Quick, Boil Some Water: The Story of Childbirth in Our Grandmothers Day: Volume 1

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Proximal determinants are the first layer of immediate daily conditions that impact health and well-being. These include health behaviors, education, employment and income, food security, and physical environments, including safe and affordable housing. Intermediate determinants of health include health care systems, educational systems, community infrastructure, resources and capacities, environmental stewardship and cultural continuity.

Distal determinants include colonialism, racism and social exclusion, and self-determination Loppie-Reading and Wien In the next three sections, I discuss the role proximal, intermediate, and distal determinants influence and affect Indigenous maternal and child health.

These include health behaviors, education, employment and income, food security, and physical environments, including safe and affordable housing Reading and Wein Statistics illustrate that more than 36 per cent of Aboriginal women, compared to 17 per cent of non-Aboriginal women, live in poverty CWF , and that poverty affects 52 per cent of Indigenous children Anderson According to Statistics Canada Poverty can be described as absolute or relative. Relative poverty describes inequality, a situation where a person is noticeably worse off than most people in his or her community.

Poverty is an important determinant of health because it is linked to social exclusion Galabuzi , which results in increased anxiety, insecurity, low self-esteem, and feelings of hopelessness Iwasaki et al. Poverty is directly related to education, employment and income. Of those who did not graduate, 34 per cent of First Nation women indicated that pregnancy or taking care of children was the main reason for not completing their education Stat Can Education impacts employment, employment impacts income, and income influences access to food, clothing and shelter.

This pathway illustrates how Aboriginal peoples are disproportionately affected by poor housing and living conditions RCAP Access to safe, adequate and affordable housing is an important SDH because issues such as overcrowding are associated with asthma and allergies Morris et al. Rather than focus on solely on individual behaviors and immediate or proximal social contexts, there is a need to examine and address midstream intermediate and upstream distal contexts and interventions Johner et al.

Indigenous women also have varying needs and access to healthcare services and supports Young et al. Indigenous women face barriers when accessing mainstream health care Tait , including maternal, reproductive and prenatal health care services in urban areas and on reserve Benoit et al. Indigenous mothers face unique barriers including healthcare providers perceptions of Indigenous women Van Herk et al. Additional barriers include gaps in sustainable funding resulting in program cessation, staff turnover and human resource shortages Stout, Kipling and Stout Human resource shortages result in a lack of access to medical personnel such as doctors, nurses, nurse practitioners and midwives.

There is a lack of culturally appropriate supports, information and resources Browne et al. Indigenous women who reside in rural and remote reserve communities are uniquely impacted by obstetric evacuation policies and practices. This policy has resulted in women feeling alone and isolated, without family and community support, as well as disruptions to Indigenous traditions, culture and midwifery practices see Couchie and Sanderson ; Kornelsen and Grzybowksi ; Kornelsen et al.

This large body of research has helped inform policy and programming to address the healthcare human resource gap and to bring birth closer to home through the creation and expansion of Indigenous midwifery and the Indigenous doula support program Carrol and Benoit ; NAHO ; Vanwagner et al. Another gap in maternal child health care and research is jurisdictional divides. Differing jurisdictions result in different governance, funding and program delivery.

In chapter three I discuss how jurisdictional divides impact research; for example, research conducted by the PHAC excluded First Nation women on reserve for operational reasons. The impacts of colonization on Indigenous peoples have resulted in historical and cumulative emotional and psychological wounding Duran and Duran over the lifespan and across generations Bombay et al.

Research illustrates how colonization has created emotional and psychological impacts Brasfield ; Corrado and Cohen , has impacted HIV rates Barlow , higher rates of fetal alcohol syndrome Tait , mental health Hart-Wasekeesikaw ; Kirmayer et al. These ideologies were centred and measured by colonial, European, Christian and patriarchal ideals that attempted to dissolve Indigenous cultures, languages, identities and autonomy as a means of gaining access to lands and resources TRC Assimilation ideology is illustrated best by a quote from Duncan Campbell Scott, who served as the deputy superintendent of the Department of Indian Affairs from to Scott put it this way: I want to get rid of the Indian problem.

