It was 2:30 in the morning when Nicolle Gonzales walked in the door of Leah Kolakowski’s house in Santa Fe, N.M., one night in April. Ms. Kolakowski was in labor with her first baby, a boy, and Ms. Gonzales, a midwife, was there to help deliver him.
Ms. Gonzales went directly to the fireplace to make an offering of cedar, a tree sacred in her Navajo culture.
A homemade altar was set up on the brick fireplace mantel, filled with herbal medicines, sage for smudging and small clay pots to collect the ashes after the dried bundles had been burned.
Ms. Kolakowski, a 29-year-old photographer who is half Ojibwe, had been laboring for about six hours, and Ms. Gonzales could tell something was not right. The pain was all in her back.
“I already knew,” Ms. Gonzales said. The baby was occiput posterior, what is often called “sunny side up.” His head was facing the wrong way—toward the sky. And the back of his head was pushing against Ms. Kolakowski’s spine.
“I felt like I was going to pass out, I was so tired and exhausted, and I couldn’t eat or drink anything,” Ms. Kolakowski said. “It was just excruciating pain.”
She was surrounded by her family—her partner, her sister and mother, as well as a doula from a group called Tewa Women United, which trains indigenous women to assist and support women in labor.
Ms. Gonzales, 39, is a certified nurse midwife who has worked in the field for about 15 years. And she is the founder of the Changing Woman Initiative, a women’s health collective in Santa Fe that aims to renew cultural birth knowledge for a new generation of indigenous women like Ms. Kolakowski.
That night, she and the doula put their skills to work. They tried to turn the baby, maneuvering Ms. Kolakowski onto her side and placing pillows under her knees and behind her back. They got her into a birthing tub set up in the middle of the living room. Ms. Gonzales pressed on her back until her hands cramped. She burned dried sage, the smoke wafting around Ms. Kolakowski as she labored.
“He was just determined to be the way he was,” Ms. Kolakowski said.
After 24 hours of laboring at home, surrounded by family and employing traditional, indigenous practices, she went to a nearby hospital, desperate for relief from the pain.
Ms. Gonzales went with her, carrying out the contingency plan that is always in place for every home birth she attends. She called ahead to the midwives she knew at the hospital, and when they got there she explained to Ms. Kolakowski how the epidural would be administered and how long it would take to work.
“I don’t know if you heard all of that,” Ms. Gonzales told her a week later at her postpartum visit.
Ms. Kolakowski laughed. All she could think about at the time, she said, was, “When is it going to work? When is it going to work?”
The two women were sitting on Ms. Kolakowski’s couch in the same living room where she labored the night of her son’s birth. There were vestiges of the homemade altar still on the fireplace, the ashes from the burned sage now cold. Her baby boy was in her arms.
His name is Waya Ode. The first name means wolf in Cheyenne, her partner’s ancestry. The second means heart in Ojibwe, her own.
Ms. Gonzales was there to check the baby’s height and weight, to make sure he was eating enough and that he was growing. She felt Ms. Kolakowski’s abdomen and asked a stream of questions about her sleep and her bleeding and her breastfeeding and if she was getting out of the house yet.
“You just make it look so easy,” Ms. Gonzales said as she finished taking notes on her laptop.
American Indian and Alaska Native mothers are 4.5 times more likely to die from pregnancy and childbirth-related causes than white women.
But for many Native women it is not. According to 2016 data from the Urban Indian Health Institute, American Indian and Alaska Native mothers are 4.5 times more likely to die from pregnancy and childbirth-related causes than white women. And the U.S. Department of Health and Human Services reports they are 2.5 times more likely to receive either no or late prenatal care. As for their children, the infant mortality rate among American Indian and Alaska Native infants is nearly twice as high as for white infants, according to the Centers for Disease Control and Prevention.
Ms. Kolakowski is striking even a week after giving birth—a week in which she cannot have slept much. She has olive skin, high cheekbones and two thick braids that reach nearly to her elbows. Her arms and legs are decorated with intricate tattoos—a buffalo skull, a crescent moon, constellations and her favorite, her tribe’s emblem, a Thunderbird, on her back. She is wearing a flowing, bright red dress. She is in a good place, but the process of getting there was not simple.
