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Mi’kmaq Women’s Childbirth Experiences: Summary of Literature Review and Proposed

Study for Master’s Thesis Joanne Whitty-Rogers

Master’s of Nursing Student Dalhousie University

JoanneWhitty-RogersisanAssistantProfessorintheSchoolofNursingatSt.FrancisXavierUniversityinAntigonish,NovaScotia.Shecanbereachedat902-867-3629(W)[email protected]

68 Pimatisiwin4(1),2006

AbstractThefundamental lifechangesthataffecthealthandgeneralwellbeing

makechildbirthandthetransitiontomotherhoodacomplexprocessforallwomenastheattitudestowardschildbirthareculturallydependent.AmongAboriginalpopulations,suchastheMi’kmaq,thechildbirthexperience(hav-ingababy)maybe complicatedby culturaldifferences,particularlywhenMi’kmaqwomendelivertheirbabiesinsettingsoutsidetheirculture.Healthcarethatreflectsculturalaccommodationofsuchdifferencesinthesesettingsmaynotbeprovided,andmaynotbeviewedasessential.Healthcareprofes-sionalsoftenfailtounderstandthecomplexityofculturaldifferencesand,asaresult,mayoverlooktheirimplicationsforhealthcareoutcomes(Salimbene1999).Althoughthereisasignificantamountofliteratureontheconceptsofcultureandtransculturalnursing,thereis limitedresearchthatspecific-allyexploreschildbirthexperiencesofMi’kmaqwomen,particularlyinrela-tiontotheirexperiencesgivingbirthinsettingsoutsidetheirownculture.AliteraturereviewprovidedthebasisforaproposedqualitativestudyforthepurposeofprovidingnewknowledgeaboutMi’kmaqwomen’schildbirthex-perienceswhichoccurinalargetertiarycarecentreoutsidetheirruralNovaScotiancommunity.

IntroductionAlthoughthereisasignificantamountofliteratureontheconceptsof

cultureandtransculturalnursing,thereislimitedresearchthatspecificallyex-ploreschildbirthexperiencesofMi’kmaqwomen.ThisliteraturereviewwillfocusonMi’kmaqcultureandonAboriginalhealthinanefforttoprovideanunderstandingofwhatisknownaboutchildbirthexperiencesofAboriginalwomenandfamilies.Theliteraturereviewbeginswithabriefoverviewofthehistoricalbackground,Aboriginalwomen’shealth,Aboriginalhealthmodel,historical evolution of childbirth, alternative birthing arenas, culture, andchildbirthwillbeaddressed.Socioeconomicissues,discrimination,andothersocietalfactorsaffectinghealth,inparticularasitrelatestochildbirth,willbeincludedinthediscussion.Basedontheliteraturereview,aproposedstudydescribingthepurpose,significance,andthemethodandmethodologywillbebrieflyoutlined.

Childbirth,thetimewhenawomangivesbirthtoherchild,isaspeciallifeeventforamotherandherfamily.Callister,SemenicandFoster(1999:280)describechildbirthas“adeeplyphysiologic,cognitive,cultural,social,

Mi’kmaqWomen’sChildbirthExperiences 69

andspiritualevent.”Labourandbirthisgenerallyatimeofexcitementandanticipation, in addition to uncertainty and fear for women and families(HealthCanada2003a).Havingababyisamajortransitioninwomen’slivesastheylearntobecomemothers.Memoriesandexperiencesofthebirthre-mainintheirmindsforever(HealthCanada2003a).Therefore,thecareandsupportwomenreceiveduringtheintrapartumperiodiscriticalformain-taininghealthandpreventing/minimizingcomplications.

Although a joyous event, childbirth is associated with perinatal risksandchallengesforwomen,babies,families,andhealthcareproviders.SomeAboriginal1 women have more serious health problems such as hyperten-sionanddiabetesduringpregnancy,thanthegeneralpopulation.Thisplacesthemathigherriskformaternalandinfantcomplications(Smylie2001).

Pregnancy, labour, and delivery are normal life processes and mostwomenhavegoodoutcomeswithsupportandminimalmedical interven-tions(KendrickandSimpson2001).However,inpresent-daybirthingunits,birthpracticeshavebeenrigidbecauseofstrongbeliefsaboutmedicalproto-cols.Thesebirthpracticesandprotocolsinclude:continuousfetalmonitor-ing,highepiduralrates,generoususeofepisiotomiesandinductionoflabour(Lothian2001).Whileepisiotomyratesmaybestillofconcerninsomeinsti-tutions,obstetricoutcomedatasuggeststhereisadecreaseinthisprocedure.AccordingtoWellbery(2005),theincidenceofperforminganepisiotomyis30-35percent,adeclineinthelast20years.Thisisduetotheriskofwomenexperiencing anal sphincter and rectal injuries aswell asotherobstetricalcomplications.Savage(2002:8)statedthat“suchpracticesareabsolutesinobstetricalculturesothatthemedicalestablishmentcommunicatesthatanydeviationsfromthemedicalnormplacemotherandinfantinjeopardy.”Thebiomedicalmodeldefinescontextuallywhatmostpeoplethinkofbirth.Thismodelrepresentstechnologyusedduringthebirthprocess,whichlimitsbirthchoices(Michaelson1988).AspointedoutbySavage,thebirthpracticesandprotocolsdescribedabovearestandardprotocolforperinatalcare.Priortothemedicalizationofchildbirth,Savagealsoclaimsthatyoungwomenweretoldthatgivingbirthwaspowerfulandnotadifficultandpainfulexperi-ence.Theinfluenceofmodernmedicineandtechnologyhasnowessentiallyreplacedwomen’swaysofknowingaboutchildbirthwithfear.

Incontrasttothemedicallymanagedhospitalbirthexperiences,homebirthsofferwomenmorechoiceaboutthecaretheyreceive.Whilelabouring

1 Aboriginal—aninclusivetermwhichreferstoFirstNations,Inuit,andMetispeople(Smylieetal.2000).


intheirhome,womentendtofeelmoreactiveandpositivebecausetheper-sonperformingthedelivery(mostlikelyamidwife)isconsideredaguestinthemother’shome(SpindelandSuarez1995).SpindelandSuareznote“thechoiceofhomebirthcancertainlybeframed,inmostcases,asarejectionofthemorepassivemedicalmodelofhospitalbirth”(p.543).

