1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

First Nation, Native American, Alaska Native childbearing women, or Aboriginal childbearing women and their families are vulnerable groups at risk for adverse maternal and infant outcomes globally, including higher rates of preterm birth and maternal and infant mortality (Heck et al., 2021; Perinatal Services British Columbia, 2021). The three leading causes of maternal mortality include hemorrhage, cardiomyopathies, and hypertensive disorders. Social determinants of health are contributing factors influencing maternal and neonatal outcomes including postpartum depression.


There is a growing body of research focusing on culturally appropriate care of this group of childbearing families in the United States and globally. Marriott et al. (2021) focused on knowledge of Australian midwives on provision of care that included increased understanding of cultural differences in indigenous women and the need to address racism in health care systems to reduce risk and improve outcomes. Wood et al. (2021) incorporated voices of aboriginal Australian women, describing suggestions to improve perinatal care of First Nation expectant mothers with gestational diabetes to reduce maternal and neonatal complications. Kildea et al. (2021) documented the redesign of a Birthing on Country perinatal care program in a remote rural community intended to upgrade service delivery for First Nation women. Changes in care resulted in better attendance at prenatal care, fewer preterm births, and more exclusive breastfeeding. Johnson (2020) evaluated effectiveness of home visits by paraprofessionals in the Family Spirit program in Sioux County North Dakota where there are access issues related to remote location and continuity of care. More research is indicated to identify the root causes of health disparities, to assist in the generation of public health initiatives and policies to reduce adverse health outcomes.


Culturally sensitive clinicians should ask; What name should I use when caring for and describing this vulnerable population? Indigenous is the most respectful umbrella term for people of indigenous groups. For example, this term can apply to the M a ori people of New Zealand and the Inuit people of the Artic living in Alaska, Canada, and Greenland, although some prefer to be referred to as First Nation people. The term aboriginal is the only common umbrella term that encompasses First Nation, Inuit and Metis people in Canada. Native American is the most common and neutral term used in the United States. It is important to ask patients what their preferred term is.


A practice resource has been developed that honors indigenous people and their families who present for perinatal care in British Columbia Canada (Perinatal Services British Columbia, 2021). This work promotes anti-indigenous racism based on respect, relevance, responsibility, and reciprocity in clinical practice. Respectful cultural humility in care provision can make a difference in the quality of care for these childbearing families.




Heck J. L., Jones E. J., Bohn D., McCage S., Parker J. G., Parker M., Pierce S. L., Campbell J. (2021). Maternal mortality among American Indian/Alaska native women: A scoping review. Journal of Women's Health, 30(2), 220-229.[Context Link]


Johnson M. B. (2020). Prenatal care for American Indian women. MCN. The American Journal of Maternal Child Nursing, 45(4), 221-227.[Context Link]


Kildea S., Gao Y., Hickey S., Nelson C., Kruske S., Carson A., Currie J., Reynolds M., Wilson K., Watego K., Costello J., Roe Y. (2021). Effect of a birthing on country service redesign on maternal and neonatal health outcomes for First Nations Australians: A prospective, non-randomised, interventional trial. The Lancet. Global Health, 9(5), e651-e659.[Context Link]


Marriott R., Reibel T., Barrett T.-L., Bowen A., Bradshaw S., Kendall S., Kotz J., Martin T., Monterosso L., Robinson M. (2021). Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women. Birth, 48(1), 132-138.[Context Link]


Perinatal Services British Columbia. (2021). Honouring Indigenous women's and families' pregnancy journeys: A practice resource to support improved perinatal care. Vancouver, BC: Provincial Health Services Authority.[Context Link]


Wood A. J., Graham S., Boyle J. A., Marcusson-Rababi B., Anderson S., Connors C., McIntyre H. D., Maple-Brown L., Kirkham R. (2021). Incorporating Aboriginal women's voices in improving care and reducing risk for women with diabetes in pregnancy: A phenomenological study. BMC Pregnancy and Childbirth, 21(1), 624-633.[Context Link]