Midwifery inscribed on the Representative List of the Intangible Cultural Heritage of Humanity

During a home visit recently, a new mom described how calm and simple her birth was as she gazed dreamily at her sweet, new baby nursing. She shared that she’d opted to be induced, and I don’t know if my eyes narrowed, or my energy changed, or if I inadvertently showed some judgment or discomfort on my face, but she quickly defended her choice.

Just in general, I often share about why after my first birth in the hospital, I opted for subsequent home births attended by midwives, how I caught my son by myself, my natural-term breastfeeding experiences, because I am proud of those things. Sometimes, personal approaches, choices and experiences can be construed as indirect judgment upon those who have divergent experiences. That’s how I was interpreting or reading into this interaction. 

Around the time I’d gone to visit this dyad, I saw the graphic, as I’m sure many of you may have, of a sketched pitocin bag and text that reads: “Holidays are not a medical reason for induction.” Indeed not! In the case of this mother, she was well-informed and she felt in control of her decision about how she would birth her child. Where there is autonomy and informed choice, there should be no judgment or scrutiny.

Home birth scene by a 4-year-old

I’ve been exposed to several of the faces of the kaleidoscope of reproductive health: as an adolescent, as a birthing patient in a hospital, as a home birther, as someone going through IVF as a prospective gestational carrier, and in all of those experiences, where I felt heard, held, safe, where my autonomy was honored, was in the care of my home birth midwives. 

It’s why I was so pleased to learn that midwifery was recently inscribed on the Representative List of the Intangible Cultural Heritage of Humanity. Securing this recognition is not only well-deserved by the many, many generations of midwives who have supported and continue to support healthy families, but essential in order to safeguard those in the practice of protecting fundamental human rights. 

Please enjoy this beautiful video by UNESCO honoring midwives. 

More to explore 

US women of color increasingly seeking alternatives to hospital births – study

more OUR MILKY WAY COVERAGE ON MIDWIVES

Honoring midwives during Women’s History Month

Alabama birth worker facilitates holistic, sustainable care for families

Taking ‘if’ out of the equation

Skin-to-skin in the operating room after cesarean birth

High schoolers explore human placenta, learn about physiological birth

Happy Birth Day, a new project by Dr. Kajsa Brimdyr

An opportunity for normal birth

Renaissance Woman

Dr. Soo Downe: International Breastfeeding Conference presenter Sneak Peak

LCTC participant rewrites cultural norms with “Afrofuturist healing modalities”

Creative solutions for facilitating traditional Navajo birth

It was a whopping 102 degrees during the day with plummeting temperatures at night in Shiprock, New Mexico on the sacred land of Navajo Nation. The soon-to-be new parents’ camp was set up completely off grid with no running water or electricity.

Indigenous Doula, student homebirth midwife, and New Mexico Doula Association birth equity co-chair Natasha Bowman and her colleague Indigenous Doula and the Executive Director for The Navajo Breastfeeding Coalition Amanda Singer, CLC got to chatting about how they could best serve their client who desired a traditional Navajo birth under these conditions.

Considering their own well-being and the safety of their clients, Bowman and Singer initially joked about hauling Bowman and her fiancé LaDarrell Skeet’s fifth wheel out onto the land. But Skeet helped make it a reality.

The team was able to set up a mobile birthing suite for the new family and their care team complete with air conditioning, clean water and a bathroom. What’s more, the certified professional midwife attending the birth brought along her small trailer too.

“When we do births on the Navajo reservation, we have to think outside of the box,” Bowman explains.

Bowman, who has always been interested in labor and delivery, realized while working with the University of New Mexico’s Birth Companion Program, the lack of Indigenous birth workers. During one training, in a roomful of 40 participants, three were Indigenous.

“I was shocked,” Bowman says. “There has to be a change. There has to be more Indigenous birth workers.”

Later, Bowman attended another training with the Changing Woman Initiative, where she first met Singer. Since then, they’ve been realizing their vision of more Indigenous doulas and birth workers.

Bowman and her partners are continually learning the traditional Navajo ways of birthing and bringing those rituals to their clients.

“Some [clients] are for it, and some are against it because they have always been told they should be birthing in a hospital,” Bowman begins.

She goes on to explain that some of her clients have been scolded and ridiculed by pediatricians, other health care providers and even family and friends for planning a home birth despite the evidence confirming that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.

Bowman describes some of the elements of traditional birth which include integrating song, herbal remedies, teas and tinctures, and traditional dress in sash belts and moccasins.

“We believe in the exchange of energy and thoughts,” Bowman continues. “Good intentions, pure thoughts, and lots of prayers.”

It is customary for birth workers to tie a bandana over their heads as well as a Sani scarf, sash belt, or rebozo with an arrowhead tucked inside around the waist to protect the reproductive system.

“It is to protect us from the powerful energy the laboring parent is releasing,” Bowman explains. “It is like armor for us.”

