Rewire.News: “The Midwives’ Resistance: How Native Women Are Reclaiming Birth on Their Terms”

 Mary Annette Pember

Birth has become dangerously medicalized for them.

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.

Many indigenous women in the United States and Canada give birth in governmental health facilities overseen by Indian Health Service (IHS) in the United States, and First Nations and Inuit Health Branch in Canada.

Health-care policies at IHS and First Nations and Inuit Health are comparable to those at conventional health-care facilities in both countries.

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.

For instance, governmental policies such as forced attendance at Indian residential schools in Canada and Indian boarding school in the United States were explicitly intended to eradicate and denigrate indigenous cultures, languages, and ways of healing and birthing. Many children in these schools were subjected to sexual and physical abuse and denied access to their families, thus creating generations of untreated post-traumatic stress disorder or historical trauma. After being cut off from families and traditional lifestyles and foods, which some suggest offer nutritional benefits, indigenous peoples began developing high rates of diabetes and poor health outcomes, such as high rates of lung, chest, and intestinal disorders.

Forcing Native women to birth in hospitals is another in a long line of colonial acts of violence, explained Kanahus Manuel, a member of the Neskonlith Indian Band of Secwepemc Nation in British Columbia, Canada. “Birth is the ultimate act of decolonization and resistance,” she said.

Reclaiming Tradition

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. According to the American Pregnancy Association, there are three stages of childbirth including early labor when the cervix moves toward complete dilation of 10 centimeters, active labor when the baby is delivered through the fully dilated cervix, and third stage which includes delivery of the placenta. The first stage of labor is usually the longest period and can last from a few minutes to many hours.

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.

Aboriginal midwife Kanahus Manuel is a self-proclaimed warrior, freedom fighter, and well-known indigenous land and water protector.

Manuel was pregnant with her first child while opposing the Canadian government’s plan to build facilities for the 2010 Winter Olympics on Secwepemc lands. When she learned that authorities had issued a warrant for her arrest for these activities, she fled to the Marble Mountain range deep in Secwepemc territory when her time came. “I knew I wanted an unassisted birth as my ancestors have done for centuries; I didn’t want to have my baby in a prison cell,” she said.

She educated herself in both mainstream and traditional birth practices and has since birthed all four of her children in the Secwepemc way, at home attended by family and/or midwives.

For Manuel, revitalizing indigenous midwifery is a declaration of sovereignty over women’s bodies and autonomy from colonial governmental systems.

Other advocates are finding ways to work within the systems to revive Native birth ways.

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 outcomes, but also as a means to help reverse overall health disparities among Native peoples.

In 1994, many Canadian provinces added a special exemption to the Canadian Midwifery Act. It allows aboriginal midwives who provide traditional midwifery services to tribal communities to practice without registering with the Regulated Health Professions Act. The act varies by province but requires midwives to complete a set of mandatory courses and abide by the rules of the act. Aboriginal midwives can practice legally without accreditation under the often-rigorous demands imposed by the act.

“Indigenous midwifery and healing practices are keystones in addressing reproductive health and longstanding problems in communities such as addiction, disease, shame and trauma,” said Cook, who helped create the 1994 exemption.

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 Carefindings 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.

Midwifery in the United States, however, is not as accepted as in Canada. Laws governing its practice vary greatly from state-to-state. Only certified nurse midwives (CNMs), not other midwives, can practice legally in all 50 states. They are afforded hospital privileges in 30 states. After earning a bachelor’s degree in certified nursing, most CNM candidates also complete graduate studies in programs certified by the American College of Nurse-Midwives.

Some midwives may practice under other designations, including direct-entry midwives, certified midwives, or certified professional midwives, who may work in birthing centers and/or help with home births. Training for and attainment of these titles varies from state to state. In some states, many midwives run the risk of arrest for practicing medicine or nursing without a license.

For most women in the United States, the path to childbirth begins with a trip to a traditional hospital. Native mothers frequently must travel great distances from rural home communities and frequently can’t afford to bring along family or other support people. More insidious, however, according to indigenous midwives, is the impact of ongoing trauma from sexual assault as well as unresolved historical trauma created by U.S. federal policies designed to separate Native peoples from their lands, cultures, and languages. According to the Department of Justice, Native Americans are 2.5 times more likely to experience sexual assault compared to other ethnicities. One in three Native women reports having been raped in her lifetime.

The hospital environment with its rigorous, sterile protocols forbidding food; regulations regarding the number of visitors; agendas dictating when to induce birth or perform cesarean sections seem like another in long line of traumatic events.

According to Cook, Native peoples won’t be healthy and whole until Indigenous midwifery, which helps to combat trauma affecting poly-victimized people, is restored to their communities.

In that vein, Dunlap and a handful of other Native women in her area are creating a local effort to spend time with traditional midwives and healers and encourage expectant people to learn more about their Ojibwe birthing ways.

