Why We Do What We Do
Most rural Alaska Native pregnant people are displaced from their homelands while also often alone, separated from their families and support systems, when giving birth. It has not been the standard model of care to provide full spectrum birth helper/doula, long-term postpartum and breastfeeding or other peer support to these birthing parents within this system. Reclaiming the birth helper role is one step to help reconnect birth knowledge back to communities.
Alaska is a unique place to live, with five major cultural regions representing more than 20 Indigenous languages, more than 200 tribes, and geographically isolated communities accessible year-round only by plane when the weather cooperates. In our centralized medical system, rural pregnant people are required to leave their home community at or before 36 weeks gestation to birth in the regional hospital, or for any deemed high risk, at a hospital in Anchorage. A labor support person’s travel to accompany the birthing person is not paid for by the healthcare system.
The displacement of expecting Alaska Native people happens despite the fact that as Indigenous Peoples we had been birthing on our lands and waters for more than 10,000 years before colonization. This happens despite the fact that the most valued resource reported by birthing women is other women in the community, and that research has shown that the continuous support of a professionally trained labor companion at birth results in shorter labors with fewer complications, increased satisfaction with the birth experience, reduced need for medical interventions, including a significant decrease in requests for pain medications. This happens despite the fact that parents who receive this type of perinatal support feel more secure and cared for, are more successful in adapting to new family dynamics, have greater success with breastfeeding, have greater self-confidence, have less postpartum depression, and have lower incidence of abuse.
Since time immemorial, our social and community structures demanded ceremonial rites of passage, that a new parent be cared for by everyone surrounding them, and that care was offered locally by traditional knowledge bearers whose wisdom and medicine passed on from generation to generation. This has changed and we are looking for ways to support this ancestral knowledge as best practices that have been developed over millennia.
The care taken during pregnancy and early childhood impact life-long health for both the child and the birthing parent. The wellbeing of the mother is the foundation for the wellbeing of the entire household. Pregnancy is an opportune time to work with families because a pregnant person is especially motivated and open to healing and to positive health changes for the benefit of their child. As Tribal Doctor and Traditional Midwife Rita Pitka Blumentstien advocates, “We are our ancestors. When we can heal ourselves, we heal our ancestors, our grandmothers, grandfathers, and our children. When we heal ourselves we heal Mother Earth.”
Protective factors identified against unhealthy behaviors are connection to community and to positive role models. Peer group support, such as the doula model, builds upon those protective factors and has demonstrated positive maternal child health outcomes, especially for underserved populations. Indigenous populations disproportionately experience health disparities and infant mortality rates and we are working to reverse this injustice.
Most of the obstetric care providers working in the tribal health system in Alaska are non-Native and therefore are unable to provide culturally-matched care.
There are no midwifery education programs or formal Indigenous doula or birthwork programs with culturally relevant and ceremonial training in Alaska. Our work seeks to change this. We hope to collaborate with our current maternal health care systems and continue to build upon the many existing strengths, such as the community-based Community Health Aide Program, the tribally owned and managed Alaska Tribal Health System, the high rate of community birth for people living in urban centers, growing access to culturally grounded education and training, and the rich wisdom and ingenuity of Alaska Native Peoples.