Home › Reclaiming Traditional and Indigenous Postpartum Care Practices as an Act of Remembering and Revolution

Reclaiming Traditional and Indigenous Postpartum Care Practices as an Act of Remembering and Revolution

By Lyani Powers

Introduction

This paper examines why the revolutionary act of incorporating traditional knowledge practices in postpartum care can benefit all birthing people and the healthcare system. The current state of maternal healthcare includes: dangerous racial disparities (MCN, 2023), an increase in morbidity and mortality, a lack of maternity leave, pressure to conform to pre-baby body standards, and the expectation to achieve maternal goals unassisted (Creanga et al. 2014). These challenges are a form of psychological warfare reflected in the increasing rates of postpartum mood disorders and postpartum mortality rates, particularly among minority women (Johns Hopkins Center for Communication Programs, 2021)

This paper’s call to action is to prioritize the health and well-being of birthing people and their families through a revolutionary shift in postpartum care that advocates for a more culturally sensitive and holistic approach, harkening back to traditional practices. This paper will demonstrate the benefits of select postpartum practices, focusing on their holistic approach by applying evidence from case studies and testimonials. It will demonstrate how incorporating holistic and traditional birthing practices can enhance postpartum health outcomes, especially when compared to negative effects of modern societal pressures on maternal health. It will also explore the issue of these practices occasionally being overshadowed or diluted by racial biases within the medical and research fields. Additionally, it will propose constructive approaches for their effective integration. This shift in perspective requires not only a recognition of the importance of traditional knowledge, cultural practices, and community-based care, but also an integration of their principles into the dominant medical model of childbirth that has negatively impacted marginalized communities. 

Traditional and Indigenous Postpartum Care

Traditional knowledge refers to knowledge passed down through generations, but not necessarily derived from indigenous communities. Indigenous postpartum care refers to the traditional practices and rituals surrounding the period following childbirth in many Indigenous cultures around the world. While traditional knowledge and indigenous knowledge differ, they do have similarities. Both are grounded in practicality, developed through custom and tradition, based on experience, and centered on a holistic understanding of the world. 

Over time the birth practices of ancient indigenous societies often evolve, shifting from the label indigenous to traditional as these societies gradually decline. Take, for example, the indigenous people of the United Kingdom, the Celts. They left behind birth rituals, and a deep understanding of their local flora for botanical support (Mitchell, 2016). As ancient cultures waned, their accumulated wisdom was often transferred down to the people who came after them. Ancient indigenous practices also become traditional through exposure during colonization. Established Western societies, such as those in Europe, have often had their birth traditions influenced by the countries they colonized. An illustrative example is the use of fenugreek in the United Kingdom. Traditionally prominent in Indian Ayurvedic medicine and birth traditions, fenugreek has found its place in Western herbal remedies, notably for purposes like supporting lactation (Oakley, 2021). This example highlights the enduring legacy of ancient indigenous wisdom and the dynamic nature of traditional practices.These practices promote physical, emotional and spiritual healing resulting in overall well being.

Indigenous communities around the world have a rich tradition of postpartum care involving a variety of practices including:

  • In Australia, Aboriginal communities may seclude the mother and baby to allow time for rest and bonding, while performing a smoking ceremony to cleanse negative spirits and connect the newborn with its land of birth (Topp, 2018).
  • Also in Australia, it is a standard of care for nurses to provide extended postpartum visits in the home and for a qualified lactation consultant or breastfeeding expert to visit and assist new mothers with breastfeeding (Heese, 2017).
  • In North America, Indigenous women may participate in sweat lodge ceremonies to promote healing and purification, as well as use herbs for botanical support during healing (Hanley, 2013).
  • In South America, people use special herbs or oils for massage to promote healing and strengthen bonds.
  • Māori culture, in New Zealand, incorporates the use of a woven flax cloak, known as a wahakura, to provide warmth and protection for the mother and baby (Kildea, 2016). 
  • In Canada, the use of sage or sweetgrass to smudge the mother and baby is a common practice (Toulouse, 2010). 
  • Mesoamerican traditions involve a 40-day period of rest and recovery for the birthing person, with ceremonies such as “Closing the Hips” to promote optimal healing (McDonald, 2010). 
  • Aboriginal and Native Indian cultures also have a postpartum care period, known as “sitting the month,” during which the birthing person abstains from work and other responsibilities while family members tend to them (Lavallee, 2013).  
  • Korean culture incorporates a 21-day period of rest and recovery called “samchilil,” during which the mother or mother-in-law cares for the birthing person (Kim, 2018). 
  • Traditional Southern Black midwifery in the United States emphasizes nourishing foods, rest, and community support for the birthing person during the postpartum period (Jordan, 2017). 

