Envisioning a culturally safe midwifery model from the perspective of Indigenous families: A case study of midwifery care in inner city Winnipeg, Manitoba, Canada

Abstract

Prenatal care is associated with improved outcomes for the mother and baby. Ongoing research in Winnipeg shows that pregnant people, especially Indigenous people, living in Winnipeg’s inner city have significantly lower rates of prenatal care than others in the city. There are no specific predictors of inadequate prenatal care among Indigenous families. Instead, being Indigenous is in and of itself a risk factor for inadequate prenatal care. This research project is a case study of culturally safe prenatal care and the role midwives can play in facilitating culturally safe prenatal care that is appropriate for Indigenous families living in Winnipeg’s inner city. It examines the decolonization of midwifery practice using pragmatic and Indigenous research paradigms. The goal was to understand, from the perspective of Indigenous midwifery clients, how midwives and other care providers can shape the quality of prenatal care services to meet the needs of Indigenous families more effectively and in a culturally safe manner. This research examines the prenatal care model of a group of midwives based out of an interdisciplinary health clinic called Mount Carmel Clinic (MCC) in Winnipeg, Manitoba. It finds increased rates of prenatal care for Indigenous families at risk of receiving inadequate prenatal care in pregnancy. It also finds that despite increased engagement in prenatal care, many MCC midwifery clients have their babies apprehended by Child and Family Services at birth. The findings suggest that the MCC midwifery model is on a continuum of culturally safe practice, and that the model of care could facilitate a deeper level cultural safety by expanding their care team to include Indigenous members and traditional knowledge about pregnancy, birth and parenting. Finally, it finds that Two-Eyed Seeing can be used by non-Indigenous healthcare practitioners as a tool for engaging in reflective practice to design a working model of cultural safety in the context of the local community.