Giving birth: towards greater cultural safety for Indigenous women

Giving birth can be an unsettling experience. Imagine being evacuated by plane after a high-risk pregnancy to give birth hundreds of kilometers away from home, sometimes without the support of loved ones, in order to receive care in a specialized hospital. 

This is what an average of 315 Indigenous women from Northern Quebec go through every year when they come to give birth at the McGill University Health Centre (MUHC). To make their stay easier, the MUHC and its partners in the Cree and Inuit communities will soon implement measures to ensure better cultural safety for these patients.

Although it is intended to preserve the health of the mother and baby, evacuation comes at a price. It can cause psychological distress, breastfeeding problems, poor diet or an increase in substance use. Some women hide their pregnancy from authorities, attempt to give birth at home alone or leave the hospital prematurely.

Revisit our ways

The tragic death of Joyce Echaquan in the fall of 2020 sent shock waves through the MUHC's Women's Health Mission.

"It was a dose of reality. Among colleagues, we were wondering what we could do," says Mischa Corman-François, a nurse clinician at the MUHC.

As a result, Joyce's Principle, which aims to ensure equitable and non-discriminatory access to health and social services for Indigenous people, was adopted at the MUHC in the fall of 2021.

"The Culturally-Safe Indigenous Birth in High Risk Obstetrics project is a concrete way to implement Joyce’s Principle," adds Hilah Silver, an MUHC nurse clinician.

Several changes will be adopted at the MUHC Birthing Centre over the next year:

• The visiting policy will be examined to see how it can be adapted to include a stronger familial presence in the delivery room. Birth is an important collective event for the Cree and Inuit communities and family members play an essential role, particularly in the transmission of traditional knowledge.
• Refrigerators, freezers and kettles will be made available for families to bring in traditional foods.
• Cultural safety training will be provided to staff by Indigenous partners. This will include online modules on Cree and Inuit perinatal health, skills labs led by Indigenous midwives and an online platform where Indigenous families will share birth testimonials. Educational materials including community maps and key words in Inuktitut and Cree will also be developed.
• In collaboration with Indigenous partners, traditional practices such as the presence of Elders, birth bundles, smudging and access to the placenta will be facilitated. Traditional Indigenous art may be installed in the rooms to provide a familiar environment for patients.

"Women need their food, their language... It sounds simple, but we realized it wasn't part of the system. We want to do better," says Jennifer Pepin, nurse manager of the MUHC Birthing Centre and Maternity Unit.

The importance of partners

This project is the result of consultations with Inuit families and their Montreal healthcare providers by an Inuit-led committee. The recommendations from these consultations were then validated with members of the Cree community: mothers, midwives, physicians, etc.

Two Inuit midwives and a Cree physician will participate in the development of the training program. A Cree mother and an Inuit mother who experienced a childbirth evacuation will be regularly consulted throughout the implementation of the project. Finally, patients and their families will be surveyed at discharge to ensure that the project is achieving its goal.

“My family and I encountered numerous situations that we wish we had experienced at home instead being sent down to Montreal for further assistance for my pregnancy. This project will make the mother to be and her family’s experience 10 times more comfortable. I was lucky enough to have the people I wanted to be with me as I was giving birth, but that is not the same for every Inuit women when sent down to Montreal,” explains Paasa Lemire, Inuit patient partner on the project.

“To be sent down for medical reasons is never easy for the mothers and families, especially for first time moms. It’s always scary, but the little things that will change thanks to this project will make it easier for everyone. I would like to thank everyone who had made my pregnancy easier when I was evacuated to complete my delivery. As I am holding my nine-month-old son in my arms, we appreciate all of the help that this project has received,” she adds.

"This is a powerful change in the way we view birth. I can't wait to implement it with a patient!" says Mischa.

The program could also serve as a pilot project and be expanded to other cultures.

"Joyce's Principle is not intended to benefit just Indigenous people, but everyone," says Hilah.

Thank you to The MUHC Foundation and The Herta Vodstrcil estate for their generous donation.