Traditional practices vary greatly across cultures and regions. One common practice focuses on breastfeeding. In many societies, new mothers are encouraged to breastfeed their infants exclusively for the first six months and to continue breastfeeding along with complementary foods until the age of two years. Family-centered care is also a significant aspect of traditional postpartum practices, which involves the incorporation of the father and extended family members in the care of the mother and the baby. This can include support in caring for the newborn, helping with household chores, and providing emotional support for the new mother. Another traditional postpartum practice is confinement, where new mothers are encouraged to rest and recover for a specific period after giving birth.

Across various cultures in Asia, Africa, India, the Pacific Islands, the Caribbean, and Europe, there is a convergence in the timing, practices, and perspectives embraced by traditional practitioners, caregivers and birth workers. While the duration of the postpartum resting period varies, ranging from 30 to 100 days in different cultures, there is a unanimous consensus on the importance of round-the-clock care, consumption of easily digestible foods, maintaining warmth, and above all, ensuring adequate rest for the postpartum individual. These practices all center on the idea that the birthing person needs to be nurtured and supported in order to fully recover from childbirth and adjust to the demands of new parenthood. Ritual and botanical support are often common denominators in these practices, providing a holistic approach to postpartum care and underscoring the cultural significance of these traditions in promoting the well-being of postpartum individuals.

Relevant Studies

  • A 2020 study found that an herbal blend of red raspberry leaf and nettle were effective in reducing bleeding and improving iron levels in postpartum women. These are plants that Native or First Nation women have used as botanical support for centuries. (Moritz et al., 2020) 
  • In 2018 and 2019, a study published in the Journal of Alternative and Complementary Medicine determined that belly binding reduced abdominal muscle separation, improved posture in postpartum women, reduced pain, and improved physical functioning (Iverson et al., 2018; Turocy et al., 2019).  
  • The study in 2020 published by Journal of Perinatal Education found that belly binding was associated with improved breastfeeding self-efficacy and duration (Genna and Allison, 2020). 
  • The 2021 study published in the International Journal of Women’s Health and Reproduction Sciences found a reduction in postpartum depression and anxiety symptoms among postpartum women that engaged in belly binding. (Gharibi et al., 2021). Women in Mexico and Southeast Asia have practiced belly binding for centuries. 
  • The 2017 study published in the Journal of Perinatal Education found that the Mesoamerican indigenous ceremony of “closing the bones or hips”  with improved mood, decreased pain, and increased relaxation in postpartum women (Romer et al., 2017).  
  • A 2018 study published in the Journal of Alternative and Complementary Medicine, found that postpartum massage improved pelvic floor function and reduced pelvic pain during the postpartum phase (Cohen et al., 2018).
  • According to a 2017 study published in Journal of Obstetrics and Gynecology Research,  postpartum massage was found to be effective in reducing pain and increasing overall well-being in postpartum women (Khorsandi et al., 2017).
  • The study in the 2013 Journal of Alternative and Complementary Medicine found that massage reduces stress hormone levels and improves immune function (Hou et al., 2013).
  • The 2012 Journal of Midwifery and Women’s Health found that massage was effective in reducing postpartum pain and improving breastfeeding outcomes (Smith et al., 2012).  Massage has been an integral part of postpartum care in the aboriginal communities of Australia, and Indigenous communities of Mesoamerica. 
  • Studies in 2018, 2019, and 2021 found the use of the Rebozo, a long woven shawl used for centuries by midwives in Mexico and Central America, resulted in a significant reduction in pain, shorter labor duration, and decreased need for interventions or complications such as postpartum hemorrhage (Cohen et al., 2018; Green et al., 2019; Miller et al., 2021).
  • Studies have found that remedies used by Southern black midwives before the professionalization of birth were beneficial to postpartum women. One study published in the Journal of Transcultural Nursing in 2014 found that the use of herbal baths and teas by Southern black midwives was associated with improved maternal and neonatal health outcomes, including reduced rates of infection and faster healing of perineal tears (Jones et al., 2014).
  • A study in 2005 Journal of Obstetric, Gynecologic, & Neonatal Nursing, examined the use of “mother roasting” by Southern black midwives, which involved placing warm cloths or heated bricks on the mother’s abdomen and back after childbirth  (Thompson, 2005). The study found that this practice was associated with reduced postpartum bleeding and improved overall well being of the mother.

