Pregnant Indigenous women who wish for their children to be literally born into their culture, guided by the hands of a midwife, can often face legal and linguistic obstacles—a problem that transcends national borders.
In Mexico and Peru, women who receive health services have been threatened with loss of access to social assistance programs if births are attended by traditional Indigenous midwives rather than doctors. Indigenous midwives are also prohibited by law from filling out birth certificates.
Many young Indigenous women in these countries do not speak Spanish, which can create a cultural barrier with medical practitioners that is never felt more intensely than during pregnancy and birth.
“Imagine yourself in one of the most vulnerable times of your life, when you are about to deliver, in a room with strangers,” says Zaida Bastos, director of the Development Partnership Program at the Primate’s World Relief and Development Fund (PWRDF). “You don’t speak the same language…. It can really make the experience of birthing the most traumatic experience.”
Similar trauma is often experienced by Indigenous women in Canada. Cheryllee Bourgeois, a midwife of Cree-Métis background and assistant professor in midwifery education at Ryerson University, points to the federal government’s evacuation policy, in which pregnant Indigenous women are required by law to travel to cities they may have never visited in order to deliver.
“Sometimes they’re coming into cities where they don’t speak the language at all,” Bourgeois says. “They’re meant to live by themselves, maybe sometimes in a hotel, maybe sometimes in a group home, just waiting to give birth to their babies so then they can fly home. Sometimes they’re also leaving children at home while that’s happening.”
For these women, Indigenous midwives, who offer culturally appropriate guidance through pregnancy and birth by drawing on traditional knowledge, can make all the difference.
Earlier this year, Indigenous midwives from Canada, Mexico and Peru came together for two gatherings as part of a three-year pilot project, in which PWRDF is providing more than $100,000 to facilitate the exchange of knowledge by midwives in all three countries.
Almost 100 midwives travelled to Peru for the first gathering in April, which took place in Lima and Ayacucho. A second meeting occurred in August in Mexico, with midwives meeting in Oaxaca, Juchitán, Salina Cruz and San Mateo del Mar. At the time this article was written, a third gathering was planned for October in Toronto.
Midwives who attended the events belonged to three PWRDF partners representing Indigenous midwives in each country: Ryerson University’s Aboriginal Initiatives (Canada); the Indigenous women’s organization Kinal Antzetik (Mexico), and the Centre for Indigenous Cultures of Peru, or CHIRAPAQ.
Representatives of the three organizations had previously met at international gatherings of midwives, including in Guatemala in 2015; in Toronto during the International Confederation of Midwives Congress in 2017; and in New York during the annual sessions of the United Nations Permanent Forum on Indigenous Issues in 2017 and 2018. But many perceived a need for a different kind of setting, PWRDF Canadian Indigenous Communities and Latin America-Caribbean Development Program coordinator Jose Zarate recalls.
“There were already those [previous] encounters,” says Zarate. “But then they said, ‘It’s time for us to meet [in] our homes, so you can meet our people and [learn our] culture or traditions.’”
As early as 2014, PWRDF had begun researching institutions that could serve as potential partners for a program focused on Indigenous maternal health. The strong track records of Ryerson’s Aboriginal Initiatives, Kinal Antzetik and CHIRAPAQ led to their selection as partners for PWRDF’s Indigenous Maternal Health and Midwifery Practices pilot project.
“We made the decision, ‘OK, this is a valuable project for us to support, to stand behind, and it falls in line with PWRDF priorities of supporting Indigenous people in their journey of recovery and protection of their cultures,’” Bastos says.
The main goal of the Indigenous midwifery project is to facilitate dialogue and communication between the three organizations and help them learn from each other, provide a broader context for their own work as midwives and envision new ways forward.
At the gatherings in Peru and Mexico, midwives participated in a range of activities with the help of translators. Workshops gave midwives the opportunity to share their own experiences and exchange methods for improving maternal and infant health. Examples included women going through various clinical scenarios and discussing how to manage them, or talking about the preparation of different plants used in childbirth.
In other cases, midwives exchanged hands-on learning tools, such as rings made out of traditional materials, to help teach the concept of cervical dilation.
Bourgeois, who attended both events, describes the meetings as a “great experience” that gave midwives an opportunity to share resources and support each other in their work.
“It’s been really quite amazing to connect with Indigenous midwives from both Mexico and Peru,” Bourgeois says. “It’s very interesting that the challenges are actually very much the same.
