Down legs so tired they can barely stand
The spines of leaves outside darkened windows
Midwives soothe softly
Bone becomes honeycomb
Passages for a safe journey
Water becomes home
She returns to the sea that loved her so
Womb becomes lava
Like soil so moist and generative
Ancestors rumble –
Granddaughter becomes mother
Grandfather becomes son
Becoming a mother is something I hadn’t quite envisioned for myself in 2020, let alone pregnant and separated from my child’s father due to a global pandemic. But that’s the story of my life, and many women across the world. Through my journey of preparation for motherhood, I embarked on a process of unlearning, connection, isolation and self acceptance. I’m still on that journey. Some days are up, some days are down.
I often experienced shaming, gaslighting and judgement from doctors or hospital staff. It was common for me to feel unimportant, or unheard in my appointments. The smell and glare of those white walls always felt disingenuous and uncompromising and not a portal I wished for my child to enter earth side through. Subsequently, when I found out I was pregnant, I launched into a deep well of research on antenatal care, birthing experiences and Indigenous midwifery. I was saddened that I couldn’t find any Pasifika mothers groups in my neighbourhood or midwives associations in Australia, and devastated to find stories of women with shared experiences to mine. I was another thread in the common narrative that Pacific people experience barriers to access to cultural safety in birthing care worldwide.
I initially learnt of the term cultural safety through my practice in the arts, but it wasn’t until I read Dr Ruth De Souza and Robyn Higgins essay ‘Cultural Safety: An overview’ in The Relationship is the Project that I learnt of it’s genealogy. Tracing back to Indigenous midwifery in Aotearoa, the term ‘cultural safety’ was initially conceived by Maori nurses and defined by Dr Irihapeti Ramsden and adopted by the Nursery Council of New Zealand (NCNZ) in 1992. DeSouza defines cultural safety as,
“Cultural safety in health is the radical idea that people who use health services should be treated with competence, care and respect, so that their dignity and sovereignty are maintained, and not compromised by the system of health care. Both an ethical framework for negotiating relationship and an outcome of care, cultural safety rests on transforming power relations and disrupting universal factory models of care premised on an ideal implicit service user, who is typically able bodied, straight, cis gendered, white and middle class”
Dr Lisa Underwood and University of Auckland research fellow Jacinta Fa’alili-Fidow’s research analysis ‘Growing up in New Zealand‘ highlights the importance of continuity of care in the health system. Their researched revealed that Pacific women in Aotearoa have higher rates of antenatal depression, which is associated with increased risk of maternal postnatal depression and post-traumatic stress, as well as impaired child behavioural, cognitive and emotional development, and decreased rates of breastfeeding.
Their report states, “The big issue here is that pacific women in New Zealand have no continuity of care because they never get to see their lead maternity carer (LMC)”. This lack of continuity can happen many times during a woman’s pregnancy or birthing period which means pacific mothers are not receiving the adequate level of support from someone who knows them well as a person and has seen them through their full reproductive cycle.”
Encouragingly, their research underlined the key role that identity, connectedness and belonging plays in combating prenatal depression, speaking to the importance of viewing prenatal care holistically. When women possess a strong sense of self and identity and are surrounded by low stress and conflict situations, they are more resilient which speaks to the importance of socio-cultural factors in maternity care.
So what do alternative models look like?