Childbirth isamajor transitionandspecialcelebration forall cultures(Callister2001).Callister states that “healthcarebeliefsandhealth seekingbehaviorssurroundingpregnancy,childbirthandparentingaredeeplyrootedinculturalcontext”(p.68).Therefore,theextenttowhichwomenfollowcul-turalpracticesandcustomsdependsuponacculturationwithinthedomin-antculture,socialsupport,andgenerationties.Individualvalues,beliefs,andlifewaysallaffectculturalidentity(Narayanasamy2002).Sincecultureisoneofthedeterminantsofhealth,recognizingtheimpactitcanhaveonhealthiscritical.Inorderfornursesandotherhealthcareproviderstoidentifythelimitations of care provided to Aboriginal women and their families, it isnecessarytobeawareofthe lackofknowledgeregardingwhatconstitutesculturallycompetentcare.

InCanada, culturalminority groups, such as theMi’kmaq, oftenfindthemselvesreceivinghealthcarefrompeoplewhohaveverydifferentbeliefs,values,andattitudesthantheirown(BakerandDaigle2000).Therefore,cul-turallycompetentcare forMi’kmaqwomenduringchildbirthneedstobeexplored.ThefactthatAboriginalwomenhaveahigherincidenceofhealthproblemsduringlabouranddelivery,ascomparedtothegeneralCanadianpopulation,indicatesaneedforclosermedicalobservationandtechnologicalinterventionsforthispopulation.ThissituationidentifiesthecontradictionthatthemedicalmanagementofbirthmightbeinanAboriginalwoman’sphysicalbest interests—whileat thesametime,notbe inherculturaloremotionalbestinterests(Michaelsonetal.1988).TheMi’kmaqwomen’sbestinterestsmustbeconsideredduringthechildbirthprocess.

Historical Background Colonization has had a disruptive effect on the health and well be-

ing of Aboriginal peoples (Smylie et al. 2000). Health care providers needtohavesomebackgroundhistoryforthefollowingreasons:1)colonizationhas impactedthephysical,mental,emotional,andspiritualdimensionsofAboriginalhealth;2)today’srelationshipsofAboriginalpeoplewithhealthcare professionals and the health care system are affected by the colonialsystem;and3)policiesandattitudesfromthecolonialsystemcontinueto


thrive(Smylieetal.2000).Smylieetal.(2000:1074)state“priortocoloniza-tion, Aboriginal communities in the Americas were diverse and thriving.”Socialandpoliticalissuesimpactmanylevelsinhealthcare.InCanada,themainstreamhealthcaresystemhasbeenshapedbyyearsofinternalcolonialpoliticsthathavemanagedtomarginalizeAboriginalpeoplesfromthedom-inantgroup(O’Neil1986).

Aboriginal Women’s HealthBeliefs about illness and wellness are deeply rooted in every culture.

Mi’kmaqviewsonhealthareholisticandunite“theideologyofbalanceandthe interconnectednessof thenaturalworld” (Baker1998:323). Thesebe-liefsarepowerfullylinkedtospirituality;healingoccurswhenthereishar-monyandconnectedness.Themedicinewheelrepresentsamodelofhealthinwhichemotions,thought,spirituality,andthephysicalbeingallplayvitalrolesinmaintainingbalanceintheperson.Battiste(2000:xxii)assertedthatthemedicinewheeldepicts“symbolicallythatallthingsareinterconnectedandrelated,spiritual,complex,andpowerful.”BattisteillustratedtheuseofthemedicinewheelusingthefourdirectionsoftheSacredWheel(windsoftheWest,North,East,andSouth).TheWesternDoorrepresentsthedirec-tionofautumnshowing “the ideas thathave shaped the last eraofdom-inationunderpinningmodernsociety”(Battiste2000:xxiii).TheNorthernDoormeansthatIndigenouspeoplesarechallengedbythewinter,however,it iswhentheylearnenduranceandwisdom.TheEasternDoorrepresentsthespring.Itisassociatedwiththeplaceofbeginningsandenlightenment,wherenewknowledge is createdor received tobringaboutharmony. Thefourthdirection isknownas theSouthernDoor,which is thedirectionofthesummerandatimeofgrowth.Here,theIndigenouspeoplehonourtheirteachings,Elders,andancestorsinceremoniesandgatherings.

People’sperceptionoftheirhealthandtheirabilitytohavecontrolhasaneffectonoverallhealth(Potteretal.2001).SinceAboriginalwomen’scul-turalbeliefsand traditionsare interconnectedwithchildbirth, recognizingandadheringtotheirculturalbeliefsandpracticescanprovideamorecultur-allyappropriateenvironmentforthebirthexperience.Aculturallysensitiveenvironmentcanhelptoempowerwomenwhoultimatelycanimprovetheirhealthandthatoftheirfamilies.Culturallysensitivemeansthattheproviderhassomeknowledgeoftraditionalhealthbeliefsamongdiversepopulationsinwhichtheyareprovidingcare(Spector2004).


Duringchildbirth,Aboriginalwomen,singleparents,womenwithdis-abilities,womenofcolour,andothers,dofacesignificanthealthissues(HealthCanada2003b).Aboriginalwomenhaveahighernumberofhealthdispar-ities thannon-Aboriginalwomen(HealthCanada1999a),placing themathighriskforperinatalcomplications.Aboriginalwomenhaveahigherriskofhealthproblemssuchasdiabetes,cardiovasculardisease,respiratorydiseases,andcancerofthecervix.Thereisincreasedincidenceofdiabetes,cardiovascu-lardisease,andrespiratorydiseasesasthepersonages(Smylieetal.2001).Aboriginalwomenalsohavea lowerlifeexpectancyandexperienceoverallpoorerhealththanthegeneralpopulation.Whenawomanbeginspregnancywithachronichealthproblemsuchasthosementioned,boththemotherandthebabyareatriskforperinatalcomplications(Pillitteri2003).Ahigh-riskpregnancy isdefinedbyPillitteri as “one inwhich a currentdisorder,pregnancy-relatedcomplication,orexternalfactorjeopardizesthehealthofthe mother, the fetus or both” (p. 329). Normal pregnancy can bring onmedicalcomplications thatareexacerbatedbyexistingchronicconditions,leavingthemotherwithlessreservetofunction,andperhapsaffectingfuturepregnancies(Pillitteri2003).

