Nicolle Gonzalez Is A Midwife On A Mission

For some, the birthing experience can be one of the most profound and joyful moments of one’s life. For others, including Native American women, it can often be the most traumatic. In fact, according to a 2022 report by research company KFF, Native women (along with Black women) have “higher rates of pregnancy-related death” as well as “higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care” compared to white women. Nicolle Gonzalez witnessed this disturbing statistic first-hand during her early years as an obstetrics nurse in New Mexico.

While working in a hospital in Los Alamos, a town outside of Santa Fe, she noted the vast difference in treatment of women (primarily white) with insurance. “These women were doted on and treated well,” she recalls. “They had doulas. There was a midwife working in the hospital who advocated for women to have a more empowered birthing experience by honoring their choices, trying to give informed consent.” These birthing stories differed greatly from those of Gonzalez’s own family members (who are of Navajo descent), including her mother and her aunts. Their experiences were rooted in fear and “mistreatment by white nurses in the IHS [Indian Health Service] system.” Her relatives recounted narratives of often being blamed or shamed for their pregnant state instead of being comforted, encouraged, and ultimately protected.

KFF reported in their findings that Native women (in addition to those of Black and Native Hawaiian and Pacific Islander communities) “have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white women.” Gonzalez recalls hearing disturbing conversations from some of the resident providers within the IHS system or those of nearby towns. “I would hear comments like ‘I love my Native patients because they don't ask questions.’ And so they really are playing on the lack of knowledge about health and medications and birth to just kind of do whatever they want to do.”

The Road To Change

After years of seeing these injustices become commonplace around her, Gonzalez took action, shifting gears to receive a Masters degree in Nurse Midwifery from the University of New Mexico, with a specific goal to serve this grossly underserved community of Native women. During her studies and midwifery training, she was shocked by the disparity in research and information regarding birthing experiences from a Native person’s lens. “If there was information about birth, it was 20 years old and it was from a white lens of research rather than our own.”

It became abundantly clear to her how few Native healthcare providers and midwives there were to advocate for their communities in those spaces and ultimately “help all the other clinicians understand” what these women needed. For this very reason, Gonzalez founded Changing Woman Initiative (CWI) in 2015. The non-profit, according to its official site, aims to “renew cultural birth knowledge to empower and reclaim indigenous sovereignty of women’s medicine and life way teachings to promote reproductive wellness, healing through holistic approaches, and to strengthen women’s bonds to family and community.”

The CWI team provides women the option of traditional birthing rituals, which Gonzalez says became somewhat forgotten due in large part to the wave of Native American boarding schools, which ran from 1819 and 1969 as a means to assimilate Native children. “People are not in relationship with [these teachings] anymore,” she says. “They're out of touch because a lot of parents, like mine, went to boarding school and [because] they don't [learn about them] they're not passing them on.”

Another major contributing factor the midwife notes was the introduction of the government sanctioned — and aforementioned — IHS services on reservations in the 1955, which moved most births to hospital settings. “So, what happens when you bring a woman to a hospital, who normally would have a traditionally ceremonial supported birth, is that everybody's displaced from supporting this baby from coming into this world,” explains Gonzalez, referencing specifically the Navajo’s rituals. “We don't have somebody to manage a fire [used in traditional Navajo births], to feed the mother [...] The medical team is not engaged. So it really separates women from these things that would support the pregnancy.”

These sacred traditions extend past simply providing a smooth birthing process. They center around creating a safe, peaceful, and spiritual passage for the mother and child from labor to delivery — and thereafter. “The traditional midwife in [Navajo] culture is actually like a medicine woman,” explains Gonzalez. “She knows the herbs and the songs and the practices to bring the baby into this world and is aware of the different parts that people in the family play and then also the protocols that women carry from their birth to postpartum and [...] for the baby as they grow up.”

The Reintroduction Of Native Birthing Ceremonies

Navajo birthing rituals include practices like blessing the procedural tools prior with sage or cedar. Childbirth often takes place in a hogan, so an outside fire is lit to keep it warm. “The partner's role is to protect the space, so he's usually outside offering prayers,” says Gonzalez. “He might come in and support [the mother], but his role is really to be more of a protector.”

