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Names. Nursery colours. Which crib fits best. How to use a car seat. All things that expectant mothers think about, worry about, or plan for in the weeks before they welcome their child.

For many Indigenous women pregnant in Canada’s remote or rural areas, they also need to consider if they will have to leave their community to give birth in a hospital far away, without their community nearby to support them — called ‘obstetric evacuation’ — from approximately 37 weeks, until after the birth. The practice has been in place in Canada for decades, with the intention to reduce maternal and infant mortality rates.

A new research project funded by a Canadian Institute of Health Research (CIHR) Project Grant aims to better understand the cost, health outcomes and experiences of Indigenous mothers and midwives impacted by evacuation, and is led by Dr. Jennifer Leason, PhD, whose Anishinaabe name is Kessis Sagay-Yas Egett Kwé: First Shining Rays of Sunlight Woman. Leason is an assistant professor in the Faculty of Arts and a CIHR Canada Research Chair (Tier II) in Indigenous Maternal Child Wellness.

UCalgary received 28 grants, including 26 CIHR Project Grants and two CIHR Priority Announcement grants, for a showing well above the national average. UCalgary researchers were awarded more than $20 million in total funding, for grants designed to capture ideas with the greatest potential to advance health-related fundamental or applied knowledge, health research, health care, health systems, and/or health outcomes.

“Maternal and child health is a critical issue for our province. Ensuring that mothers and their children have access to safe, high-quality and equitable care benefits everyone,” says Dr. William A. Ghali, vice-president (research). “The project led by Dr. Leason, and the 27 other grants awarded to our researchers in this competition, demonstrate our thriving research community and commitment to excellence at UCalgary. I am incredibly proud to see these results from CIHR.”

The research was identified as a priority by the , , , and , and is in partnership with , on Six Nations, and .

"As identified in the , the and the , all peoples have the right to culturally relevant and gender-based health policies and practices,” says Leason.

“Improving health outcomes for Indigenous people through sustainable maternal-child health care is critical to advance reconciliACTION. This research responds directly to the community, who identified a need to expand evidence on community-based Indigenous midwifery and the role it plays in improving health outcomes, ensuring cultural continuity, and the need to bring birth closer to home."

Leason is part of an interdisciplinary team that brings together Indigenous communities, midwives, organizations, government, and academic institutions. The project has three main goals: to do a cost analysis of obstetric evacuations, something that hasn’t been done to date; to conduct an analysis of the health outcomes of women who have given birth in their community with Indigenous midwives; and, to engage mothers, birth partners, families and communities on their experiences accessing and using Indigenous midwives.

"We have an incredible team and it is anticipated that the research will build evidence on health outcomes, costs and impacts resulting from Indigenous midwifery practice. And it is my hopes that the research will translate to improved maternity care for all Indigenous women across this country," she says.

A continuum of care for pregnant people

Midwifery is still a lesser-known outlet for maternal health in Canada — as of 2016, only 10.8 per cent of births were supported by midwives nationally, according to the . In Alberta, the rate drops to 5.5 per cent. Midwives provide government-funded primary care to pregnant people and their newborns. Under the midwifery scope of practice, a midwife provides care to support the health and safety of mothers and babies from early pregnancy, through labour and birth, until six weeks postpartum.

“In terms of Indigenous midwives, they provide the highest quality and continuum of maternity care to Indigenous women who may not be supported or may have faced racism and discrimination when accessing mainstream health care. They provide ongoing, culturally safe and relevant health care and support," says Leason.

“Many Indigenous communities are matriarchal and reclaiming or resurging these practices are transformational. Indigenous midwives also provide culturally relevant support and care for women. The use of traditional medicines, teachings, storytelling — smudging baby, rosehip baths, a birth where baby’s first smell is sage, the first hands that touch them are the community midwife, the first words they hear are the language of their ancestors.”

Leason and her team hopes that this research will tackle the health disparities and associated inequities for Indigenous women, to better inform policy-making in the future to fully support the health of Indigenous women and their children in their own communities.

“It is an honour to work with such remarkable women, midwives, communities and leaders who have celebrated the resiliency and beauty of Indigenous cultures, peoples and birth. Projects like these are the reason why, as an Indigenous woman, I worked to get a PhD — to research and provide evidence needed for our communities to advocate for the resources and supports they need to improve the health and well-being of our communities today and for the next seven generations."

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ii’ taa’poh’to’p, the ����ɫ��’s Indigenous Strategy, is a commitment to deep evolutionary transformation by reimagining ways of knowing, doing, connecting, and being. Walking parallel paths together, ‘in a good way,’ UCalgary is moving toward genuine reconciliation and Indigenization.