For Ellen Blais it's about time Ontario's health-care providers reflect on their own practices and ask themselves if personal biases may influence care for Indigenous patients.

Blais, a member of the Oneida Nation of the Thames, said health-care providers may have "implicit biases that they are not even aware of. They have stereotypes of Indigenous people."

She's also been a midwife since 2006, and said in her experience she's seen Indigenous mothers intimidated by going to a hospital.

"She may present herself in the hospital not having much prenatal care," Blais said. That's then interpreted as lack of care for the child and can snowball to "a serious level, where the social workers get called in and they take the children away."

Blais, a policy analyst with the Association of Ontario Midwives, recently vetted an online course she said is mandated for health-care providers in British Columbia.

"How could I have said something differently?" - Ellen Blais, Assoc. of Ont. Midwives

She said that same program could help those in health care in Ontario understand the roots of that woman's anxiety and prompt good questions such as: "How could I have said something differently? In a different tone of voice? How could I have asked, make that connection with that patient differently?"

Indigenous cultural safety

Diane Smylie, provincial director of the Ontario Indigenous cultural safety program, explained the eight-week interactive online course has one Indigenous trainer and one who is not and costs $250.

To date, Smylie, who is Cree-Metis, said about 8,000 Ontarians have taken the San'yas Indigenous cultural safety training.

The intention is "to improve the capacity for service providers to provide care to Indigenous people that's respectful and where people can trust they will be treated with dignity and respect."

But given that there are approximately 275,000 health care service providers in the province, both women would like to see many more go through it.

'Eye-opening'

Dr. Elin Raymond, an obstetrician at Michael Garron Hospital (formerly Toronto East General), took the course after joining the quality assurance committee at the Toronto Birth Centre. The centre was established about three years ago and follows an Indigenous framework.

The course prompted her to reflect on her own process "and how that is brought into a relationship with patients."

Calling the experience "eye-opening," Raymond drafted a proposal for MGH advocating that others take the training to increase cultural safety at the hospital.

"Let's look at our past. Look at our present. What is our future going to be?" - Dr. Elin Raymond

In the family birthing centre, where she and colleagues deliver 250 to 300 babies a month, she would like to see "plans to incorporate Indigenous practices," for example when a patient is transferred from the Toronto Birth Centre for medical reasons.

"Let's look at our past. Look at our present. What is our future going to be?" she said.

At Sunnybrook Health Sciences Centre, midwifery privileges include a policy for smudging, which involves burning a small amount of usually sage, cedar bough or sweetgrass — medicine to Indigenous people.

Midwife Cheryllee Bourgeois explained that for Indigenous expectant moms, the practice is a way to "put yourself in the moment to acknowledge that you're starting a process."

For years she saw "policies get in the way of being able to do this simple act."

It has been a struggle, she said, "coming up against infrastructure and policy."

If that changes, she hopes "it's a ripple effect. You throw one stone across the pond and it goes across the city."

The Cree Metis founder of Seventh Generation midwifery believes if more people took the cultural safety training it would "provide a wider base of people to understand why these cultural practices and beliefs are so integral to Indigenous people."

Smylie agreed the training provokes "pretty deep reflection" that will involve "unlearning  some of the values" health-care providers have — whether they're conscious or unconscious.