September 2016

Breath of My Heart – A Birth Story


Jessica Frechette-Gutfreund


Sandy Martínez, her partner David Rivera and close family members arrived at Breath of My Heart Birthplace in the early morning on a hot summer day. Sandy and David, both 18, were raised in the Española Valley, and like most first-time parents were excited and anxious about their baby on the way. Sandy’s contractions started overnight and had become more painful over the last few hours. She settled into the birth room and started to get comfortable. Doula Tauz TamuPovi, from Tewa Women United’s YVK doula program, rubbed her back with each contraction and helped her slow her breathing. Her family made themselves at home—setting-up food, texting family members and trying to guess how long it would take for the baby to come. Belin Marcus, apprentice midwife, filled a bathtub so Sandy could relax in the water. As the day went on, family members trickled in and out. David’s grandparents spent time sitting in the waiting room, telling stories and remembering other births in the family.


Midwifery has been a New Mexican practice as long as people have lived on these lands. Pueblo, Chicano/Hispanic and Mexicano communities have carried midwifery knowledge through generations, with medicine-people, parteras and curanderas supporting women during birth and honoring birth as sacred. Across communities, birth is a moment in which time stands still. For generations, birthworkers have performed the role of bringing culture, language and traditions to welcome a new baby.


A hundred years ago there were likely more than 1,000 midwives across the state; today an estimated 40 licensed midwives assist with home births or birth-center practices. Nurse-midwife scholar Felina Ortiz has written that the numbers of traditional midwives fell to fewer than 100 by 1965. She says it then dwindled to very scarce numbers through the second half of the century. Many factors led to the decline in New Mexico, including regulations instituted by the state. Associated literacy requirements weren’t accessible for many older midwives. Expansion of New Mexico Department of Health services and Indian Health services changed the ways people accessed pregnancy-related services. Simultaneously, there was a national push to encourage people to rely on hospitals and doctors as the only suitable birth providers. Even so, midwives continued to serve under-resourced and hard-to-reach rural communities. New Mexico remains one of the few states where midwifery was never made illegal. Over the last 40 years, New Mexico has been friendly to home birth and birth-center practitioners. Today, licensed midwives offer prenatal, labor and delivery, postpartum and well-woman care outside of a hospital setting for low-risk women.


Research shows that planned home births or those in a birth center are associated with good health outcomes, including drastically lower rates of caesarean section, as well as higher rates of patient satisfaction and use of breastfeeding than among births that occur in a hospital setting.


And births at home or in a birth center are on the rise. The Center for Disease Control reported that from 2004‑2012, births at home or in a birth center increased by more than 30 percent. Interestingly, this increase was among non-Hispanic white women across the country. The numbers of births at home or in a birth center stayed the same or declined for women of every other race/ethnic group.


The recognition that many families in the Española Valley didn’t have access to these options was the incentive behind the establishment of Breath of My Heart Birthplace (BMH). In 2010, a group of midwives and community stakeholders in Española began to imagine what it would mean to have high-quality maternity care that respected family and cultural values. Many of our grandparents were born at home, and many of our grandmothers were midwives.


BMH operates with a model of community midwifery care that addresses health inequities and barriers to quality prenatal care. BMH offers a no-cost walk-in clinic every Monday as a means of increasing access to prenatal care and to give the Española community a chance to meet midwives and learn about birthing options that are covered under Medicaid. BMH provides maternity care that reflects the needs of Española’s diverse families—including young parents, immigrant women and families living through cycles of substance use and trauma—with an evidence-based model of care that has shown to be safe and cost-effective in serving rural areas. Teaching student midwives, like Belin Marcus of Ohkay Owingeh Pueblo, is another aspect of the organization’s work.


As the baby was close to being born, Sandy’s midwife, Jessica Gutfreund, listened to the baby’s heartbeat with a handheld Doppler, making sure that the birth was moving along normally. The baby’s heartbeat was strong; the sound gave Sandy a needed boost of energy. Surrounded by her family, she leaned on her partner between pushes. Sandy asked her mom to say a prayer for the strength needed to birth her baby. Her cousins stood at the foot of the bed encouraging her with kind words as the baby’s head began to emerge. After more than 12 hours of labor, Sandy birthed her baby, Luna Andrea. David helped catch the baby and lifted her onto her mother’s chest. The whole family burst into tears of joy and relief. The midwives were watchful, caring for new mom and baby and assisting with the delivery of the placenta. They made sure the new family made a smooth transition. They gave Sandy and David some time alone to bond and admire their new baby without interruptions. When they were ready, the new parents and their baby went home.


Sandy and Luna are doing well and are recovering from the hard work of labor and birth. The midwives came for a check-up at their home the next day and visited three more times over the week as part of their post-partum care. Sandy was glowing when the midwives stopped by. “I’m so glad I did it this way,” she said. “I knew I could do it, even though I was scared.”


Sandy and David want to learn all about their new baby. The midwives sat with them and answered their questions, reassuring them that they have what it takes to be great parents. Baby Luna has been nursing well. As the midwives left, the baby was alert and aware in her father’s arms.


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Jessica Frechette-Gutfreund LM, CPM, a midwife in the Española Valley, serves as the chief academic officer for the National College of Midwifery in Taos, New Mexico.






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