L, Pijl-Zieber E, Foster-Boucher C. Restoring the blessings of the morning star: childbirth and maternal-infant health for first nations near Edmonton. Alberta Aboriginal Policy Stud. 2015;5(1):47–68.
11.
Heaman MI, Sword W, Elliott L, Moffatt M, Helewa ME, Morris H, et al. Perceptions of barriers, facilitators and motivators related to use of prenatal care: A qualitative descriptive study of inner-city women in Winnipeg. SAGE Open Med. 2015;3. doi: 3: 2050312115621314.
12.
Tait NH. Patient and caregiver perspectives of health provision practices for first nations and Métis women with gestational diabetes mellitus accessing care in Winnipeg. Manit BMC Health Serv Res. 2014;14:440. doi:10.​1186/​1472-6963-14-440.CrossRef
13.
14.
Canadian Institutes of Health Research. CIHR Guidelines for Health Research Involving Aboriginal People. Ottawa: Health Canada; 2007.
15.
Wallerstein N, Duran, B. The theoretical, historical, and practice roots of community-based participatory research. In Minkler M & Wallerstein N (Eds.), Community-Based Participatory Research for Health: From Process to Outcomes. 2008. San Francisco, CA: John Wiley & Sons. Chapter 2, p, 25-46.
16.
Mayan MJ. Essentials of Qualitative Inquiry. Walnut Creek: Left Coast Press, Inc.; 2009.
17.
18.
Whittemore R, Chase SK, Mandle CL. Validity in qualitative research. Qual Health Res. 2001;11(4):522–37.CrossRefPubMed
19.
Milne J, Oberle K. Enhancing rigor in qualitative description: a case study. J Wound Ostomy Continence Nurs. 2005;32(6):413–20.CrossRefPubMed
20.
Beck RS, Daughtridge R, Sloane PD. Physician– patient communication in the primary care office: a systematic review. Am Board Fam Med. 2002;15:25–38.
21.
Roter DL, Frankel RM, Hall JA, Sluyter D. The expression of emotion through nonverbal behavior in medical visits. Mechanisms and outcomes. J Gen Intern Med. 2006;21 Suppl 1:S28–34.CrossRefPubMedPubMedCentral
22.
23.
Kurtz DLM, Nyberg JC, Van Den Tillaart S, Mills B. Okanagan urban aboriginal health research collective. Silencing of voice: an act of structural violence: urban aboriginal women speak out about their experiences with health care. J Aboriginal Health. 2008;4(1):53–63.
24.
World Health Organization. WHO Recommendations on Health Promotion Interventions for Maternal and Newborn Health 2015. Geneva: World Health Organization; 2015.
25.
Society of Obstetricians and Gynaecologists. Health professionals working with first nations, Inuit, and Métis consensus guideline. J Obstet Gynaecol Can. 2013;35 Suppl 2:S1–S52.
26.
Birch J, Ruttan L, Muth T, Baydala L. Culturally competent care for aboriginal women: a case for culturally competent care for aboriginal women giving birth in hospital settings. J Aboriginal Health. 2009;4(2):24–34.
27.
Couchie C, Sanderson S. A report on best practices for returning birth to rural and remote aboriginal communities. J Obstet Gynaecol Can. 2007;29(3):250–60.CrossRefPubMed
28.
Skye A. Aboriginal midwifery: a model for change. J Aboriginal Health. 2010;6(1):28–37.
29.
30.
31.
Di Lallo S. Prenatal care through the eyes of Canadian aboriginal women. Nurs Womens Health. 2014;18:38–46.CrossRefPubMed
32.
Lu MC, Lin YG, Prietto NM, Garite TJ. Elimination of public funding of prenatal care for undocumented immigrants in California: a cost/benefit analysis. Am J Obstet Gynecol. 2000;182:233–9.CrossRefPubMed
33.
Jarvis C, Munoz M, Graves L, Stephenson R, D’Souza V, Jimenez V. Retrospective review of prenatal care and perinatal outcomes in a group of uninsured pregnant women. J Obstet Gynaecol Can. 2011;33:235–43.CrossRefPubMed
34.
Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada Calls to Action. 2015. Winnipeg, MN: Truth and Reconciliation Commission of Canada.
Metadata
Title
Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study
Authors
Richard T. Oster
Grant Bruno
Margaret Montour
Matilda Roasting
Rick Lightning
Patricia Rain
Bonny Graham
Maria J. Mayan
Ellen L. Toth
Rhonda C. Bell
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1013-x

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