I do not think as a matter of fact, that the country ought to continuously protect a class of people who are able to stand alone. Our objective is to continue until there is not a single Indian in Canada that has not been absorbed into the body politic and there is no Indian question, and no Indian department, that is the object of this bill Act for the Gradual Civilization of the Indian Tribes in the Canadas, Perhaps the most destructive assimilation policy was implemented through the creation of residential schools.

Changes in the Indian Act enabled provincial child protection authority over Indigenous peoples, and as a result, there was an increase in child apprehension in Indigenous communities. For example, in , nine Aboriginal children were in British Columbia government care; by there were 1, in care, representing 34 per cent 25 of the total number of children in foster care Pivot Eurocentric, western hegemony and dominance has created a society in which Indigenous knowledge, understanding, and ways of being have been marginalized and excluded NCCAH Negative stereotypes Acoose ; Levin and epistemic, institutional, relational and internalized racism NCCAH perpetuate discriminatory attitudes, beliefs, and misconceptions.

In turn, negative attitudes and actions perpetuate violence towards Indigenous peoples, specifically Indigenous women Anderson , ; Lavell-Harvard and Brant ; Riel-Johns Historical racism and violence against Indigenous men and women has also manifested through bio political strategies such as forced sterilization Grekul, ; Stote, An Act of Genocide: Prejudice, discrimination and racism have negative consequences and have been linked to negative health outcomes Galabuzi ; Kirmayer et al.

However, the social and economical marginalization of Indigenous women in Canada along with a history of government policies that have torn apart Indigenous families and communities, have pushed disproportionate numbers of Indigenous women into dangerous situations including extreme poverty, homelessness and prostitution Amnesty International Canada Indigenous women face multiple oppressions. The intersections of race, sex and class Thornhill This disparity can be attributed to the colonial experience in Canada, which is unique to Indigenous Peoples Bourassa et al.

For example, Indigenous women continue to experience gender oppressive policies and discrimination within the Indian Act that discriminate against women and extinguish their rights and title Jamieson ; Lawrence ; Silman Discrimination and the Indian Act continue to perpetuate a struggle for Indigenous women and mothers Lavelle-Harvard and Corbiere-Lavell Those who held status under the Indian Act prior to are referred to as 6 1 Indians, whereas those who gained status through Bill C, or after April , are categorized as 6 2 Indians… the three categories are NS [non-status], 6 1 and 6 2 extend to the classification of offspring.

As the previous sections illustrate, colonization and assimilation policies and ideologies have resulted in racist and sexist policies and practices that have had a profound intergenerational effect on identity, and connections to culture and community Sinclair Maternal and child health disparities are embedded within a complex web and layers of proximal, intermediate and distal social determinants of health. Through ten in-depth 29 interviews, women described their invalidating encounters with healthcare, which include being dismissed, feelings of being judged based on negative stereotypes, discrimination and healthcare employees disregarding their personal circumstances and situations of vulnerability such as a history of residential school attendance.

However, the participants also described affirming experiences, such as active participation in decision-making, affirmation of cultural identity and development of positive, long-term relationships with health care staff. Another study found that Aboriginal single mothers in Saskatchewan reported significant and negative relationships with social exclusion, and lower perceived levels of health Johner The research examines and advocates for Indigenous women to give birth closer to home and within their home communities see Couchie and Sanderson ; Kornelsen and Grzybowksi ; Kornelsen et al.

Maternity research on obstetric evacuation has created policies and programs aimed to address the healthcare human resource gap and to bring birth closer to home through the creation and expansion of Aboriginal midwifery since the s Carrol and Benoit ; NAHO ; Vanwagner et al. Their research illustrates how First Nation women are faced with diminishing maternity care choices, racism, and challenging economic circumstances that arise from historical, economical and social circumstances. Indigenous women identified healthcare barriers, such as limited access to transportation for health care appointments, lack of choice for prenatal care, lack of daycare and expenses related to childcare to attend medical appointments.

