Nicolle Gonzales is a 35-year-old certified nurse midwife (CNM) with three kids ages 9 to 14. She’s Navajo (or Diné, as Navajo people refer to themselves), from Waterflow, New Mexico, and has embarked on a journey to create the nation’s first Native American birth center. “I’d like to see a nice building with pictures of our grandmothers, cedar welcoming you into the door, and moccasins for babies instead of blankets," says Gonzales. "I want a place where women and families feel welcome.”
Gonzales is among only 14 other Native American CNMs in the United States. She and Brittany Simplicio, another midwife who is Navajo/Zuni, began raising money for a nonprofit that will run the center, Changing Woman Initiative (CWI), last year.
“There is this huge disconnect between the cultural teachings and our bodies as women. [I want] to advocate for taking back our teachings about our bodies that our ancestors knew before the boarding schools or Indian Health Services came,” says Gonzales. “I've worked at Indian Health Services. I was not happy with the care that the Native women were receiving there. I needed to do something to step up and support Native women.”
Indian Health Services (IHS), a program funded through the U.S. federal government, provides the majority of health care for Native people. Gonzales says it is routinely underfunded, and she points to her stint at the Santa Fe Indian Health Services. The facility was forced to shut down its labor and delivery ward in 2008 due to underfunding. Native women can get prenatal care there, but have to then apply for Medicaid and transfer to another hospital for the actual delivery. This interaction between IHS and Medicaid creates confusion, as some in the community don’t realize they are eligible for both. “I had one couple [whose baby died] and the nurses said it was because the doctor wasn’t available to do a C-section," says Gonzales. "This couple came back [to IHS] a year later because they didn’t feel like they could go anywhere else.”
IHS also has a complicated reputation among Native women because of widespread sterilizations performed there in the 1970s. In a chapter for an upcoming book, Gonzales explains further: “As part of the government’s efforts to assimilate and disempower [N]ative women, in the 1970s, the Indian Health Service oversaw the nonconsensual sterilization of approximately 40 percent of women of childbearing age. It is events like this that still resonate strongly for American Indian women, and contribute to the historical trauma they have experienced over the centuries.”
Along with providing a pregnancy care alternative to IHS, Gonzales says the CWI birthing center project will also address the significant health disparities faced by Native women in the Southwest region. In the center's strategic plan she and Simplicio attribute the disparities to the destruction of indigenous knowledge systems by colonization and to "cultural disparities" created by poverty, discrimination, geography and racism. “Among the 23 government-recognized tribes in New Mexico, these disparities manifest as higher rates of gestational diabetes, increased rates of postpartum depression, and higher rates of preterm birth and low birth weights,” they write.
For the birthing center to work, Gonzalez says there needs to be a culture shift in how midwifery is perceived in her community as something "white." “Even as I applied [to midwifery school] and I went back to my community, they asked why I wanted to be a hippy midwife. In fact we’ve always Native American midwives in our tribes. They see it as a white women thing.”
This stands in contrast to the history of Native midwives that Gonzales outlines in her book chapter: “Before [W]estern ideological influences converged with the Native traditional ways of birthing, [i]ndigenous tribes had traditional midwives or family members who attended to births in their own communities. In the Navajo culture, these women were called ‘baby medicine women’ or ‘umbilical cord cutter.’" Before the emergence of hospitals, births primarily took place in homes called ‘Hogans.’”
Seventy percent of births at IHS nationally are attended by CNMs, but the vast majority of those are non-Native providers. Recent research from aboriginal communities in Australia show that outcomes improve when indigenous women are served by indigenous providers.
Gonzales and Simplicio plan to use IHS funds to run their center, but they will also seek funds from foundations and other agencies. They haven't yet decided if they will locate their center on tribal land. “We would have to find a tribal community that has a stable enough government that would be safe to build a birth center on,” Gonzales says. “You have to go back to that conversation about [whether] tribes value their health. The tribes here are focused on water rights and land rights. Health care is not one of their priorities.” There are also benefits to being placed on non-tribal land, Gonzales says, like higher reimbursement rates from Medicaid for ameliorating rural provider shortages.
Gozales notes that there are three birthing centers in aboriginal communities in Canada, and CWI is planning to visit them to learn about their models. They've launched a GoFundMe campaign to raise money for this research.
CWI has been in development for five years and its founders are at least three years away from seeing the birth center open. In the meantime, Gonzales says she is focusing on supporting other Native American midwifery students and building with indigenous midwives across North America. Toward the end of our conversation she describes attending the National Council of Aboriginal Midwives gathering in 2011. “I just balled my eyes out because these women looked like me,” she says. “They understood what it was about—it was about healing their communities. It’s a spiritual path.”