Co-designing Culturally Safe Indigenous Birth in High-Risk Obstetrics: Implementing Joyce’s Principle with Inuit and Cree Families and Their Medical Providers

Introduction . Maternal evacuation—the transfer of women from remote communities to urban hospitals for childbirth—negatively affects many Indigenous Peoples in Canada. A working group of perinatal service providers in Montreal sought to enhance cultural safety in a high-risk obstetrical unit serving evacuee Indigenous families. This article describes co-design, implementation, and evaluation of short-term cultural safety interventions with Indigenous stakeholders. Methods. Indigenous families and their non-Indigenous service providers displayed their recommendations for culturally safe birth using fuzzy cognitive mapping (FCMs). Joyce’s Principle—a framework for securing culturally safe healthcare for Indigenous Peoples—guided their implementation. Results. Four high-priority FCM recommendations included an Indigenous-led cultural safety training for hospital staff. Third party evaluation showed a positive influence on cultural safety knowledge and actions. Discussion . Health services designed with Indigenous stakeholders in accordance with Joyce’s Principle have the potential to enhance cultural safety of maternal evacuation.