What Does Culturally Competent and Safe Perinatal Care Look Like? Lessons from an Ethnographic Study at the Maison Bleue

<h3>Context:</h3> The Maison Bleue is an organization in Montreal whose mission is to reduce social inequalities by helping a vulnerable pregnant woman, and by fostering optimal development of their children. They use prevention-based approach termed “social perinatal care.” Data shows that their approach is effective in achieving key benchmarks (e.g., better birth outcomes; cost effectiveness). However, the content of the work that primary healthcare providers do at the Maison Bleue remains poorly understood, limiting capacity to transpose and/or scale up the model. <h3>Objective:</h3> To explore how primary care providers at the Maison Bleue understand and implement culturally safe and competent care, and to identify challenges to providing such care. <h3>Study Design and Analysis:</h3> Ethnographic methodology, using interviews and ethnographic observations; thematic analysis component. <h3>Setting or Dataset:</h3> 18 in-depth interviews with healthcare providers (physicians, nurses, social workers, child psychologists, midwives; translators, administrators); 40 hours of observations of team meetings. <h3>Population Studied:</h3> Primary care providers. <h3>Intervention/Instrument:</h3> N/A <h3>Outcome Measures:</h3> N/A <h3>Results:</h3> Care providers identified the Maison Bleue’s interdisciplinary model, shared values among providers, and efforts to foster two-way exchange with clients as being integral to providing culturally competent and safe care. Tensions were apparent between a notion of “culture” as an asset to be mobilized (e.g., connecting isolated women from similar backgrounds), and as a threat to clients’ wellbeing. Topic areas that were challenging for providers to navigate included corporal punishment of children, infant feeding practices, contraception, domestic violence, and patriarchal gender norms in families. <h3>Conclusions:</h3> Interdisciplinary, non-hierarchical care may be crucial for providing holistic care to vulnerable perinatal care patients. Efforts to teach and provide culturally competent and safe care should have a clear idea of what is meant by culture. Care providers need support in navigating cross-cultural differences in parenting practices, and cross-cultural gender norms.