Indigenous women expressed a need for additional support during pregnancy, including support to address social determinants of health barriers that contribute to adverse pregnancy outcomes such as higher rates of GDM. In another study conducted by Oster et al. In Search of a Healing Place: Women also expressed a need for additional sexual and reproductive health services, including access to contraception and abortion services. There are also gaps in research that include the perspectives of young or teen Indigenous mothers. In Young and Aboriginal: Labour and Birth Experiences of Teen Mothers in Winnipeg, Downey and Stout researched the experiences of labour and birth of 19 urban Aboriginal teen mothers age 15 to Although there are limitations to a small sample size, their research poses important questions for young and urban Aboriginal women, women who experience obstetric evacuation and issues of cultural safety when accessing maternity health care.

It is an equally important inquiry to include the voices and perspectives of Indigenous women who speak from diverse experiences on issues that intimately shape their lives. Childbirth is an intimate and complex transaction whose topic is physiological and whose language is cultural. Topic and language or, to put it another way, content and organization are never available one without the other. For a holistic view of the phenomenon they must be considered together. It is for this reason that I propose to treat the process of parturition here within a biosocial framework, that is to say, as a phenomenon that is produced jointly and reflexively by universal biology and particular society.

To speak of birth as a biosocial event, then, suggests and recognizes at the same time the universal biological function and the culture-specific social matrix within which human biology is embedded Jordan I am fascinated with and inspired by the generations of Indigenous women writers and authors, who continue to resist oppression, reclaim Indigenous-mothering practices and restore the balance on inequity and injustice.

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The life stories of Angela Sidney, Kitty Smith, and Annie Ned are [about] three remarkable and gifted women of the Athapaskan and Tlingit ancestry who were born in southern Yukon Territory around the turn of the century. Their life stories tell us much about the present as about the past, as much about ideas of community as about individual experience; they call our attention to the diverse ways humans formulate such linkages Cruikshank Reconstructing Native Womanhood explores forty life histories of Indigenous women from across Canada.

The final section is a call to rebuild our communities to improve and address sexual health, violence, education, internal oppression, gender roles, disability and loss of land and culture. Rebuilding communities begins with children, moves on to women, and concludes that change lies in the gender equity of balanced interdependency, renewed trust and true respect between men and women that Native people should strive to reclaim. In order to achieve this goal, we must live more like our ancestors.

Our path must come to create a spiral, one that turns back to the past while at the same time progressing forward in order to survive in a different world Fernandez In the Days of Our Grandmothers: Just the sheer volume of work produced in this field has made selecting 36 articles for inclusion difficult, but it has made clear the strength of the field and indeed, of Aboriginal women themselves.

Refuting the myth of silence, this reader amplifies the persistent voice of Aboriginal women over three centuries of Canadian history Kelm and Townsend While the majority of literature focuses on describing the deficits and dysfunction of Indigenous peoples that perpetuate social stigmatization, their book aims to Restoring the Balance by taking a positive perspective. Their collection of essays illustrates how Indigenous women are protectors of culture, guardians of tradition, and agents of change within their own lives, as well as in the lives of their families, communities and nations.

Experiences, including the experience of mothering and motherhood, are a complex web of people, places, events and the interconnected relationships between and among threads of that web. An alternative to patriarchal motherhood includes Indigenous maternal pedagogy and epistemology that describes Indigenous women and mothers as powerful.

Aboriginal Mothering, Oppression, Resistance and Rebirth They describe Aboriginal maternal pedagogy and epistemology as resisting oppressive models of motherhood, dominant culture, patriarchy and colonialism thus, leading toward a revolution of social change. The voices of our sisters, and their account of our longstanding resistance to the imposition of patriarchal motherhood and all it entails, can be a source of empowerment in the struggle for revolution. We, as Aboriginals, have always been different [othered], we have always existed on the margins of the dominant patriarchal culture Lavell-Harvard and Lavell Prior to European contact and the marginalization of Indigenous women and mothering, Indigenous societies were primarily egalitarian Gunn Allen The colonization of childbirth Jasen and wombs Anderson Patricia Montour-Angus writes that self-determination begins at home.

I like to take it a step further—that self-determination begins in the womb. If more babies were born into the hands of Indigenous midwives using Indigenous birthing knowledge, on our own land, surrounded by our support system, and following our traditions and traditional teachings, more of our women would be empowered by the birth process and better able to assume their responsibilities as mothers and nation-builders Simpson In Life Stages and Native Women, Anderson shares her journey of reconnecting to and restoring Algonquian oral history about pregnancy, infancy and toddler years through childhood and youth, young and middle aged women, to elderly women.