In 1999, the Mi’kmaq Health Research Group assisted The Unions ofNovaScotiaIndianswiththeFirstNationsandInuitLongitudinalRegionalHealthSurvey,whichstudiedthehealthoftheMi’kmaqpopulationlivingonreservesinNovaScotia.Theparticipants(N=723)includedchildren,youth,andadults,ranginginagefrominfancyto55yearsandolder.Areasofcon-cern relevant to maternal/child included Mi’kmaq women’s smoking rateduringpregnancyat52percent,comparedto24percentamongthegeneralpopulationofCanadianmothers.Breastfeedingratesrevealedthat28percentofMi’kmaqmothersbreastfedtheirbabiesincomparisonto72percentforCanadianmothers.BoththehighsmokingandlowbreastfeedingratescanhaveanegativeimpactonanAboriginalmother’shealthandthehealthofherbaby(Mi’kmaqHealthResearchGroup1999).Smokingincreasestheinci-denceofprematurelaborandlow-birth-weightbabies(Freda2001).WalkerandCreehan(2001)reportedthatbreastmilkmeetstheneedsoftheinfanttobuildanimmunesystemneededforhealthybraindevelopmentamongother benefits, such as decreasing respiratory diseases, otitis media, andgastrointestinalillness.AlthoughthereissomeresearchonchildbirthissuesamongAboriginalwomen,itisverylimited.

Infantmortalityisconsideredoneofthemainindicatorsofhealthofapopulation,andgenerallylessenswithanincreaseinwomen’shealth(Adelson


2005).The infantmortalityrate forFirstNations is8deathsper1000 livebirths,whichis1.5timeshigherthanthemainstreampopulation(Adelson2005).Highbirthweight(>4000grams)is18percentinFirstNationsbabiescomparedto12.2percentforotherCanadianbabies.Low-birth-weightbabies<2500grams,agroupwhoaregenerallyconsideredmoreatrisk,isactuallyslightlylessthanthegeneralCanadianpopulation(Smylieetal.2001).

Goodmaternal,sexual,andreproductivehealthisneededtoassistchil-drentodeveloppositiveself-esteemandestablishlong-lastinghealthyrela-tionshipsthroughoutlife.Healthyoutcomesoccurwhenastrongfoundationisestablished.Highratesofsexualandreproductiveproblemssuchasteenpregnancy,sexuallytransmitteddiseases,andsexualandfamilyviolencearefoundintheAboriginalpopulation;thushealthcarestrategiesneedtoreflectthesehealthconcerns(HealthCanada2001).Reducingsocialandeconomicdisparity,primarilypovertyanddiscrimination,whichaffectsexualandre-productivehealth,isessential.

Aboriginalwomen’sneeds and concernshavebeen under representedinpreviousresearchstudies.IncludingAboriginalwomeninresearchstud-iestoestablishkeyprioritiesandstrategiesisaneffectivewayofpromotingAboriginalhealth (Stout,Kipling, andStout2001). TheRoyalCommissiononAboriginalPeoples(1996)recommendedthatgovernmentsandorganiza-tionsgiveAboriginalwomenfairopportunitytoparticipateinareasthatef-fectthehealthandhealingoftheirpopulation.AccordingtoHealthCanada(2003b),asignificantchallengeforhealthcareprovidersistoacknowledgethestrengthsofminoritypeopleandtoworkwiththeminoritypopulationstheyserve.

Aboriginal Health ModelThepaucityofresearchonthechildbirthexperiencesofMi’kmaqwomen

necessitatedapersonalcommunicationwithMurdenaMarshall,aMi’kmaqeducator/Elder and mother living in a First Nations Community in CapeBreton.MarshalldiscussedthebeliefsabouttheMi’kmaqpeople’sviewsonhealth,includinglabourandchildbirthinherunpublishedmanuscripttitled“Parenting and Traditional Beliefs Are Essential” (1992). The following is abriefexcerpt:

During labor and childbirth the mother is instructed not to make too much noiseoruseabusive languageduringdelivery.Theoldladieswillaskthatyoumaintainyourselfsothatwhenthebabyisborn,heorshewillbeinaworldthatiscalmandpeaceful.It’sbadenoughthatthebabyleavesthedark,warmcradle


tobeexposedtocold,lightandabusivelanguage.Theysayatleasteliminatethenoise,itstillwillbecoldandbrightbutitcouldbewelcoming.(p.4)

ThehealthmodelinAboriginalcommunitiesusuallyincorporatesphysic-al,mental,emotional,andspiritualhealth(Mi’kmaqHealthResearchGroup1999).AccordingtoMurdenaMarshall(personalcommunication2004),theabove health model includes the same four components of a person whois “required towork together inharmonyandbalance for goodhealth tohappen.” The physical represents the “body-birth” and the spiritual refersto the “soul anddeath,” a “duality”which signifiesopposites inmeaning.Marshall stated “you have to overcome the negative for healing to begin”withfourcomponentsintegraltothehealingprocess.Forexample,Marshallstated,“youwillfeelbettereventhoughyouhavecancer.”Just“thankGod”forwhatyouhave(personalcommunication2004).ManyAboriginalpeoplebelievethattraditionalcustomsreflectingthisbalanceofessentialpartsarenecessary tohelp improveandmaintain thehealthofAboriginal societies(Mi’kmaqHealthResearchGroup1999).Understandingthebeliefsofawell-respectedMi’kmaqeducatorprovidesinsightintoMi’kmaqbeliefs(i.e.,bal-anceandhealth).ThissuggeststhatprovidingculturallyrelevantchildbirthcareforAboriginalwomenmayhaveadirectpositiveimpactonthephysicalandpsychosocialoutcomeoftheprocess.

Historical Evolution of ChildbirthPrior to the 17th century, birthing in most countries was considered

withintherealmofwomenanditoccurredprimarilyoutsideahospitalset-ting (Johanson,Newburn, andMacfarlane2002).Hospitalbirthswerees-sentiallyunheardofpriortothe20thcentury(Savage2002).AccordingtoLothian(2001:13)“thesocialstructuresurroundingbirth[has]changeddra-matically” since a century agowhen the labour anddeliveryof childbirthwasconsideredaneverydayevent.Duringthattime,womenlearnedaboutchildbirthfromtheirmothers,sisters,otherrelatives,andfriends;birthstor-ieswerepasseddown fromgeneration togeneration.Womendeliveredathome,oftenwithmidwives,andsurroundedbytheirlovingandsupportivefamilies.InNorthAmerica,bythe1950s,ashifttodeliveringbabiesinhos-pitalshadgraduallyoccurred(Savage2002).Withthischangecametheideathatbirthwasamedicalevent(Jordan1983).

