Gonzales, a certified nurse-midwife, is the co-founder of a burgeoning organization working to renew cultural birth knowledge and reclaim indigenous sovereignty of women’s health. The Changing Woman Initiative is a collective of like-minded women who plan to open the first Native American Birth Center.
“Think about it like a ceremonial space,” Gonzales said of the center, which is still in planning stages. “I envision a birth center where you feel comfortable practicing ceremonies, burning cedar or speaking to the baby in the Native tongue. It’s a place where you don’t have to ask permission.”
The initiative is named after the Navajo legend of Changing Woman, who represents life, fertility and changing seasons. Ceremonies dedicated to Changing Woman are performed to celebrate puberty, weddings and childbirth.
Gonzales is using the concept of Changing Woman to appeal to Native women who for decades now have taken a passive role in childbirth. Before birth transitioned from home to hospital, Native communities embraced traditional midwives who take a holistic approach to reproductive health.
“If you think about pregnancy and birth, those are the times that women want to make changes to have healthy children,” Gonzales said. “We’re always talking about walking the corn pollen path, the idea of living our daily lives with intention, with prayer and ceremony, so Native birthing is incorporating these practices into prenatal care.”
Gonzales, 35, launched the initiative in response to her frustration at an apparent lack of options for Native women giving birth in hospitals. After earning a bachelor’s degree in nursing, Gonzales went to work as a labor and delivery nurse where she witnessed doctors treating childbirth with a physiological approach.
“They looked at pregnancy as something you have to manage, like a disease,” she said. “That’s not how we as indigenous people view birth.”
Gonzales went back to school and earned a master’s degree in nurse midwifery with a focus on women’s health. She now works as a nurse-midwife at a women’s clinic in Los Alamos, New Mexico, where she caters her care to each woman’s individual needs.
It’s a model of care Gonzales wants to extend to all indigenous women.
“I spend a lot of time educating women about the normal changes of their bodies and ask them to set the stage for their birth experience,” she said. “Native women often don’t ask questions. They have no plan, no initiative, no process. They just go to the hospital and have the baby. Native women don’t know they have options.”
Indigenous childbirth today is a far cry from what it was two generations ago, said Christina M. Castro, a Ph.D. student at Arizona State University’s School of Social Transformation. Castro, who hails from the Jemez and Taos pueblos of New Mexico, is an advocate of “reproductive justice” who points to the effects of colonization on indigenous women’s bodies.
“Starting with Spanish colonization, the Catholics saw the sexual power that our women had, and of course that was one of the first things they wanted to eradicate,” Castro said. “Moving into assimilation policies, you really start to see these layers of stripping not only the female wisdom, but also the places and spaces we held in our communities. We still have the same roles. We’re still mothers and caretakers, but somewhere along the way we have lost the ability to really connect with that inherent knowledge of our bodies.”
When Castro’s mother was born in a home with a dirt floor in 1955, traditional midwives attended, she said. But when Castro herself was pregnant in 2012, she got the “crazy eyes” when she asked for a similar experience.
Castro advocates for a Native American birth center as a way to “reclaim our spaces, our bodies and our voices.”
“A birth center takes you out of the medicalized setting,” she said. “You can go to a birth center and have a space that’s uniquely indigenous, a space to have our sage or songs, a place you don’t have to worry about whether that’s OK.”
The Indian Health Service has employed nurse-midwives since 1969 when the first one was assigned to a remote village in Alaska, according to a 2008 publication from the American College of Nurse Midwives. Yet modern health care systems tend to complicate the birthing process, said Jane Dyer, a certified nurse-midwife and region 6 representative for the ACNM. Region 6 includes the Indian Health Service and tribal affiliate.
More than half of Native births occur in rural settings, said Dyer, who worked as a nurse on the Navajo Nation in the late ‘70s.
“They’re called health care systems for a reason,” she said. “They’re very complex and they’re trying to provide safe care to a whole variety of people and what sometimes gets lost in those challenges is what is important to an individual. How does the individual want care provided and how do they want to participate in that care?”
Prenatal and delivery care can present specific challenges, especially among populations with specific beliefs or traditions, Dyer said. Midwives, who often deliver at hospitals, can offer more culturally sensitive care for Native women—and help ensure healthier mothers and babies. Native midwives, Dyer said, offer the best of both worlds.
“If you have providers who don’t speak the language, don’t understand the culture, women are not going to access care as early as they should,” she said. “We know that patients receive and perceive better care when they’re talking to somebody who is of their community. People keep their appointments, they follow the advice they are given if they’re being cared for by someone in their community.”