(Re)Birthing Systems in the Qikiqtaaluk Region of Nunavut: A Place-Based Inquiry into Inuit Birthing, Systems of Care, and Maternal Health Research
Within the Qikiqtaaluk Region (Eastern Nunavut), pregnant women are required to travel outside their home communities for birthing care. This model differs from the prior norm of place-based, midwife-attended birth and impacts Inuit wellness. This research characterized Inuit women’s birthing experiences and perspectives on enriching the medical obstetric system through the lens of place, culture, and health, and explored how maternal health research methodologies might be increasingly place-based and locally-driven. Informed by a community-based approach, a team of Inuit and non-Inuit researchers conducted a case study with Inuit women in Iqaluit, Nunavut, Canada. A systematic critical review was completed to examine prior maternal health research methodology in Nunavut and underscored opportunities for maternal health research to be increasingly Inuit-led through all research stages. Sewing was explored as a locally-specific, arts-based approach for data gathering and was found to enhance data quality and participants’ research experience by creating space for voicing, sharing, relating, and embodying Inuit knowledge. Qualitative data were gathered (2017-2020) using: (1) focus groups (structured as two-part sewing sessions) (n = 5) with pregnant women (n = 19); and (2) conversational interviews with pregnant women, Inuit Elders, and other community members (n = 22); and validated in meetings with Inuit knowledge-holders (n = 4). Thematic analyses were iterative and guided by a grounded theory approach. Participants described the importance of place-connections to Inuit birth experiences and the value of Inuit relational supports and knowledge-sharing throughout the birthing process. Inuit women voiced a desire for place-based birthing and further Inuit involvement and integration of Inuit birthing practices into obstetrical care. Women shared knowledge on stewarding birthing resources from the land and using skilled Inuit midwifery techniques: this knowledge connects to three Inuit Qaujimajatuqangit principles important for health system governance in Nunavut (Avatittinnik Kamatsiarniq, Inuuqatigiitsiarniq, and Pilimmaksarniq) and illustrates the importance of aligning the regional obstetric system with Inuit birthing values. This collaborative research emphasizes how maternal health research and maternity care may be enriched by including place-specific, locally-embedded methods and by providing space for Inuit women to shape the systems that affect them.