Welcome to
Facilitating access across the
pregnancy care continuum
Hypothesis: A pregnancy continuum care network, led by an Indigenous health systems navigator, will improve pregnancy care and neonatal outcomes among Indigenous women and their children in Northern Manitoba.
Design: To test the hypothesis and research questions, we will rely on an interrupted time-series analysis of prenatal care and maternal-child health outcomes in the 18 years (2000-2018; 76 time points) before and 4 years (2019-2024; 16 time points) following the perinatal care network.
Population: We will rely on population-level administrative data for all Indigenous women who delivered a children in Manitoba between 2000 and 2024. We will exclude data from women that delivered in the city of Winnipeg and those who delivered in their community, due to differences in the health systems.
Intervention: Over a period of 2 years, we conducted a mixed methods formative study to assess barriers and facilitators to prenatal care. Then, we used that information to co-design an intervention with health care providers and Indigenous community leaders. We came to a consensus that a perinatal network, consisting of an Indigenous systems navigator, sharing of information across systems and jurisdictions combined with training in cultural safety and shared decision making would be the appropriate intervention to improve maternal child health outcomes in the region.
Outcomes:
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Adequate pregnancy continuum care
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A composite measure of infant outcomes; preterm birth defined as a birth occurring before 37 weeks gestation and small for gestational age.
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Rates of 6 week post-partum care, infant breastfeeding initiation, 2 month vaccination rates and rates of infant apprehension in the first 7 days of life.
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Family experiences within the health systems at different time points of the perinatal period.
In addition to these quantitative outcomes, we will work with local Elders and knowledge keepers to create narratives to describe the “women’s journey” during the perinatal period. We will rely on local women to gather the narratives of women throughout their journey to describe the contextual factors associated with the intervention. We will also examine the cost effectiveness of the intervention based on changes in the hard end-points described above.
Why?
Why address inequities in PNC in Northern MB
Pregnancy continuum care (PNC) is critical: it has the potential to reduce perinatal morbidity and mortality by treating medical conditions, identifying and mitigating risks, and helping women to address behavioral factors that contribute to poor outcomes.
However, despite Canada’s universally funded health care system, pregnancy care use varies widely across the province with the highest rates of inadequate pregnancy care found in northern Manitoba. Although research has been conducted in inner-city Winnipeg on the determinants of inadequate PNC, little is known about the determinants of inadequate PNC in northern Manitoba. Indigenous women living in these areas experience several transitions in care during this time, between both health systems and jurisdictions. Poor transitions or lack of continuity in these transitions can lead to poor prenatal and infant care, resulting in significant morbidity in mothers and children, perpetuating inequities in health. Wholistic, culturally safe interventions are needed to support continuity of care during the perinatal period to reduce these inequities and promote lifelong well-being among Indigenous women and their children.
To address these inequities, we gathered a multi-disciplinary team of scientists, policy makers, health providers and Indigenous women to develop and evaluate an intervention to improve continuity of care for Indigenous women during the perinatal period.
This will be the first health systems intervention to improve health systems transitions during the perinatal period for Indigenous women living in northern regions in Canada. It will serve a model for improving health systems and jurisdictional transitions among Indigenous women during the pernatal period.
This project builds upon a successful health systems intervention delivered in Winnipeg’s inner city that improved rates of prenatal care. To hear more, click here. To read the final evaluative report, click here.
Meet the Research Team
Susan Kobliski
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Executive Director of Nisichawayasihk Cree Nation's women's shelter
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Cultural Coordinator for Nisichawayasihk Cree Nation
Patricia Gregory
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Registered Nurse
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Assistant Professor, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba
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Coordinator for Research and Scholarship in the Bachelor of Nursing Program, Red River College
Wanda Phillips-Beck
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Nurse Research Manager for the Community Based Primary Health Care Innovation Team within the Health and Social Secretariat of Manitoba.
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Anishinaabe from Hollow Water First Nation
Nathan Nickel
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Assistant Professor, Manitoba Centre for Health Policy, Max Rady College of Medicine
Jon McGavock
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Associate Professor, Department of Pediatrics and Child Health, Max Rady College of Medicine
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Co-Lead of the DREAM Theme and the Developmental Origins of Health and Disease in Youth Research Cluster (DEVOTION)
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CIHR Applied Public Health Chair in Resilience and Childhood Obesity
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Research Scientist, Children’s Hospital Research Institute of Manitoba
Meet the Stakeholders
Working Together
