Aboriginal or indigenous midwifery is seeing a resurgence as conventional health-care policies in hospital and clinics perpetuate an environment in which most contemporary pregnant Native women are considered pathologically unhealthy.
“The mainstream medical narratives surrounding Native women depict moms who don’t breastfeed and don’t have partners. According to this portrayal, Native women don’t exercise, eat poorly, and have diabetes. We are seen as hopeless,” said Marinah Farrell, an indigenous Chicana certified professional midwife based in Phoenix.
“When I worked in the hospital, I saw so many Native mothers who would hemorrhage and have terrible outcomes during their births. It seemed so abusive; they were treated like they were sick already when they entered the hospital doors,” said Rebekah Dunlap, a member of the Fond du Lac Band of Ojibwe who works as a doula and is a registered nurse, bachelor of science nurse, and public health nurse in Minnesota.
What began quietly as the efforts of a few dedicated women has in recent years grown in size, scope, and agility. Today, Native women across the United States and Canada are putting their skills to work in challenging the status quo of mainstream medicine.
Birth has become dangerously medicalized for them. Cut off from traditional diets, support networks, and community midwives due to colonization and assimilation, many Native women have chronic health conditions that mean giving birth is a high-risk activity—and one that requires travel to well-equipped hospitals.
Aboriginal or indigenous women, especially those in the United States, are overwhelmingly classified as high-risk. In Canada, according to Statistics Canada, birth outcomes among indigenous peoples are consistently less favorable than among the non-indigenous population. Native American and Alaska Native women have higher rates of maternal morbidity or injury compared to the general population, according to the Centers for Disease Control and Prevention (CDC). The risk of maternal death for Native women is twice that of white women in the United States. The infant mortality rate for Native American and Alaska Native babies is .83 percent, second only to rates for non-Hispanic Black American babies of 1.13 percent.
The practice of forcing Native women to travel to hospitals because their traditional ways of caring for pregnant people were outlawed contributes to an endless cycle of poor outcomes. Despite the public health industry’s best attempts at addressing Native women’s high-risk status, this cycle can’t be addressed by the same Western-style institutions that are complicit in perpetuating the problems in the first place, according to indigenous midwives including Katsi Cook of the Mohawk Nation.
The efforts of indigenous midwives in Canada and the United States run a wide spectrum of styles and practices. However, according to Nicolle Gonzales, Navajo nurse-midwife, “Indigenous peoples share a worldview of connection to the land. We view birth and motherhood as ceremony,” she said.
“Traditional midwives took time to sit and talk with the mothers about their lives, families and challenges,” Dunlap noted. “Our women were given time and support to have their babies; there was no agenda dictating the various stages of labor,” she said, drawing a clear distinction between birthing experiences at hospitals versus in Ojibwe communities.
Among indigenous peoples, as birthing women moved through the stages of labor, they were fed certain foods to provide physical, emotional, and spiritual strength. When the baby was born, its feet touched the earth even before it was given to the mother. “All of these ways had important meanings that are not yet completely lost,” she said.
“Woman is the first environment,” Cook said, echoing Dunlap’s sentiments. “With our bodies we nourish, sustain, and create connected relationships and interdependence. In this way the Earth is our mother, our ancestors said. In this way, we as women are earth.”
Cook has influenced and inspired generations of midwives to embrace their traditional Native ways. “I have a long tail in championing indigenous midwifery extending back to when I was first pregnant in 1973,” Cook said.
Cook has worked as an indigenous women’s health and midwifery advocate for many years. In 1983, she helped create a “Birthing Crew” of local elders and midwives on her home reservation of Akwesasne in New York and Canada. The crew provided midwifery services and health education to tribal members. In 1985, after the nearby St. Lawrence River was polluted by polychlorinated biphenyls (PCBs) from General Motors, Cook established the Mother’s Milk Project. A study found PCB contamination of breast milk of Mohawk women who ate fish from the St. Lawrence River.
Today, Cook’s many devotees and students continue taking up the challenge to revitalize indigenous midwifery.
Gonzales is working within U.S. medical laws and regulations to create what will be what she describes as the first Native culturally focused birth center on tribal lands. Founder and executive director of the New Mexico-based Changing Woman Initiative, Gonzales received her bachelor’s of science in nursing and master’s degree in nurse-midwifery from the University of New Mexico and is a member of the American College of Nurse-Midwives and certified with the American Midwifery Certification Board. Although eligible to practice in a conventional hospital, Gonzales envisions creating a birthing environment that is friendly and welcoming and where Native women can have ceremony, eat traditional foods surrounded by family, and reclaim their traditional ways of birthing and healing.
According to the CDC, in 2015, 98.5 percent of births in the United States occur in hospitals. Out-of-hospital deliveries represented 1.5 percent of births in 2015. Of the more than 61,000 out-of-hospital births, 63 percent occurred at a home and 31 percent at free standing birthing centers. However, most insurance companies don’t cover home births and may only offer limited coverage at birthing centers.
Gonzales hopes she can establish Medicaid certification for the birthing center they are building and establish other ongoing funding in order to offer services for women who may lack other health insurance.
She and her supporters and co-workers at Changing Woman Initiative equate Native women’s rights to birth in their own ways as inherent and inalienable rights affirmed by the United Nations Declaration on the Rights of Indigenous Peoples. They hope to complete the birthing center, on the Pojoaque Pueblo, north of Albuquerque, this year.
Providing Truly Culturally Sensitive Care
Gonzales and her colleagues argue that although the Indian Health Service is tasked with providing health care to Native Americans, it is unable to effectively meet its mission. IHS is the federal agency within the federal Department of Health and Human Services that is charged with meeting treaty agreements between federally recognized tribes and the U.S. government, which promises to provide tribal members with health care. These promises have their base in Article I, Section 8 of the U.S. Constitution governing duties and powers of the Congress.
Criticism of the type of health care offered by IHS, however, could be lodged against other conventional health-care facilities in the United States that are also subject to the same limitations and laws regarding types of services that can be offered.
A statement provided by the Phoenix Indian Medical Center indicated that it employs ten certified nurse-midwives who provide culturally sensitive and relationship-based services. According to the statement, the health center provides pregnant people with therapeutic massage, hydrotherapy, and lactation support. Gonzales, however, argues that although IHS insists it offers culturally sensitive birthing practices, most of the midwives are non-Native and the facilities are still governed by the same strict hospital-style protocols as its mainstream counterparts. So no matter where a Native pregnant person might reside, their access to culturally sensitive care will be limited, if nonexistent. Birthing mothers are restricted regarding food consumption and the use of open fires, and ceremonial food preparation is restricted.
Aboriginal midwifery in Canada, however, has long been recognized by mainstream organizations such as the College of Midwives of Ontario. The college, responsible for registering midwives in the province, declared in a 2001 vision statement that midwifery care in Ontario, including aboriginal midwives, was defined by ongoing support for community-based midwives working in partnership with childbearing women. Aboriginal midwifery is seen as a valuable way not only to improve patient and infant health
“Indigenous midwifery and healing practices are keystones in addressing reproductive health and longstanding problems in communities such as addiction, disease, shame
Preliminary data and evaluations indicate that birth outcomes have improved since the exemption was added. For instance, Inuulitsivik Health Centre’s Midwifery Service in Nunavut territory has provided care by traditional Inuit midwives to clients since 1986. According to research funded by Health Canada and published in Birth Issues in Perinatal Care, findings indicated low rates of intervention for births despite the high-risk designation of many Inuit mothers. Ninety-seven percent of births were documented as spontaneous vaginal deliveries; Inuit midwives attended 85 percent.
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