BIRTH EXPERIENCES IN REMOTE & NORTHERN COMMUNITIES: NORWAY HOUSE CREE NATION. Dr. Jaime Cidro Elisabeth Dolin RM

Transcription

1 BIRTH EXPERIENCES IN REMOTE & NORTHERN COMMUNITIES: Dr. Jaime Cidro Elisabeth Dolin RM NORWAY HOUSE CREE NATION 7 th International Meeting on Indigenous Child Health April Denver Colorado

2 Faculty/Presenter Disclosure Dr. Jaime Cidro & Elisabeth Dolin RM have no relevant financial relationships with the organizations discussed in this CME activity The authors do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation This research is funded by a Canadian Institute of Health Research, Aboriginal Two-Eyed Seeing grant; and supported by the University of Winnipeg

3 Repatriating Birth Services in Northern First Nations: Norway House Cree Nation Outline 1. Project Overview 2. Community Perspectives 3. Practitioner & System Perspectives 4. Readiness

4 Birth Services for Northern & Remote Communities

5 Project Overview Community initiated Multiple elements for a 360 degree view: 1. Women s narratives, experiences, perspectives 2. Health care providers experiences, perspectives 3. Clinical chart review Sub-projects: Perinatal Policy; Community survey; Costs Multiple Partners: First Nations Health & Social Secretariat of MB; NHCN - Health Division; UM Rural/Remote Residency Program

6 Community Partnership & Data Governance Comprehensive Band Council Resolution on who owns, controls and manages data Governed by a Community Advisory Circle : advise on data collection tools, assist with interpretation and analysis, manage data after data collection is complete Regular project updates for Chief & Council, the community, and health care providers

7 COMMUNITY PERSPECTIVES Community & Birthing Women s Experiences and Views

8 Community Survey & Interviews Community Survey: 95% confidence level 465 adults participated o 314 female, 151 male; aged o majority were parents o 86% of female, 68% of male Interviews of Women: 31 women, representing 127 births; pre-1986 to 2016

9 Readiness to Have a Baby in the Community 74% would have / support a family member having a baby in Norway House with current resources N=426 82% would have / support a family member having a baby in Norway HouseIf if additional resources* were available 90% of women who had a baby in NH would do so again (n=123) 73-74% of women who had a previous baby in a referral centre would consider having a baby in Norway House (n=82)

10 Community Perspectives I tried to keep it low key. I didn t want to tell anyone. There was a chance it wouldn t happen. Plus I didn t want anyone to talk about it in the community. I did tell my mom and my dad, and my sister My dad didn t really say anything. I don t think he knew what to say. It was divided. Some people were excited and other people thought I should just go to the hospital.

11 Community Perspectives I think it would be beneficial for a lot of people to have births here. It just makes more sense. If you have complications then you have Medivac. You get to know families and their birth history. Why not get the right doctors here that can provide better care?

12 Community Perspectives Yeah. I'm proud to have had my son here, I can say, yeah I had my kid in Norway House, nothing different about him. Nothing different at all. Honestly. I wish we could have a birthing program here. I get so excited, about births, you know.

13 Community Perspectives I would say go for it, but be prepared when you go to the hospital because they are going to try and send you out, and they will ask you over and over. You might crack and say yes. Just be prepared because they might try to just make you go. I was lucky Darlene was there and I signed it* in front of her. *refusal to leave / acknowledgement of risk document

14 PROVIDER & SYSTEM PERSPECTIVES Health Care Providers and Administrators Experiences and Views

15 Interviews & Focus Groups Direct Recruitment Workplace interviews Knowledge sharing All levels & employers Role Level of Care Profession Experience Individual interviews (19) + 3 Focus groups (17) 33 participants total Administration 5 Acute 7 Nurse 10 Current 29 Combined 5 Primary 13 Physician 12 Previous 4 Direct care 23 Community 13 Other 11

16 Experience / Experiences Education & Training Perinatal care experience volume location(s) Community-specific experiences

17 Perspectives Resources Priorities Locus of control RISK Clinical maternal Clinical neonatal Professional Social / personal

18 READINESS OTHER AREAS OF THE RESEARCH: HISTORICAL INFORMATION & POLICY REVIEW OF EVIDENCE & MODELS CLINICAL REVIEW COSTS

19 Clinical Chart Review Volume of births; # low-risk and high-risk Types, volumes and locations of current services TO: Inform other aspects of the research, and Support Practice improvement Service planning Cost analysis Community advocacy

20 Changing Practice Priority Policy People Parity Education Equipment Experience Evidence Research, Readiness Return of Birth

21 Acknowledgements NHCN and Community Advisory Circle Community & Student Research Assistants: Christina Queskekapow; Aine Dolin & Sarah Wood Partners: NHCN Health Division, FNHSSM (Kathi Kinew) UM Rural & Remote Residency Program (Dr.Joanna Lynch) Kinosao Sipi Midwifery Clinic (Darlene Birch, RM)