Tewa Women United, a multicultural and multiracial organization founded and led by Native women in the Tewa homelands of northern New Mexico, is committed to building Beloved families and communities to end violence against women, girls and Mother Earth. Alongside programs that address environmental justice, support for survivors of sexual violence, and others, Tewa Women United works toward reproductive justice as a fundamental part of its mission.
Tewa Women United believes that all mothers deserve respect, encouragement and support on their birth journey.
In practice, that means working to increase choices in the birthing experience for low income women of color in Northern New Mexico, a demographic that frequently lacks access to resources that can support maternal-child health and improve birth outcomes. A central element of this work involves expanding the numbers, capacity, and professional standing of doulas in the region, so that more families can experience the advantage of knowledgeable and compassionate advocacy during pregnancy, birth and beyond.
The effort has grown from its early beginnings. In 2003, Tewa Women United encouraged, supported and assisted at the first traditional birth at San Ildefonso Pueblo in over 50 years. This simple but transformative act reflected a desire among many Tewa people and their allies to "decolonize" birth, and led to the Tewa Birthing Project, an effort to reclaim traditional practices and honor Indigenous knowledge. Throughout this work, Tewa Women United has sought to return to the power of women's knowledge and to birth as sacred ceremony.
Yiya Vi Kagingdi, in the Tewa language, means "helper of the mother."
Although the name has changed since then, the impetus has not. Since 2008, TWU's Yiya Vi Kagingdi Doula Project has served hundreds of families in northern New Mexico through doula services, breastfeeding assistance, childbirth education, and numerous other outreach efforts. The project has sought to surround new parents with culturally congruent support to help them access their true voice and desires for their birth experiences and new parenting roles.
"The doulas are doing something tremendous for this community," writes Hope Logghe, formerly YVK Doula Project Coordinator. "They are tending the seeds, carefully and slowly, from which more and more memory can grow. We are only a few generations away from when the people of this land birthed at home with traditional midwives by their side. It hasn’t been forgotten, but we need help with this process of gaining back what has been pushed aside."
To date, Yiya Vi Kagingdi Doula Project has supported more than 30 local residents in the process of becoming certified doulas by hosting trainings from various organizations throughout the United States. These new doulas are now able to serve mothers and families in their own community, guided and mentored by seasoned YVK doulas.
In 2018, Yiya Vi Kagingdi will realize a dream.
Drawing on a multi-year process of reflection, research, and extensive community input, YVK has developed a doula training curriculum and certification program that will be offered locally. Residents will be able to pursue in-depth study while benefiting from the mentorship of practicing doulas. Just as importantly, the accumulated wisdom of the local community, anchored in an Indigenous framework and focused on regional needs, will inform the process of deep personal and professional preparation to serve others in the role of doula.
This presentation explores what we know about birth justice, about the value of doula care within an Indigenous framework, and about the need that exists in northern New Mexico and in similar areas. Centered in a rural Indigenous region where the memory and effects of historical trauma are a part of everyday life, Tewa Women United's Yiya Vi Kagingdi is a model for communities seeking to honor traditional practices around childbirth alongside contemporary medical safeguards. By launching the new doula training program, TWU aims to afford local residents the opportunity to learn to serve their community as birth workers and contribute to a more equitable future for New Mexico's families.
"We have lost a lot of connection and ceremony around our birthing experience. Who held that expertise around birthing? Who was involved in that process? What were the ceremonies? Would changing this make an impact on the trends we were seeing in our communities around sexual assault, substance abuse, and child abuse?" - Dr. Corrine Sanchez, San Ildefonso, Executive Director of Tewa Women United.
WHAT IS BIRTH JUSTICE?
Pregnancy, birth, and the postpartum period are vastly different now than they were formerly experienced in traditional communities. Within the last century, pregnancy came to be seen as a medical condition, and childbirth shifted from the home to the hospital. With the advent of modern reproductive technology, women's wisdom, intuition, and autonomy took a back seat to the authority and requirements of western science.
While these changes cut across cultures, communities of color have been disproportionately impacted by the shift. SisterSong, a nationally-based reproductive justice collective, has written, “Women of color in the US largely experience limited choices due to a system that keeps us in poverty, gives us inadequate education and healthcare, racially profiles and over-polices us, discriminates against us, disparages us, and more. Reproductive justice shifts the conversation from choice to access, because...