It could look like antenatal care and postnatal care by community based providers, by Indigenous midwives integrating Indigenous models of care connected to land, water and cosmological knowledges. The reality, however, is that labour shortage is a pressing issue. One midwife claimed on twitter with that there are as few as 90 Pasifika midwives in Aotearoa and that she’s the only midwife in Auckland who speaks Samoan fluently. The Bula Sautu report from the Health Quality & Safety Commision New Zealand shared that 53% of Pasifika expectant mums in Aotearoa don’t have midwives, compared to 17% of other mums. Fa’afana Tamese from Pacific Midwives Wellington is quoted in the report,
“I think there’s a choice for European women, and a choice for the privileged. Not necessarily all these women, but the majority. There aren’t choices for Pacific. There aren’t choices for Indigenous and minority groups. You get what you get because it’s the system, and it’s not our system. Women with privilege have a full understanding of what they’re getting and what they’re into, and it suits their way of living. They’re used to that kind of process, and the process is set up for them…”
At 28 weeks I accepted that borders would remain closed and my partner would not make it over for the birth of our child, so I re-located back to the west coast to be with family. This was incredibly disorienting as I had to enter a new hospital system. At first people wouldn’t see me for two weeks because I had travelled from NSW, then no clinics were taking new patients, and once I finally was able to book an appointment my midwives in NSW were refusing to share my records, despite me having signed consent forms. Six weeks later, I was anxiously waiting for my first appointment, not knowing what to expect. I had been told so many stories of traumatic birthing experiences from Pasifika friends and reading or watching online, where doctors and midwives did not properly inform them of their rights, and they felt forced into consenting to being induced or having a caesarean and were still dealing with the PTSD from birthing.
The check up went as expected. Bub didn’t respond well to a midwife poking around, and I dodged intrusive questions about being able to support a family working in the arts, my partners occupation and why he is stuck in Fiji. I brushed it off, I just needed answers. “How many birthing partners can I have in the room with me?”, I began. “One” she replied. Okay, that’s fine. I had decided my mum would be my birthing partner. “How long can she stay with me?”, “During labour, an hour after labour and one hour a day during visiting hours for as long as you’re in hospital.” Oh…okay. Next round of questions. “What does your birthing suite look like? And how does water birthing work here? Do I need to hire a pool or are there baths?” was met with, “It’s a shared ward, and we don’t have water birthing facilities. You can sit under the hot shower for pain relief until you’re in active labour and then we will move you to the bed.” It felt like a punch in the face. I sat with it for a moment, so my mum asked the midwife if she had a hospital or home birth, “I had a home birth” she replied. I prodded further, “Why did you choose a home birth?”, she hesitated then fell silent. Holding my sweaty palms, I waited for her answer. A beat later she muttered, “It’s just better…I felt safer at home”.
That was all I needed to hear. I left the hospital system at 35 weeks.
I reflect on why I made that choice, and recall Dr Naomi Simmonds (Raukawa, Ngati Huri), speaking on Ruth DeSouza’s podcast ‘Birthing & Justice‘, and how she speaks on the importance of space enacting safe practice.
“There’s the material things…those kind of physical, tangible things that are part of our customs and protocols but theres a whole lot of other things that are part of what I would call Māori maternities, that aren’t as tangible and then therefore are often more difficult to create the kind of understanding and space. Things like the spiritual side of birthing, the importance of our wairua, the importance of our whanau…”
At no point through my antenatal care in the hospital system did anyone ask about cultural birthing practices that mattered to me as a Tokelauan Fijian woman. The lack of continuity of care created small pockets of anxiety in my chest, as I constantly had to re-tell my story and stats to each midwife and doctor I met. I left because I was scared. I chose a home birth under the supervision of two highly trained and emotionally intelligent midwives. They weren’t Indigenous or Pasifika but they were what I needed. I chose a birthing space where I could be supported emotionally, physically, intellectually and spiritually, by my midwives and my kaiga. I chose birthing space where I didn’t have to justify my choices, apologise for my body or shrink into myself. A space where my baby and I felt no pressure to do anything beyond be in conversation with one another.
I didn’t know anyone in my friend or family circles, beyond my grandmothers, who had given birth at home. My knowledge was limited to watching a lot of Youtube videos of Black women in America and the UK sharing their home birthing experiences, but I knew it was the right choice for me and my baby. And even though I made this choice out of fear, the sad truth is that choosing home birth is still a privilege. It was afforded to me because my pregnancy was low risk, I was lucky enough to find midwives amongst a time of high demand (after desperately scouring google and facebook homebirth pages and emailing doulas), and I had the financial means to pay for the private care.
