The Power of Culturally Matched Care - A Mother's Perspective
Alaska Native Birthworkers supported Penny Gage throughout her pregnancy. She shares her experience and insight on why their work is so important.
After my husband and I learned we were pregnant last summer, I began partaking in a common part of modern pregnancy: googling all the things I did not know.
I was searching online for a virtual childbirth preparation course when I first came across the Alaska Native Birthworkers Community (ANBC) website. It was a welcome surprise to see familiar faces smiling back at me from their home page; specifically, sisters Helena (Lena) Jacobs and Margaret David, two of the cofounders of ANBC, and women who I already knew and admired. I knew I wanted more support during my pregnancy and birth, especially in the pandemic when interacting with the healthcare system was daunting. So, I submitted their online request for services form, eager to learn more.
For my prenatal care, I was fortunate enough to be seen by Margaret in her full-time position as a Certified Nurse Midwife with Southcentral Foundation. And Lena quickly replied to my ANBC online request that she’d love to be my assigned birth helper. Over the subsequent months, Lena and I had several Zoom calls to check in on how my pregnancy was going, go over a birth plan, discuss my preferences and answer questions my husband and I had about the process. It was clear to me throughout our interactions that she has a heart for this work and possesses a gift for listening, sharing and supporting.
I know that even without the help of ANBC, I likely would have fared okay; I have a strong support system and a spouse, and have been exposed to pregnancy and birth through volunteer experience, family and friends. But I also know that without ANBC it would have been a much harder experience during every stage, from pregnancy to postpartum, and I believe this group provides the kind of care and consideration all Native families in Alaska deserve.
Supporting Indigenous Birth
ANBC helps Indigenous families through the birthing process. Their work falls into three categories: direct peer support services to Indigenous families; training for current and aspiring Indigenous birthworkers; and building partnerships for systemic change to better support Native and rural birthing families.
Based in Anchorage, ANBC focuses on bolstering and filling gaps in maternal care at no cost to Native families, including assisting with births, education, breastfeeding counseling, nutritional guidance, postpartum healing, public health research and advocacy. To ANBC’s founders, true sovereignty for Alaska Natives means “reclamation of Indigenous power during rites of passage that are rooted in ancestral knowledge, and each birthing person being surrounded by their community in connection to their sacred lands and waters”.
ANBC largely serves in-person births in Anchorage to both Anchorage-based and rural families who travel to our state’s largest city to give birth (roughly half of all births at the Alaska Native Medical Center in Anchorage are to non-Anchorage families). Other ANBC-provided virtual services are available statewide.
The ANBC birthworkers do not make medical decisions for you, but instead help you ask the right questions to ensure you receive the care that you want from your midwife, doctor, or provider team. They refer to themselves as “birth helpers” or “birthworkers,” which a lot of people in urban Alaska and the Lower-48 would probably call a doula – a name derived from the ancient Greek term for “female servant” – but not commonly used in Alaska Native communities.
As recipients of the care received through the Indian Health Service and as providers of peer support in these same facilities, ANBC members witness that it has not been the standard model of care to provide non-clinical birth help, long-term postpartum, and breastfeeding or other peer support to birthing parents. ANBC notes that most of the obstetric care providers working in the tribal health care systems in Alaska are non-Native. ANBC views their role in “reclaiming” the birth helper role through “culturally-matched care” as one step to reconnecting birth knowledge back to communities.
Unique Needs in Native Communities
There’s a long list of statistics showing that Indigenous people face significantly worse outcomes when it comes to maternal health and prenatal care. Likewise, there are significant historical, structural and social impediments that have kept our communities from realizing the best, healthiest versions of ourselves.
But we don’t necessarily need statistics to tell us what we already know – decades of oppression under colonialist policies and structural racism has taken a toll on Indigenous communities. It makes sense that in the perinatal period when families need increased support from the healthcare system and their communities, these barriers can present increased challenges in achieving health equity.
There is one data point in particular that demonstrates how vital ANBC is. According to 2007-2016 U.S. Centers for Disease Control and Prevention data¹, American Indian and Alaska Native women are more than twice as likely as White women to die from conditions caused or exacerbated by pregnancy.
Additionally, according to research in the journal Health Equity², pregnant individuals of color – particularly Black and Indigenous people – experience significant disparities in birth outcomes compared with their White peers. Research has associated the stress resulting from daily exposure to racism with higher rates of preterm births and low birthweight, depression and post-traumatic stress disorder, as well as a reduced probability of breastfeeding. Communities of color also report challenges in receiving healthcare, including brief encounters with providers, extended wait times for appointments, and gaps in communication.
This same research notes that community-based birthworker/doula services can positively impact birth outcomes, especially for Indigenous populations and other communities of color. Birthworkers not only provide physical, emotional and informational assistance to pregnant individuals, they also offer additional support to address the experiences and effects of structural racism. This can increase a pregnant person’s trust and engagement, strengthening their ownership of decision-making about their care.
