(Re)birthing systems in the Qikiqtaaluk Region of Nunavut: a place-based inquiry into Inuit birthing, systems of care, and maternal health research

Abstract

AbstractObjectives: Within the Qikiqtaaluk Region (Eastern Nunavut), pregnant women are required to travel outside their home communities for birthing care. This model differs from the prior norm of place-based, midwife-attended birth and impacts Inuit wellness. This research characterised Inuit women’s birthing experiences and perspectives on enriching the medical obstetric system through the lens of place, culture, and health, and explored how maternal health research methodologies might be increasingly place-based and locally-driven.Methods: Informed by a community-based approach, a team of Inuit and non-Inuit researchers conducted a case study with Inuit women in Iqaluit, Nunavut, Canada. A systematic critical review was completed to examine prior maternal health research methodology in Nunavut and underscored opportunities for maternal health research to be increasingly Inuit-led through all research stages. Sewing was explored as a locally-specific, arts-based approach for data gathering and was found to enhance data quality and participants’ research experience by creating space for voicing, sharing, relating, and embodying Inuit knowledge. Qualitative data were gathered (2017-2020) using: (1) focus groups (structured as two-part sewing sessions) (n = 5) with pregnant women (n = 19); and (2) conversational interviews with pregnant women, Inuit Elders, and other community members (n = 22); and validated in meetings with Inuit knowledge-holders (n = 4). Thematic analyses were iterative and guided by a grounded theory approach.Results: Participants described the importance of place-connections to Inuit birth experiences and the value of Inuit relational supports and knowledge-sharing throughout the birthing process. Inuit women voiced a desire for place-based birthing and further Inuit involvement and integration of Inuit birthing practices into obstetrical care. Women shared knowledge on stewarding birthing resources from the land and using skilled Inuit midwifery techniques: this knowledge connects to three Inuit Qaujimajatuqangit principles important for health system governance in Nunavut (Avatittinnik Kamatsiarniq, Inuuqatigiitsiarniq, and Pilimmaksarniq) and illustrates the importance of aligning the regional obstetric