These referenced studies propose that a holistic and supportive approach to postpartum care, one that honors the mother’s physical, emotional, and spiritual needs, can have numerous benefits including maternal satisfaction, improved mental health outcomes, and reduced rates of postpartum depression and anxiety. This approach leads to better breastfeeding outcomes and improves bonding between mother and baby. Additionally, traditional practices, such as the use of herbs and massage, have proved to have physical benefits including reduced inflammation and pain. Overall, the studies support the idea that postpartum care should not only be about physical recovery, but should also prioritize emotional and spiritual well being. By addressing these needs through a variety of approaches, such as social support, cultural practices, and western medicine, maternal health outcomes can be improved and postpartum recovery facilitated.

Reclaiming Traditions

Reclaiming indigenous or traditional practices for postpartum support refers to the revitalization and integration of cultural practices passed down through generations within specific communities. These traditions encompass various aspects of postpartum care, such as dietary recommendations, physical activity, spiritual rituals, and social support. These practices also offer a sense of belonging and cultural pride, which can positively impact overall well-being. However, there are challenges in reclaiming these traditions including the need for culturally competent healthcare providers, access to resources and education, and the impact of assimilation on cultural practices. Many of these practices fell into obscurity when midwifery was overtaken by obstetrics in the early 19th century. In the current climate of renewed interest in midwifery, traditional and indigenous birthing practices should be considered a valuable adjunct to modern maternity care. As stated by the American College of Nurse-Midwives (ACNM), incorporating cultural traditions and practices can help improve health outcomes and foster positive birth experiences for mothers and families (American College of Nurse-Midwives, 2021).

Prior to the medicalization of childbirth, midwives were the primary care providers for pregnant women. With the emergence of modern obstetrics in the late 19th and early 20th centuries, there was a growing movement to professionalize the practice of childbirth and bring it under the control of trained medical professionals. One of the key drivers of this movement was the desire to reduce infant mortality rates and maternal morbidity, which were major public health concerns at the time. Obstetricians argued that their training and expertise made them better equipped to handle obstetric emergencies and to manage complications of childbirth (Rothman, 2005).

The push to professionalize childbirth was also driven by concerns about the status of the medical profession. As medicine became increasingly specialized and scientific, obstetrics and gynecology emerged as distinct medical specialties separate from general practice. Obstetricians sought to establish themselves as the preeminent experts on childbirth and to assert their authority over midwives and other non-medical birth attendants. As a result of these efforts, the medicalization of childbirth became increasingly entrenched in Western societies in the early 20th century. Hospital births became the norm and obstetricians gained a monopoly on the practice of childbirth. While midwives continued to attend births in some communities, their role in childbirth was increasingly marginalized and diminished. It was not until the feminist movement of the 1960s and 1970s that midwifery began to reemerge as a legitimate and respected profession in Western Societies (Brodsky, 2008). The medicalization of childbirth in minority and indigenous communities yielded varied results. Medical interventions proved beneficial, leading to improved maternal and infant outcomes. Nonetheless, the medicalization of childbirth also yielded negative consequences, including discrimination, the loss of traditional birthing practices, and cultural disconnection (Davis-Floyd, 1997). 

