By Melissa Harley, CD/BDT(DONA), LCCE

November is Native American Heritage Month and LCCE Melissa Harley shares some interesting facts about the rich culture included in some of the varied childbearing year traditions observed by some of the U.S. tribes. There are many different tribal nations, and each one has their own ceremonies and practices around pregnancy and birth. Beautiful and fascinating stories that are each unique in their own right. This post is part of Science & Sensibility's 'Welcoming All Families' series, which shares information on how your childbirth class can be inclusive and welcoming to all. - Sharon Muza, Community Manager, Science & Sensibility.

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As childbirth educators of today, we must strive to have a connection to childbirth of yesterday. As educators, we should continually be looking for ways to be welcoming of all cultures, customs, and traditions in the classroom setting and when working individually with students. In order to achieve these goals, it is helpful to better understand how such traditions played out in years gone by. So often, we look at birth from a very telescopic lens of the past (singling out one or two cultures) rather than looking at history from a more wide panoramic view point. As we strive to embrace cultural diversity, we should continue to explore populations that are perhaps a little less known. Have you considered the culture of Native Americans in childbirth and how the past compares to childbirth in our society now? According to the Centers for Disease Control and Prevention (CDC), currently, there are roughly 5.2 million American Indians and Alaska natives spread throughout 565 federally recognized tribes in the US. (CDC, 2013) Let's take a look at some of the commonalities that we have with our Native American ancestors and learn a little together about being welcoming, helpful, and inclusive of Native Americans in our classes today!

Native Americans and Pregnancy

Although there are some differing opinions regarding historical pregnancy and birthing traditions of Native Americans, according to historian Ellen Holmes Pearson, PhD, Native Americans were known to take exceptional care of themselves during pregnancy. Similar to today, maintaining good health throughout pregnancy often led to an uncomplicated labor and birth. Much regard was taken to ensure that a Native American mother's health needs were met in a way that would support the nutritional and physical needs of both mom and baby. From the website teachinghistory.org, Dr. Pearson states 'During their pregnancies, women restricted their activities and took special care with their diet and behavior to protect the baby. The Cherokees, for example, believed that certain foods affected the fetus. Pregnant women avoided foods that they believed would harm the baby or cause unwanted physical characteristics. For example, they believed that eating raccoon or pheasant would make the baby sickly, or could cause death; consuming speckled trout could cause birthmarks; and eating black walnuts could give the baby a big nose. They thought that wearing neckerchiefs while pregnant caused umbilical strangulation, and lingering in doorways slowed delivery. Expectant mothers and fathers participated in rituals to guarantee a safe delivery, such as daily washing of hands and feet and employing medicine men to perform rites that would make deliveries easier.'

In addition to caring for the body in pregnancy, it was extremely important for Native Americans to care for their mind and spirit. In the Navajo communities, pregnancy and childbirth were approached as a spiritual event. Much time and effort was spent making sure that the mother had a positive pregnancy. Ceremonies in the Navajo community in general were very important. Some ceremonies could last for days and days. It was only natural that the tribes would hold Blessing Ways for expectant mothers. Unlike many other Navajo ceremonies, the Blessing Way was not held to cure a sickness, but rather to invoke positive blessings and avert misfortune. Contrary to current use of the Blessing Way, the traditional Navajo tribes used the Blessing Way for more than just pregnancy and birth. The ceremony was also used for blessing of the home, and also to enhance good fortune through the kinaalda (girl's puberty rites). Native Americans today that wish to connect with their heritage during the childbearing time often do so by being very careful about their spiritual surroundings. It is quite important for mothers to keep their thoughts positive, and to maintain a climate of peace with those around them. It is also suggested that mothers should avoid arguing with others during pregnancy, or to allow bad thoughts to enter their minds.

Native Americans and Birth

Native Americans were known to give birth in a simple way, with only other women in attendance as men were never allowed to see a woman give birth. In general, Indian women likely gave birth without much assistance at all. A midwife would at times attend the birth, along with other female family members from the tribe. In very simplistic style, the baby would be birthed directly onto the leaves below the mother who used upright posturing for birth. The baby would be welcomed by the earth, rather than by man's hands.