Medicalization continues to be the principle ideology underlying cur-rent health policies and practices in the Aboriginal population (Royal


CommissiononAboriginalPeoples1996).ConsistentwithWesternbiomed-icalbeliefsabouthealthandillness,therehasbeenatendencyto“medical-izesocialproblemsasarisingfromindividuallifestyles,culturaldifferences,or biological predisposition — rather than from impoverished social andeconomic circumstances, marginalization and oppressive internal colonialpolitics”(BrowneandSmye2002:29).Althoughbiomedicinehashelpedtolower morbidity and mortality rates, their focus on disease often ignoresgender issues and the social,historical, and cultural aspectsofhealthandillness(MeleisandIm2002).Biomedicalmodels,whichpromotethemedic-alizationofwomenandwomen’sbodies,createfeelingsofhelplessness,thuspromotinglossofcontrolregardingmanagingthewholewellness-illnesscon-tinuum(MeleisandIm2002).

Womenarevulnerableduringchildbirthandoftenhavelimitedcontrolovertheirchildbirthexperiences,includingdecisionssurroundingthemed-ical care they receive (Lazarus 1997, Esposito 1999). Lazarus studied threegroupsofwomen:alaymiddle-classgroup,ahealthprofessionalgroup,anda group of poor women (those with limited resources). She found thosewomenwithlimitedresourceshadfewerchoicesandlesscontrolovertheircarethandidtherestofthepopulation.Thedisadvantagedgroupofwomenreportedbeingburdenedwithsocialandeconomicproblemsthatleftthemfeelingoverwhelmed.Womeninthepoorgroupprimarilyfocusedon“con-tinuityofcareratherthanonissuesofcontrol”(Lazarus1997:133).Becausemanyoftheseeconomicallydisadvantagedwomenhadgivenbirthataveryyoungage, theywerealsounemployedandhad limitededucation.Havingchoiceandcontrolover their childbirthexperiencewasgiven lowprioritybecauseoftheurgentnatureoftheirsocioeconomicsituation.Lazaruscon-cluded thatwomenwithmoreeducation seemed toenjoygreater controlovertheirchildbirthexperience.

Davis-Floyd(1992)reportedsimilarfindingswhensheinterviewed100pregnantwomeninboththehospitalandathome.Davis-Floyddescribedhow most women in American hospitals were given hospital gowns, con-nectedtofetalheartmonitors,andadministeredintravenoustherapy.Somewomenweregivenasynthetichormonecalledpitocintospeedupineffect-ive labour contractions (changes in cervical dilatation less than 1 cm perhour).Duringthedeliveryofthebaby,manyreceivedanepisiotomy,whichwasperformedtowidenthebirthoutlet.Becausemostobstetriciansusedtheseobstetricalprocedures,theywereconsideredthenorminmosturbansettingsortowns.Davis-Floyddescribedhowchildbirthactiongroupstried


tochangethehospitalenvironmenttoamorenaturalchildbirthapproachtoeliminatetechnicalritualsincorporatedintotheobstetricalinterventionsthatwomenexperiencedaspartoftheirchildbirthexperiences.Davis-Floydacknowledgedtheimportanceofrespectingwomen’sbirthchoicesstressingtheneedforaholisticapproachinsteadofatechnicalmodelforchildbirth.

Priortothemedicalizationofchildbirth,womeningenerallistenedtostoriesabout the strengthandpowerofgivingbirth rather than thepaintheywereabouttoendure(Savage2002).Givingbirthwasconsideredaposi-tive and empowering event. Savage claims that today, women are sharingtheirpersonalstoriesabouttraumaticbirthexperiencesandmedicalinter-ventionstosavetheirbabywithlessemphasisonhowpowerfulbirthcanbeandthejoyofmaternalnewbornbonding.

Farley andWidmann (2001:22)described storytellingas “a culturallyuniversalinteraction”bywhicheventsinpeople’slivesareshaped,thusen-ablingunderstandingofthemeaningofaparticularsituation,sotheycanmoveforward.Inamedicalizedbirthenvironment,sharingbirthingstoriesisnotvisiblysupportedorenabled(Savage2002).Savagedescribedhowthe“culturalconstructsofthetwenty-firstcenturyoverwhelminglysupportthetechnocraticmodel”(p.10).Increasingknowledgeabouthistoricalchildbirthpracticesthatwomenhavepassedonformanygenerationsisdisregardedasamechanicalviewemergesinbirthingunits.Stronginfluencesfrommedicineandtechnology“havereplacedwomen’swaysofknowing”(Savage2002:9)aboutbirthingpractices resulting in fearofexperiencingpain, fearof fail-ure,andfearthatifonedoesnotfollowthemedicalrecommendation,thereisariskofbirthcomplicationsanda“lessthanperfectbirthandbaby.”Inmostbirthingunitstoday,medicalequipment,fetalheartmonitors, intra-venoustherapy,epiduralanesthesia,oxygentherapy,andpainmedicationsare used to assess and provide care to mothers in labour (Health Canada2003a).However,Hiebert(2003:47)claims“childbearingpractices,heavilyinfluencedbyWesternmedicine,areinoppositiontoanAboriginalworld-viewthatembraceschildbirthasaninfluencednaturalevent.”

Alternate Birthing ArenasInrecentyears,despitethebeliefofhealthcareprovidersthatthebest

placetogivebirthisthehospital,therehasbeennosoundevidencetoprovethat thehospital setting is safer forwomenwithuncomplicatedpregnan-ciestodeliver(Lothian2001).Womenwithuncomplicatedpregnancieshavebegunadvocatingfortheestablishmentofbirthingcentresandhomebirths.


Although this change is gradual in North America, women in general arebeginning to make some significant strides toward natural childbirth. Forexample, the Reproductive Care Program of Nova Scotia (RCPNS) (2003)reportedthat,althoughmostwomeninCanadadeliver inhospitals, therearesomefree-standingbirthcentresandasmallbutincreasingnumberofCanadianwomenaregivingbirthathome.JohnsonandDaviss(2005)re-portedthatwomenwhoplannedonhavingahomebirthwithamidwifepresentatdelivery,hadminimal intrapartumandneonatalcomplications,comparable to women delivering in low-risk hospitals in North America.AccordingtoBourgeault,Benoit,andDavis-Floyd(2004:7),therehasbeenagrowingmovementtowardhomebirthssincethelate1960sand1970s,with“lesseningoftrustinprofessionalauthority,anunprecedenteddeclineinre-spectformedicine,andagrowingrecognitionofemotional,social,andspirit-ualcomponentsoflifeandhealinginparticular.”Bourgeaultetal.reporttheanticipationthatmostareasinCanadawillsoonlegalizemidwiferyandinte-grateitintothecurrenthealthcaresystem.CurrentlyinCanada,midwiferyhasbeenadoptedinOntario,BritishColumbia,Alberta,Saskatchewan,andManitoba(Potteretal.2001).Thus,uniqueformsofmidwiferypracticewillemerge,providingwomentheoptionofchoosinghomebirth.

