Reclaiming Birth Sovereignty

For Indigenous people of this hemisphere, prior to colonization (and continuing today) we had intricate forms of governance rooted in values, tradition, spirituality, and community wellbeing. Most likely these systems of governance had little to do with pregnancy and birth. With the onslaught of the formation of what is now the United States, however, Native people resist, grapple with, and adapt colonial governance systems in order to exist on our traditional lands. The ways governments intercede is undoubtedly foreign to most Indigenous peoples whose external systems did not regulate such personal processes. 

Birth in the United States is heavily regulated by multiple and intersecting government entities, from the provision of reproductive health-care services to health-care providers who oversee the birth process. Due to overt governmental regulation of birth and birth workers, for Native people, the intersection of three different governments (Tribal, state, and federal) renders this issue complex. Most tribal governments today do not regulate reproductive health care nor do they keep their own vital records departments that document births. Rather, most reproductive health care is overseen by either the federal or state governments through Indian Health Service (IHS; itself controlled by the federal Department of Health and Human Services), its contracted health facilities, or through private access to other health systems. 

The first health care provided to Native people was through military doctors and clinics in the early 1800s as laid out through treaties between Native nations and the federal government. Although the U.S. provided subpar health services to Native people throughout the 1800s and early 1900s, what we now know as the Indian Health Service was not organized until the 1950s. Indian Health Service and its expansion as the primary health-care service for Native people has only been in place for the last 75 years. In that time, birth has been put into IHS hospitals or more commonly, hospitals outside of our communities. 

The U.S. colonial system has systematically harmed Native people in a multitude of ways, including disrupting how we birth, forcing sterilizations, and stealing children to attend boarding schools. Through the regulation of medicalized health care, birth was stolen from midwives and traditional knowledge keepers and placed squarely in the hands of Western-educated doctors with little to no knowledge of Native birthing practices. There is now an emergence in the United States, especially in Indigenous and Black communities, of an effort to restore the care of birth to midwives through community-led birth centers and clinics. One example is Breath of My Heart Birthplace, established in 2010 in Española, serving the surrounding communities, including the eight northern Pueblo communities in north-central New Mexico. This Indigenous-led birth center provides a community-care model in which midwives honor the ceremony of birth through compassion, patience, and holistic care of the pregnant person and their family. 

Although many Indigenous midwives have retained, reclaimed, and maintained their birth knowledge, they are forced to decide how they must interact with the various governmental systems in order to continue to serve their communities. In the United States where midwives are categorized as health-care providers, midwives must establish their licensure to practice. The licensure requirements vary from state to state. Currently, tribal governments are not actively addressing the matter of governance over midwives who practice within tribal lands. Rather, most Indigenous midwives who assist with birth on tribal lands do so with licensure from the states. More importantly, Indigenous midwives must decide how to interact with governmental regulations that ultimately do not align with how they provide care for their community. 

At Breath of My Heart, midwives cultivate a relationship with each pregnant person to create trust that will assist the midwives and birth workers in honoring the pregnant person throughout the birth journey. A pregnant person who receives care at Breath of My Heart has the opportunity to be surrounded by family and loved ones during each visit with the midwife. To the extent possible, a pregnant person is able to have a much less intrusive birth experience than they might have in a hospital system. Additionally, a pregnant person and their newborn baby can receive care up to two years after the birth. This wraparound holistic care approach is what makes Breath of My Heart appealing and most culturally aligned to those in the community who want to restore traditional birth practices. 

The United States is experiencing a maternal mortality crisis at staggering rates, especially for Indigenous people. Indigenous people are 2.3 times more likely to die from pregnancy-related causes as compared to white, non-Hispanic people. According to research compiled by Tewa Women United, a Native women-led community-based organization addressing the challenges of reproductive health and justice for Indigenous women also located in Española, in 2011 there were less than 20 obstetricians and gynecologists for every 100,000 people in northern New Mexico. The solution to the Indigenous maternal mortality crisis is within Indigenous communities and with midwives who honor and care for pregnant people in a way that hospital systems will not. Like many midwives around the world, Indigenous midwives and birth workers focus on the wholeness of care of the birthing person, community knowledge, and an intention for healing and restoration of ceremony. 

Birth is a universal truth for all human beings; it is the beginning of our human journey on Earth. It is vital to our reclamation of knowledge, spirit, and sovereignty that we, as Indigenous people, center the importance of birth, midwives, and birth knowledge keepers. We must increase access to culturally congruent reproductive care, break down the barriers for Indigenous midwives to serve our communities on our sovereign land, and transform reproductive governance to be in alignment with Native wisdom and values.