When New Mexico-based midwife Nicolle Gonzales helps Native American women deliver their babies, she finds many turn to traditional ceremonial practices that have existed for thousands of years.
But she finds they only perform them in the privacy of their own homes, not in the hospital, in front of others.
"They don't feel comfortable doing those things in the hospital," Gonzales -- who is herself Navajo, or Dine' -- told The Huffington Post. "I [encourage] them to burn sage, to help cleanse the space... but that's a whole process of getting permission." The same goes for drumming sessions, or the mother's blessing way, a sacred ceremony used by Navajo women right before labor, to help reaffirm everything will go well, Gonzales explains.
It is precisely that sense -- that there is no room within modern obstetrical care for a culture of birthing that has existed for generations -- that Gonzales, 35, hopes to change by establishing the first Native American birth center in the United States in northern New Mexico.
"At the birth center, you won't have to ask anybody for permission," said Gonzales, who currently works in a very small private practice and is the only midwife at Los Alamos Medical Center, on-call 24 hours a day, seven days a week. "You just get to burn sage, or bring your drum and [play] while the baby is being born, or bring as many family members as you want to be there... you don't get that gatekeeper saying, 'You can only have two people.'"
"Birth in our native communities has always been very community-centered," continued Gonzales, who, according to a recent Colorlines article, is one of just 14 Native American certified nurse-midwives in the United States. "People have roles that have been kind of stripped away as birth has been moved to the hospital and a medical model has been [adopted]."
But the goal of the the birth center isn't simply cultural; it's also to directly tackle many of the health issues that disproportionately affect mothers and mothers-to-be in her community.
For example, Native American women are more likely to receive late prenatal care, and have higher rates of issues like preterm birth and postpartum depression, Gonzales said. The birth center will be holistic, taking into consideration social determinants of health that may otherwise be overlooked, like access to healthy food. One reason why many Native American women in her area don't get adequate prenatal care, Gonzales said, is that they don't have cars and simply don't have a way to get to their appointments.
For now, the birth center is still in the planning and fundraising stage. Gonzales predicts that if all goes according to plan, it will open in three years' time. There are many issues to consider, both broad ("What kind of values is this center going to have?") and more concrete (What services is it going to provide, and how will reimbursement work?). The location has not yet been determined; if the center opens on tribal land, Gonzales will have to navigate a distinct set of laws.
The ultimate mission, however, is never far from her mind: providing Native American women with much-needed education and modern medical support, while also preserving traditional teachings -- two goals she believes can easily co-exist.
"The Changing Woman [the name of Gonzales' health collective], in our Navajo culture, she birthed the first set of twins. She's the ultimate mother in our tribe, so women identify with her," she said. "If you can use a language and a story that women identify with, then they understand the process and are willing to participate in the care more fully versus me being a Western medicine person saying, 'You have to come get your blood pressure checked, and you have to do this.'"
Gonzales hopes to enlist the services of Tewa Women United, an inter-tribal nonprofit in New Mexico that runs a community doula program, training Native American women to support mothers throughout labor and delivery process and beyond.
"Then you have a birth attendant that looks like you and sounds like you, [and] is from your community, so you have this trust with them," Gonzales said. (Indeed, studies have shown that community doulas can help boost breastfeeding rates, and improve mothers' relationships with their babies.)
For Gonzales, it's all about improving birth outcomes by making room for a sense of culture and community.
"I often ask women to consult family elders about their own traditional birth practices, as that this connects them to their ancestral legacy," she wrote on The Changing Woman Initiative's Facebook page. "[It reminds them] that pregnancy is not just a medical, physiological process."
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