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

. 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. 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. 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. . Health services designed with Indigenous stakeholders in accordance with Joyce's Principle have the potential to enhance cultural safety of maternal evacuation.