In doing so, they inspire Indigenous women, mothers, families, communities, their Nations and allies to forge a better, brighter and healthier future. Theory and Methods 2. My location historical, geographical and generational and position age, gender, race, class, sexuality influenced my decision on my research topic, questions, methods, analysis as well as the write up phase of my dissertation. Therefore, it is critical to position myself within my research. I chose to conduct research at-home Gupta and Ferguson in the Okanagan Valley and Canada rather than research abroad Fainzang ; Van Ginkel As a single mother of two small children, traveling to conduct research was not only financially impractical but would also have been disruptive to my children.

After residing in the Okanagan valley for ten years, I have created a social and community support system that enabled me to study and conduct research while working part time and raising my children. As an Indigenous woman and mother conducting Indigenous health research, I am both an insider Jones and researcher-activist Gough and Leacock Throughout my interviews with my sister-participants, there are many examples where I shared common experiences and insider accounts Acker ; Dwyer and Buckle For example, I have experienced and witnessed the intergenerational effects of colonization and residential school, racism, sexism, as well as the struggles and stereotypes of being a single Indigenous mother.

I have also faced multiple barriers associated with adverse social determinants of health, including stress associated with education, employment and income. My position may have contributed to enhanced trust and rapport Palmer and Thompson For example, in my conversation with Lisa, we discovered a common geography and connection, which facilitated her to feel more comfortable and to discuss her experiences more freely.

Another potential research limitation was the risk of taking for granted common understanding Simmons In order to address these limitations, I used structured participant-observations Appendix F as a tool for reflexivity. I used my participant-observation and field notes to reflect on my research process, questions I could have gone into more deeply, as well as trends within my data.

I discuss reflexivity further in the methods section. However Indigenous and non-Indigenous alike, it is not enough to be well intentioned. The culturally relevant and often racist results of these studies are then disseminated to an often equally disengaged and uninformed academic audience, thus perpetuating the dominance of western research on Aboriginal people NCCAH Not only is the dominance of western research perpetuated, but also research has been critiqued for ignoring the diversity within and among Indigenous groups and that results are often generalized, which perpetuates stereotypes Letendre and Cain As I reflect on Indigenous health research ethics and how my methodology reflects who I am, the tepee teaching informs my research methodology.

I was struggling as a new student and mother and in my dream I met my grandmother Eva Cecile Chartrand. We were sitting next to each other beside the fire and when I looked up, I saw the intersecting teepee poles. I interpreted the dream as a sign to restore the relationships, knowledge and connections between land, family, spirituality, values and everyday living Castellano and to restore the teepee teaching within my own life.

I embarked on a process of decolonizing 43 Smith After three years of collecting and peeling lodge pole pine and being gifted a tepee cover, I reclaimed and revitalized the teaching with my family and friends, with the support and guidance from Vern and Mona Tronson. I was struggling with my Indigenous identity when I met Mary Lee in It was her tepee teaching and Ernestine who inspired me to seek out more information and reconnect with my Indigenous culture, language, genealogy and identity.

The tepee is … the spirit and body of woman, because she represents the foundation of family and community. It is through her that we learn the values that bring balance into our lives.

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The tepee is constructed of 15 poles, each representing a value and teaching. The first pole is obedience, teaching us to accept guidance and wisdom from others. The second pole is respect and the teaching is respect for self and others. The third pole is humility; teaching is that we are not above or below others in the circle of life. The fourth pole is happiness, teaching us to show enthusiasm and encourage others. The fifth pole is love, teaching the love of oneself and love of others, not things. The sixth pole is faith and belief in the spirit world. The seventh pole is kinship, the forming of relationships with parents, siblings, extended relatives, and all our 44 relations.

The eighth pole is spiritual cleanliness, teaching us to walk bimatisawin, in a good way. The ninth pole is thankfulness, teaching gratitude for life and family. The tenth pole is sharing and the teaching involves sharing our knowledge, stories and traditions with future generations. The eleventh pole is strength and the teaching includes having spiritual strength, to do things that are difficult. The twelfth pole is good child rearing and teaching that we must guide and protect the sacred gift of children. The thirteenth pole is hope, teaching hope that women, who are the life givers and the nurturers, will carry on these teachings to bring healthy and spirited people into the world.