Home birth is not covered by Medicare or any insurance companies in Australia, and it’s still looked upon as a deviation from ‘normality’ in maternity care. All of my appointments were covered by Medicare, but the birth itself wasn’t covered by anything, meaning that the risk for my midwives was just as high as it was for me and my baby. Lou, my midwife, came to my house and sat with my family for three hours while we asked her every question we could think of. Not just the questions relating to home birth but the ones I had been harbouring in my hospital appointments for fear of judgement. She visited once a week, and was on call once my due date came around. And everytime she came, we would talanoa over tea and cake before checking on bub. She mixed essential oils for me every week, gave me pregnancy massages. I suffered from awful sciatica throughout my pregnancy and midwives had previously suggested panadol but I didn’t want to take any medication whilst pregnant, so Lou connected me to her network of community nurses who gave me localised massage and acupuncture which was transformative. Once bub was born, Lou dropped by everyday for a week, and twice a week for six weeks. She had become an important part of our family and my healing process, it was hard to let her go. The postnatal continuity of care, just knowing she was only a text message away made a huge impact on my mental and spiritual wellbeing and recovery.
Across the Pacific and beyond, birthers continue to defy and re-conceptualise what a ‘normal’ birth looks like, and incredible initiatives are supporting mothers to deliver their babies safely.
Project Yumi is an intiative that is quietly determined to provide support to mothers and communities in rural Papua New Guinea. Founded by a group of friends, all with connections to Papua New Guinea, who were sick of discussing the injustices and inequalities that the people of Papua New Guinea faced they decided to take action. One of their initiatives is the annual bush babies appeal, where they collect newborn clothing, baby towels and blankets, beanies, booties, soap and maternity pads. These packs are then delivered to rural health centres and hospitals to distribute to pregnant women in rural areas to encourage them to give birth in health centres where they can receive the medical attention they need.
Initiatives like Project Yumi are even more important during the Covid-19 pandemic, as women have to adapt their birthing plans. Two of Fiji’s largest hospitals have resorted to staffing medical ships with midwives for birthing, due to the overcrowding with growing Covid cases. Our women, midwives and birthers need our support.
The pandemic brought with it an affirmation of the importance of Indigenous worldviews as armour against an unstable, capatalist society – birthing practices included. In the abscence of a Pasifika midwife and my partner, I found a lot of comfort in binge watching My Maori Midwife and my circle of Fijian, Maori, Niuean and Papua New Guinean mothers who were always a text or phone call away with suggestions, affirmations or a check in – thank you my beautiful sistas.
The last two months of my pregnancy was a completely different experience. It was a woman-centred approach.
Above all, the greatest gift my midwife nurtured is self-determination. She encouraged me to ask questions, to push back, and most importantly to listen to the ancestral knowledge that I embodied. “Trust yourself māmā, your body knows what to do”, I can still hear my midwife’s whispers. In this moment of labour, when I had no choice but to stop thinking I had realised how much as a woman, as a Tokelauan Fijian woman, I had been taught to distrust my own body, my own intuition. My grandmothers and their mothers all birthed ancestors into this world wrapped in love and Indigenous wisdom and I was now enacting that legacy. My son is named after his tupuna, as am I. And just through this process of listening and softly encouraging me, transformed the way I view mothers and birthers, my community and how I approach my work in storytelling. I’ve learnt to hold space for the many manifestations motherhood takes, to encourage other mothers around me to talk about their maternal care and birthing experience and to see birthing for the truly magical declaration of human existence that it is.
I’m inspired by the work birthworkers are doing for maternal health care for women, and hopeful for how we can continue to transform birthwork for the integrity and empowerment of our peoples.
It is by breath that I came into this world, a breath of life passed on by word of mouth since the dawn of time. A breath that has emerged of the shattering uproar of my birth when my ancestors freed me from my mothers womb – Emmanuel Tjibaou