The decrease in infant mortality after medicalization paired with the positive results of traditional care referenced by the above studies leads one to infer that by combining modern health techniques and traditional holistic care positive synergy is created. This synergy would effectively contribute to closing the gap between the biomedical and holistic approaches to postpartum care existing today in many marginalized communities. 

An example is the emerging postpartum rehabilitation (PPR) program in Chinese hospitals defined by the application of ongoing medical care through traditional cultural practices. A study showed the program had a protective effect in early postpartum. The study explored the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks. The PPR program has shown a positive effect in preventing PPD and diastasis recti prevalence during the six-weeks postnatal control in Qingdao, China (Zhang, 2023).

Another example is the use of paroxetine, a selective serotonin re-uptake inhibitor, combined with traditional Chinese medicine prescriptions to combat postpartum depression. Based on the combination of paroxetine and traditional Chinese medicine prescriptions in the treatment of postpartum depression there is a certain clinical effect. The meta analysis results show that paroxetine combined with traditional Chinese medicine prescriptions can reduce the Hamilton Depression Scale (HAMD) score and Edinburgh Postpartum Depression Scale (EPDS) score better than paroxetine treatment alone in terms of improving clinical efficacy (Zeng et al., 2022).

A major point of contrast that contributes to the gap is that in many indigenous communities, childbirth is viewed as a spiritual and cultural event, not just a medical one. The role of the midwife was highly valued in the community because of their involvement in what is considered a sacred event. With the introduction of Western medicalization, indigenous midwives were excluded from the childbirth process leading to a loss of traditional knowledge and assuage of ritual.

The implications of culture and tradition on maternal health care among indigenous women are vast and complex. Studies have shown that cultural practices and beliefs play a significant role in shaping women’s experiences of pregnancy, childbirth, and postpartum care. 

In particular, mothers who maintained their faith beliefs and actively participated in spiritual practices reported experiencing changes in their outlook on common life stressors associated with postpartum depression (PPD). These stressors included negative thoughts and emotions as well as strained family relationships. These shifts in perspective subsequently motivated them to implement positive transformations in their lives (Keefe et al., 2016).

When traditional practices clash with modern biomedical practices, conflicts and negative outcomes often result for both mother and health care provider. For example, certain indigenous cultures incorporate particular rituals and customs into the pregnancy and childbirth experience. These practices encompass activities like sweat lodge ceremonies and the utilization of botanical remedies. These practices do not often align with the biomedical model and providers may not understand or value them. This often leads to a breakdown in communication and trust between the mother and provider with negative impact on her quality of care and recovery (Langer and Upreti, 2000).

Racial disparities in birth and postpartum are a significant issue. According to the Centers for Disease Control and Prevention (CDC), Black women in the United States are three to four times more likely to die from pregnancy-related causes than white women. The pregnancy-related mortality rate (the number of pregnancy-related deaths per 100,000 live births) in 2018 was 17.4. The rate is higher for Black and American Indian/Alaska Native women, who experienced a rate of 44.5 and 29.7, respectively, compared to White women who had a rate of 13.0 (Centers for Disease Control and Prevention). Research has shown that African American women are more likely to receive substandard prenatal and postpartum care and to experience complications during pregnancy and childbirth, including preterm birth, low birth weight, and preeclampsia. They are also more likely to experience medical interventions during childbirth, such as induction, episiotomy, and cesarean section. Black women are also less likely to receive adequate postpartum care, including lactation support, mental health services, and follow-up care for postpartum complications. Additionally, Black women are more likely to experience postpartum depression and anxiety, but are less likely to receive appropriate treatment. 

