By Elizabeth O'Sullivan Issue 127, November/December 2004
Although a doula had been with Pat Welch when her daughter was born, she hadn’t been able to afford a doula two years later, at the birth of her son. When the pushing stage of labor triggered an episode of post-traumatic stress disorder, Welch decided that she was not ready to push and that she wasn’t going to do it. “I remember being yelled at, and at that point, you’re like, ‘Yeah? Well, make me!’” Welch recalled.
The child’s father and another friend were present, but they weren’t able to talk her out of that fear. At just the right time, a friend of 20 years showed up. “Martha got very close to my ear, and in a very firm but soft voice said, ‘You better start pushing, and you better start now.’” Welch was then able to move ahead with her labor. “What I needed was that person I trusted.”
Because of that experience, Welch was convinced of the importance and power of doulas. She was also aware that some people who most need a doula aren’t able to afford one. According to Jennifer Nunn, former president of Doulas of North America (DONA), the average cost of a doula is between $400 and $500, and in parts of the country costs can run as high as $1,000. Although an increasing number of health insurance policies cover the service, a vast majority of them do not, Nunn added.
Pat Welch saw a need and took action. She received a grant and founded the Turtle Women’s Project, a culturally specific program providing free doulas for American Indian mothers and operating out of the American Indian Family Center in St. Paul, Minnesota. More than five years have passed since the birth of this project, and it has grown and merged with other local doula programs that it originally helped inspire. Now the American Indian doulas, called Turtle Women, work through the Family Center Community Doula Program, which also offers culturally specific services for Hmong, Latina, African, and African American women. Jessica Atkins, coordinator of the Community Doula Program, said it serves several hundred mothers every year, from those who have recently discovered that they’re pregnant to those whose babies are two months old. The Turtle Women work with 10 to 20 of those mothers, she added.
A Culturally Specific Program
Pat Welch created the Turtle Women’s Project to be culturally specific, beginning with its name. Because in most American Indian tribes the turtle symbolizes creation, instead of using the Greek word doula, meaning “woman servant,” the program calls them Turtle Women. These Turtle Women receive DONA training for doulas, but they also have the knowledge that comes from being American Indian.
“All the Turtle Women are American Indian, and there’s just a sense of really knowing that you don’t have to explain anything,” Welch said. For example, a laboring woman wouldn’t need to take her focus off her own experience to tell a doula why she wanted to smudge a hospital room. (Smudging, the traditional practice of burning sage, is done to cleanse the surroundings.)
Tara Rasmussen, who gave birth to her third child accompanied by a Turtle Woman, said it made her happy that the hospital room had been cleansed with burning sage before her child was born. It was a smell that she had grown up with, and one that she enjoyed. It also gave her a sense of peace. “I felt it was good for my baby to come into the room smelling sage,” she said.
Smudging, playing traditional music, and having another native woman present can help make birth a ceremonial experience for mothers, said Jennifer Almanza Lopez, a Turtle Woman who has since left the program to pursue training in midwifery. Almanza Lopez wants to help acknowledge birth as a precious time when the spiritual becomes tangible.
Turtle Women can also help bridge communication barriers during birth. Betty Day, another Turtle Woman, said that mainstream American culture differs from many American Indian cultures around such issues as when it’s appropriate to touch, speak, make eye contact, or use humor. For some mothers, dealing with issues of cross-cultural communication might be a distraction during labor. As someone who is attuned to those differences, Day is able to help mothers relax and focus on childbirth. “When you go into labor, you need to go into a place where you can just take care of yourself,” she said.
Jennifer Almanza Lopez added that she often works with very young women, who usually don’t trust the medical authorities but are often reluctant to speak up for their needs. “Culturally, they’re very quiet when it comes to communicating with people they’re not familiar with,” she explained. In meeting with women before birth, Almanza Lopez tries to prepare them to speak up for the birth they want.