The fourteenth pole is protection and teaching is to protect the minds, spirit, emotions and health of the youth. Each pole is placed in opposition around the circle, teaching us that we each bring a unique perspective and story and to value of multiple ways of being, knowing and experiencing the world. Although the poles are separate and placed around the perimeter, they intersect at the top and are bound together. If only one pole were raised, it would fall to the ground, teaching us that no one stands alone; rather, we lean on one another for support.

This teaches us the value of community, support, inclusion, relationships, connection and interconnection. The space within the teepee is an ethical and sacred space that represents diversity, equality, cross-cultural and interdisciplinary communication and collaboration. Setting up the tepee was a healing process and continues to be a gathering space where women from all walks of life come together to share teachings, stories and meals. It is a space to sleep, rest, recover and rejuvenate the strength that is needed to continue on our journey as women and mothers, children and partners, family and community.

Each pole around the parameter represents multiple perspectives. However, the poles intersect and lean on one another in the centre to create a space of understanding, growth and transformation. As illustrated in chapter one, Indigenous health disparities is the result of complex genetic, biological, historical, social, political, economic, and cultural causes and contexts. Therefore, there is a need for collaboration, coalitions of knowledge systems, hybridity, alliances of world-views Canella and Manuelito between and among a range of theories and methods to research and understand the complexity.

Two-Eyed seeing adamantly, respectfully, and passionately asks that we bring together our different ways of knowing to motivate people, Aboriginal and non-Aboriginal alike, to use all our understandings so that we can leave the world a better place and not compromise the opportunities for our youth in the sense of Seven Generations through our own inaction Bartlett et al.

In , I had the privilege of taking Enowkinwix with Dr.

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Jeannette Armstrong Armstrong How Food Was Given Edwards During the course, I designed Gwayahkooshkaywin4 to illustrate the collaboration and relationships between the Four Food Chiefs. I also integrated my own Anishinaabe teachings that are informed by the Ojibway creation story Benton-Benai , the four hills of life Peacock and Wisuri , Ojibway ceremonies Johnson , and the four directions model NWAC The four disciplines include Indigenous scholarship, epidemiology and social determinants of health theory, critical medical anthropology, and feminist scholarship.

The interconnected circles represent the relationship within, between and among each discipline. In Research is Ceremony, Shawn Wilson encourages the development of Indigenous research paradigms that are based on relational accountability and the circle. He states that, by putting ideas in a circle, the ideas flow from one to the next, change in one affects the others, which in turn effects new change in the original. All parts of the circle are equal; no part can claim superiority over, or even exist without the rest of the circle.

The entities are interconnected, inseparable, interrelated, whereby the whole is greater than the sum of its parts Wilson Indigenous Research Paradigm 2. Colonial and Eurocentric history has created racially biased ways of knowing or epistemic racism whereby research definitions and methodologies [that] have been rooted in Euro-Western epistemologies-positivism to post-modernism, post-structuralisms- [that] arise out of a social history and culture of the dominant race. These epistemologies reflect and reinforce that social history and that social group and this has negative results for people of color in general and scholars of color in particular Scheurich and Young Since , a movement to dismantle, deconstruct, and decolonize Western epistemologies Lincoln and Denzin has resulted in Indigenous peoples researching and writing about their own community epistemologies, needs, theory, methods and research ethics Archibald ; Castellano ; Kovach ; Weber Pillax , ; Wilson A movement toward the critical expansion Denzin et al.

Contextualization has two aspects. Ethnography, or researching and writing about culture, has a long history within anthropology Boas ; Evans-Prtichard ; Hallowell , ; Leslie ; Malinowski , Turner There is also a rich ethnographic history of writing about Indigenous women and birth Cameron ; Landes ; McPherson , , ; Olbrechts ; Jordan When applied to studying health, illness and medical institutions, medical anthropology emphasized the role of culture and how culture shapes illness experiences, narratives Kleinman , and illness semantics Good , while at the same time, examining social hierarchies, power dynamics Farmer , and the socioeconomic context Baer et al.