Reconnecting to Tradition
Ms. Kolakowski decided to give birth at home after she passed out at work early in her pregnancy. A coworker rushed her to the hospital, where she was treated for dehydration.
“I didn’t like being confined in bed and had all these IV’s in me,” she said. “I was just like, ‘I hate this.’”
For her prenatal care, she turned to the Santa Fe Indian Hospital; but even that, she said, was nothing like what she felt she would experience under the care of Ms. Gonzales. With her, she felt empowered in a very different way.
“It didn’t feel like something was happening to me,” she said. At the hospital, it was all about the baby. “I mean, that’s important, don’t get me wrong,” she said. “But [becoming a mother] is also a huge transformation.”
And that transformation, for Ms. Gonzales, is a sacred one.
“Those changes in your body are happening, like you’re growing a baby and your breasts are changing. Yes, those things are happening, but there's also this spiritual and emotional thing that’s happening at the same time,” she said. “That’s never really addressed in the Western medical way because they don’t understand those connections the way we do as Native people.”
Early in her career, Ms. Gonzales worked for the Indian Health Service as a nurse, then spent a decade working in private hospitals, and eventually earned her master’s degree in nursing midwifery from the University of New Mexico while working. In 2015 she launched the Changing Woman Initiative, envisioning a birthing center for indigenous women. A few years later, she left her job as a midwife to devote all her time to it.
'Maybe the first thing the baby should hear is the native language of their community.'
While she has yet to raise the funds to open a birthing center, Ms. Gonzales’s practice is growing. At the Changing Woman Initiative’s office, there is a women’s health clinic that provides free, easy access to care, as well as a healer who offers everything from massage and cupping therapy to acupuncture and herbal medicine consultations.
And Ms. Gonzales attends home births in the region for mothers who receive pre- and post-natal care and doula support in addition to healthy groceries from a local co-op.
Changing Woman, or Asdzáá Naadleehi, the center’s namesake, is a sacred creator in the Navajo culture who represents, as Ms. Gonzales put it, transformation. Ms. Gonzales’s goal is to offer women the space to bring back ancient tribal birthing practices and, at the same time, provide much-needed care and information to women who might not otherwise be able to get it.
As she drove from one new mother’s home to the next, Black Belt Eagle Scout’s album “Mother of My Children” played on the stereo and bags full of Ms. Gonzales’s midwifery gear—laptop, thermometer, stethoscope and a baby-sized scale—jiggled in the back of her big S.U.V.
Ms. Gonzales is slight and powerful at once. Her long, black hair hangs straight and her movements —especially when she’s holding a baby—are gentle, like her voice. Black tattoos mark both of her forearms—a cedar leaf on one and the Navajo tree of life, a corn stalk, on the other.
She is a mother of three and says her own experience is what led her to this work.
Despite her mother’s wish that she put her education and career before marriage and a family, she met and fell in love with her husband during college. They married, and by the time she was 20, she was pregnant with their first daughter.
“It wasn’t something that was really supported by my family,” she said. “They were kind of disappointed and thought maybe that, you know, you kind of failed us.” In fact, she said, in Native communities, young motherhood is often not encouraged.
Most doctors who work with native populations are not from native communities.
“It’s kind of like ‘Oh, we have many baby daddies and we’re not going to do anything with our lives and we’re just going to have babies,’” Ms. Gonzales said. “And when I was pregnant with my kids, that’s kind of also how I felt.”
People assumed she did not have a husband, and even doctors treated her accordingly. Through their eyes, she said, “I was just this kind of single, brown woman having a baby that I didn’t know what to do [with].”
During that first birth, little went as planned. She was diagnosed with pre-eclampsia, doctors told her her blood pressure was too high; and, when she finally delivered, they had to use forceps to get the baby out. She tore badly and hemorrhaged afterward.
When Ms. Gonzales was pushing, she asked the doctor if she was doing it the right way, but he did not talk to her. “I had to get feedback from the nurse,” she said.
After her first daughter, she had three miscarriages and two more children, and her understanding of her Navajo culture grew.