Usually, Turtle Women meet with a pregnant woman several times before the birth. The program also offers culturally specific prenatal classes, whether or not the mother plans to use the services of a Turtle Woman. All this preparation for birth incorporates cultural issues, such as the traditional parenting methods of breastfeeding and keeping babies close. The traditional roles of the father and other family members are also discussed, but these vary from tribe to tribe. Welch said that if she and the other Turtle Women aren’t familiar with a certain tribe’s practices, they ask around and try to learn about them.
Empowerment Amid Challenges
Having a doula and other culturally specific support is especially important for many of the mothers who use the services of a Turtle Woman, Welch said. Many face such challenges as poverty, domestic violence, social isolation, chemical abuse, or being adolescent parents. The pregnancies of all of them are, for one reason or another, considered to be “at risk.”
Although the doulas at the Family Center Community Doula Program don’t try to address issues such as a lack of housing, they can refer families to other staff at the American Indian Family Center who can help. Taking care of other pressing situations is necessary if a woman is to receive good prenatal care. For example, Welch said, if a mother has other children who are hungry and who don’t know where they’re going to stay, then caring for those children takes priority over making it to a prenatal checkup.
Amid all these challenges, giving birth can be an opportunity for women to connect with their own strengths, and then to carry that feeling into their daily lives. Doing that, Welch said, can have implications that can extend beyond just one birth, and even beyond one generation, because it helps women reclaim a legacy of power that centuries of history have tried to take away. They can then pass that legacy along to their children.
“Having a good birth is great,” Welch said. “It helps you feel empowered. It’s the most powerful time in your life; it’s creation. . . . But the self-empowerment that comes with knowledge and being able to make choices that are good for you, and good for your baby, and good for your family, helps put women on that path of being able to use that for the rest of their lives. So for me, that’s the whole point of doing this.”
Almanza Lopez said that by working with mothers, she’s helping to counteract the violence that indigenous people have faced for centuries. She has seen modern medical practices turn birth into another violent experience for many mothers and babies. Helping births be peaceful is part of a movement among indigenous people to rebuild safe communities for themselves, she emphasized, adding that the prophecies of many native peoples predict that their nations will be rebuilt by women.
One step in rebuilding the nations of native peoples is to reconstruct lines of communication that have been broken, according to Jennifer Almanza Lopez. Historically, women learned about birth from their mothers, grandmothers, or other women in the community, but now this practice is not as common. When Almanza Lopez attends a birth, she considers herself to be almost an adopted grandmother of the pregnant woman. “It’s helping to build some of the trust back up and heal some of the damage that’s been done,” she said.
One of Betty Day’s goals as a Turtle Woman is to make a powerful connection with a pregnant woman. That task is often easy for her, because she sees her own daughters and sisters in the eyes of the mothers she works with. “With that connection comes honesty, and that creates lots of different feelings that empower the woman,” Day said.
One of those empowering feelings must be relief. Tara Rasmussen was anxious when she went to the hospital to have her baby, but when her Turtle Woman arrived, she relaxed. “She’s here! Everything is OK!” Rasmussen remembered thinking. In contrast with nurses and doctors who came and went during the birth, Rasmussen’s Turtle Woman stayed with her, rubbing her legs, giving her aromatherapy and massage, and speaking to her in calming tones. After her Turtle Woman helped her try several birthing positions, Rasmussen found one that was right and delivered her baby quickly.
“With her, I felt a lot better and more at peace,” Rasmussen said, adding that every time she sees a pregnant woman, she encourages her to have a doula. Initially, Rasmussen wasn’t sure if she wanted to use the services of a Turtle Woman. She decided to because “she’d be just for me, and I rarely have something just for me.”
Working with the Medical Community
The American Indian community generally doesn’t trust the medical community because of a history of abuses such as forced sterilization, Welch said. She added that she worked with a woman who previously had been tied down while giving birth, and that some American Indian mothers feel that doctors and nurses routinely talk down to them.
Welch said that she’s worked with many wonderful doctors and nurses, and that more of them are becoming sensitive to mothers’ needs. Occasionally, however, problems arise. “Racism is still alive and well and flourishing,” Welch said. “Some of it is really subtle. Some of it is not.”