Ethnographic research and health narratives inform our understanding about the social and cultural context of health experiences. Maori Elder Merata Mita says this best: We have a history of putting Indigenous peoples under a microscope, much like a scientist looks at an insect. Those who do the looking are giving themselves the power to define in Smith By shifting our gaze away from Indigenous peoples towards upstream forces of power, we can then redefine health, wellness, and address health disparities and inequalities. Not only does critical medical anthropology shift our focus away from individual health and circumstances, but it also a tool to bring about social change.

Critical qualitative research empowers individuals and communities, and brings about emancipatory change and 54 transformation by challenging various forms of unequal power relationships, class exploitation, racism and sexism Singer and Bayer An Indigenous feminist approach encourages creating spaces for Indigenous voices and perspectives, as well as a process of critique, decolonization and Indigenization Green ; Smith Historically, Indigenous women have been excluded and misrepresented Van Kirk As Patricia Monture in Boulton And if women are the footnote, then Aboriginal women are the footnote to the footnote.

Secondly, my research is feminist because it aims to address power imbalances Luttrell et al. My location and position as an Indigenous health researcher discussed above and reflexivity within my participant observations are the third characteristic that frames my research within a feminist perspective. The MES design and methods Chalmers et al. The questionnaire was gathered in to from three urban pilot study sites in Moncton, Vancouver and Yellowknife Dzakpasu et al.

The MES sampling frame was taken from the Census population and included birth mothers 15 years of age or older, who had a singleton live birth in 56 Canada and lived with their infants at the time of the survey. The sample received an introductory letter and survey pamphlet and telephone interviews with a Stat Can interviewer took place between 23 October and 31 January PHAC The MES identified recent immigrant, young age , and Aboriginal women to be at higher risk of adverse pregnancy outcomes and that specific results from each population would be produced through focused publications PHAC Subsequent publications were never produced.

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My initial research questions were: Research Data Centres provide researchers with access, in a secure university setting, to micro data from population and household surveys. Aboriginal mothers were sampled according to their natural distribution and were not adjusted to address for small sample sizes or lower than expected response rates. Lower than expected response rates for Aboriginal women resulted in a 64 per cent response rate compared to 78 per cent for the non-Aboriginal population.

However, the small sample size did not allow for further disaggregation by province. All statistical analyses were vetted and released by a Statistics Canada CRDC employee to ensure participant anonymity and statistical accuracy. Because I was only interested in a comprehensive overview, additional statistical tests were not conducted. In addition, I found the data quality limitations and the exclusion of First Nations women residing on reserve to be non-representative of Canadian Indigenous women and further analysis would be futile.

Therefore, data quality limitations and comparisons between the total MES population and Aboriginal women are not statistically significant and should be interpreted with caution. Through an Indigenous lens, the findings did not include the voices and stories of Indigenous women who speak from diverse viewpoints. Why do Indigenous women experience higher rates of stress, violence and postpartum depression?

The purpose of my experiential focused ethnographic research was not to replicate the MES survey. I conducted ten semi-structured interviews from 29 January to 8 April that varied between two and five hours in one sitting. With permission, I audio recorded each conversation. Each conversation unfolded differently based on the unique experiences and circumstances, as well as the amount of information each sister- participant shared. The semi-structured interview Fife included open-ended questions informed by an interview script Appendix E.

The interview script served as a guideline that directed and kept the conversation on track, but the conversations were not limited to these questions. The semi-structured questions and interview script were developed from and elaborated on my analysis of the MES data and included questions pertaining to: Participant information and socio-demographics; 2. Labour and birth experiences; 4. Postpartum experiences during the 6 months following birth of baby ; 5. Postpartum depression; and 7. Questions pertaining to prenatal, labour and birth, and postpartum experiences encouraged women to describe their thoughts, feelings, experiences and perceptions of perinatal healthcare and support.

Additional questions were asked to determine if they experienced any barriers that prevented them from obtaining their optimal level of perinatal health. Specific questions related to stress and postpartum depression encouraged women to speak about the circumstances and context related to stressors and how it affected them personally, their relationship and their child or children.