“With each of my miscarriages, I went to see a medicine man. He helped restore things and restore balance in my body,” she said. As she learned more about the deity Changing Woman and what it means to become a Navajo woman, she felt more connected to her community and its teachings.
“The world is telling you you’re not important, or, if you’re a brown person, that you’re a burden or that you’re worthless, or you’re not good enough, or even that you’re just property,” Ms. Gonzales said. “I feel like that is constantly reinforced in our Native communities.”
She sees her work as a midwife as a way of reclaiming the beauty of her culture.
She sees her work as a midwife as a way of reclaiming the beauty of her culture.
When she worked in a hospital, she said she tried to make sure that Native families knew they had the power to advocate for themselves.
“You can tell me and the nurses to be quiet when the baby comes so that the first thing they hear is you,” she would tell them. “Or that maybe the first thing the baby should hear is the native language of their community and not a nurse talking to them in English.”
“To me that’s reclaiming,” she said. “That’s reclaiming that space for tradition and culture and language.”
‘Different Forms of Trauma’
According to Christina Novoa, senior policy analyst with the Center for American Progress, that work is especially necessary right now.
“There is a serious crisis in maternal and infant mortality going on in [Native] communities,” she said. “But we’re not hearing as much about them.” In fact, in the last few years, Native women are the only demographic that have not seen a decline in infant mortality, Ms. Novoa said.
Last year, Ms. Novoa released a report that documented the connection between this grim reality for indigenous women and children in this country and the institutional racism they face.
“The United States just has a really fraught and a really long and difficult history dealing with Native Americans,” she said. “The United States was founded on genocide of indigenous populations, forced migration, cultural erasure.”
These traditional, indigenous birth practices should never have been erased in the first place.
Just a few generations ago, Native American children were taken from their families and put into boarding schools. And as recently as the 1970s, the Indian Health Service pushed sterilization of Native American women through force, coercion and misinformation.
“They are different forms of trauma,” Ms. Novoa observed.
Child development experts like Ms. Novoa call these adverse experiences. If they are not addressed in children, they can embed themselves in a person’s psyche, she said, and affect their long-term health and development.
“So all of these things that we’ve seen historically in the United States, all of these assaults, frankly, on indigenous women really can get under the skin,” Ms. Novoa said, “and that has serious implications for their long-term health—including their reproductive potential and their ability to have healthy infants and have a healthy pregnancy.”
For long-time Navajo health care worker Olivia Muskett, the challenges for Navajo women and infants begin long before they are in labor.
Ms. Muskett is community outreach manager for C.O.P.E., or Community Outreach and Empowering Patients, a partnership with the Navajo Nation’s Community Health Representative Outreach Program. The way she describes it, trying to track down the women who need pre- and post-natal care can be like a game of hide and seek.
Despite efforts by I.H.S. and health care workers like the ones she trains, “they’ll come in, they’ll take a pregnancy test and then won’t come back until they’re ready to have their baby,” she said. There are many reasons for that.
Many women have to drive hours to prenatal appointments.
The Navajo Nation is largely rural. Many women have to drive hours to prenatal appointments, which are usually monthly. When a woman is close to term, those appointments are weekly.
In addition, it can take a long time to get in to see a specialist like an obstetrician or gynecologist, Ms. Muskett said, especially for the growing number of women of the Navajo Nation who are being diagnosed with gestational diabetes.
“The clinics are having a hard time trying to make sure they’re reaching out to everyone. They’re having evening clinics, they’re trying to extend their hours, but it’s really difficult,” she said. “You’ll see some of the women, they’ll just leave because they don’t want to just stay and wait for their appointments.”
There are other challenges: There are not enough doctors, especially specialists, and people move and can be difficult to find. “There’s a lot of Yazzies; there’s a lot of Begays,” Ms. Muskett said, referring to some of the most common last names for Navajos.
There is an entire system of providers, which C.O.P.E. supports, who take prenatal care to women living on reservations, and even some hospitals on Navajo land that are bringing traditional Navajo practices into birthing. But building trust has been difficult.
Most doctors who work with Native populations are not from Native communities, Ms. Muskett pointed out. “And the other thing is, I think, they’re not here for the long term. They’re not here to build those relationships.”