Theintroductionofthefamily-centredcareconceptintohospitals,wherethebirthexperiencebelongstothemotherandherfamily,hassignificantlychangedmaternal-childpractices(KendrickandSimpson2001).Birthisin-creasinglybeing seen as a family event wherewomen select their supportpeopleduringthechildbirthexperience.AccordingtotheRCPNS(2003:1),“inatrulyfamily-centeredcareenvironment,womenareactiveparticipantsineveryaspectoftheircare.”Therefore,familiesarevisibleandpartofthedecision-makingprocess.Respectisgiventowomenfortheirknowledgeoftheirownhealthandthatoftheirfamilies(RCPNS2003).Aboriginalfamiliesareallowedtotaketheirwomentothehospitalandremainwiththemdur-ingthechildbirthexperience.However,insomeremoteareassuchasintheNorthwestTerritories,Aboriginalwomenaretransportedoutoftheircom-munitytodeliver in largerhospitals leavingtheirhusbandandchildrenathome(Paulette1990).

Thedeliveryofsafeandcompetentcare,thatmeetstheneedsofwomenand their families, is amajorpriority.Evidence is growing to support thebenefits of having a normal and natural birth experience (Lothian 2001).By choosing a home birth, women and their families share responsibilityfor careand theoutcomewith the labourattendants (VedamandKolodji


1995).Tremendouseffortgoesintoassessingthemothertodetermineifsheisacandidateforhomebirth,andthebenefitsofbeingabletodelivertheirbabiesinthehomeenvironmentmaketheentireprocesssatisfyingformoth-ersandfamilies.SinceAboriginalpeoplevaluetheimportanceofsharingthebirthexperiencewithmembersoffamilyandcommunity,beingabletode-liverintheirowncommunitiesinabirthcentreorhomebirthcouldhelptobuildstrongbondsandcaringrelationshipsbetweencommunitymembers(Paulette1990).

Culture and ChildbirthChildbirthforwomenandfamiliesisgenerallyahappyandexcitingevent

characterized by anticipation and uncertainty about giving birth (HealthCanada2003a).Thisbirthexperience representsamajor life transition formothersandfamilies(ChickandMeleis1986,HealthCanada2003a,Nelson2003).AccordingtoVandeVusse(1999)thememoriesandexperiencesofgiv-ingbirthremainwithwomenfordecades.Assuch,childbirthhasdeepandlifelongeffectsforwomen.Theoverallaimofchildbirthisforwomentohaveapositivebirthexperience,whilemaintaininghealthandpreventingand/orminimizingcomplicationstobabiesandwomen.

Callister (2001) asserted that one’s healthcare beliefs and behavioursabout the childbirth experience aredeeply entrenched in cultural context.She contends that culture represents women’s identity. Women’s culturalpractices,beliefs,andtraditionsarecomplexanddependonfactorssuchassupportandacculturationintoadominantculturewithinsociety(Callister2001). It is important to remember that, even though individuals share acommon birthplace, their cultural traditions may be different. Sokoloski’s(1995)qualitativestudyofFirstNationswomenreportedsimilarfindings.The FirstNationswomenviewedpregnancy as a verynatural andnormalevent, requiring neither medical interventions, nor attending to prenatalcare.

In Canada, cultural minority groups often find themselves receivinghealthcarefrompeoplewhohavebeliefs,values,andattitudesdifferentthantheirown(BakerandDaigle2000,Sokoloski1995).Clarke(1997:12)empha-sizedthatresearchapproaches, inadditiontobeingculturallyappropriate,needtobeculturallysuitabletothepopulationbeingstudiedinorder“togeneratevalidknowledgeaboutculture,todeveloptheory,andtotranslatethisintoculturallysuitablenursingandhealthcare.”Sincefeminismhashis-toricallyfocusedonvaluingwomenandchallenginginjusticesbasedongen-


der(Dugas,EssonandRonaldson1999),afeministperspectiveforthisstudywould explore the importanceof gender in relation toMi’kmaqwomen’schildbirthexperiences.

Individual values, beliefs, and traditions all affect cultural identity be-causeindividualsreceivingcaremaydifferfromthosewhoareprovidingcare(Narayanasamy 2002). Baker and Daigle (2000: 8) state “few studies haveexaminedMi’kmaqpeople’sperceptionsofbeingcaredforinanon-Aboriginalhealthcaresetting,butthelimiteddataavailablesuggestthiscanbeaprob-lematicexperience for them.” Inorder topromotehealingamongculturalminoritygroups,healthcareprovidersneedtounderstandthemeaningofchildbirthforwomenwhodelivertheirbabiesinanunfamiliarculture.

FirstNationswomenholdtraditionalhealingknowledgeinhighregardbecausethisknowledgeispasseddownfromfemaleElders(BrowneandFiske2001).Formanywomen,exposuretothisknowledgehelpstovalidatetheirculturalidentityandimproverelationswithhealthcareproviders.AccordingtoAnderson(2005:8-9),Aboriginalpeople’shealthisrootedin

...oppressionanddispossession....Aboriginalwomensuffertheilleffectsofma-terialpoverty,buttheyalsosufferfromapovertythathappenedwhenourtrad-itionalknowledge,cultures,andidentitieswerestrippedawayfromusthroughaggressivepoliciesofassimilationandculturalgenocide.

IfAboriginalpeoplearegoingtogetbettertheyneedtoreclaimthecul-tural,intellectual,andspiritualwaysthatweretakenaway.Ifisolatedfromtheirculture, theywill “experiencean intellectual, emotionalandspiritualrupture”thatcancreateillness(Anderson2005:9).

