Culturally competent midwifery

When Jennifer Almanza gave birth to her first child at age 22, she wanted a midwife who looked like her. Almanza, who is biracial, identifies as Chicana. She wanted a Latina midwife but couldn’t find one. When she graduates in 2018 with a doctorate of nursing practice from the University of Minnesota, Almanza will be a certified nurse midwife (CNM) who can start filling that void.

The seeds for what Almanza refers to as this “long and winding path” had been planted when she was 19. A friend asked for Almanza’s support during the birth of her child. “I realized … what a profound place that is to be [yet] it felt like that wasn’t being held, or seen, or witnessed, or even afforded in the room during birth,” Almanza says. She noticed similar indifference during her own birthing experience.

Spurred by witnessing birth even before delivering her own, Almanza pursued her doula certification in 2001. In 2005, she received a degree as a registered nurse and worked seven years in labor and delivery at Regions Hospital. Over the next several years, Almanza added to her resume: neonatal intensive care unit (NICU), high-risk obstetrics case management.

The next twist on her path came in 2016, when she left HealthPartners for the University of Minnesota, where she currently works as a project manager at the School of Health Policy and Management. Almanza is a researcher for a program examining the relationship between birth outcomes and racial inequities across the United States. The goal is to uncover best practices for culturally-centered prenatal care.

Disparities in infant mortality

The disparities in Minnesota are glaring. Two times as many African American and American Indian babies die in their first year of life as do white babies, according to a 2014 report by the Minnesota Department of Health.

Countries that encourage midwifery care for normal, low-risk pregnancies have improved infant outcomes, Almanza says. But it’s not enough to have more midwives, she adds. These midwives need to look, speak, pray and celebrate like the women they care for. She is keenly aware of how significant this is. “I know so many people who would be amazing midwives,” but life has presented too many barricades, she said. As the mother of three children – ages 19, 15 and 5 – Almanza said she couldn’t have afforded the $100,000 price tag of her CNM degree without the financial support of a Bush Fellowship, which she received in 2015.

Almanza’s vision of providing culturally competent midwifery care is not hers alone. She mentions there are networks of doulas and midwives that provide prenatal, birth and postpartum services for families, such as Ahava BirthWorks and Roots Community Birth Center, both in north Minneapolis. Almanza also serves on the board of Indigenous Roots Cultural Arts Center in St. Paul, a collective of artists and organizations dedicated to promoting and practicing holistic well-being through indigenous arts, culture and traditions.

The collective female body

Almanza contends that traditional, cultural approaches to pregnancy and birth are very different from that of western medical practices. Many cultures share in the belief that “our womb as females is connected to an entire line, an entire collective female body,” Almanza says. In contrast, she continued, western practices tend to value quantifiable data and can be disconnected from the sacred nature of birthing.

Referring to menstruation, Almanza says, “Generally we are not very aware of our bodies. We don’t pay attention unless we’re trying to plug it up or get rid of the cramps. Being in touch with our womb can help to center and ground us. Many find hypnobirth or yoga during pregnancy to be a deeply profound experience.”

By reclaiming the traditions of Mexican midwives (parteras) that she has studied with, and by lifting up birthers in her own community, Almanza believes outcomes for both mothers and babies will improve. “The system is too big,” she says. “We can do better. On so many levels, we can do better.”

To Almanza, the key is acknowledging and welcoming the ways of being, history and individual stories that each woman brings to a birth. Basing care on evidence is vital, she says, but we also need to be sure we are not basing our care on past traumas and bias, of both mothers and providers. “We know that that type of care, and other factors, has brought us down a path of immense health disparities for black and brown babies.”

Almanza laughed as she recalled how long ago her journey started, as a 19-year-old with a crockpot of healing herbs in tow as she stood beside a friend in labor. “I’m not from academia,” she declares, despite years pursuing various degrees. She believes anyone with this calling can manifest it over time. “I’m just a scrappy doula who made her way to midwifery school. That’s all I am.”

For the women she will serve, that will be enough.

FFI:
Cultural Wellness Centerculturalwellnesscenter.org
MN Cultural Birthworkersfacebook.com/mnculturalbirthworkers
Ahava BirthWorksahavahbirthworks.com
Roots Community Birth Centerroots-midwifery.com