“They will manifest in different ways, and the long-term effects can be quite different. But the actual issues themselves are really the same, which are criminalization [of midwives], the lack of ability to actually register births, education, and having Indigenous knowledge and Indigenous education recognized by local authorities.”
Along with legal obstacles that deter the presence of Indigenous midwives, cultural differences can increase trauma felt by Indigenous women during pregnancy and while giving birth.
Many Indigenous communities have traditionally seen birth as a communal experience in which women are supported by the presence of their families. By contrast, many women are now compelled to leave their communities and give birth in large hospitals where they may face discrimination.
“There is a tendency of making the birth a medical issue…. Even in Western society, there was a time when birthing was bringing the family all together, being there for the joyful moment,” Bastos says. “By medicalizing it, taking the woman away from their community, they are re-traumatizing someone that has already been taken away from their own culture, their own traditions.”
At the Mexico gathering, attendees heard a story from a Peruvian midwife about a young Indigenous mother-to-be from a rural area, who was taken to a hospital by a professional midwife or partera. The hospital refused to accept the woman, who was going through labour at the time, because she was “dirty” and not wearing any shoes—telling her to clean herself before they would provide any treatment.
Bastos views such discrimination as a remnant of colonial behaviour, which affects Indigenous people throughout the Americas, and as a human rights issue. “What our partners are trying to say to the medical institutions is, ‘Make your services receptive and culturally sensitive to the women that are not from your own background,’” she says.
A United Nations fact sheet on Indigenous Women’s Maternal Health and Maternal Mortality, published during the 2018 permanent forum on Indigenous issues, indicates that Indigenous women and girls experience significantly worse outcomes in maternal health than majority populations, including higher rates of death during pregnancy and childbirth.
The National Collaborating Centre for Indigenous Health, a publicly funded organization established by the Government of Canada, noted in a 2014 report on Indigenous maternal health in B.C. that “having women leave their communities to give birth has been linked to increased perinatal morbidity and mortality as well as increased anxiety, stress, and preterm delivery.”
Pointing to such research, Bourgeois says that Indigenous midwives who provide “culturally safe care in pregnancy” are not just “a nice thing to have. Providing culturally safe care to an Indigenous person actually improves health outcomes.”
The value of Indigenous midwives’ traditional knowledge has been increasingly recognized by “mainstream” Western medicine. One growing trend in the United States and Canada: classes and workshops teaching techniques involving the rebozo, a long piece of cloth worn in Mexico, to help babies pass through the birth canal and prevent unnecessary C-sections.
Bourgeois, however, sounds the alarm at those who profit from traditional practices without crediting Indigenous midwives, which she describes as a form of appropriation. She describes such individuals as “commodifying Indigenous knowledge” while “the people where the skills originate don’t actually receive any sort of benefit from it.”
Bastos concurs. “There is kind of a gradual stealing of this best practice from Indigenous midwifery without acknowledging,” she says. “It’s time that the world knows that this is a contribution of Indigenous people, that Indigenous midwifery is not just part of the birth itself—it’s a process that brings a community together.”
Based on her experiences in Mexico and Peru, Bourgeois plans to incorporate some of the knowledge gained into her teaching at Ryerson.
She also hopes for a curriculum exchange to help midwives in all three countries share notes and improve how new midwives are taught, and to improve advocacy for midwives at the national and international levels.
“I think that one of the most important pieces of this [program] is that it’s Indigenous midwives working with other Indigenous midwives,” Bourgeois says. “I think that that’s actually a real strength of the program, and something to be really proud of.”
She adds, “As an Indigenous midwife working in a system where your knowledge and your approach is not always valued or is questioned quite a bit, it’s really helpful to be able to see examples of other Indigenous midwives in other places that are really supported by the community.”
For PWRDF, which typically funds projects in three-year cycles, a final report is expected in 2020 that will evaluate outcomes and lessons learned from the Indigenous midwifery program and determine whether the project will continue.
In facilitating knowledge sharing between Indigenous midwives at Ryerson, Kinal Antzetik and CHIRAPAQ, Bastos sees PWRDF’s role as part of a larger effort towards the recognition of traditional Indigenous knowledge in maternal health.
“PWRDF really looks at support of these three organizations and the work that they are doing as the right of Indigenous peoples to retain their best practices and be acknowledged—not as folkloric, but as part of humanity’s contributions towards the universal culture of birth.”