When Turtle Women encounter racism from the medical community, Welch said, they try to act as buffers between the mother and the offending person. Then they go back and work with the medical establishment on an administrative level to try to prevent a repetition of the incident. Turtle Women have also been educating many medical professionals about traditional practices such as smudging a room, or taking a placenta home from the hospital to bury.
A Different Kind of Birth
Julie Kurschner took prenatal classes taught by Turtle Women before the birth of her fifth child and said she would not have felt comfortable taking a class that wasn’t culturally specific. “Everyone’s culture is different,” she said.
The birth of Kurschner’s fifth baby was unlike the births of her other children, who were born while she was in an abusive relationship. “Before, it was like a shaming
experience,” Kurschner said. “But this experience was more positive, and more natural, and more real.” For this birth, she was no longer in a bad relationship, and she went to the hospital equipped with knowledge and accompanied by her Turtle Woman, Betty Day.
Unlike during her previous births, Kurschner didn’t feel she had to stay on her back the whole time. Before, nurses had come and gone, but no one had mentioned trying alternate birthing positions. “Nobody ever told me there’s more than one position to deliver the baby, and when you’re on your back, you hurt the most,” Kurschner said. Because there were so many monitors on her and her baby during the fifth birth, Kurschner’s positions were still somewhat limited, but Day helped her switch from side to side as she labored.
Day stayed with Kurschner during the three-day labor, ducking out one evening to make meat loaf for Kurschner’s four other children. She also brought soothing music, sweetgrass, and sage to the hospital, in case Kurschner wanted to smudge her room in the traditional way. Kurschner also knew she could pray with Day if she wanted to. “Having positive people around is a really important piece to keeping your saneness in having a baby,” Kurschner said.
After two days of labor, when the medical professionals said they would need to operate if the baby weren’t born soon, Day walked for an hour with Kurschner, encouraging her to talk to the baby. Kurschner said that during her other births, she would have felt strange walking around talking to her unborn child, but with Day’s support, it felt natural.
Kurschner told the child, “It’s time. We have to do this together.” Soon after the hourlong walk, Kurschner’s only son was born. She said she felt she was bringing him into the world with love instead of just going through the motions, as she had four times before.
“I feel more bonded to my baby,” Kurschner said. “All the other births were real, but this birth was more important to me because I was at a positive stage of my life.”
Pat Welch said women who use the services of a Turtle Woman have babies with better birth weights, that the mothers are more likely to breastfeed, and that cesarean sections are less common. The sense of empowerment that Welch wants the program to foster is harder to measure, but Welch recalls stories of mothers who have gone back to school or left abusive relationships after working with a Turtle Woman.
Betty Day said she will never see all the results of the work she does helping mothers experience their power during birth and bringing children into the world in an atmosphere of peace. Those results might not be known until many years have passed. “You never know where it might lead,” she said.
Jennifer Almanza Lopez also believes that the impact of her work will linger for many years. If mothers experience birth as a spiritual event that brings them closer to their communities instead of as a violent incident that takes place among strangers, then they can pass that attitude along to their children. “They can take that back and give it to their children to give to their children,” she said.
The decisions a woman makes while giving birth set the stage for the many decisions she will need to make as a mother, Lopez explained. Being empowered during that crucial time of her life can help a woman foster the healthy growth of the next generation.
As she described this idea during a telephone conversation, Lopez’s phone beeped to indicate that someone was calling on the other line. It was a mother who had
just gone into labor; Almanza Lopez rushed off to help with the birth of the child, and perhaps to help with the rebirth of a nation.
For more information about doulas, see the following articles in
past issues of Mothering: “Nature’s Way Circle: An American Indian Breastfeeding Community,” no. 107; “A Doula Makes the Difference,”
no. 87; and “A Doula Rises Early,” no. 43.
For more related material, go to www.mothering.com
Elizabeth O’Sullivan is a mother, writer, and Mothering subscriber who lives in Minneapolis.