Giving birth is a powerful personal experience for the mother and the child but, in the hospital setting, there might be as many as a dozen medical professionals in the room during the event.
Navajo midwife and nurse Nicolle Gonzales wants to change this sterile and impersonal birthing experience for indigenous women, and bring the focus back on traditional ways.
One of just 15 Native American midwives in the United States, Gonzales founded the Changing Woman Initiative, a nonprofit that aims to revolutionize how people – particularly Native women – think about reproductive health.
A major goal of the initiative is to open a reproductive wellness and birth center in Pojoaque. The center will be open to all, but will focus on providing equitable, thoughtful and culturally relevant reproductive health care that will strengthen indigenous women’s bonds to family and community.
The wellness center Gonzales envisions offers women choices about where to give birth, such as in a bed, in a water bath, outside in a private courtyard, or even in a tipi. Birthing mothers will be encouraged to think about things such as which direction their beds face (each direction has a significance) and whether the first sound a baby hears is her native language or ceremonial songs.
“By creating a physical space for education and healing for Native American women, we will reclaim cultural identities through birth and motherhood that has been shaped through our cultures,” Gonzales explains.
When Gonzales was in school at UNM, she met students in her midwifery program who had more knowledge of traditional birthing practices than she did. “My population had no idea of our own rich history,” Gonzales explained. “Although I was raised with ceremony as part of my daily life, even my mother had a disassociation with the birth experience.”
The women Gonzales assists at Los Alamos Medical Center have clear ideas about their birthing experience options, but at Indian Health Services (IHS) – where she also worked – Gonzales noticed Native women were passive and uninvolved in their own health care.
In the 1950s, Native women were strongly influenced to use IHS hospitals when giving birth and today 96 percent of Native births occur in hospitals. Currently, there are no IHS policies that support working with certified professional midwives, those who perform home births, who are reimbursed by Medicaid only $1,700 for the birth. Private insurance provides up to $5,000 per birth, making home births for Medicaid clients a less viable option for the midwives, as well.
“There’s a long history of Native women not accessing health care before the birth, often because of lack of transportation or an understanding of the importance of first-trimester care. Despite statistics proving the safety of home births, there’s also still fear around it, along with the misconception that it’s more modern to birth in a hospital with an epidural,” Gonzales adds.
Education that helps empower women to be proactive with their health care is an important component of the Changing Woman Initiative.
“Many Native ladies don’t ask questions about the birthing process, and there’s no self advocacy. We’re still forcing Native women and families into this structure that doesn’t reflect their values and culture,” she said. “Our outcomes haven’t improved all that much over the years, which begs the question, ‘Why?’ .”
After graduating with a master’s in nurse midwifery in 2011, Gonzales traveled to a National Aboriginal Council of Midwives gathering in Ontario, Canada. She visited the Six Nations Birth Center, which has served aboriginal families for 20 years. After visiting their facility in Ontario, she came away with ideas on which to model her own center in New Mexico.
In the aboriginal medical center, the mothers develop relationships with their providers before the birth occurs, and the providers smudge, or cleanse, the rooms with burning herbs between patient visits. Families are present during the birth, even bringing photographs of ancestors to bear witness.
The positive impact from this unique care is reflected in the statistics of reduced antenatal hospitalizations, reduced risks of babies not surviving the first 24 weeks, reduced use of epidural anesthesia, fewer instrumental deliveries and overall improved maternal health.
“I began to think of my responsibilities to my people, so I learned more about our culture and history by talking to elders about our ceremonies around birth,” Gonzales said. “Our traditional knowledge is still there. Using midwives was once common practice, but was lost with colonization and modernization of Native communities.”
She hopes to offer a holistic health model to patients, including nutrition education and plant medicines specific to pregnant and lactating mothers. Gonzales is working with tribal farmers to provide fresh, local food and cooking classes as part of the care plan.
“By looking at what our ancestors ate to support the health of the baby, such as blue corn mixed with ash to treat anemia, we are experts around our own bodies and within our own communities,” she said. “It’s one side of science and research, and one side of tradition.”
Gonzales is negotiating with Pojoaque Pueblo about the land for the new center, and is raising $7.5 million for the construction while still working as a nurse and midwife, and raising three of her own children. She’s also traveling to Guatemala to train with indigenous midwives and visiting government representatives in D.C. to advance a bill to improve access to maternity care.
“There is historic trauma around our bodies as Native women, but I didn’t get into this work because of the politics. I did it for my community and to give the control of the birthing experience to Native women.”