BrownandFiske(2001)describeFirstNationswomen’shealthcareex-periencesfromareserveinnorthwesternCanada.Someinformantsdescribedsituationswheretheirhealthconcernswerenottakenseriously.Forexample,someparticipantsreportedthatwhentheyarrivedattheclinic,nursestoldthewomentherewasnothingwrongwiththemandsentthemhome.Asaresult, theybecamemore ill. Theparticipantsdescribedsomeof theclinicnursesasbeingintimidating.Yet,amemorableexperienceoccurredwhenanurse,ratherthanleavingattheendofhershift,remainedwithamotherandheldherhandwhileshegavebirthtoaprematurebaby.Whenhealthcareprovidersprovidedemotionalsupportandmedicalcare,theparticipantsfelttheyreceivedoutstandingcare.

The value placed on cultural identity was evident in a qualitativestudyconductedbyBrowne(1995)withCree-Ojibwaypeople innorthern


Manitoba.Theparticipantsdescribedinstancesinwhichtheyperceivedthenurseasinsincereduringclinicvisitsforhealthcare.Theinformantsquicklysensedwhetherthenursewas inahurryordidnotwanttoanswertheirquestions.Thehealthcareproviders’verbalandnonverbalbehavioursintheinitialcontactwiththepatientswereinterpretedasasignofrespect.BeingsensitivetotheimportanceofrespectduringinteractionswithFirstNationspeoplewasconsideredhighlyimportant.TrustdevelopedwhenFirstNationspeoplebelievedthathealthcareprovidersgenuinelycare.

AstheMi’kmaqpeoplehave lived incloseproximitywithclose familymembers forcenturies, ifamember ishospitalizedduringchildbirth, it iscustomaryforsomefamilymemberstostaywiththemother,enablinghertofeelconnectedtohercommunity(Baker1998).AccordingtoBaker,“theculturalemphasisontheinterconnectednessofpeopletotheirenvironment,totheirfamily,andtothecommunitycanmakehospitalizationaparticularlydifficultexperiencefortheMi’kmaqpeople”(p.318).Havingfamilymem-bers present during hospitalization respects cultural traditions. The familyplaysaprominentroleduringchildbirthandshouldbeinvolvedindecision-making.

Birthisanactive,notpassive,experienceandwomen’sroleasactivepar-ticipantsisofprimaryimportanceinchildbirth(Lothian2001).Supporttothemotherduringchildbirthisessential.Nursesmustbecompetenttoas-sessthewomen’sneedsbasedonherculturalexpectationsandpreference;andsupportwomeninhavingapositivechildbirthexperience(ReproductiveCareProgramofNovaScotia2003).

Sinceresearchoncross-culturalissuesislimitedandwithgrowingnum-bersofethnicandminoritygroupsinCanada,researchisrequiredinculturalgroupstofurtherunderstandeffectivecross-culturalcaregiving(BakerandDaigle2000).Studiesarelimitedonculturalencounterswithinhealthcaresettings;availableliteraturedemonstratesseriousconcernsaboutthelackofculturalsensitivityandrespectbythenon-Aboriginalpopulation(BakerandDaigle2000,Browne1995).Enang(1999)inaHalifaxstudyonanothermin-oritygrouphadsimilarfindings.

Purpose of the StudyA review of the literature regarding Mi’kmaq women’s childbirth ex-

periencesprovideddirectionforaproposedqualitativeresearchstudy.ThepurposeofthestudyistoprovidenewknowledgeaboutMi’kmaqwomen’schildbirth experiences, which occur in a large tertiary care centre outside


theirruralNovaScotiancommunity.Thestudywillprovideagreaterunder-standingofMi’kmaqwomen’schildbirth.TheresearchwillexploreMi’kmaqwomen’sperceptionsoftheirbirthexperiencestohelpensurethatculturallyappropriatecareisprovidedtothispopulation.

Theresearchquestionsposedforthestudyinclude:

What is theexperienceofMi’kmaqwomengivingbirthoutsidetheirFirstNationscommunity?

WhatdoMi’kmaqwomenperceivetobeanoptimalbirthexperi-encefromtheirownculturalperspective?

Significance of the StudyMi’kmaqwomenlivinginaFirstNationscommunityinNovaScotiare-

ceivethemajorityoftheirprenatalcareandpostnatalfollow-upcareattheHealthCentre,primarilybyFirstNationscareproviders.However,theirac-tualchildbirthexperiencesareprimarilymanagedbynon-Aboriginalhealthcare professionals and occur in a tertiary care centre off the reserve, ap-proximatelyforty-fiveminutesfromtheircommunity,byroad.AllMi’kmaqwomendelivertheirbabiesoffthereservebecausethereisnohospital lo-catedintheFirstNationscommunity.Ininstanceswherethemotherorbabyis high-risk, requiring more intensive health care than can be provided atthistertiarycarecentre,transfertothemajortertiaryHealthCentreintheprovince,afour-to-fivehourdrivebycar,iscarriedout.Priortotheestablish-mentofanAboriginalHealthCentreonthereservefouryearsago,womenreceivedhealthservicesatneighbouring facilities.TheFirstNationsHealthCentredoesnotprovideintrapartumandimmediatepostpartumcare,thus,womencontinuetoreceivetheseservicesawayfromtheircommunities.Thissituation is similar tootherAboriginalandnon-Aboriginalpopulations inCanada,whooftenfindthemselvesbeingcaredforatadistancefromtheirhomecommunities andoftenbynon-Aboriginalhealth careprofessionals(BakerandDaigle2000).

AsMi’kmaqwomendelivertheirbabiesinaculturedifferentfromtheirown,dissimilarvalues,beliefs,andattitudes,mayresultingreatervulnerabil-ityintheirtransitiontomotherhood(Meleisetal.2000).MoffittandWuest(2002)notedthatAboriginalpeoplelivingintheNorthwestTerritoriesbe-lievethatindividualandcommunityvaluesaredirectlyrelatedtoindividualhealthandrecoveryfromillness,andifnotacknowledged,recoverymaybehampered.MoffittandWuestrecommendedthatculturalcaregiversinclude

1.

2.


customary healing traditions and the use of interpreters as active partici-pantsinthecareprocess.

Inasocietydominatedbynon-Aboriginalculture,womenfromaminor-itygroupsuchastheMi’kmaqmayexperiencechildbirthinanarenathatisnotculturallysensitivetotheirneeds.Enang(1999)maintainedthelinkbe-tweencultureandhealthisapparentwithmarginalizedgroups,inreferencetoraciallyvisibleindividualsexperiencingsocialandeconomichardshipsasaresultofunemployment.AccordingtoWillis(1999:58)“modelsofcarethatarepatient-drivenandthatrespectculturalpreferencesandmotivationsaremostlikelytopromotethedesiredhealthbehaviorsandpositivehealthstat-us.”Forexample,culturallycompetentcarethatrespectsculturalstrengthsisakeyfactorinhelpingfamiliesfeelempoweredand,therefore,enablingthemto maintain their cultural beliefs, values, and health practices throughouthealthcareexperiences.