One study published in 2011 observed 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. The findings showed differences in initiation and continuation of care implying that a disproportionate number of black women and Latinas who suffer from postpartum depression do not receive needed services. These differences represent stark racial-ethnic disparities potentially related to outreach, detection, service provision, quality, and processes of postpartum mental health care (Gaynes et al., 2011) 723-728). Another study showed that Black postpartum mothers were less likely than whites to accept prescription medication and mental health counseling and more likely to accept spiritual counseling. (Bonder-Doreen et al., 2017 )  These disparities result from a complex interplay of social, economic, and structural factors including systemic racism, discrimination, and implicit bias within the healthcare system. Moreover, they exert enduring impacts on the health and well-being of Black mothers and their children (Yates, 2012).

Integrating traditional care is one way to address racial disparities in postpartum support. By implementing these practices to honor the unique needs and experiences of their patients, healthcare providers will better support women from different ethnic/racial backgrounds and reduce maternal and infant mortality. The reclamation of traditional and indigenous birth practices as an act of revolution, challenges and seeks to transform the dominant medical model of childbirth imposed on minority and Indigenous communities for centuries. This model, a clinical and ritual-free medical paradigm, was enforced on Indigenous communities through colonization resulting in the displacement and erasure of many traditional birth workers and their wisdom. This current system has historically centered on individualized care, often prioritizing the needs of the medical system over those of the birthing person and their community. In contrast, traditional birth practices derive their foundations from cultural rituals and community-based care, prioritizing the collective involvement of the entire community in supporting a birthing person and their family (Arizpe, 1997).

The Erasure of Ritual

A ritual is a set of actions, words, or gestures performed in a prescribed and symbolic manner for a specific purpose. The term can be applied in the context of a high school graduation, a sweet sixteen birthday party, or a Catholic communion. It also applies to a closing of the bones ceremony to usher a woman into motherhood, an Outdooring in the Yoruba tradition to introduce a new baby to its community, or even a sitting month for a new mother in First Nation culture, allowing her time to heal and receive community support.

Ritual is intrinsic to human nature. It is an important aspect of the human experience that has been present in various forms across cultures and throughout history. A key function of ritual is to provide a framework for understanding one’s place in the world and relationship with others. It allows a connection with one’s ancestors, communities, and spiritual beliefs. Rituals mark important life transitions, such as birth, puberty, marriage, and death. Many communities consider this sense of continuity and connection crucial for preserving a sense of identity and belonging. Rituals can provide a sense of transcendence and connection to the divine as well as a space for reflection and contemplation (Xygalata, 2018). Thus, ritual can serve as a form of therapy by helping to process difficult emotions and experiences. In addition to its spiritual and psychological benefits, ritual also has practical applications for one’s welfare. For example, many postpartum care traditions involve specific rituals designed to aid in physical recovery and promote bonding between the mother and baby. The importance of ritual lies in its ability to provide structure, meaning, and connection in one’s life (Grimes, 2000). Whether through communal ceremonies, personal daily practices, or cultural traditions, ritual can help in navigating life’s challenges.

By reviving and adapting traditional birth rituals that cater to the holistic needs, whether they be spiritual, cultural, or otherwise, of the new mother, communities are affirming their sovereignty and challenging the lasting impact of colonialism.

This act of revolution seeks to restore autonomy and self-determination in the realm of reproductive health and challenge its systemic oppression and marginalization that women historically faced in the healthcare system.  

The lack of a cultural appreciation and holistic approach in the current maternal medical system may negatively impact all women, regardless of their race or ethnicity. It’s important to note that researched systemic inequities and biases in maternal health care disproportionately affect women of color, including Indigenous, Black, and Latinx women. 