"There is no choice where there is no access.”
Given these disparities, what is meant by "birth justice?" According to a 2007 working paper from National Advocates for Pregnant Women, “It is, at a minimum, having access to evidence-based maternity care, accurate information about pregnancy, the risks and benefits of medical procedures, and the agency to choose whether or not to undergo those medical procedures. It is having the power to make those choices and give birth free from fear of intimidation or interference from outsiders for “noncompliance” with medical advice, or because of poverty, race or ethnicity, or immigrant status."
Birth justice "is also having access to culturally respectful labor support.”
For Indigenous people, the history of physical and cultural genocide as a result of colonization has caused irreparable loss and an ongoing legacy of trauma. Many traditional teachings, songs, and ceremonies around childbirth have been stolen or lost. Reclaiming sacred practices, and integrating them into a contemporary setting that returns power to the families, can be an essential part of reproductive justice for some.
"The removal of births from many aboriginal communities has had profound spiritual and cultural consequences, which are difficult to quantify. The loss of traditional birthing practices has been linked to the loss of cultural identity.” ---Midwifery and Aboriginal Midwifery in Canada, 2004
Birth was a sacred and natural process for Tewa people. "Women's intuition, bodies and lives were valued and trusted," the TWU staff shares. "Sacred songs, ceremonies & teachings on parenting were a normal part of life. We drank special teas, ate special soups, we were fed by our communities before and after birth. The new mother was never left alone, & had emotional support all around her."
“In birthing, a family and community are reminded of the everlasting cycle of the natural world: genesis, transformation, and return," writes Patrisia Gonzales. "The concept of regeneration, so crucial to life, birth, and the social reality of communities, is expressed not only in birthing practices, but also in ceremonies, dreaming ways, and purification ways.”
Even when families choose not to incorporate traditional practices into their birth plan, an awareness of the presence and role of trauma in Native communities--historical and intergenerational, as well as immediately experienced--is essential for all who work in health care and related fields. The high rate of violence against indigenous women makes it essential that birth workers adopt a trauma-informed perspective and cultivate approaches that foster healing, not further harm.
Tewa Women United deeply understands the need to acknowledge and address the impact of trauma. At the same time, TWU and its many allies recognize, honor and build on the fundamental strength and resiliency that Indigenous people, both individually and culturally, possess. These qualities form the foundation for the Yiya Vi Kagingdi Doula Project, and are invested from the start in the Doula Training and Certification Program curriculum.
The vital and unwavering vision of this effort is based on a return to a tradition that draws women from within communities to become doulas, training them in the knowledge, skills and resources they'll need to support their peers, and mentoring them toward independence and collective advocacy for the good of families in the region.
Doulas who work with Tewa Women United see themselves as "pollinators," advocating and sharing information, not exerting force of opinion or imposed judgement.
WHAT DO DOULAS DO?
"My doula was respectful of my cultural beliefs and I felt really good. It helped a lot that we were able to connect and be friends. I was able to share more things with her that way. Coming from a pueblo, it’s all like a family. When you feel a bond with somebody, it brings that closeness. We are interdependent. We take into consideration how our actions will affect everyone. I was happy because my doula was open to being a part of our family."
A doula is someone who supports a woman physically, emotionally, and spiritually through her journey to becoming a mother.
While midwives and medical personnel often play a defined and significant part in promoting healthy childbirth, doulas have a more porous, more mother-centered role on the birth team. Some of the ways a doula might help include:
- providing peer education on pregnancy, childbirth, and postpartum;
- assisting mothers-to-be in finding health and community services;
- helping to create a birthing plan;
- providing compassion, knowledge and support during pregnancy, childbirth and postpartum;
- helping the birthing mother to understand midwifery practices, hospital policies, and medical procedures;
- supporting breathing, relaxation, pain-coping skills, and decision making during labor;
- supporting the mother-baby relationship;
- helping with breastfeeding before and after birth; and
- remaining available at any time to discuss questions, concerns, and emotions.
Studies show that, as IWH Director Jessica Riggs put it: "Just having another person in the room [during a birth] makes a difference." In fact, continuous support during childbirth is universally acknowledged to result in improved birth outcomes. In 2014, researchers calculated a potential cost savings of $973 to Medicaid-reimbursed births with a doula present versus births absent a doula.