“Our Ojibwe stories describe how the fathers would keep a fire burning while the woman birthed so the baby’s spirit could find its way.” Having a prescribed role for the father provides him with a sense of connection and purpose with the birth.

“For Ojibwe, birth is a ceremony; baby is on a spiritual journey before they actually arrive,” Dunlap said.

“We have ancestral knowledge that Ojibwe women can share with each other,” she added.

The reclamation of indigenous women’s medicine is a true grassroots endeavor, Cook pointed out.

“In indigenous communities, health begins at home, at the kitchen table, using the everyday language of everyday people,” she said.

CORRECTION: This piece has been updated to clarify Kanahus Manuel is a member of the Neskonlith Indian Band. A previous version of the piece also listed Rebekah Dunlap as her online pseudonym R.A. Mackelberry.

Evidence-based journalism is the foundation of democracy. Rewire.News, is devoted to evidence-based reporting on reproductive and sexual health, rights and justice and the intersections of race, environmental, immigration, and economic justice.

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Birth Statistics ~ The need for more Midwives

Demetra Seriki is a NARM registered Midwife and owner of A Mother’s Choice – Birth Options and Beyond

She is also a Midwife who serves the community of Colorado Springs, Colorado and is currently seeking Student midwives of Color who are interested in training to complete their education as midwives. With so many hospitals closing in many states across the country, the necessity for properly trained Midwives are seemingly increasing.

She recently shared some disturbing but much needed statistics about birth:

 

It is with a very HEAVY heart that I will report the 2016 birth statistics in El Paso County (Colorado Springs) for families of color. They do not separate the stats by birth location so these numbers represent total births and all birth locations.

Total births (all races) 9,499
1. Hispanic – 1,517
2. Black – 814
3. Asian – 468
4. Native – 92

Low Birth Weight (<2,500):
1. Hispanic – 8.8
2. Black – 14.1
3. Asian – 9.0
4. Native – 13.0

Very Low Birth Weight (<1,500)
1. Hispanic – 1.5
2. Black – 2.5
3. Asian -0.9
4. Native – 6.5

Preterm
1. Hispanic – 10.4
2. Black – 13.5
3. Asian – 9.8
4. Native – 19.6

52 infant deaths
34 neonatal deaths

Unfortunately the data that I can see does not identify these babies (angles babies) by race. (I can’t imagine why)

 

If you are a student midwife or a women seeking health services in the Colorado Springs, Colorado area please feel free to contact her.

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Midwifery Myths Set Straight by ourmomentoftruth.com

The profession of midwifery has evolved with today’s modern health care system. But there are many myths about midwives in the United States based on centuries-old images or simple misunderstandings. You might be surprised to learn the truth about some of these common midwifery myths.

 

True or False?

Midwives have no formal education.

FALSE. Most midwives in the United States have a master’s degree and are required to pass a national certification exam. There are many different types of midwives, each holding different certifications based on their education and/or experience. Certified nurse-midwives (CNMs) and certified midwives (CMs) attend approximately 93% of all midwife-attended births in the United States, and as of 2010 they are required to have a master’s degree in order to practice midwifery.

Midwives and physicians work together.

TRUE. CNMs and CMs work with all members of the health care team, including physicians. Midwifery care fits well with the services provided by obstetrician/gynecologists (OB/GYNs), who are experts in high risk, medical complications, and surgery. By working with OB/GYNs, midwives can ensure that a specialist is available if a high-risk condition should arise. Likewise, many OB/GYN practices include midwives who specialize in care for women through normal, healthy life events. In this way, all women can receive the right care for their individual health care needs.

Midwives only focus on pregnancy and birth.

FALSE. Midwives have expert knowledge and skill in caring for women through pregnancy, birth, and the postpartum period. But they also do much more. CNMs and CMs provide health care services to women in all stages of life, from the teenage years through menopause, including general health check-ups, screenings and vaccinations; pregnancy, birth, and postpartum care; well woman gynecologic care; treatment of sexually transmitted infections; and prescribing medications, including all forms of pain control medications and birth control.

Midwives can prescribe medications and order tests.

TRUE. CNMs and CMs are licensed to prescribe a full range of substances, medications, and treatments, including pain control medications and birth control. They can also order needed medical tests within their scope of practice and consistent with state laws and practice guidelines.

Midwives cannot care for me if I have a chronic health condition or my pregnancy is considered high-risk.

FALSE. Midwives are able to provide different levels of care depending on a woman’s individual health needs. If you have a chronic health condition, a midwife still may be able to provide some or all of your direct care services. In other cases, a midwife may play a more of a supportive role and help you work with other health care providers to address your personal health care challenges. In a high-risk pregnancy, a midwife can help you access resources to support your goals for childbirth, provide emotional support during challenging times, or work alongside specialists who are experts in your high-risk condition to ensure safe, healthy outcomes.

