Résultats de recherche

1. Objectifs

Intentions :
The «aims of this scoping review are threefold: […] to map the existing knowledge of maternal evacuation among rural and remote First Nation, Inuit and Métis communities in Canada; […] to identify and analyze the gaps in the knowledge base and […] to identify and evaluate the key factors and outcomes associated with maternal evacuation.» (p. 12)

2. Méthode

Échantillon/Matériau :
The authors «examined 61 studies including 43 published papers, 6 book chapters, 7 reports and 5 dissertations covering more than 10,000 births between 1978 and 2019 (see Table 1). Studies reviewed employed qualitative, quantitative and mixed methodologies. Thirty-one percent of the studies were authored by at least one scholar who publicly identified as Indigenous. Among the three officially recognized Indigenous groups in Canada most studies examined maternal evacuation among the Inuit (54.8%) followed by First Nations (38.4%) and Métis (6.8%).» (p. 14)

Type de traitement des données :
Analyse théorique

3. Résumé

«Three insights emerge from mapping the documented and mostly published evidence on maternal evacuation of Indigenous women in Canada. First, the emotional, social and cultural harms associated with evacuation are persistent and pervasive, with surprisingly little variation across time, place, or Indigenous group. Evacuation sets up childbirth as an experience punctuated by loneliness, anxiety and sadness for women who must leave their families and supportive networks behind, instead of being a pivotal moment for healing and breaking the cycle of intergenerational trauma. […] Evacuating women also leaves family management gaps that must be held together by family members who remain in the community.» (p. 19) «The second insight relates to the stated objective of evacuation improving maternal and infant health. With the weight of its adverse impacts on women, families and communities, paradoxically evacuation seems to defeat this goal. Examining the colonial origins of evacuation highlights the legacy of dispossession of Indigenous bodies, knowledge and land, and the consequences of this dispossession. Evacuation repeatedly assaults Indigenous women’s embodiment and sovereignty, depriving them of fundamental rights in childbirth. Those who are willing to assert their desires in childbirth must stand against governmental and medical authorities, risking coercion and policing.» (p. 19) «Finally, evacuation continues in the face of decades of evidence on its associated emotional, social and cultural harms, with little examination of its consequences to Indigenous maternal-infant health.» (p. 19)

1. Objectifs

Intentions :
This study explores «how the process of childbirth evacuation is implicated in the quality of the medical encounter between Indigenous women and their southern, typically non-Indigenous health care providers. [The authors] document and analyze patient–provider interactions from the perspectives of medically high-risk Indigenous childbirth evacuees and their southern, non-native doctors and nurses (hereafter, health care providers).» (p. 1859)

2. Méthode

Échantillon/Matériau :
«The patient sample consists of 25 pregnant and postpartum First Nations and Inuit women who were medically evacuated or transferred from northern Quebec to Valley Hospital for pregnancy-related complications or child-birth. Valley Hospital is a tertiary care institution located in Metropolis, a city in southern Quebec. [The authors] also included a total sample of eight physicians and nurses who delivered care to Indigenous women in either the OB/GYN clinic or the antepartum/postpartum unit.» (p. 1861-1862)

Instruments :
Guide d’entretien semi-directif

Type de traitement des données :
Analyse de contenu

3. Résumé

«The medical encounter between Indigenous childbirth evacuees and their southern, non-Indigenous health care providers were affected by three factors: evacuation-related stress, hospital bureaucracy, and stereotypes. The combination of these factors created situations where misunderstandings and mistrust could occur. […] Childbirth evacuation was a stressful experience for Indigenous women, owing in part to their medically high-risk pregnancies. But the separation from their families, especially older children, was also a source of stress. Significant household management and childrearing challenges arise for women because they must coordinate with adult family members and friends to care for their older children while they are away.» (p. 1863) The results also highlight «the mechanisms whereby hospital bureaucracy compounds women’s distress by leaving them feeling dehumanized by the medical encounter. Specifically, short medical visits emerged as an important bureaucratic impediment to building effective communication and trusting patient–provider relationships. [Moreover, the authors] found that stereotypes of Indigenous patients and the ensuing misunderstandings and avoidance behaviors that occur further strains patient–provider interactions. Stereotypes of Indigenous patients as unresponsive due to their more reticent communication style can hinder the development of trusting relationships. The potential for harm lies in individual health care providers’ behavioral responses to the stereotypes.» (p. 1867)