But doulas do much more than just show up. The depth and nuance of what it means to be present—for a particular client, in a particular setting, with specific concerns or desires; and given the historical background, material disparities, and variations in birth plan, team, and outcomes among clients—gives some sense of the magnitude of the role.
To be a doula is to bear witness to the special moment of birth. Having helped the mother prepare in the way that feels right to her, the doula holds space, prayer and intention as a new life comes forward. Doulas advocate for the family to make sure that they understand their options and that their wishes are heard. They honor and support the bonds being formed through pregnancy, birth and postpartum.
And, looking beyond the scale of the family, doulas can impact community health, as well. Jeretha McKinley of Health Connect One writes, "“Don’t look at doulas as one on one providers but as community based health workers who impact a variety of health outcomes. A doula’s impact is more than just sitting in a room when someone is having a baby. Doula care impacts community wellness in many ways. It may reduce poverty, food insecurity, domestic violence, and child abuse." In regions like northern New Mexico, where poverty and other causes lead to pronounced health disparities, the doula's role becomes even more critical.
WHY WE NEED DOULAS
Doulas contribute to positive birth outcomes in myriad ways. While concrete data collection in this arena is still in its early stages, meta-research conducted across the literature by Cochrane Systematic Reviews suggests a decrease in the frequency of medical interventions, including Caesarian births, when doulas are present. Multiple studies report positive changes in such metrics as birth weight, Apgar score, and breastfeeding initiation and persistence.
The women of Yiya Vi Kagingdi believe that "the best start for newborn babies comes when they are born into the watchful eyes of trusted and trained aunties and sisters and grandmothers who really care for them and really have the tools to hold these new mothers and fathers in a good way. By giving these new families the very best guidance about how to gently birth and breastfeed and nurture their new babies, our doulas are helping to pave the way for a healthy bright future."
One mother who worked with a YVK doula shared that "My strongest memory was being surrounded by this lineage of really capable, loving women, with different skills and capacities, ushering us through this sacred passage. It felt like unconditional support... I felt really grateful for how we were able to bring our daughter into the world, and that she could come out with the grounding force of all these skilled people."
Anecdotal accounts confirm that doula support may have lasting positive effects beyond the evident physical measures. Experienced doulas are especially adept at fostering bonding and attachment between parents and newborns, easing the transition from pregnancy to parenting. Their gentle guidance can aid and encourage the developing relationship, and their wisdom and diplomacy can hold space for families to express emotions, make decisions, and create structures to strengthen and sustain them throughout the years to come.
Regional health and income disparities, among other reasons, make doula support especially valuable in northern New Mexico.
There is a profound need for compassionate and knowledgeable birth support in Rio Arriba County, where nearly a quarter of residents live in poverty. In 61% of homes, a language other than English is spoken. Hispanic (71%) and Indigenous (20%) residents form the majority of Rio Arriba's population of 40,000, and a low population density (7 people per square mile) means that rural residents may have to travel long distances to receive appropriate care. Northern New Mexico, as with other lower-income areas, offers fewer options for maternal/child health care than those available in more prosperous regions.
"I didn't think I could afford a doula. Im glad they offered the volunteer option, otherwise I would have missed out on this incredible experience."--YVK client
Many clients report a higher level of satisfaction with the birth experience when assisted by a doula. For those who have previously experienced sexual or birth trauma, this can be especially meaningful.
For incarcerated parents, young parents, single mothers, LGBTQ families, or a wide variety of others who may not fit comfortably into the dominant culture's social norms, a trusting relationship with a caring and nonjudgmental advocate can have a positive influence on birth outcomes and subsequent parenting attitudes.
Statewide, nearly a third of New Mexico women receive delayed or no prenatal care. Lack of insurance is a perennial problem in northern New Mexico. A second obstacle concerns the availability of caregivers. More than 60% of women in New Mexico live in medically underserved areas; both Rio Arriba County and Taos County are classified as such, and as counties of persistent poverty. The caregivers that do work in the region may carry an increased caseload, and may have fewer resources to draw on for high-risk clients or those with special needs.