system with Inuit birthing values.Conclusions: This collaborative research emphasises how maternal health research and maternity care may be enriched by including place-specific, locally-embedded methods and by providing space for Inuit women to shape the systems that affect them.INUKTITUT TRANSLATIONᐃᕐᓂᓱᒃᓰᓂᖅ ᐊᐅᒪᓂᖓ ᕿᑭᕐᑖᓗᖕᒥ ᓄᓇᕘᒥ: ᓄᓇᒋᔭᖏᓐᓃᓪᓗᑎᒃ ᖃᐅᔨᓇᓱᖕᓂᖅ ᐃᓄᐃᑦ ᐃᕐᓂᓱᒃᓰᕙᖕᓂᖏᑦ, ᐸᕿᓂᕐᒥᒃᓗ ᐊᒻᒪᓗ ᓇᔾᔨᔪᑦ ᖃᓄᐃᖏᓐᓂᖏᓐᓂᒃ ᖃᐅᔨᓴᕐᓂᖅᓚᐅᕆ ᔭᐃᓐ ᐳᕈᐸᐃᑯᕿᑭᕐᑖᓗᖕᒥ (ᑲᓇᖕᓇᖓᓂ ᓄᓇᕗᑦ), ᓇᔾᔨᔪᖅ ᐊᕐᓇᖅ ᐊᐅᓪᒪᕆᐊᖃᖃᑦᑕᕐᒪᑕ ᓄᓇᓕᖓᑕ ᓯᓚᑖᓄᑦ ᐃᕐᓂᔭᕐᑐᕐᓗᑎᒃ. ᑕᐃᒪᐃᑎᓪᓗᒍ ᐊᔾᔨᒌᖏᒻᒪᒍ ᐃᓕᖁᓯᐅᕙᓚᐅᕐᑐᓂᒃ ᐊᖏᕋᕐᓯᒪᓪᓗᑎᒃ ᓄᓇᒋᔭᖏᓐᓃᓪᖢᑎᒃ ᐃᕐᓂᓱᒃᓰᕙᓚᐅᕐᒪᑕ ᖃᓄᐃᖏᑦᑎᐊᕐᓂᖏᓐᓄᓪᓗ ᐃᒃᐱᖕᓇᐅᑎᖕᒪᑦ. ᑖᓐᓇ ᖃᐅᔨᓴᕐᓂᖅ ᑐᑭᓯᓇᓱᒃᖢᓂ ᐃᓄᐃᑦ ᐊᕐᓇᐃᑦ ᐃᕐᓂᓱᒃᑎᓪᓗᒋᑦ ᐊᑐᕐᓯᒪᔭᖏᓐᓂᒃ ᐊᒻᒪᓗ ᐃᓱᒪᒋᔭᖏᓐᓂᒃ ᐱᐅᓯᒋᐊᕐᑕᐅᔭᕆᐊᖃᕐᓂᖓᓂᒃ ᐃᕐᓂᓱᒃᓰᓂᖅ ᓄᓇᒋᔭᖓᓂᓪᓗᓂ, ᐃᓕᖁᓯᖓᒍᑦ, ᐊᒻᒪᓗ ᖃᓄᐃᖏᑦᑎᐊᕐᓂᖓᒍᑦ, ᐊᒻᒪᓗ ᖃᐅᔨᓇᓱᒃᓗᓂ ᖃᓄᖅ ᓇᔾᔨᔪᑦ ᖃᓄᐃᖏᑦᑎᐊᕐᓂᖏᓐᓂᒃ ᖃᐅᔨᓴᕐᓂᖅ ᐃᓕᖁᓯᐅᔪᑦ ᓄᓇᓕᒋᔭᖓᓂᑦ ᐊᒻᒪᓗ ᓄᓇᓕᐅᔪᓂᒃ ᐱᒋᐊᕐᑎᑕᐅᕙᓪᓕᐊᓕᕐᓂᖓᓂᒃ. ᑐᓴᐅᒪᑎᑕᐅᓪᓗᑕ ᓄᓇᓕᖕᓂᑦ ᐱᒋᐊᕐᑎᑕᐅᓯᒪᔪᓂᑦ, ᐃᓄᐃᑦ ᖃᓪᓗᓈᓪᓗ ᖃᐅᔨᓴᕐᑎᑦ ᖃᐅᔨᓇᓱᓚᐅᕐᒪᑕ ᐃᓄᐃᑦ ᐊᕐᓇᐃᑦ ᐃᖃᓗᖕᓂ, ᓄᓇᕗᑦ, ᑲᓇᑕ. ᕿᒥᕈᔭᐅᓚᐅᕐᑐᖅ ᐃᓕᖁᓯᐅᓯᒪᔪᑦ ᖃᓄᐃᓕᖓᖃᑦᑕᓚᐅᕐᒪᖔᑕ ᐃᓕᖁᓯᐅᔪᑦ ᐃᕐᓂᓱᕐᑐᓂᒃ ᓇᔾᔨᔪᓂᒃᓗ ᓄᓇᕗᒥ ᐊᒻᒪᓗ ᐊᑐᖏᑎᑕᐅᓗᐊᕐᓂᖏᓐᓂᒃ ᐱᕕᖃᕐᓂᐅᔪᑦ ᐃᓄᖕᓄᑦ ᐊᐅᓚᑕᐅᓗᑎᒃ ᖃᐅᔨᓴᕐᓂᖅ. ᒥᕐᓱᕐᑎᑦᑎᓂᒃᑯᑦ ᓄᓇᓕᖕᓂ ᐊᑐᕐᑕᐅᕙᒋᕐᑐᖅ, ᓴᓇᐅᒐᓕᕆᓂᕐᓗ ᑎᑎᕋᕐᑕᐅᕙᓪᓕᐊᓪᓗᑎᒃ ᐊᒻᒪᓗ ᑐᑭᓯᔾᔪᑕᐅᓚᐅᕐᑐᖅ ᐱᐅᓯᒋᐊᕈᑕᐅᓪᓗᓂᓗ ᐊᒻᒪᓗ ᐃᓚᐅᖃᑕᐅᔪᑦ ᖃᐅᔨᓴᕐᓂᕐᒥᒃ ᑐᑭᓯᓪᓗᑎᒃ ᓂᓪᓕᕈᓐᓇᕐᑎᑕᐅᓪᓗᑎᒃᓗ, ᐅᖃᐅᓯᖃᕈᓐᓇᕐᖢᑎᒃᓗ, ᐊᖏᖃᑎᖃᕈᓐᓇᕐᓗᑎᒃᓗ, ᐊᒻᒪᓗ ᐃᓄᐃᑦ ᖃᐅᔨᒪᔭᖏᓐᓂᒃ ᑐᑭᓯᕚᓪᓕᕐᖢᑎᒃ. ᐱᐅᑎᒋᓂᖓ ᑎᑎᕋᕐᓯᒪᔪᑦ ᑲᑎᑕᐅᓚᐅᕐᑐᑦ (2017-2020) ᐊᑐᕐᖢᑎᒃ: (1) ᑲᑎᒪᔨᕋᓛᖑᒧᓂᒃ (ᐋᕿᒃᓯᒪᓪᓗᑎᒃ ᒪᕉᓕᓪᓗᑎᒃ ᒥᕐᓱᑲᑕᕐᑐᑦ) (n = 5) ᓇᔾᔨᔪᓂᒃ ᐊᕐᓇᓂᒃ (n = 19); ᐊᒻᒪᓗ (2) ᐅᖃᓪᓚᖃᑎᒋᔭᐅᓪᓗᑎᒃ ᐊᐱᕐᓱᕐᑕᐅᕙᓪᓕᐊᓪᓗᑎᒃ ᓇᔾᔨᔪᑦ ᐊᕐᓇᐃᑦ. ᐃᓄᐃᑦ ᐃᓐᓇᐃᑦ, ᐊᓯᖏᓪᓗ ᐃᓄᐃᑦ (n = 22); ᓇᓗᓇᐃᕐᑕᐅᕙᓪᓕᐊᓗᑎᒃᓗ ᑲᑎᒪᑎᑦᑎᓪᓗᑎᒃ ᐃᓄᐃᑦ ᖃᐅᔨᒪᔭᑐᖃᖏᓐᓂᒃ ᑎᒍᒥᐊᕐᑎᐅᔪᓂᒃ (n = 4). ᖃᐅᔨᓴᕐᑕᐅᕙᒃᖢᑎᒃ ᑐᑭᓯᔭᐅᓇᓱᒃᖢᑎᒃ ᐊᒻᒪᓗ ᐊᑐᐊᒐᖃᕐᖢᑎᒃ ᐃᓱᒪᒋᔭᐅᓯᒪᔪᓂᒃ. ᐃᓚᐅᖃᑕᐅᔪᑦ ᐅᖃᐅᓯᖃᖃᑦᑕᓚᐅᕐᑐᑦ ᓄᓇᒥ ᐊᒃᑐᐊᓂᖓ ᐱᓪᓚᕆᐅᓂᖓᓂᒃ ᐃᓄᐃᑦ ᐃᕐᓂᓱᒃᓰᓂᖏᑦ ᖃᐅᔨᓯᒪᔭᖏᑦ ᐊᒻᒪ ᐊᑑᑎᖃᕐᓂᖓᓂᒃ ᐃᓄᐃᑦ ᐃᒪᒋᔭᖏᓐᓂᒃ ᐃᒪᐅᑎᑦᑎᓂᕐᒥᒃ ᐊᒻᒪᓗ ᖃᐅᔨᒪᔭᕐᒥᓂᒃ ᐅᖃᐅᓯᖃᖃᑦᑕᕐᓂᖅ ᐃᕐᓂᓱᒃᓰᓂᕐᒥᒃ. ᐃᓄᐃᑦ ᐊᕐᓇᐃᑦ ᐅᖃᖃᑦᑕᓚᐅᕐᑐᑦ ᓄᓇᒦᓪᓗᓂ ᐃᕐᓂᓲᖃᑦᑕᕈᒪᓪᓗᑎᒃ ᐊᒻᒪᓗ ᐃᓚᐅᑎᑕᐅᓂᕐᓴᐅᓗᓂ ᐃᓄᐃᑦ ᐊᒻᒪᓗ ᐱᖃᓯᐅᔾᔭᐅᖃᑦᑕᕐᓗᑎᒃ ᐃᓄᐃᑦ ᐃᕐᓂᓱᒃᓰᓂᖏᑦ ᐃᕐᓂᓱᒃᑐᓄᑦ.. ᐊᕐᓇᐃᑦ ᖃᐅᔨᒪᔭᕐᒥᓂᒃ ᐅᖃᐅᓯᖃᖃᑦᑕᓚᐅᕐᑐᑦ ᐃᕐᓂᓱᒃᑐᓄᑦ ᐃᓕᖁᓯᕆᔭᐅᓚᐅᕐᑐᓂᒃ ᐊᐅᓪᓚᕐᓯᒪᓪᓗᑎᒃ ᐊᑐᕐᑕᐅᓪᓗᑎᒃᓗ ᖃᐅᔨᒪᓂᖏᑦ ᐃᕐᓂᓱᒃᓰᕙᒃᑐᑦ ᐃᓄᐃᑦ. ᑖᓐᓇ ᖃᐅᔨᒪᓂᖏᑦ ᐊᒃᑐᐊᓂᕆᔭᐅᖕᒪᑦ ᐱᖓᓱᓄᑦ ᐃᓄᐃᑦ ᖃᐅᔨᒪᔭᑐᖃᖏᑦ ᐊᑐᐊᒐᐅᔪᓂᒃ ᐱᓪᓚᕆᐅᓪᓗᑎᒃᓗ ᐊᓐᓂᐊᖃᕐᑕᐃᓕᒪᓂᕐᒧᑦ ᐊᐅᓚᓂᖓᓄᑦ ᓄᓇᕘᒥ (ᐊᕙᑎᑦᑎᓐᓂᒃ, ᑲᒪᑦᓯᐊᕐᓂᖅ,ᐃᓅᖃᑎᒌᑦᓯᐊᕐᓂᖅ ᐊᒻᒪᓗ ᐱᓕᒻᒪᒃᓴᕐᓂᖅ) ᓇᓗᓇᐃᒃᑯᑕᐅᓪᓗᓂᓗ ᐱᓪᓚᕆᐅᓂᖓᓂᒃ ᐃᕐᓂᓱᒃᑐᑦ ᒪᓕᒃᑎᑕᐅᓗᑎᒃ ᐃᓄᐃᑦ ᐃᕐᓂᓱᒃᓰᓂᖏᑦ ᐅᒃᐱᕆᔭᖏᑦ. ᐃᑲᔪᕐᑎᒌᒃᓗᑎᒃ ᖃᐅᔨᓴᕐᓂᖅ ᓇᓗᓇᐃᕈᑕᐅᓚᐅᕐᑐᖅ ᐱᓪᒪᕆᐅᓂᖓᓂᒃ ᓇᔾᔨᔪᑦ ᖃᓄᐃᖏᑦᑎᐊᕐᓂᖏᓐᓂᒃ ᖃᐅᔨᓴᕐᓂᖅ ᐊᒻᒪᓗ ᓇᔾᔨᔪᑦ ᖃᓄᐃᓐᓂᖏᓐᓂᒃ ᑲᒪᒋᔭᐅᑦᑎᐊᕐᓂᖏᓐᓂᒃ ᐱᐅᓯᒋᐊᕐᑎᑕᐅᒧᓐᓇᕐᓂᖓᓂᒃ ᓄᓇᒥᒃ ᐃᓂᖃᕐᓗᑎᒃ, ᓄᓇᓕᖕᓂ ᐃᓚᐅᖃᑕᐅᓗᑎᒃ ᐊᑐᕐᑕᐅᔪᓄᑦ ᐊᒻᒪᓗᐱᕕᖃᕐᑎᑕᐅᓗᑎᒃ ᐊᕐᓇᐃᑦ ᐃᓄᐃᑦ ᐋᕿᒃᓱᐃᖃᑕᐅᓗᑎᒃ ᐃᓅᓯᖏᓐᓄᑦ ᐊᒃᑐᐊᔪᓂᒃ.

Keywords

• Inuit
• Nunavut
• birthing
• maternity care
• health and place
• qualitative methods