For centuries, Native American communities upheld traditional childbirth practices that enlisted the help of family and friends, midwives and doulas, and other birth workers.
Indigenous communities used oral traditions to pass down knowledge about childbirth, ensuring a safe, healthy, and positive experience for the entire family. This support extended from before birth through delivery and after postpartum.
However, by the 1920s, the Bureau of Indian Affairs disrupted these practices by relocating home and community births to hospitals. Then, in 1955, with the inception of the federal Indian Health Service to manage the health care of Native Americans, birth became a medicalized affair and, more often than not, was directed by white male obstetricians.
Many Indigenous traditions and ceremonies were outlawed, including birth work, and families were separated as Native American children were removed from their homes and placed in Indian boarding schools from the late 1860s until the 1960s. It was the U.S. government’s forced assimilation of Native American children into Western culture. It led to the suppression of Indigenous practices.
Now, however, with the help of Indigenous doulas, birth workers and lactation consultants, many Indigenous communities in Michigan are reviving their cultural practices around pregnancy and familyhood, including traditional birth methods, in an effort to reclaim birthing as a ceremony.
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“Traditional birth workers provide a holistic approach to childbirth, acknowledging the transition from the spiritual to the physical world, incorporating the emotional, mental and spiritual components crucial to Indigenous health,” said Kelsey Wabanimkee, a certified doula who serves as the Community Doula TA Specialist for Miigwech, Inc., a nonprofit based in Wagasking Odawak aki, Little Traverse Bay, Michigan, that prioritizes education, outreach, community development, and direct assistance for Native people in Michigan.
“Birth is an act of ceremony, and it encompasses all of that in honoring our next seven generations and the generations before us,” she explained.
Wabanimkee, a citizen of the Grand Traverse Band of Ottawa and Chippewa Indians and a leader in Anishinaabe family health, said doulas provide non-clinical emotional, physical, and informational support to pregnant people and their families.
In addition, doula-assisted mothers are four times less likely to have a baby with a low birth weight, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding, according to a 2013 study published in the Journal of Perinatal Education.
Interest in doula care as a support for pregnant people is increasing in the United States; according to recent projections by research company Future Market Insights (FMI), it is expected to grow by 6% each year from 2023 to 2033. The growing interest is reported to be highest among BIPOC families living in rural and urban areas.
“It’s essential to reframe the significance of doula care for Native families due to the disconnection of solely Western-based care. We are here to navigate spaces that connect the community; this is the Anishinaabe way,” Wabanimkee said.
Why the return matters
Not only are Indigenous families still impacted by the almost 100-year separation and disruption of their community, but Native Americans face several barriers now when it comes to childbirth in Western-based care, as reported by the National Institutes of Health in 2021. These include reduced access to standard prenatal care and inaccurate estimation of gestational age, which can lead to post-term pregnancies and pre-existing medical conditions.
Recent data show that the mortality rate for Indigenous mothers is almost double that of white mothers.
“Having increased access to Indigenous birth workers is essential to reframe the significance of care for Native families due to the disconnection of solely Western-based care,” said Jamie Hubbard, owner and founder of Sacred Soul Doula and a former breastfeeding peer counselor for the Women, Infants, and Children program at the Berrien County Health Department.
Hubbard is Waganasking Odawa, a citizen of the Little Traverse Bay Bands of Odawa Indians. She works with individuals on their postpartum journey, providing lactation assistance as a certified Indigenous Lactation Counselor and Indigenous Postpartum Doula. Hubbard is also a knowledge keeper who holds teachings and has been taught how to care for these teachings of traditional medicine, herbs, and foods to help her clients “heal the body, spirit, and mind,” she said.
According to the Centers for Disease Control and Prevention, about 25% of maternal deaths occurred on the day of delivery or within seven days after, and 53% occurred between seven days to a year after pregnancy. A 2019 report from the CDC found that mental health conditions and hemorrhage were the leading causes of pregnancy-related deaths among Indigenous people, accounting for half of the known causes with underlying reasons. Ninety-three percent of these deaths were considered preventable.
The most recent data from the Michigan Maternal Mortality Surveillance Program, maternal death reporting in Michigan, reveal the mortality rate for Indigenous mothers is almost double that of white mothers. Additionally, Black mothers are more than 75% more likely to die than white mothers.
Pregnant individuals experience the highest rate of maternal deaths among high-income countries, and according to the CDC, the gap has widened since the 1980s and spiked significantly in the past five years. The state saw a rise in maternal deaths from 2011 to 2020, with a 33.6% increase from 2019 to 2020.
‘We are dehumanized’
Hubbard advocates for the use of doulas as a whole, but especially for Indigenous women, because she knows the issues firsthand.