When it comes to I.H.S. facilities, the problem is compounded by memories of the forced sterilizations performed on Native American women.
And when it comes to I.H.S. facilities, the problem is compounded by memories of the forced sterilizations performed on Native American women.
Ms. Muskett thinks that, for the most part, I.H.S. is doing good work for the Navajo people. But she also remembers something that happened earlier in her career, when she worked as an environmental research specialist, surveying pregnant women about contamination from uranium mining.
“People were so angry at the uranium companies for coming in, for polluting the area, for having the mines,” she said. At one community meeting, someone said, “You know, if we could just get the companies or the president of the United States to apologize to us, we can let this go. And, thinking about that, you know, maybe that’s something that I.H.S. needs to do.”
“They need to publicly come out and say, ‘We’re sorry for what happened in the past; we’re sorry we did all of these things to you as a community, but we want to change now.’”
The Legacy of a Social Sin
The roots of these challenges for Native American mothers go far beyond recent history, according to Jeannine Hill Fletcher, a Catholic theologian at Fordham University.
Her work has focused on motherhood and racism, and more recently she has begun looking at the intersection of those topics. In her current work, she is asking more specific questions about women of color and their acts of resistance in the face of white Christian supremacy.
And just as Christina Novoa discovered in her research, Ms. Fletcher said none of this is happenstance.
“The maternal mortality rate and the infant mortality rate for indigenous women in this country isn’t by accident,” Ms. Fletcher said. “It is an economic reality that is directly traceable to legislation and historical dispossession of indigenous peoples in the U.S.”
What Ms. Gonzales and others like her are doing is an act of resistance.
Moreover, she does not see the problem as being a strictly secular one. What is happening to Native women is, at least in part, the result of a social sin that Christian theology played a part in creating, she said.
Ms. Fletcher points as far back as the Doctrine of Discovery, which, for centuries, by papal decree, allowed Europeans to seize Native peoples’ lands in the name of discovery. It was enshrined into law by the U.S. Supreme Court in 1823, and it still affects indigenous nations in the United States today, Ms. Fletcher said.
“Part of witnessing the struggle of these women is that it’s an economic struggle,” she said, “and that economic struggle has legislative roots in Christian theology, Christian ideology and Christian practice.”
In Ms. Fletcher’s view, what Ms. Gonzales and others like her are doing is an act of resistance. Women are finding strength and power in their historically marginalized traditions, she said, “which should say something to Christian theologians. And say something to Christians.”
Ms. Fletcher calls such resistance “the empowerment, the nearness of the divine.”
There is a word for this in Christianity, too: grace.
And that raises another question for Catholics and Christians, Ms. Fletcher argued. “If Christians see this as a practice that brings people in touch with the sacred reality, the divine reality, how might we mobilize resources to empower that practice?”
These traditional, indigenous birth practices should never have been erased in the first place, she said, and indigenous women should never have had to suffer the consequences.
“There should have been no need to rediscover this,” she said.
There is a word for this in Christianity, too: grace.
About five weeks after the mothers she has cared for have given birth, Ms. Gonzales assists the healer who works in her practice in performing a ceremony called the Closing of the Bones.
They boil medicinal herbs in a pot for a new mother to sit over. “It soaks into her pores; it causes her to sweat,” Ms. Gonzales said.
Then the mother is wrapped in a blanket, and the midwife uses her hands to massage muscles stretched out from months of carrying a child. It is a physical closure as well as an emotional one.
“We talk about the birth and things you were happy with, things you weren’t happy with,” she said. “It’s really more for you to release whatever feelings that you’re harboring—even if it’s crying or whatever. You just let it go.”
The herbs are meant to make the mother rest, and maybe sleep, a welcome respite for any new mom. “And then we feed you after,” she said.
Ms. Gonzales said it is mostly young women who seem to be interested in home birthing.
“They’re 30, they’re 25; I have somebody who’s 18,” she said. Their mothers and aunts are often skeptical. But these young women on the brink of motherhood see it differently, Ms. Gonzales said.
“They’re really seeing this reclaiming of birth as a way for them to be activists of their own bodies.”
Editor’s note: America reached out to the Indian Health Service multiple times for comment on this story but received no response in time for publication.