Reclaiming Indigenous birth: research framework to assess the economic costs and outcomes of obstetric evacuation and experiences of Indigenous midwifery in Canada.

backgroundIndigenous communities in Canada (First Nations, Inuit, and Métis peoples) have distinct traditional knowledge and practices for pregnancy and birth, and these have sustained healthy and thriving Indigenous communities for millennia. Indigenous midwives historically held a leading role as primary providers of sexual and reproductive healthcare. However, colonial practices severely disrupted the role of Indigenous midwives and the transfer of their knowledge from generation to generation. The obstetric evacuation policy in Canada requires people who live in rural and remote locations to leave their community to have a hospital delivery. Evidence suggests this policy negatively impacts Indigenous people who desire to give birth in their communities. To implement optimal perinatal care for Indigenous people, Indigenous midwives in Canada seek evidence to answer the following questions: (1) What is the cost of obstetric evacuation, compared to Indigenous midwifery? And (2) What are the health outcomes for obstetric evacuation versus Indigenous midwifery?

methodsWe present our framework for Reclaiming Indigenous Birth, a study using multiple methods. Our framework brought together researchers, midwives (National Council of Indigenous Midwives, Association of Ontario Midwives, and Juniper Midwives), community organizations (Native Women's Association of Canada and Pauktuutit Inuit Women of Canada) and knowledge users (Indigenous Services Canada). We used Gwayakgooshgawin (balance) to bring four disciplines together in a theoretical framework: Indigenous methodologies, gender-based analysis, critical medical anthropology, and population and public health. We then created a relational framework with guidance of the Seven Grandparent Teachings, which taught us to nurture relations with research team members, partner organizations, and individuals whose data was included in this study. We upheld standards for Indigenous research ethics. The specific objectives of this study were to: (1) examine economic costs and outcomes of obstetric evacuation and Indigenous midwifery; (2) understand experiences of Indigenous midwifery; and (3) conduct knowledge translation activities to inform policy and programming for perinatal health in Indigenous communities. DISCUSSION: This research framework will contribute evidence to support calls to action to reclaim Indigenous ways of birth and address disparities between Indigenous and non-Indigenous people in birth outcomes.