A B S T R A C T Context: The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants are significantly poorer than they are for other Australians; they worsen with increasing remoteness where the provision of services becomes more challenging. Australia has committed to ‘Overcoming Indigenous Disadvantage' and ‘Closing the Gap’ in health outcomes. Issues: Fifty-five per cent of Aboriginal and Torres Strait Islander birthing women live in outer regional and remote areas and suffer some of the worst health outcomes in the country. Not all of these women are receiving care from a skilled provider, antenatally, in birth or postnatally while the role of midwives in reducing maternal and newborn mortality and morbidity is underutilised. The practice of relocating women for birth does not address their cultural needs or self-identified risks and is contributing to these outcomes. An evidence based approach for the provision of maternity services in these areas is required. Australian

http://espace.cdu.edu.au/view/cdu:9772/Kruske_9772.pdf

'Closing the Gap': How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women

Context: Research in the sciences is now beginning to acknowledge what many Aboriginal educators and students have experienced or witnessed in educational curricula, a general dismissal of Indigenous knowledge as being considered scientifically ‘worthy’. This is the result of educational institutions’, and the systems within which they are placed, failure to teach from broad cultural orientations. Aboriginal persons are under-represented in post-secondary education programs, with a similar disparity in the limited number of Aboriginal persons holding careers in health, science and engineering occupations.Issues: The University of Lethbridge is attempting to increase the number of Aboriginal students who successfully complete programs in a variety of areas. To that end, the Support Program for Aboriginal Nursing Students (SPANS) commenced in Fall 2007 in order to increase the numbers of Aboriginal students who enter and complete the 4 year nursing program. At one time there were as few as 2–3 Aboriginal nursing students across the 4 years of the program. Since SPANS began there are now 34 students of Aboriginal background across all 4 years of the nursing program. This is noteworthy because statistically there are only 1200 Aboriginal Registered Nurses in Canada, a daunting statistic that is alarming low. One of the objectives of SPANS is to enhance the nursing faculty and clinical instructors’ understanding of Aboriginal science so that it can be integrated into the current curriculum. With this aim, an Aboriginal Science Symposium was held in May 2009 to bring nursing faculty together with other University faculty and experts in Aboriginal science. The symposium attempted to highlight the links between programs in nursing and health sciences and the need for integration with Aboriginal science. The 3 specific symposium objectives were to: (1) generate an understanding of traditional scientific knowledge; (2) bridge Aboriginal and Western scientific thought, toward and; (3) understand ways of implementing and raising awareness of how Aboriginal knowledge and understanding of science can be applied to help inform and improve teaching in all educational science settings.Lessons learned:  From keynote addresses, panel group discussions, and breakout sessions, participant responses to the symposium objectives coalesced into 4 themes: (1) Aboriginal ways of knowing: informing Western science curricula; (2) Elders and community, enhancing science education; (3) Aboriginal student experience in the science classroom; and (4) strategies and advice to meet the needs of the Aboriginal science student.

/pdf/aboriginal-science-symposium-enabling-aboriginal-student-39ne60g9pe.pdf

Aboriginal science symposium: enabling Aboriginal student success in post-secondary institutions.

Objective: The Joint Working Group on First Nations, Indian, Inuit, and Metis Infant Mortality of the Canadian Perinatal Surveillance System is a collaboration of national Aboriginal organizations and federal and provincial/territorial stakeholders. Our objective was to better understand what is currently known about Aboriginal infant mortality rates (IMR) in Canada. Methods: As part of a larger international systematic review of Indigenous IMR calculation, we searched the published literature for original research regarding the calculation of First Nations, Inuit, and Metis infant mortality rates at the national and provincial/territorial level. Synthesis: We identified major deficiencies in the coverage and quality of infant mortality data for Aboriginal populations in Canada. The review of provincial and territorial reporting of infant mortality for Aboriginal populations revealed substantial provincial and territorial variation in the way that birth and death data were collected. With respect to coverage, high-quality IMRs were available only for Status Indians and communities with a high proportion of Inuit residents. No rates were available for Metis or non-Status Indians. Conclusion: Striking and persistent disparities persist in the IMRs for Status Indians and in communities with a high proportion of Inuit residents, compared to the general Canadian population. There is an urgent need to work in partnership with First Nations, Indian, Inuit, and Metis stakeholder groups to improve the quality and coverage of Aboriginal IMR information and to acquire information that would help to better understand and address the underlying causes of disparities in infant mortality between the Aboriginal and non-Aboriginal population in Canada. Key words: First Nations; Indian, North American; Inuit; Metis; infant mortality