These facts have dire consequences. Maternal deaths in New Mexico, at 18.5 per 100,000, are 40% higher than the US average of 13.3 per 100,000, and 60% higher than the national goal of 11.4 per 100,000. But, according to the American College of Obstetricians and Gynecologists (ACOG), half of maternal deaths are preventable.
YVK doulas have been providing informed, compassionate and non-judgmental services to pregnant and parenting families for over a decade.
Since 2008, doulas from TWU's Yiya Vi Kagingdi Project have been present at the birth of well over one hundred children. They have aided many more families through outreach services, conducting community classes in childbirth education, baby wearing, pregnancy and postpartum yoga and myriad other topics. YVK doulas have hosted parents' circles and support groups, held workshops on topics like herbal remedies for seasonal colds and informational events around issues such as gender-based violence. They have addressed the state legislature in support of New Mexico's families. They've been active in coalitions to secure rights and draft policies to benefit women, children and families.
PREPARING FOR THE FUTURE
TWU's Yiya Vi Kagingdi Doula Training and Certification Program launches in 2018
In 2016, after years of supporting local residents through external doula training programs, TWU YVK embarked on the creation of an in-house doula training program. The team invited community members—practicing doulas, midwives, and doctors; community providers who serve in other contexts; educators; parents who have experienced doula care; representatives of local organizations and agencies; and others—to participate in the process as part of a Curriculum Advisory Committee.
The meetings of the committee provided a useful real-world perspective on the impact doulas can have and the issues they are likely to encounter while serving in northern New Mexico. By relating personal experiences, sharing information about resources, discussing cultural traditions, offering practical advice, making fruitful connections, and conveying strong support for the program, their input made a meaningful contribution to the Yiya Vi Kagingdi Doula Training Project curricular content.
"The support we provide isn’t just related to pregnancy and childbirth – it’s so much more. Doulas need the training and skills to work with issues of substance abuse, neglect, safety and mental illness. We've had to adapt the way we look at and address these issues. We couldn’t spend time just focused on breathing once we found that women aren’t safe."
Building on the extensive knowledge base of the TWU YVK staff and national expert Peggy O'Mara, the team developed a comprehensive curriculum to be delivered to a pilot cohort in 2018. The Tewa Women United Yiya Vi Kagingdi Doula Training and Certification Program guides doulas to be passionate about birth justice and prepared to provide services within Northern New Mexico context. The Indigenous foundation of YVK Doula Project, with its vision of reclaiming birth wisdom and its emphasis on birth justice, forms the bedrock for the curriculum, and community input is apparent in every session.
Tewa values and community needs are fundamentally entwined in the program's philosophy. YVK trained doulas will respect birth as a ceremony; circle around the whole family; honor the sacredness in all things; attune to the qualities of relationships; support a culture of consent; protect the right of parents to birth in the way of their choosing; and acknowledge Women as the First Environment.
YVK doulas will learn to bring compassion to every stage of creating a family, from conception to the transformation of parenthood. They will learn about the use of local foods and herbs to support health and wellbeing. They will learn to develop enhanced listening skills, and practice skills that allow them to dive into difficulty and complexity. YVK trained doulas will understand and be sensitive to the diverse experiences of families including: young parenthood, LGBTQ identities, poverty, trauma, substance dependency, domestic/sexual violence and stigma. Their role will be to share knowledge and encourage the client in self-advocacy and empowerment, serving indirectly as a change-agent with respect to reproductive justice.
While many other doula training programs rely heavily on self-study and limit themselves to a single in-person weekend session, the YVK training is intensive, taking place over the course a year and meeting for seven weekends. Doulas will have access to mentorship throughout the training and certification process, and their cohort will provide a circle of fellow birthworkers with whom to find connection and support.
""We hope to be a model for other communities to create trainings for doulas that are culturally relevant to their local people. We will continue to create positive social change one birth at a time, and to provide opportunities for women to enhance their own lives by contributing to the community as a trained YVK Doula."
Tewa Women United plans to launch the Doula Training Program with a small initial cohort in fall 2018. To learn more about this, please email doulas@tewawomenunited.org, or call the office of Tewa Women United, (505)747-3259 ext 1206.
Deepest thanks to all the families who have shared their stories, their words, and their images with us.
This presentation was created by i2i Institute for Tewa Women United