The Center for Indigenous Midwifery, in collaboration with Open Arms Perinatal Services and King County Best Starts for Kids in Washington, has launched the Indigenous Childbirth Educator program amidst the pandemic to improve the childbirth experience within Indigenous communities.
Rhonda Lee Grantham, founder of the Center for Indigenous Midwifery, said the purpose of the program is to provide participants with both cultural knowledge and perinatal care information they need to help support childbirth within their communities. The curriculum is a combination of scientific knowledge that can be applied to every childbirth as well as cultural and traditional knowledge that is specific to Indigenous communities in the United States. It ranges from information on epidurals and cesareans to sexuality in birth and what it means to be a Native father, and will be provided by a team of instructors that include Indigenous midwives and birthkeepers, maternal child health workers, experts, traditional healers, and community families.
While the program is launching during the coronavirus pandemic, it has been over five years in the making. Grantham says what first inspired her to think about childbirth and maternity care that is grounded in community and tradition is her own pregnancy. As a member of the Cowlitz Nation, a Salish-Sahaptian tribe of southwest Washington, she had been gifted blessings from the ceremonial people in her community. But when it came to her midwives, although she felt supported, she did not feel the spiritual connection she hoped she would because they did not know about the childbirth rituals and ceremonies that are a part of her culture.
“So many of our traditions are not written down and I support that,” Grantham said. “But at the same time, being a pregnant person, I was really aching to be able to hear the birth stories and not have a leg in two worlds. The traditional people in my life were not my midwives.”
Seeing the disconnect between her community and her maternal care providers, Grantham realized that more healthcare providers need to be equipped with Indigenous knowledge, and more Indigenous community members need to be equipped with clinical maternal care information. This is why the program also aims to bring together community members who have tremendous knowledge about Indigenous childbirth without a formal education, and childbirth workers such as midwives and doulas who lack the necessary traditional and ceremonial knowledge, to learn together and learn from each other. An example of this was when one of the participants in her midwifery assistant training in August taught the class about preparing for a home birth. The participant who led the class had been a wound care nurse for over 30 years, so Grantham felt there was a lot the others could learn through her experience.
“[The participants are] people that are doing phenomenal work in their community and they’re stepping forward and saying, ‘I went through a childbirth educator program but there was not one single thing that felt culturally relevant,’ or, ‘I’m an auntie, but I don’t have a formal education—I just really like to help people and I’d love to be able to help more,’” she said. “It’s the people who want to be the future providers—this is a step in their journey.”
Along with providing the knowledge that people need to support childbirth in their communities, Farrah Rivera, the perinatal and lactation support director at Open Arms Perinatal Services, says the childbirth educator program aims to address infant morbidity, infant mortality, and maternal deaths in the state as well as the country.
In a report released by the Washington State Department of Health in October last year, American Indian/Alaska Native mothers were shown to have statistically higher maternal mortality ratios than any other ethnic group between 2014 and 2016. The issues that impacted the majority of pregnancy-related deaths included access to healthcare services, gaps in continuity of care, gaps in clinical skill and quality of care, and lack of care coordination at the provider, facility, and systems levels.
Date collected in 2017 by the U.S. Department of Health and Human Services’ Office of Minority Health also shows that American Indian/Alaska Natives have twice the infant mortality rate as non-Hispanic whites, and American Indian/Alaska Native mothers were 2.8 times as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
“One of the things we’re focusing on is childbirth education that is culturally responsive, where you respond to the concerns within your own community,” Rivera said.
According to Grantham, one of the reasons for high infant morbidity and maternal mortality rates in Native American communities is that most maternal healthcare providers working with Native American women do not identify as Native American themselves. Added to this is the fact that many women have to travel outside of their communities to receive health care. This is why the program is currently accepting only Native American applicants, and the year-long program not only trains these participants, but does so by combining virtual training with on-site and in-community learning. The on-site and in-community learning component requires participants to take what they learn throughout the year and apply it on the ground in their communities.
A community-specific response to childbirth is especially important during the pandemic caused by the novel coronavirus, according to Saraswathi Vedam, a professor of midwifery and lead investigator of the Birth Place Lab at the University of British Columbia.
In 2019, Vedam published the The Giving Voice to Mothers study, which looks at inequity and mistreatment during pregnancy and childbirth in the United States. Her research found that Black women, Indigenous women, and women of color are treated more poorly than others. The research found differences in mistreatment by race, including twice as many Hispanic and Indigenous women as compared to white women reporting that healthcare providers shouted at or scolded them. Similarly, Black women, Hispanic women, Asian, and Indigenous women were twice as likely as white women to report that a healthcare provider ignored them, refused their request for help, or failed to respond to requests for help in a reasonable amount of time.
While her 2019 research demonstrates significant differences among pregnant people by race and place of birth in level of mistreatment during pregnancy and childbirth, Vedam says the pandemic has made the process even more challenging because of the strain on healthcare providers and social distancing measures across the country. An example of this is not allowing doulas to be a part of the birth. While this reduces the number of people who are physically present in the hospital, Vedam says the experience can be very isolating and stressful, thereby increasing the risk of pregnancy-related complications.
“One perspective is that, ‘We reduced our overall risk for the patient and for the system and for the other patients by having one less person there.’ But by taking that one-on-one support away, you’re also increasing the risk that [the mother] needs more intervention and every intervention means more exposure to everybody because you’ll need more nurses,” Vedam said.
Vedam says having Indigenous Knowledge Keepers and midwives who support pregnant people in their communities, especially during COVID-19, gives them the opportunity to make their own decisions under the guidance of their Elders and community members.
“Community-generated solutions preserve resiliency while respecting traditions of the [Indigenous] Nations,” she says. “These are complex times that we’re all living in and there are certainly challenges. But we don’t have to go from the pan to the fire.”
It is this process of “reclaiming birth” that Grantham hopes to promote through the program.
“The way that each family needs support and how each community can answer that is unique and different and I want to make space for that,” she said.