Bowman and Singer and their partners are confronting the health realities in their community through other collaborations too. Their funding partners are The Kellogg Foundation, The Brindle Foundation and United HealthCare. Partnering organizations include Indigenous Women Rising, New Mexico Doula Association, Bidii Baby Foods and Saad K’idilyé, a grassroots organization dedicated to providing traditional teachings to the urban Diné communities around Albuquerque, New Mexico.

Last summer, the Saad K’idilyé Diné Language Nest (SKDLN) opened as a  central urban hub where Saad K’idilyé meets with families, babies, caretakers, and its community.

“A language nest is a community site-based language program for children from birth to three years old where they are immersed in their Native (heritage) language,” as described on their website. “SKDLN is a safe, home-like environment for young children to interact with Diné Bizaad speakers, often elders, through meaningful activities.”

Bowman was able to witness the interactions.
“It was amazing!” she exclaims.

Eventually, Bowman says that she and her colleagues would like to create their own Indigenous Doula training with teachings specific to Navajo birth culture.
In the meantime, they’re celebrating National Breastfeeding Month with Indigenous Milk Medicine Week: From the Stars to a Sustainable Future during the week of August 8 to 14. The breastfeeding coalition will reveal a Navajo translation breastfeeding art piece during this celebration.

And while the fifth wheel doula mobile has stirred up great interest within the community on social media, for the time being, there won’t be an expansion of this service. Bowman and Skeet’s fifth wheel remains on the move though, helping keep the birth team comfortable. Follow its tracks by following the Navajo Breastfeeding Coalition on Facebook.

Breastfeeding is part of a continuum. 

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is part of a continuum.

It has been hypothesized that starting around nine weeks of fetal development, the pattern and sequence of intrauterine movements of the fetus seem to be a survival mechanism, which is implemented by the newborn’s patterns of movement during the first hour after birth  (described as the 9 stages)  when skin-to-skin with the mother to facilitate breastfeeding.

Photo credit United States Breastfeeding Committee

This very behavior refutes the idea that breastfeeding is “an adjunct to birth” as it is generally viewed in maternity care settings in America.

Not only are human babies hardwired to progress through 9 stages and self attach to the breast, mammalian bodies are hardwired to produce milk too.

Around 16 weeks of pregnancy, the body starts to prepare for breastfeeding. This phase, called Lactogenesis I is when colostrum begins to be created. During Lactogenesis II, the secretion of copious milk follows the hormonal shift triggered by birth and the placenta delivery. After this phase, milk production must be maintained through a supply-and-demand-like system. [Neville 2001]

Even before a pregnancy is achieved, individuals are being influenced by the infant feeding culture that surrounds them, consciously or subconsciously laying a foundation for how they feel about feeding their own babies.

Pat Hoddinott’s, et al study found that women who had seen successful breastfeeding regularly and perceived this as a positive experience were more likely to initiate breastfeeding.

Exposure to prenatal breastfeeding education also affects breastfeeding outcomes. Irene M. Rosen and colleagues found that women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls.

Photo by Luiza Brain

Mode of birth and birth experiences influence infant feeding too, for both members of the dyad.

A growing body of evidence shows that birth by cesarean section is associated with early breastfeeding cessation.

Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. [Brimdyr, et al 2019]

What’s more, the authors of Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways found “No positive relationships between the administration of synthetic oxytocin and breastfeeding.” They comment, “Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use of synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes.”

Photo by Olivia Anne Snyder on Unsplash

In Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum, author Miriam Labbok takes a detailed look at “the power and potential of synergy between and among organizations and individuals supporting breastfeeding, the mother-child dyad, and reproductive health to increase sustainable breastfeeding support.”

Labbok points out that a paradigm shift on the issues in the reproductive continuum – family planning, pregnancy and birthing and breastfeeding– is needed.

“These are issues that are intimately, biologically, gender linked in women’s lives, and yet ones that are generally divided up to be addressed by a variety of different professional disciplines,” Labbok begins.  “Despite the impact of child spacing on birthing success, of birthing practices on breastfeeding success, and of breastfeeding on child spacing, we are offered family planning services by a gynecologist, birth attendance by an obstetrician or midwife, and baby care by a pediatrician. Having these ‘silos’ of care, each with its own paradigm and priorities, may lead to conflicting messages, and hence, may undermine the search for mutuality in goals, and collaboration.”

One such initiative looking to deconstruct siloed care is the Baby-Friendly Hospital Initiative which includes standards and goals for birthing practices, for breastfeeding-friendly communities, and guidance for birth spacing, in addition to reconfirming the original Ten Steps to Successful Breastfeeding, in recognition that breastfeeding occurs along a continuum.

Source: United States Breastfeeding Committee

1,000 Days emphasizes how breastfeeding fits within the global picture as a crucial part of a whole.

In the U.S. context, the 1,000 Days initiative recognizes comprehensive health coverage, comprehensive guidelines on nutrition during pregnancy, lactation, and early childhood for women in the first 1,000 days, paid family  and medical leave policy for all workers, and investments to ensure parents and caregivers can access good nutrition as solutions to a well nation and a well world.

 

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share with us some or all of your birth stor(ies).

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.