In regards to the actual labor, Navajo families can enlist a medicine person to come and sing a song or perform a ceremony if the birth is taking too long or if there are any complications. “And during birth or during labor, women can drink cedar water,” says Gonzales. “Usually it's only two cups to help with labor. The medicine woman boils it ahead of time.” A blue corn paste can also be fed to the mother to help her keep her strength — cedar ash is often mixed to add some nutritional value (like iron and calcium).

Red sashes are also used during birth for mothers to hold onto for assistance with labor. “We're not supposed to tie knots in our hair or knots in our clothes in childbirth because that can be perceived to make the birth harder,” explains the midwife. “[Once the baby comes though], while mom and baby are sitting there, we won't bathe them, but we’ll put either white corn or yellow corn that's dried and grated on their skin as kind of their first bath.”

In studying for her masters degree in midwifery at the University of New Mexico, Gonzalez says she’s learned the value of bringing babies into the world in this way, and wanted to provide a resource for Native women who wanted to embrace the old traditions of their people. “I feel like the work that I do is really to uplift that and to give that voice and to start to share the stories and the possibilities,” she says. “Some of the conversations I've had with women who are reconnecting to this knowledge is a lot of grief and sadness that they weren't aware it was possible to birth this way.”

In addition to offering “culturally integrated healthcare for Native American and Indigenous women” via prenatal clinics and homebirth and postpartum services (which at the moment serve the Northern New Mexico area), Gonzalez and her team also provide things like plant medicine making workshops, parenting classes, sexual education and awareness courses, and informational sessions on health policy and education on Indigenous midwifery.

Looking To The Future

Gonzalez, who has spearheaded CWI’s efforts for nearly a decade, said she’ll be transitioning out of her leadership role in 2024 to focus her efforts on coaching new non-profits and consulting with tribes who want to integrate traditional birthing practices back into their care. “I'm also getting my PhD in organizational leadership because I've been doing this for so long,” she explains. “I realize, as much as I love midwifery and traditional birthing practice education and sharing, I really enjoy organizational design.”

That said, Gonzalez passion for CWI’s mission and growth is still stronger than ever, so she will continue to play a role in big-picture planning and projects within the organization. “I do a lot of fundraising and grant writing for CWI [...] So my connection with my org as a founder will never be severed because I value what we're doing,” she says, noting the non-profit’s next big goal: a capital campaign for a first-of-its kind birthing center. “Because of all of the changes through the years, we've not gotten to that point [of raising the capital needed], as the building [we originally envisioned] is like $7 million to build. What we're thinking is to actually pivot from that design to more of a home with a nice garden and a place to build a Hogan where women can stay over an extended period of time to be fed and for [breastfeeding] support following their birth. And that's going to be about $2 million to get to that.”

Gonzalez will also continue in her advocacy efforts, as she emphasizes how much work and progress is still to be made in regards to the rights of Native women. And while the past decade has kept her focus on her local community, she’s now ready to take the fight global. “I feel like something that isn't talked about often is the lack of investment in maternal health work,” says Gonzalez. “There's the White House report on improving maternal health. They have a plan. But what are these foundations and philanthropy [efforts] doing to improve maternal health? I don't see an investment. I definitely don't see an investment in Native maternal health.”

Because she’s led the charge on grant writing and fundraising for CWI, Gonzalez says she knows many of these maternal health-focused foundations only spend about 1% of their budgets on Native issues, which isn't very much. “What happens with foundation funding is they'll give you just enough to do the work you're doing, [but not] enough to expand or grow,” she says. “[...Native women] have the second highest maternal mortality rate in the United States [...] Some of the thoughts I've been having [center on] starting a foundation to fundraise and start conversations with the funders directly about investing in Native-led projects that are maternal health focused. Where is that kind of commitment?”

With this question at top of mind, Gonzalez will be entering 2024 with a fresh mission. And judging from the strides she’s made within her own community and with CWI, there’s no doubt of her success in making waves around the world in the name of Native women.