Informed choice, power and the normalization of traveling for birth: An action research study

Ashley StruthersCHI Evaluation Platform, Winnipeg Regional Health Authority Darlene Girard Population and Public Health Program,

Winnipeg Regional Health Authority

Evaluation Platform

Objectives

1.Review research process and findings2.Describe how the research findings are reflected in day-to-day service provision

BackgroundThe Maternal and Child Healthcare Services (MACHS) Task Force in Manitoba identified challenges and gaps in services for women who travel for birth: –Women report feeling lonely, bored, isolated,

overwhelmed and fearful for their health and safety

–No prenatal referral to public health

(The Maternal and Child Health Care Services (MACHS) Task Force, 2008)

PurposeThe purpose of this study was to gain an

understanding of the strengths, resources and needs of women from rural and remote communities who

temporarily relocate to Winnipeg for birth in order to design an effective and culturally safe range of prenatal services

and supports to meet these needs.

Methods• Action Research– Literature Review– Interviews and one focus group with

women/families (n=25)– Interviews with care providers in Winnipeg

(n=22)– Interviews with HCPs in Northern

Manitoba (n=5) and Nunavut (n=8)

Findings

9 themes emerged:• The normalization of traveling for birth*• Challenges managing daily life in Winnipeg• The importance of social support • Informed choice and power*• The importance of cultural awareness• Health and health care challenges• Perceived consequences of birthing away

from home• Coping strategies • Suggestions for improved care

The normalization of traveling for birth

“It is just normal, how it’s always been, you have your baby in Winnipeg and then you come home.”

(HCP Nunavut)

An ordinary experience

It wasn’t a huge burden, huge, it wasn’t fun, but it wasn’t a huge burden to come down either. (Mother of 3, Northern Manitoba)

Well, I was just happy I was here cause I wanted to go shopping. (Mother of 4,

Nunavut)

Fear of birthing locally

There was the option to stay in Rankin and have the baby there but … mom was quite, was more worried that I should have the first baby down there where there was better medical service.

(Mother of 1, Nunavut)

It is not that we can’t deliver a baby here but if there are complications we don’t have a chance of

saving them. (HCP Nunavut)

But it’s still scary

I was seventeen when I had my first baby and I was confused and alone, it was very

hard. (Mother of 5, Nunavut)

They experienced anguish when they were sent away for birth. (HCP

Winnipeg)

Choice and Power“Women who must travel for birth have

lost all power.” (HCP Winnipeg)

Not being in controlI became confined here and not allowed to go

home. (Mother of 5, Northern Manitoba)

They normally ship the mother here to Winnipeg one month in advance. (Mother of 2,

Nunavut)

Just do what the nurses say, the doctor. Just make an agreement and everything’s gonna be

fine. (Mother of 4, Nunavut)

Lack of free choiceI wanted to stay home but the doctor said the

hospital isn’t equipped to deliver babies. I was threatened that if I didn’t come to

Winnipeg they would bring in the police to make me. (Mother of 4, Northern Manitoba)

They are only given money for transportation to medical appointments, and they check to see if they attended. If not, they don’t get a

flight or money. (HCP Winnipeg)

Reasserting power

They tried to make me come to Winnipeg on the bus on Sunday, but I refused. (Mother of 4, Northern Manitoba)

Some of the women do hide in the community or out on the land so you can’t find them to send them at 36

weeks. (HCP Nunavut)

Prenatal Connections

Service Delivery Model• 2-3 Prenatal visits• Prenatal Standards and Clinical Practice Guidelines• Postpartum visit• Bi-weekly Healthy Parenting/Prenatal Education

Group• Access to community services ie swimming, Healthy

Baby group, library• Primary Care

Needs Assessment Validates Experiences and Guides Service

Delivery • Relationships • Policies and Advocacy • Continuum of care• Mutual respect

Conclusions-Next Steps• Long-term goal: Repatriation of birth• Needs Assessment: 1st step in Action Research

Cycle• Evaluation plan drafted

AcknowledgementsCo-authors: Shannon Winters & Colleen Metge, CHI Evaluation Platform, Winnipeg Regional Health AuthorityThank you to all members of the WRHA Prenatal Connections Steering Committee!References: Kornelsen, J. (2004). Canadian Woman Studies, 24(1). ; Kornelsen, J. (2006). Journal of Midwifery and Women's Health, 51(4); Kornelsen, (2010). Health and Place, 16(4); Lee Sinden, J. (2013). International Review for the Sociology of Sport, 48(5); Phillips-Beck, W. (2010). (Unpublished Master of Science). University of Manitoba, Winnipeg, MB; Telford Gold, S. (2007). Canadian Journal of Midwifery Research and Practice, 6(2), 5; The Maternal and Child Health Care Services (MACHS) Task Force. (2008). Advice to the minister of health.