Women were also asked to describe the support or lack thereof that they received. Additional exploratory questions related to Indigenous mothering, suggestions for improvement, personal strengths and supports were used to summarize additional feedback that was not addressed in the interview questions but were important for my sister-participants to share. My sister participants were selected through purposive snowballing sampling. I chose snowball sampling because of my insider position and involvement with Indigenous communities and organizations, which allowed for ease of access to participants Palmer and Thompson Snowball sampling includes a small number of individuals selected for particular characteristics Green and Thorogood ; Somekh and Lewin and my sister participants were selected according to following criteria, they 1.

My sister participants included a diversity of Indigenous identities i. The posters provided my email and telephone number. Those who were interested in participating in the conversation were asked to contact me directly. A call for participation was distributed to: Okanagan Nation Alliance 8 member bands within the Okanagan: Once my sister-participants initiated contacted either by email or telephone, I emailed them a letter of initial contact Appendix B to explain the purpose of the conversation and outline my research process. We then agreed to a scheduled time one week after initial contact to give my 62 sister-participants sufficient time to consider and confirm their participation.

Each interview was held in an environment coffee shop, in the park, sister-participant home where she felt the most comfortable and was able to respond freely. Upon meeting, participants completed the consent form Appendix C and photo release form Appendix D. Prior to the interviews, I utilized an Indigenous Anishinaabek methodology by presenting each sister with a cowrie shell, tobacco, sage, sweet grass and cedar in a small plastic bag as a gift to ask for their stories.

Within my analysis, I compiled over 40 hours of interview tapes and over pages of transcribed interview data. In my research analysis, I attempted to balance between the dual process of telling the story from the point of view of the research participants, and unpacking that story in some way such that the broader meanings can be elicited Green and Thorogood The recurrent or common themes serve as a means of evoking additional conversation about the underlying phenomena, relationships among the themes that emerge, and the context s in which they occur Lincoln and Guba I uploaded and transcribed conversations and structured participant observations notes into MAXQDA, which is a software program for qualitative and mixed methods data analysis.

It organizes and sorts themes, categories and coding schemes based on word frequency and identified patterns and themes. After uploading all transcription data, I conducted a word frequency count. I then went through each interview to colour code system entries and I identified 17 category patterns. The 17 category patterns were education, employment and income, housing, homelessness, single parenting and relationships, violence and postpartum depression. Women also spoke about their fear and barriers when accessing mainstream healthcare.

In addition, women also shared their experiences with foster care and a history of residential school, and the impacts of addictions. When asked exploratory questions about Indigenous mothering, women spoke about the importance of ending negative cycles, reviving culture and language and the role of being strong Indigenous women warriors. After compiling a list of category patterns, I organized the17 patterns into five main themes including: Strength Based Narratives and Resiliency.

I then organized the themes into three sections related to proximal, intermediate and distal determinants of health and well-being.

Ethnographers studying health experiences immerse themselves in social context of illness and treatment for prolonged periods of fieldwork to collect descriptive data and form an understanding of local culture and embodied experience. This was informative when sister-participants elaborated on the content of the interview and I could ask questions, explore tentative hunches, and recognize trends and emerging patterns in the data.

I was also able to develop my own impressions of the sister-participant and her level of discomfort with certain topics, emotional responses to people, events or objects. Of the Aboriginal mothers, Aboriginal respondents were from Ontario The maternal age of delivery varied and Aboriginal mothers had lower educational attainment and income levels. Nearly one quarter of the Aboriginal MES respondents However, the lower education rates may also be reflective of the higher rates of young mothers age 15 to Within my MES analysis, Aboriginal women were three to six times more likely to live in a household of five or more people.

First Nation women were four times more likely and Inuit women were twice as likely to report being homeless at some point throughout their pregnancy Table 3. Studies have illustrated an association between intention and adverse infant and maternal health outcomes Santelli et al. Although Aboriginal women were happy to be pregnant and satisfied with the timing of their pregnancy, Within the MES Aboriginal mothers were less likely to take a multi-vitamin with a folic acid supplement Long-term effects of children of mothers who smoke during pregnancy include higher rates of respiratory illness, asthma and neurodevelopmental and behavioural problems Pattenden et al.

