Background: Pregnant people experiencing housing instability often have complex needs. Urban Indigenous doulas can benefit from the expertise of social service and healthcare providers to learn best practises for supporting this population in the urban centre of Winnipeg, Manitoba.

Purpose: The purpose of the study was to gather the experiential knowledge of healthcare and social service providers in inner-city Winnipeg, focusing on their perceptions of essential care practises to support unsheltered Indigenous clients throughout their reproductive experiences. Findings will inform the training curriculum for the She Walks with Me: Supporting Urban Indigenous Expectant Mothers through Culturally Based Doulas project.

Methods: A two-phase mixed methods design was used: Phase 1 used a questionnaire as an informal needs assessment scan of current supports available for pregnant people experiencing housing instability and served as a recruitment tool (n=58); Phase 2 involved exploratory qualitative semi-structured interviews with social service and healthcare providers to explore their approaches and challenges in supporting pregnant people facing housing insecurity or unsafe housing (n=16). Thematic analysis was conducted to identify key themes.

Results: The questionnaire responses noted various reasons why pregnant people experiencing housing instability seek services at service providers’ workplaces, including accessing mental health services, housing support, and harm reduction supplies. Interviews revealed best practises and approaches to care that emphasise cultural safety, compassion, and interprofessional collaboration. Participants shared nuanced approaches for supporting pregnant people with housing instability, highlighting that care should be nonjudgmental, provide resources and referrals, foster trust, incorporate harm reduction practises, and be client-led. They also identified critical gaps, such as the need for a supportive housing shelter for families that offers onsite support for mental health and substance use through an interprofessional wrap around model of care as a best practise. Further, providers offered practical strategies for self-care to avoid burnout when supporting birthing folks with complex circumstances.

Conclusion: The study highlights the importance of trauma-informed, anti-racist, and client-led care practises in supporting pregnant people facing housing instability in Winnipeg, while recognising urban Indigenous doulas need to foster relationships, provide anti-racist and trauma informed care, and advocate for this population's unique needs.