Since there is very little literature available about the experiences ofMi’kmaq women during childbirth, it is hoped that the knowledge andinsightswill assisthealthcareprofessionals toprovidemoreculturallyap-propriate care. Receiving culturally competent care could enable Mi’kmaqwomentohavehealthieroutcomesforboththemselvesandtheirbabies.ItisanticipatedthatthefindingsfromthestudymayalsobeusedtoinformpolicydevelopmentforAboriginalhealth.

Method and MethodologyAqualitativestudytoexploreMi’kmaqwomen’schildbirthexperiences

outsidetheirculturalcontextwillbeconducted.Qualitativeresearchdesignstakeplaceinreallifesettingsandtheresearcherdoesnotinfluencethephe-nomenonbeingstudied(Patton2002).Thereisanaturalunfoldingprocess,where the researcher observes and interviews participants in familiar sur-roundingsthatarecomfortabletothem.Aqualitativemethodissuitedtothestudy,asthepurposeistoprovidenewknowledgeaboutchildbirthex-periencesandtoexploreMi’kmaqwomen’sperceptionsoftheirbirthexperi-ences.

Feminist methodology forms the guiding principle for the study.AccordingtoKing(1994),feministmethodologyreferstoquestionsthataf-fectwomen,areimportanttowomen,andoccurasaresultoftheirstrug-glesinsociety.FeministresearchisparticularlyappropriatetothestudyofchildbirthexperiencesofMi’kmaqwomen.Sincechildbirthisaboutwomenhavingbabies,andthefamilyisoneofsociety’smostimportantinstitutions


(Wong,Perry,andHockenberry2002),thenthecareofwomenbyhealthcareprofessionals requirescultural sensitivityandcompetence.Since this studywillbeaboutwomen,andtraditionallywomenhavebeenoppressed,notonlytheparticipantbut thenursingprofessionwhoarepredominately female,canbenefitfromusingafeministapproachtodoingresearch.Enang(1999:47)asserts “asnursesbecomemore involvedwith feminism,wemustnotignorethefeministperspectivethatisrelevanttotheexperiencesofwomenofcolourandothermarginalizedgroups.”Evans(1993)addedthatfeministresearchcouldinfactactasahealerregardingissuesrelatedtoequalityandsocialjusticeforwomen.

Doering(1992:26)definedfeminismas“aworldviewthatvalueswom-en and confronts systematic injustices based on gender.” Feminist theoryand research are focused on women with a major emphasis on class andracebias(Wuest,1994).Feministtheorieshaveprogressedbyplacinggenderfirst,byincludingwomeninthedialogueofsocialandpoliticaltheory,andbyraisingawarenessofwomen’sneeds(Morse1995)andtheoppressionofwomen(MacPherson1983).Theyalsoofferthepotentialfornewvisionsofjusticeandfreedomforwomen(MacPherson1983).Thepurposeoffeministresearch is tocreateasocial systemthatrepresentsequality,questionsthestatusquo,challengesexistingsocialsystems,createsnewpersonalchoicesrelatedtohealth/lifechoices,andshiftsthebalanceofpower(Wuest1994).Inthestudy,feministmethodologyisthemostsuitablechoiceforexploringwomen’s experiencesof childbirthbecause it addressesMi’kmaqwomen’slives, thus valuingwomenandwomen’s experiences.Enang (1999)assertsthatfeministmethodologyprovidestheflexibilitythatisrequiredtocompre-hendwomen’sviewsandtheirexperiences.

According to Wuest (1994: 578), “a major goal of feminist research isseeingtheworldthroughtheeyesof‘theother’forthepurposeofemancipa-tion.”Streubert-SpezialeandCarpenter(2003)addthatfeministresearchersstrivetoseetheworldfromtheviewpointofthewomenbeingstudied,at-tempttobeanalyticalinexaminingtheissues,andadvocateforimprovingthe livesof thosebeing studied.Using feminist theorymoves the conceptofemancipationcloserandspecificallyaddresseswomen’s lives(Streubert-SpezialeandCarpenter2003).Intheproposedstudy,thefindingsgeneratedhave thepotential to improve thebirth experienceofMi’kmaq women ifsharedwithhealthprofessionalsandAboriginalwomen.

Keddy(1992)assertsthatschoolsofnursingandhealthcareinstitutionsareslowlyembracingfeminismasameansofhopeforadiscordantnursing


profession.Researchersarebeginningtore-examinetheirtraditionalmeth-odsforexaminingquestionsandareseeingthevalueofhavingafeministper-spectiveinthenursingtheoriestheyareusing.Byusingafeministapproach,thehierarchicalrelationshipisavoided,andpowerdifferencesbetweentheresearcher and theparticipants are reduced. In thisway, feminist researchgivesanopportunityfortheparticipants’voicestobeheard.Hence,inthisstudy,afeministapproachwouldhelptodiminishthepowerdifference.

In addition to using a feminist approach in this study, an IndigenousFrameworkwillbeusedtohelpunderstandFirstNationspeople,makecon-nections, and recognize Indigenous knowledge and pedagogy. Indigenousknowledge

[includes]awebofrelationshipswithinaspecificecologicalcontext;containslinguisticcategories,rules,andrelationshipsuniquetoeachknowledgesystem;haslocalizedcontentandmeaning;hasestablishedcustomswithrespecttoac-quiringandsharingknowledge....”(Battiste2002:14).

Battiste(2000)assertsthatIndigenousknowledge,includingoralmodesoftransmission, is an essential and significant process for Indigenous educa-torsandscholars.TheSupremeCourtofCanadarecognizesoralmodesoftransmissionasalegalformfortransmittingandunderstandingIndigenousknowledge.Battiste (2000)adds that, if thecourtsare required toupholdIndigenous knowledge, then others in society should value oral traditionsandrecognizethemasanimportantsourceofknowledgeandscholarship.KnowledgefromaFirstNationsperspectiveisaprocessthatcomesfromcre-ationandisconsideredsacred.Learningisconsideredtobealife-longjour-ney.Knowledgeeducatespeopleabouthowtotakeresponsibility fortheirlives, helps to develop relationships with others, and guides First Nationspeopletouserespectfulbehaviour.Traditionsandceremoniesareconsideredpartofeverydaylife.

