Abstract
BackgroundPregnant 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).MethodsWe 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.ResultsAccording 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.ConclusionsAligned 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.
Highlights
Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women
We sought to explore the characteristics of effective care with First Nations women from the perspective of healthcare provider (HCP) in a large First Nations community in Alberta
There is no shortage of qualitative research with Indigenous women indicating relationships with prenatal HCPs are often poor, and women voice regularly experiencing impersonal and dismissive clinic visits as well as judgmental and seemingly untrustworthy HCPs [7,8,9,10,11,12]
Summary
Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. We explored the characteristics of effective care with First Nations women from the perspective of prenatal healthcare providers (HCPs). A growing body of perinatal research has detailed considerable global health disparities experienced by Indigenous women and their infants compared to non-Indigenous populations [2]. Among First Nations women fertility/birth rates are significantly higher and inadequate prenatal care occurs more often than in non-First Nations women [5, 6]. Pregnant First Nations women in British Columbia (Canada) were less likely to have early ultrasonography, to have at least four antenatal care visits, and to undergo labour induction after prolonged pre-labor rupture of membranes or at postdates gestation compared to non-First Nations women [6]. Improved care and a greater understanding of how to effectively work in this context is needed
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