Defining and Evaluating Cultural Safety at Seventh Generation Midwives Toronto: Exploring Urban Indigenous Women’s Perspectives on Culturally Safe Maternity Care

Abstract

In recent years, Indigenous midwifery has reemerged as a vital form of maternity care in Canada. With the majority of practices being situated in rural and remote areas, Seventh Generation Midwives Toronto (SGMT) remains the only urban-based Indigenous focused midwifery practice in the country. Looking to develop a culturally relevant performance measurement system for the practice, SGMT partnered with the Well Living House (WLH) – an Indigenous action research centre in Toronto – to undertake a community-based, participatory, realist, and utilization-focused evaluation study. This thesis project was nested in one of the qualitative branches of this evaluation. Semi-structured interviews were conducted with nine former clients of SGMT who self-identified as Indigenous to determine (1) how Indigenous women conceptualize cultural safety and (2) the extent to which their experiences at SGMT aligned with these conceptualizations. The interviews were transcribed verbatim, and the transcripts were analyzed using collaborative, consensus-based, iterative, and decolonizing methods. Twelve core themes that were grouped into four thematic pillars or containers emerged from this process. Even though the women participants were unique in their backgrounds, insights, and experiences, when taken together, culturally safe Indigenous midwifery care meant (1) "culturally continuous care”, (2) being able to access both Indigenous knowledge and practice and practical reproductive health information, (3) being connected to the community, and (4) feeling “at home” in a health care setting. There was also widespread support for SGMT as a practice; most – although not all – women felt that their pregnancy, birthing, and reproductive needs were fully met, and that they were made to feel culturally safe. All of the women offered constructive and loving feedback for the practice, even if they had experiences that fell short of their expectations. This confirms that SGMT can and does provide culturally safe care, and that cultural safety both has benefits and a place in the mainstream health care system. This project also sheds light on the roles and responsibilities of contemporary Indigenous midwives and the ways in which they can be supported. Altogether, herein lies a compelling argument for the continued support and expansion of urban-based Indigenous midwifery, and the application of cultural safety in a Canadian context.