A Review of Aboriginal Infant Mortality Rates in Canada: Striking and Persistent Aboriginal/Non-Aboriginal Inequities

Background
The Inuulitsivik midwifery service is a community-based, Inuit-led initiative serving the Hudson coast of the Nunavik region of northern Quebec. This study of outcomes for the Inuulitsivik birth centers, aims to improve understanding of maternity services in remote communities.

Methods
We used a retrospective review of perinatal outcome data collected at each birth at the Inuulitsivik birth centers to examine outcomes for 1,372 labors and 1,382 babies from 2000 to 2007. Data were incomplete for some indicators, particularly for transfers to Montreal.

Results
Findings revealed low rates of intervention with safe outcomes in this young, largely multiparous “all risk” Inuit population. Ninety-seven percent of births were documented as spontaneous vaginal deliveries, and 85 percent of births were attended by midwives. Eighty-six percent of the labors occurred in Nunavik, whereas 13.7 percent occurred outside Nunavik. The preterm birth rate was found to be 10.6 percent. Postpartum hemorrhage was documented in 15.4 percent of women; of these cases, 6.9 percent had blood loss greater than 1,000 mL. Four fetal deaths (2.9 per 1,000) and five neonatal deaths (< 3.6 per 1,000) were documented. Nine percent (9%) of births involved urgent transfers of mother or baby. The most common reasons for medical evacuation were preterm labor and preeclampsia, and preterm birth was the most common reason for urgent neonatal transfer.

Conclusions
The success of the Innulitsivik midwifery service rests on the knowledge and skills of the Inuit midwives, and support of an interprofessional health team. Our study points to the potential for safe, culturally competent local care in remote communities without cesarean section capacity. Our findings support recommendations for integration of midwifery services and Aboriginal midwifery education programs in remote communities. (BIRTH 39:3 September 2012)

Remote midwifery in Nunavik, Québec, Canada: outcomes of perinatal care for the Inuulitsivik health centre, 2000-2007.

The geography of belonging: The experience of birthing at home for First Nations women ☆

Background During the last four decades, policies and practices based on modern obstetrical techniques and knowledge have replaced traditional practices in many rural and remote Aboriginal communities. As most of these communities do not have obstetrical facilities or staff, women often have to leave their communities to give birth. Objective To review policies currently in place in Aboriginal communities that recommend evacuation of all pregnant women at 36 to 37 weeks' gestation to deliver in a Level 2 hospital. Options Allowing Aboriginal women, their families, and their communities to decide whether it is safe and practical for women to deliver close to home. Outcomes Increased opportunities for Aboriginal women in remote and rural communities to deliver within their own communities or closer to home in a familiar environment. Evidence PubMed was searched for articles on subjects related to birth in Aboriginal communities, birth in rural and remote communities, and midwifery in Aboriginal and remote communities. The web sites and libraries of the National Aboriginal Health Organization, The First Nations and Inuit Health Branch, and Health Canada were also searched for relevant documents. In addition, the authors visited three communities that have trained local midwives and that support deliveries within the community to observe and participate in their programs. Benefits It is hoped that improved communication between health institutions and remote and rural communities and changes in policies and procedures concerning the care of pregnant women in these communities will contribute to reductions in perinatal morbidity and mortality. Sponsors First Nations and Inuit Health Branch (FNIHB), Health Canada.