Midwives offer pain relief to women during labor.

TRUE. Midwives are leading experts in how to cope with labor pain. As a partner with you in your health care, your midwife will explain pain relief options and help you develop a birth plan that best fits your personal needs and desires. Whether you wish to use methods such as relaxation techniques or movement during labor or try IV, epidural, or other medications, your midwife will work with you to help meet your desired approach to birth. At the same time, your midwife will provide you with information and resources about the different options and choices available if any changes to your birth plan become necessary or if you change your mind.

Midwives only attend births at home.

FALSE. Midwives practice in many different settings, including hospitals, medical offices, free-standing birth centers, clinics, and/or private settings (such as your home). In fact, because many women who choose a midwife for their care wish to deliver their babies in a hospital, many hospitals in the United States offer an in-house midwifery service. And because midwives are dedicated to one-on-one care, many practice in more than one setting to help ensure that women have access to the range of services they need or desire and to allow for specific health considerations. In 2012, about 95% of births attended by midwives in the United States were in hospitals.

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What is a Doula vs. Midwife

[Article below is from   http://www.diffen.com/difference/Doula_vs_Midwife }

Childbirth today has several alternatives to the standard hospital experience with an obstetrician, and doula and midwife are just two of many.

A doula is an assistant who provides physical as well as emotional support during childbirth. She helps women in a non-medical capacity.

A midwife is a qualified professional from an institution of her country, which enables her to help a pregnant woman in delivering a baby. The World Health Organization defines a midwife as: A person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.

Comparison chart

Doula versus Midwife comparison chart
  Doula Midwife
Definition A doula is an assistant who provides physical as well as emotional support during childbirth. She helps women in a non-medical capacity. A midwife is a qualified professional from an institution of her country, which enables her to help a pregnant woman in delivering a baby.
Duties Prenatal Doula aids with Educating women about their own choices regarding options for their upcoming birth of their child. Childbirth Doula helps the mother during labor and childbirth. Postpartum Doula offers services after the child is born Aids with preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
Types Prenatal, Childbirth and Postpartum Doulas. Certified nurse midwife (CNM), certified professional midwife (CPM), direct-entry midwife (DEM), registered midwife (RM), licensed midwife (LM), depending on availability of state licensure for non-nurse midwives.
Etymology Ancient Greek doulē, meaning female who helps Middle English Mid meaning with & Old English wif meaning woman.
Certification Childbirth International, D.O.N.A (Doulas of North America), and C.A.P.P.A. In Canada: C.A.R.E. (Canadian Association Registry and education) North American Registry of Midwives & American College of Nurse Midwives. In Canada: Registered by the College of Alberta Midvives (AAM) and Canadian Association of MIdwives (CAM)
Salary $300 to $1000 per pregnancy they assisted mother in, depending on factors like cost of living, employer, credentials, experience. $40, 000 – $90, 000 as a base salary respect to change according to the employer, education, experience of the midwife etc.

Types & Duties

A doula can characteristically be classified into three types: prenatal doula, childbirth doula and postpartum doula. Based on the qualification, a doula may assist a pregnant woman before child birth by getting her necessary commodities and preparing her to deliver a baby. A childbirth doula, does just that, i.e. helps a pregnant woman deliver a baby. Her role may include assisting the mother during childbirth by supporting her emotionally etc. However, a postpartum doula can help a mother after child birth with all the essential chores at home, including but not limited to cooking, caring for the child, assisting in breast feeding etc.

Typically, there are two types of midwives: Direct-entry midwives, who usually enter directly into midwifery education programs without a prior professional credential and Certified nurse-midwives who are registered nurses before entering midwifery training. A midwife’s duties include helping child bearing women during labor, childbirth and providing postpartum care until the baby is six weeks old.

Etymology

The word Doula is derived from the Ancient Greek word doulē, meaning female slave.

The term Midwife is derived from Middle English word mid meaning with an Old English word wif meaning woman.

Salary

An experienced doula can earn anywhere from $300 to $1000 a time in the United States of America. These rates are flexible and usually depend on the cost of living of the area where the service is being delivered.

A midwife however, can make up to $40,000 – $90,000 a year in the United States of America. The amount mentioned is the base pay and can differ based on your employer, industry, credentials, experience etc.

Certification

Though it isn’t essential for a doula to be certified by an agency or an institution, many women prefer their doulas to meet some basic requirements. These requirements can be fulfilled from various doula certifying agencies across the country or even by appearing for exams over the internet. Doulas need to attend specific number of births before they can be certified, which varies from agency to agency. A few agencies in the United States are : Childbirth International and Doulas of North America.

Midwives can be certified through North American Registry of Midwives for Certified Professional Midwife, American College of Nurse Midwives for Certified Nurse-Midwife.

References