Interactions Between Indigenous Women Awaiting Childbirth Away From Home and Their Southern, Non-Indigenous Health Care Providers

Abstract

We examine patient-provider interactions for Indigenous childbirth evacuees. Our analysis draws on in-depth interviews with 25 Inuit and First Nations women with medically high-risk pregnancies who were transferred or medevacked from northern Quebec to receive maternity care at a tertiary hospital in a southern city in the province. We supplemented the patient data with interviews from eight health care providers. Three themes related to patient-provider interactions are discussed: evacuation-related stress, hospital bureaucracy, and stereotypes. Findings show that the quality of the patient-provider interaction is contingent on individual health care providers' ability to connect with Indigenous patients and overcome cultural and institutional barriers to communication and trust-building. The findings point to the need for further training of medical professionals in the delivery of culturally safe care and addressing bureaucratic constraints in the health care system to improve patient-provider communication and overall relationship quality.

Perspectives and Experiences of Obstetricians Who Provide Labor and Delivery Care for Micronesian Women in Hawai‘i: What Is Driving Cesarean Delivery Rates?

“…Several of our findings are consistent with other qualitative research studies highlighting concerns about poor patient–provider communication in racial/ethnic minorities and immigrant/migrant and indigenous patients’ health care encounters (Ayers et al, 2017; Roman et al, 2017; Vang et al, 2018). For Micronesian communities specifically, researchers have found that communication barriers impact health care for Marshallese women in Arkansas and Chuukese patients in Hawai‘i (two distinct communities with ancestral origins in nations within Micronesia; Ayers et al, 2017; Inada et al, 2018; McElfish et al, 2018).…”

A review of health and wellness studies involving Inuit of Manitoba and Nunavut

“…Twenty-nine studies captured in our review focused on maternal health (27.9%); however, only two studies used primarily qualitative methods and focused on Inuit women’s experience as patients during care [ 77 ; 78 ]. In one study, interviews were conducted with both First Nations and Inuit women who were identified as having medically “high-risk” pregnancies that resulted in their transfer to southern hospitals for maternal care [ 77 ].…”

“…Twenty-nine studies captured in our review focused on maternal health (27.9%); however, only two studies used primarily qualitative methods and focused on Inuit women’s experience as patients during care [ 77 ; 78 ]. In one study, interviews were conducted with both First Nations and Inuit women who were identified as having medically “high-risk” pregnancies that resulted in their transfer to southern hospitals for maternal care [ 77 ]. Although this study interviewed women from Northern Quebec, medical evacuation is standard practice for Inuit (and First Nations) women living in rural and remote regions throughout Canada and is said to reduce the high rates of maternal and infant mortality among Indigenous women [ 78 ; 79 ] and improve perinatal outcomes [ 80 ].…”

Identifying Perspectives About Health to Orient Obesity Intervention Among Urban, Transitionally Housed Indigenous Children

“…However, a majority of childhood obesity studies are adult-centric; they tend to represent the perspectives of investigators, health care providers, and/or parents while casting children in passive roles (Adams et al, 2008;Bhawra et al, 2015;Gibbs et al, 2013;Kostenius & Öhrling, 2006;Snethen & Broome, 2007). In addition, many studies are conducted without a concerted effort to understand cultural perceptions of health and the environmental realities facing study participants (Adams et al, 2008;Vang et al, 2018). Ferris (2010) observes that, "Too often, government policy people come into our communities to implement a quick fix.…”