It is positive outcomes like these that serve as a rallying cry for the ANBC and its supporters. ANBC notes that pregnancy can be an opportune time to work with families to increase wellbeing for an entire household, since a pregnant person may be especially motivated and open to healing and positive health changes to benefit their baby.
Becoming a Parent
Growing up in rural Southeast Alaska, I saw many people who were medevacked to larger communities because of birth complications. In fact, that’s how I arrived in the world: my parents had to leave their home in the small community of Pelican when my mom started going into labor weeks before my due date, depositing my older brother with friends in Juneau as they scrambled to get to a Seattle hospital.
Though in the years since I’ve seen many family and friends happily deliver in rural healthcare facilities and birthing centers, I knew I wanted to have our first child in a hospital. Thankfully, by the time our baby was due, COVID restrictions at the Alaska Native Medical Center allowed for one support person and one certified birth helper to be present. This meant my husband Zach could be by my side (and occasionally dozing on a couch), as well as Lena. Well in advance, Lena blocked out her calendar around my due date and gave me her cell phone number, telling me to call or text any time.
The day before our daughter was born, I didn’t realize I was in labor. While I experienced irregular pain, I took a bath and tried to distract myself with tasks of the day, including working from home, chatting with my mother and taking her on an errand. I texted Lena for advice, feeling more secure whenever I received a bit of digital support or guidance about what I was experiencing. She offered to come by my house, but at the time I didn’t think it was necessary. By dinner that evening I had descended into essentially a non-verbal state, wandering between rooms and doing whatever I could to ease the growing discomfort.
At some point that evening I managed a grunt to my husband, “It’s time to go to the hospital.” He and my mom were midway through chewing their dinner and quickly sprang into action, running around the house with mounting urgency. A couple hours later at the hospital, once I had been cleared in triage to be admitted, Lena arrived with her bags of birthing goodies in tow. Zach was still in shock, adjusting to the reality that we were in fact at the hospital after what had seemed like a largely normal day to him.
Lena’s calming presence immediately set us both more at ease. She offered to massage my feet with essential oils, sprayed cedar-scented mist around the room which reminded me of home, braided my hair, used homemade chamomile oil on my chest, and encouraged us to put on our calming music playlist. Though we were very supported through the many competent nurses and the midwife present, it was Lena’s familiar face that guided us through one of the scariest and most painful experiences I’ve had. She helped Zach know how to help and sat beside me through the early morning hours as we waited for the baby after my epidural. She stood by my head as I pushed, holding one hand as Zach held the other. Her affirmations and encouragement helped me conjure the energy I needed to bring my baby into the world.
When our daughter, Loretta Latseen, arrived in the morning, Lena captured photos of the first moments of her life – pictures that we’ll always treasure. She helped welcome our baby into the world as a friend and fellow Native sister, something that in the pandemic when visitation is not allowed in the hospital, was very important to me. Lena stopped by our home a week later to bring cupcakes, check in and help us figure out how to use a baby wrap that was perplexing us. Her continued presence helped me feel safe and supported in what’s known as the “fourth trimester,” when the body is healing, adjusting to parenthood and sleep deprivation, and hormones are all over the place.
The same day my daughter was born another ANBC birthworker was next door supporting a birth. Lena said they greeted one another in the hallway and I imagined them throwing out a high five to each other when the babies were born. Underscoring the importance and need for these services, we were told that over five days the week I gave birth, an impressive 31 babies were born at the Alaska Native Medical Center.
My mother and I participated in one of ANBC’s virtual talking circles the week following the birth, catching up with Margaret and processing my birth experience with her and two other birthworkers in training. They validated my rapidly shifting emotions, expressed joy at Loretta’s growth and health, and held space for my mom to open up about her own birth experiences decades earlier.
My mother, who is Tlingit, Japanese and Caucasian, shared stories I hadn’t heard before about complications she experienced with the births of my two siblings and me and the challenges of being medevacked to larger communities to give birth. Hearing her stories, I realized that birth experiences stay with you for a lifetime. Having the space to talk about it and process, no matter how much time has passed, was a gift that ANBC gave to my mother and me.
I’m so grateful to the amazing women of the ANBC, and also their families that support them in this demanding and essential work. I hope that by sharing my story, I can inform others of the critical work they do in our community and state, and encourage other Native families to reach out for their eager and healing support.
Writing by Penny Gage. Penny is Managing Director at Launch Alaska. She grew up in Pelican and Sitka, Alaska, and has family across the state. She is Tlingit Alaska Native from the Raven Dog Salmon clan, and is a member of the Sitka Tribe of Alaska. Her Tlingit name is Xʼwaséeya. Penny lives in Anchorage with her husband, Zach, and daughter, Loretta Latseen.
The Alaska Native Birthworkers Community works to improve maternal, birth, and breastfeeding outcomes by reclaiming Indigenous birth practices, and increasing the capacity and reach of Indigenous birth workers. You can reach Lena at firstname.lastname@example.org to learn more, or visit the Alaska Native Birthworkers website.