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To hasten labor and reduce pain during the birth, tribes sometimes utilized herbal remedies. Cherokees made a tea with Partridgeberry and started consuming it several weeks before the birth. They were also known to use Blue Cohosh to promote rapid delivery and to speed delivery of the placenta. To relieve pain, the Cherokees turned to wild black cherry tea made with the inner bark from the tree. The Koasati tribes made a tea of the roots from the plant of cotton that reduced pain for birthing women.

In some tribes, rituals to 'scare' the baby out were utilized. An elder female would often yell 'Listen! You little man, get up now at once. There comes an old woman. The horrible [old thing] is coming, only a little way off. Listen! Quick! Get your bed and let us run away. Yu.'

Another common tradition in birth was the use of the rope or Sash Belt thrown over tree limbs for the mother to hold. The traditional Navajo sash belt is made of intricate-colored sheep wool that is woven upon a wooden loom. Some hospitals today near Indian reservations have a Sash Belt installed in the ceiling for mothers to use.

Connecting the Past and the Present

While the mothers of today might not fear that eating speckled trout will cause birthmarks, most do still have concerns and want to take steps to ensure a healthy baby. We see mothers avoiding large amounts of caffeine and high mercury fishes. While we don't often see our students choosing to give birth without much assistance onto the leaves of the trees, many do still choose upright posturing. We also see a desire at times to hasten the labor, and some mothers turn to herbal or medicinal means to help that happen. As childbirth educators, we can at times be of comfort to our students as they prepare for the healthiest birth possible. We can connect the past with the present, allowing parent's space to explore the traditions within their cultures while also honoring current evidence and research based maternity care. As I say in my classes, while pointing students to the evidence associated with Healthy Birth Practice #5, those mamas from long ago knew something intuitive: that using upright positions for labor and birth made a difference!

Health Services for Native Americans Today

If you live and work near an Indian reservation, you may be familiar with Indian Health Service(IHS). IHS was established in 1955 with a goal to raise the health status to the highest possible level for Native Americans registered in a federally recognized tribe. As childbirth educators, some of our students may seek medical attention at one of the nation's 33 IHS hospitals or 59 IHS health centers. Dr. Michael Trujillo, past director of IHS states in regard to IHS, 'The values of human dignity, honesty, compassion, coupled with shared values of many different tribes and cultures, that have come to be spoken of as 'Indian values, of listening, mutual respect, dignity, and harmony must always be at the forefront of what we do and how we do it. We must be professional in all our actions.'

This year, in accordance with the Affordable Care Act, the Indian Health Care Improvement Act was permanently reauthorized. This provision in the current law will increase access of quality health care to Native Americans near IHS facilities as well as those who do not live near an IHS facility. The ACA includes some very specific benefits that will impact American Indians and Alaskan Natives. Tribes across the country are encouraging members to become familiar with the new laws, and to evaluate how the provisions can increase access and affordability to quality healthcare for their members.

Connecting our Native American clientele with quality prenatal care is extremely important. Consider the following statistics from the CDC:

• American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites.
• American Indian/Alaska Native babies are 2.2 times as likely as non-Hispanic white babies to die from sudden infant death syndrome (SIDS).
• American Indian/Alaska Native infants were 2.5 times as likely as non-Hispanic white infants to have mothers who began prenatal care in the 3rd trimester or not receive prenatal care at all.

What's a Childbirth Educator to Do?

As we strive to better serve the mothers of today, first and foremost, we should recognize the importance of the history that First Nations people bring to birth. Many Native Americans today still practice customs and traditions from years gone by. If you currently service a population that includes American Indians and Alaskan Natives, then you may already be aware of the customs in your area.

© Ursula Knoki-Wilson

To help Native Americans feel welcomed in class, ensure that visuals of contemporary Native Americans are included in your curriculum. You might also offer a segment in your comfort measures class that specifically addresses the customs from that population. In general, keeping language inclusive of a variety of cultures can also lead to a sense of acknowledgement and acceptance. Simply recognizing that you are aware of different cultural traditions in class can lead to parents feeling more comfortable, thus opening a door for sharing and further education.