UsingaqualitativemethodwillfacilitatethestudyofMi’kmaqwomen’schildbirthexperiencesinmoredepthanddetail(Patton2002).King(1994)addsthatqualitativeresearchmethods,whichtendtobeusedinfeministre-search,areabletoassistwithidentifyingthemostimportantissuesconcern-ingwomen.Qualitativemethodscangobeyondthetraditionalmethodstocreateeffectivechange.

ApprovaltoengageinthisstudywillbeobtainedfromtheHumanEthicsReviewCommitteeofDalhousieUniversity.Followingapproval,anapplica-


tionwillbesubmittedtotheMi’kmaqEthicsWatchCommitteetogainad-ditionalapproval,priortocommencingtheresearchstudy.

Participantswillbepurposivelyselected(Patton2002)onthebasisofthefollowingcriteria:

Mi’kmaqwomen;

19yearsorolder;

livinginaFirstNationscommunityinCapeBreton,NovaScotia;

arefirst-timemothers;

havegivenbirthwithinthepast2yearsatahealthcarecentregeographi-callyseparatedfromtheircommunity.

IftheMi’kmaqwomenarenotfluentinEnglish,orneedassistanceinunder-standingsomequestionsintheinterview,aMi’kmaqinterpreter(withthepermissionoftheparticipants)willbepresenttoassistwithinterpretation.

Thecommunityhealthnurse,aMi’kmaqwoman,willapproachMi’kmaqwomen,accordingtothecriteriadescribedabove,whentheycometothehealthcentrefortheirpostnatalcareand/orcontactthembytelephone.Asappropriate,shewillhandoutormailpotentialparticipantsacopyofalet-terofintroductiontothestudy.Thecommunityhealthnursewillverballyclarifyinformationintheletterofintroduction,ifnecessary,toensurethatpotentialparticipantsunderstandthepurposeofthestudyandthenatureofparticipation.This letterwilldescribetheresearch, itspurpose,andthenatureofMi’kmaqwomen’sparticipation.Itwillalsoaskpotentialpartici-pantstocontacttheresearcheriftheywouldlikemoreinformationorwanttoparticipateinthestudy.Theresearcher’sphonenumberwillbeprovided.However,thecommunityhealthnursewillnotbeawareofthewomen’sin-tentiontoparticipateinthestudy.Additionally,astampedenvelopeandaparticipationformwillbeprovidedwiththeletterofintroduction.ConsentwillbeobtainedfromeachMi’kmaqwomanpriortobeginningthestudy.

Datawillbecollectedbymeansofaone-on-one,in-depthinterviewde-velopedbytheresearcherandafocusgroupdiscussion.Interviewsandafo-cusgroupmeetingwillenabletheresearchertoobtaininformationfromtheparticipantsinordertogainanunderstandingoftheirsituationsandobtaindetails.

Interviewswillbeaudio-taperecordedandtranscribedverbatimtoen-sureaccuracyofthedata.Theresearcherwillwritefieldnotesaftereachin-terviewhasbeencompleted.Datawillbeexaminedusingthematicanalysis.Inthisstudy,theresearcherwillevaluatedatathroughparticipantvalidation

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followedbyafocusgroupmeetingaftertheinitialinterviewandanalysisiscompleted,toensuretrustworthinessofthedata.Theparticipantswillbeas-suredthatconfidentialityismaintainedthroughouttheresearchprocessandinthedisseminationofinformationbytheresearcher.

ConclusionTheliteraturereviewdemonstratesthatresearchisongoinginthearea

ofculture;morespecificallyculturalidentity,culturalawareness,andculturalcompetence.However,minimalresearchhasbeenundertakenintheareaofAboriginalwomen’schildbirthexperiencesandlessresearchonthistopichasbeenconductedwithMi’kmaqwomen.

Aboriginal women view health as inseparable from their families andcommunities(Stout,Kipling,andStout2001).Theirmajorroleconsistsofbeingcaregivers,leaders,andnurturerstopeopleintheircommunity(Stout,Kipling,andStout2001).However,becausethesewomenhaveahighinci-denceofmedicalconditions,suchasdiabetesandhypertensionduringpreg-nancy,theyoftenbecomehigh-riskandrequiremoreintensivemedicalinter-ventions.Asaresult,theyareoftencaredforinatertiaryhealthcaresettingbyhealthcareproviderswhomayhaveverydifferentbeliefsandvaluesre-gardingtheirhealthandchildbirth.ThisstudywillprovidesomenewinsightsintothischildbirthexperienceofMi’kmaqwomen.

This research will help to build Aboriginal health research capacity byestablishing trust between the participating Mi’kmaq women and the re-searcher. The women will understand that the purpose of the study is toexploretheirchildbirthexperiencesoutsideoftheirculturalcontextandnotmeanttoinformthemaboutwhattheexperienceshouldbelikeforthem.InterviewingMi’kmaqwomenone-ononeandinvitingthemtoparticipateinafocusgroupsessionwillhelptoidentifyissues,shareideas,anddevelopstrategiesthatmaybenefitMi’kmaqwomenandfamiliesduringchildbirth.ParticipatinginthisresearchwillgiveMi’kmaqwomenavoiceandaforumtotelltheirbirthstoriesandsupporttheirfeelingsandconcernsrelatedtosuchapersonalexperience.Itisanticipatedthataskingthewomentopar-ticipatewillenablethemtofeelempoweredandthereforeserveasameansofimprovingtheirlivesandhealth.

Thisstudywillalsobuildhealthresearchcapacitybydevelopingasup-portive partnership between Aboriginal communities and non-Aboriginalcommunities. Becoming familiar with each other’s communities helps to


fosterstrongerrelationshipsandimproveculturalawareness,culturalsafetyandculturalsensitivity.

DisseminationofthefindingstotheFirstNationscommunitiesandoth-ersinNovaScotiainamannerthatisunderstandableandmeaningfulwillbecarriedout.PresentinghealthresearchtoAboriginalpeopleinawaythatisaccessible,appropriate,andeasilyunderstoodcanalsohelptobuildhealthresearchcapacity.Thefindingswillbepresentedatpeerreviewedconferencesandworkshops, interestedgroups inuniversities,health care settings, andothercommunitiesforthepurposeofincreasingknowledgeaboutMi’kmaqchildbirthandculturallycompetentcare.

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