A Report on Best Practices for Returning Birth to Rural and Remote Aboriginal Communities

Objective To provide an overview of current information on issues in maternity care relevant to rural populations. Evidence Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. Outcomes This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration. 9. Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care. 10. Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported. 11. Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery. 12. All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met. 13. Quality improvement and outcome monitoring should be integral to all maternity care systems. 14. Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.

Rural maternity care.

Objective To provide an overview of current information on issues in maternity care relevant to rural populations . Evidence Medline was searched for articles published in English from 1995 to 2012 about rural maternity care . Relevant publications and position papers from appropriate organizations were also reviewed . Outcomes This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities . Recommendations 1.Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2.The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3.Rural maternity care services should be supported through active policies aligned with these recommendations. 4.While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5.The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6.Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7.Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8.Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration. 9.Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care. 10.Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported. 11.Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery. 12.All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met. 13.Quality improvement and outcome monitoring should be integral to all maternity care systems. 14.Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.

No. 282-Rural Maternity Care

Resume Contexte Au cours des quatre dernieres decennies, des politiques et des pratiques fondees sur des techniques et des connaissances obstetricales modernes ont remplace les pratiques traditionnelles au sein de nombreuses communautes autochtones rurales et eloignees. Puisque la plupart de ces communautes ne disposent pas de personnel ni d'installations obstetricales, les femmes qui y habitent doivent souvent les quitter pour accoucher. Objectif Evaluer les politiques actuellement en vigueur au sein des communautes autochtones, lesquelles recommandent l'evacuation de toutes les femmes enceintes entre la 36e et la 37e semaine de gestation, afin de pouvoir proceder a l'accouchement dans un hopital de niveau 2. Options Permettre aux femmes autochtones, a leur famille et a leur communaute de decider s'il s'avere sur et pratique de proceder a l'accouchement pres de la maison. Issues Accroissement des occasions, pour les femmes autochtones habitant des communautes rurales et eloignees, d'accoucher au sein de leur propre communaute ou plus pres de la maison dans un milieu familier. Resultats Des recherches ont ete menees dans PubMed afin d'en tirer les articles traitant de sujets lies a l'accouchement au sein de communautes autochtones, a l'accouchement au sein de communautes rurales et eloignees, et a la pratique de sage-femme au sein de communautes autochtones et eloignees. Les sites Web et les bibliotheques de l'Organisation nationale de la sante autochtone, de la Direction generale de la sante des Premieres nations et des Inuits, et de Sante Canada ont egalement fait l'objet de recherches afin d'en tirer les documents pertinents. De plus, l'auteur et sa collegue ont visite trois communautes qui ont forme des sages-femmes locales et qui soutiennent les accouchements au sein de la communaute, et ce, afin d'observer et de participer a leurs programmes. Avantages Nous esperons que l'amelioration des communications entre les etablissements de sante et les communautes rurales et eloignees, et que la modification des politiques et des modalites liees aux soins offerts aux femmes enceintes de ces communautes contribueront a la baisse des taux de morbidite et de mortalite perinatales. Commanditaire Direction generale de la sante des Premieres nations et des Inuits (DGSPNI), Sante Canada.

Rapport sur les pratiques optimales en ce qui concerne le retour de l’accouchement au sein des communautés autochtones rurales et éloignées

Resume Objectif Offrir un apercu des donnees actuelles sur les questions de soins de maternite qui sont pertinentes pour les populations des regions rurales. Resultats Des recherches ont ete menees dans Medline en vue d'en tirer les articles publies en anglais, entre 1995 et 2012, au sujet des soins de maternite en region rurale. Les publications et les exposes de principe pertinents issus d'organisations appropriees ont egalement ete analyses. Issues Ces donnees aideront les fournisseurs de soins obstetricaux des regions rurales a continuer d'offrir des soins de qualite aux femmes de leurs communautes.

Carol Couchie

Papers

A Report on Best Practices for Returning Birth to Rural and Remote Aboriginal Communities

Rural maternity care.

No. 282-Rural Maternity Care

Rapport sur les pratiques optimales en ce qui concerne le retour de l’accouchement au sein des communautés autochtones rurales et éloignées

Soins de maternité en région rurale