Regardless of your target clientele, it would be helpful for a childbirth educator to become familiar with the many different traditions surrounding childbirth in the cultures around us. A quick internet search can lead to a wealth of information that might be helpful in class. As with any tradition or culture that you are not familiar with, education is power! If you are on or near a reservation, perhaps reaching out to the IHS facility nearby might be an option. Some facilities have staff members that hold workshops and courses to help the people within their tribes stay connected with tradition. In addition, it might be helpful to inform area IHS facilities that there is a childbirth educator nearby who is sensitive to the mental, physical and spiritual needs of the tribe members. It would also be advisable for childbirth educators to become aware of the provisions in the ACA for American Indians, as to be prepared with resources, if you are asked any questions in regard to healthcare for American Indians. As childbirth educators, we are in a unique position to encourage our clients to seek quality prenatal care. Working together with the families in our classes, we can positively impact the infant mortality rates among these populations by educating the families about safe and healthy birth practices and the options available to them.

Ultimately, it is important to keep our space open for all cultures and honor the individual traditions of the parents that attend our classes. By becoming more educated and sensitive to the cultures around us we can better serve our clientele as a whole. And for our Native American students, I'll leave you with this blessing:

Earth's Prayer
From the heart of earth, by means of yellow pollen blessing is extended.
From the heart of Sky, by means of blue pollen blessing is extended.
On top of pollen floor may I there in blessing give birth!
On top of a floor of fabrics may I there in blessing give birth!
As collected water flows ahead of it [the child], whereby blessing moves along ahead of it, may I there in blessing give birth!
Thereby without hesitating, thereby with its mind straightened, hereby with its travel means straightened , thereby without its sting, may I there in blessing give birth!S.D. Gill, Sacred Words

Note: to read more information about the images of the cradleboard welcoming home two generations of families, please follow this link to the Turtle Track organization for the full story. - SM

References

American Indian & Alaska Native Populations. (2013, July 2). Retrieved November 15, 2014, from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html

Blessingway (Navajo ritual). (n.d.). Retrieved November 15, 2014, from http://www.britannica.com/EBchecked/topic/69323/Blessingway

Holmes Pearson, E. (n.d.). Teaching History.org, home of the National History Education Clearinghouse. Retrieved November 15, 2014, from http://teachinghistory.org/history-content/ask-a-historian/24097

Infant Mortality and American Indians/Alaska Natives. (2013, September 17). Retrieved November 15, 2014, from http://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=38

Knoki-Wilson, U.M. (2008). Keeping the sacred in childbirth practices: Integrating Navajo cultural aspects into obstetric care. [PowerPoint slides]. Retrieved from Naho.ca website http://www.naho.ca/documents/naho/english/IG_Presentations2008/009KnokiWilsonUrsula.pdf

About Melissa Harley

Melissa Harley, CD/BDT(DONA), LCCE has worked with birthing women since bearing witness to the vaginal birth of her twin nieces in early 2002. She is a Native American registered in the Cherokee Nation Tribe (OK) and the owner of Capital City Doula Services in Tallahassee, Florida. Melissa holds certifications as a Lamaze Certified Childbirth Educator, DONA International Certified Doula and an Approved Birth Doula Trainer(DONA). She currently holds leadership positions with DONA International as a Florida state representative, and she sits on both the DONA International Education and Certification Committees.Melissa is a contributor to several birthing publications including the Journal for Perinatal Education (JPE), the Bearing Witness Series: Childbirth Stories Told By Doulas, and the sequel book Joyful Birth: More Childbirth Stories Told By Doulas.Married for 16 years and the homeschool mother of two teenagers, Melissa, values education and a life-long pursuit of learning. Her teaching style is comfortable, fun, and interactive, with an emphasis on leading the learner to have their own 'light bulb' moments. As a childbirth educator and doula, Melissa most enjoys watching women become empowered to listen to their inner voice and acknowledge their own strength to birth. Mentorship and education are both her passions, and Melissa is dedicated to fulfilling those passions by actively facilitating childbirth education classes as well as training and mentoring new doulas regularly. Melissa can be reached at Melissa@capitalcitydoulaservices.com

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