After years of practicing as a nurse and midwife, Nicolle Gonzales (Navajo) began thinking about the traditional Indigenous birth practices that she wasn’t seeing reflected in hospital births.

At Standing Rock in 2016, she and other midwives began discussing the relationship between reproductive justice and the land — and their shared desire to reclaim birth work.

She reached out to Native elders — like Katsi Cook (Mohawk), Patrisia Gonzales (Kickapoo/Comanche/Macehual) and Ursula Knoki-Wilson (Navajo) — who worked to preserve birth practices through the 1970s and ’80s. She also began networking with other midwives — like Rhonda Lee Grantham (Cowlitz), Margaret David (Koyukon Athabaskan) and Autumn Cavender-Wilson (Wahpetuwan Dakota) — at national gatherings.

Back home in New Mexico, Gonzales began organizing with the ultimate goal to build the nation’s first Indigenous traditional birth center.

More than five years later, that dream is nearing a reality. The Santa Fe-based organization that Gonzales founded in 2015, Changing Woman Initiative, has grown to include a national board of directors and a local staff of two Indigenous midwives. The birth center that Gonzales first imagined now seems a tangible possibility. In creating a space for Indigenous families to come together around birth, Gonzales and her team want to improve birth outcomes for Native parents and babies while reclaiming traditional practices.

Nicolle Gonzales and Melissa Brown during a brainstorming session for CWI. (Courtesy of CWI)
Nicolle Gonzales and Melissa Brown during a brainstorming session for CWI. (Courtesy of CWI)

The CWI traditional birth center “is so necessary and so needed,” said Abigail Echo-Hawk (Pawnee), director of the Urban Indian Health Institute and chief research officer at the Seattle Indian Health Board.

According to Echo-Hawk’s team at the Urban Indian Health Institute, maternal mortality rates among American Indian and Alaskan Native mothers are 4.2 times as high as those for non-Hispanic whites. American Indian and Alaska Native infants are nearly twice as likely to die by their first birthday as White infants.

“These disparities didn’t begin the moment that person became pregnant. Those disparities began for Native people 500 years ago, with the systems of systemic racism and oppression that created environments where our people are not as healthy as they should be when they become pregnant,” said Echo-Hawk, referencing federal policies that disrupted traditional food systems and medical practices. “Science has proven that systematic and continuous racism on women and on people who birth’s bodies creates stress on their bodies, which again impacts their ability to birth.”

“What we’re looking for is reproductive sovereignty,” says Maymangwa Flying Earth (Lakota/Dakota, Anishinaabe, Akimel O’odham), CWI’s interim director of Native American health policy. “Really being able to have a say in how a Native person gives birth. I think for so long, because the Indian Health Service has been the primary health-care system that’s been available, that Native women have sort of forgotten that they have that capability to say: ‘This is what we want. This is how we would like to give birth.’”

Flying Earth has begun to lead much of CWI’s policy work to figure out how the team could get referrals from the Indian Health Service (IHS) and how future birth centers could work with tribal governments to operate on reservations.

When completed, CWI’s birth center will provide members of New Mexico’s northern Pueblos with lactation consultation, nutrition education, plant medicine workshops, well-woman care and — of course — birth services.

The aim of CWI’s birth center, says the organization’s executive director, Arizona-based midwife Marinah Farrell (Chicanx), “is returning birth to the community itself.”

Birthing traditions look a little different in every Native community — where a Navajo mom might want to deliver in a hogan, another mom might be more interested in giving her newborn a cedar bath. What matters is building “a system that honors all of that,” Farrell said, and part of that is training Indigenous birth workers so they’re able to serve their own communities. Native Americans make up only 1 percent of nurse-midwives and 0.5 percent of certified professional midwives, Gonzales says.

Because the IHS is notoriously underfunded, Farrell says, it often fails to provide care to all Native families.

“It’s not that you can’t get care. It’s that it could take you six months,” said Farrell. She also cites a lack of cultural inclusion and that many IHS sites are located far from family homes. Because the IHS receives federal funding, she notes, under the Hyde Amendment it cannot provide abortion care.

In designing the birth center, CWI’s team isn’t thinking only about the indoor space, but also the land. “Incorporating the land into the work that we do with our families is really critical to us,” said Farrell. She hopes the birth center will have space for a sweat lodge and for gardens to grow traditional herbs.

For the building itself, CWI has consulted with Indigenous architects to design a space with a customary roundhouse center. The building will include three birthing rooms with fireplaces and birthing pools, but also separate wings for prenatal, postpartum and newborn care. The hope is not only to create a space for birthing but also one for community: where families can take classes, browse a library and participate in ceremony.

“There is a reclaiming happening in the United States, where young Native American birth workers are really starting to understand that they have a very important place in healing their communities,” Farrell said. “And the truth is, that is who is going to heal their communities. The communities are going to heal themselves.”

Bethany Moody (Shawnee and Potawatomi), CWI’s vice president and a Michigan-based certified nurse midwife, says that although it has taken generations, she sees a change coming.

“You’ll hear people say: ‘Well, we lost our tradition. We lost our ceremonies. We lost. It was taken from us.’ Actually, it kind of went underground. … It was the Earth that held it for us. And so now the time is right, the Earth is opening up and allowing us to say: ‘I’m here. I’m ready. You’re ready. Let’s move this forward.’”

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