Hubbard had complications during her first pregnancy that made the birth high-risk, and she said with her second-born child, she was treated as high-risk, “There were no explanations as to what was being done or why,” she said.
She felt that during her experience in the hospital, she didn’t “have a say” in her delivery.
“It’s seen throughout statistics and our own stories that we are dehumanized, and there are cascades of unnecessary interventions and the pathologization of birthing naturally,” Hubbard said. That experience pushed her to become certified in Indigenous birth work and lactation support to help marginalized people.
Traditional birth work fosters more than just birth outcomes; Hubbard explained that the approach to perinatal support focuses not only on the medical aspects of giving birth and being a parent but “also on our cultures and the reclaiming of Indigenous bodies, empowering and connecting the community,” she said.
The lack of accessibility to health care, financial resources, stable housing, and food security exacerbates the challenges faced by Black and Indigenous communities during pregnancy, which can lead to higher risks of pregnancy-related complications and deaths, according to a report by the Michigan Public Health Institute.
Hubbard and Wabanimkee want state officials to make doula care more accessible to BIPOC (Black, Indigenous, and People of Color) communities. Hubbard said breaking into the field is strewn with obstacles, including the cost of training and the state’s guidelines for becoming certified.
“There are significant barriers to accessibility for birth workers and doulas; the state has made it an economic systemic problem; birthing is viewed as a business,” Hubbard said.
Michigan requires doulas to be certified by one of nine approved doula training programs. With input from the Doula Advisory Council, the Michigan Department of Health and Human Services may approve additional programs.
Hubbard said the training organizations are not the best equipped to train doulas who will serve people under Medicaid. The approved organizations mainly train doulas who go on to serve clients who can afford to pay directly out of pocket.
Additionally, the programs may not always include training in cultural humility or trauma-informed care, which are essential for doulas to effectively serve Medicaid enrollees with care and understanding.
Doulas, who provide services to Medicaid beneficiaries, must be registered with the Michigan Department of Health and Human Services (MDHHS) and enrolled as Medicaid providers. Being “enrolled in Medicaid” does not guarantee that a doula is also a provider for every Medicaid Health Plan. For Indigenous people, having culturally competent care throughout the entire pregnancy, birth, and postpartum period goes even further, according to Elizabeth Montez Giras, an International Board Certified Lactation Consultant (IBCLC).
“Indigenous brilliance and practice-based wisdom is not recognized on the clinical side,” said Montez Giras, who is also the community education and lactation clinical lead for Open Arms Perinatal Services and the Indigenous Breastfeeding Liaison for Michigan WIC. She provides lactation support and clinical lactation mentorship to rising lactation professionals of color.
According to the CDC, about 78% of Native Americans (including Native Hawaiians) are breastfed, compared to about 84% of all babies in the country.
Breastfeeding is a traditional practice and the baby’s first food. Montez Giras said it is all connected to reclaiming food sovereignty as Indigenous people.
“I grew up watching my mother breastfeed, which I know is a privilege, and when I had my first child, I thought that giving birth was going to be the hardest part of it.”
A push for fair treatment
But soon after birth, Montez Giras said there was difficulty latching, and now, as a certified professional, she realizes the care she was receiving from the hospital “was dismissive and damaging.”
“I had to push just to receive fair treatment, and I struggled,” Montez Giras said. The experience shifted her perspective on breastfeeding and birthing in a clinical setting.
“Then I attended an Indigenous lactation training and listened to Camie Jae Goldhammer discuss the first time her baby latched and felt the connection with her ancestors. That’s when it changed for me. That’s what was missing; my education had been strictly clinical, not relationship-based, until then.”
The difference, Montez Giras said, is crucial.
“Colonial practices look at even the body as something to extract from,” she said. Milk, for example, is often valued simply for ounces transferred and pounds gained, whereas the Anishinaabe view is much more vast.
“Breastfeeding is a ceremony; the lactating body is an entire universe and ecosystem,” Montez Giras explained.
“The system that is in place is not built to support Indigenous-based methods. It is disconnected from the idea of community-based practices that hold traditional knowledge,” she said. “It’s hard to feel seen and recognized in this system.”
The disparities that Indigenous peoples face are looked at by professionals in the medical field as part of our culture, Montez Giras said, “rather than what has happened and is happening to us.”
“There have been generations of policies separating our babies from us,” Montez Giras said.
Her community’s return to what was lost is part of what will help mothers thrive.
She said reflecting on the separating of babies requires her to spend some time grieving, “but I have come to the realization that our knowledge can never truly be lost because it lives in the land and our spirits.”
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