In the three months prior to pregnancy or before realizing they were pregnant, 40 per cent of First Nations, During the last three months of pregnancy, Aboriginal women were at higher odds OR 2. This is consistent with findings from the MES, where Previous research demonstrates that Compared to non-Aboriginal women, Aboriginal women have significantly higher odds OR 2.

Among Aboriginal women who experienced violence, This finding demonstrates that Aboriginal women were at higher odds of three or more abusive acts in the last two years OR 4.

The ethnicity of the perpetrator is unknown. Of those who experienced violence, Aboriginal women were at higher odds OR 3. For First Nations mothers, For 35 per cent of Inuit mothers, the most common stressful life event included someone very close to them die, Within the MES, the majority of Aboriginal mothers Unfortunately the MES does not clarify what types of supports are utilized, for example family, friends, community, or health care providers. Aboriginal mothers reported similar rates of 1 pregnancy not ending in a live birth, however Among Aboriginal women, According to the MES, 68 per cent of Aboriginal women had a spontaneous vaginal birth, 7.

Supine position, or giving birth on your back is associated with increased episiotomies, prolonged second stage of labour pain and increased perineal tears WHO Thirty seven per cent of Aboriginal women reported having their legs in stirrups when the baby was born, compared to 57 per cent of the total MES population. The most frequent position reported by Among Aboriginal mothers with a vaginal birth or who attempted a vaginal birth, Among Aboriginal mothers who had a vaginal birth or who attempted a vaginal birth, In the MES, 8.

Under half, or Ratings and levels of satisfaction are also used to measure quality of care. The MES measured six aspects of quality of care women received by their health care providers including: Birth experiences and satisfaction of care from health care providers for Aboriginal women is important to understanding their perspective and perceptions and ensure that the health care system is 82 responsive to their needs and concerns.

Among Aboriginal mothers A majority, or This finding varied across Indigenous populations. Over seventy percent of First Nation mothers, Overall, Aboriginal mothers reported that they had enough information on basic infant and maternal care e. The number one source of information for prenatal care for A period of maternity leave following birth is important, as it allows mothers to care for themselves and their newborn.

Within the MES, There are three major categories of postpartum emotional conditions: The EPDS is a item screening tool to identify postpartum depression was administered to identify postnatal depression at the time of the interview. A score of 13 or higher on the EPDS is considered indicative of postnatal depression and a score of is indicative of being at risk for postpartum depression.

The item questionnaire asks women to rate their feelings within the last 7 days Cox et al. Indigenous women were also at higher odds OR 1. Although there are a number of limitations with the MES, which are discussed further in chapter seven, the MES offers valuable insights. Overall, Aboriginal women report positive experiences, as well as high levels of satisfaction with the care they received throughout pregnancy, labour, birth and postpartum.

In some instances, Aboriginal women fared better. Aboriginal women had higher rates of breastfeeding initiation and rates following three months postpartum. Aboriginal women, specifically young mothers age 15 to 19, were more likely to attend prenatal classes. However, it is unknown if this is voluntary or mandatory attendance.

For example, parents involved with the Ministry of Child and Family Services may have mandated prenatal class attendance as a requirement to prevent child apprehension. Aboriginal women had lower rates of pubic shaving, episiotomies and perineal stitches, as well as lower rates of induction and speeding up labour. However, these rates were still higher than the national average.

Aboriginal women had higher rates of unassisted vaginal births and were less likely to be in a supine position or have their legs in stirrups during delivery.

In addition, Aboriginal women had lower C-section rates. However, it is uncertain if lower C-section rates are the result of a lack of access to caesarean birth for mothers who require it. Valid only on your first 2 online payments. Cashback will be credited as Amazon Pay balance within 10 days from purchase. Here's how terms and conditions apply. Customers who bought this item also bought. Page 1 of 1 Start over Page 1 of 1.

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Celebrating Baby Beginnings

Most helpful customer reviews on Amazon. I really like this book. It was interesting to see some of the difficulties and joys the midwives of the U. Some of their complications scared me to death. I would have freaked out, if I had been the midwife. I can't imagine dealing with some of the problems they had. I passed my certification exam to be a childbirth educator after completing a two year program.

After that, I taught early pregnancy, childbirth preparation, sibling, and grandparents classes. Once a couple begged me to be at their home delivery that they planned.