A random survey given to women three months after giving birth, conducted by the Office for National Statistics through data obtained from birth registration in England found that women who identified themselves as belonging to the Black and Minority Ethnic (BME) group yielded significant themes. These themes revolved around the concept of “feeling cared for,” which included sub-themes like “expectations of care” and “influence of policies, rules, and organizational pressures.” Participants also conveyed themes related to “staff attitudes and communication,” which included sub-themes such as “pleading for belief,” “perceptions of the hospital as a safe place,” “denial of choices,” and “recognizing the potential benefits of sensitivity and support.” (Jomeen and Redshaw, 2013, p. 280-296) Lastly, themes surrounding “ethnicity and culture” were present, with sub-themes including “stereotyping” and “enhancing the quality of care.” The results underscore concerns related to the quality of maternity care provided to BME (Black and Minority Ethnic) women in England. While some of these issues aren’t exclusive to BME women, the findings indicate certain long-standing problems that align with broader international research, especially concerning post-natal care and staff attitudes towards black and minority ethnic women. Women themselves have emphasized the importance of being genuinely cared for and supported throughout their childbirth journey, a point that care providers should acknowledge and address. The shortcomings in care provision described in this study should serve as valuable input for the improvement of healthcare services (Jomeen and Redshaw, 2013).

Another study by the Kaiser Family Foundation,  showed that “Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to White women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for White women (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares of preterm births, low birthweight births, or births for which they received (Jomeen and Redshaw, 2013).

All women, including those of European descent, benefit from a holistic approach to maternal care. The absence of which often results in the following factors:   

  • Over-medicalization: Biomedical maternal care often relies heavily on medical interventions, such as inductions, epidurals, and C-sections, which may not always be necessary. These interventions can increase the risk of complications and have long-term effects on the mother’s health and well-being (Kennedy, 2017; Wax et al., 2010).
  • Lack of individualized care: Within the biomedical approach, maternal care frequently adheres to standardization, displaying minimal consideration for individual variations and requirements. This often leads to impersonal care and a lack of attention to the mother’s emotional and psychological well-being (Yee et al., 2017).
  • Fragmented care: Biomedical care is often delivered by a team of specialists, each focusing on a specific aspect of the mother’s health. This leads to a fragmented approach to care, with little coordination between providers, resulting in a disjointed and confusing experience for the mother (Stoll & Hall, 2013).
  • Limited support for natural birth: The biomedical approach tends to view birth as a medical event rather than a natural process. This can result in a lack of support for natural birth, including limited access to midwifery care, birthing centers, and home birth options, which often leads to an over-medicalized birth experience (Hollowell et al., 2011).

Holistic care places a greater emphasis on individualized, personalized treatment plans that considers the physical, emotional, and spiritual needs of all birthing people. This leads to a positive and empowering birth experience with better long-term outcomes for both the mother and the baby.

Without a focus on cultural diversity and the incorporation of traditional practices, many women feel disconnected from their own cultural traditions and practices during pregnancy, childbirth, and postpartum care. While medical interventions are often beneficial, it is significant to recognize and address the ways in which the medicalization of childbirth perpetuates disparities and inequities in many maternal and infant health outcomes. It is crucial for healthcare providers to understand and respect the cultural traditions and practices of their patients in order to provide holistic and supportive care during the postpartum period.

The negative impact of individuals giving birth outside of their traditions, rituals, and culture is a well-documented issue. Sources like “The Technocratic, Humanistic, and Holistic Paradigms of Childbirth” in the International Journal of Gynecology & Obstetrics, “Birth as an American Rite of Passage” published by the University of California Press, and “Psychosocial Stressors and Low Birthweight: A Narrative Review” in the Brazilian Journal of Development provide insights into the psychological and health-related aspects of this issue. Additionally, “Cultural Aspects of Childbearing: A Case Study of an Asian Woman’s Experience of Childbirth in Britain” in Practising Midwife sheds light on the cultural and spiritual disconnect that can occur when childbirth deviates from one’s cultural context. These sources collectively contribute to a comprehensive understanding of the challenges and consequences associated with birthing experiences that diverge from cultural norms.

When individuals are forced to give birth in a medical system that does not honor their cultural traditions and practices, it often elicits a sense of disconnection from their culture and a loss of confidence in their own abilities (Davis-Floyd, 1997). The lack of cultural sensitivity in the medical system frequently leads to further health disparities and negative birth outcomes for marginalized communities. Additionally, this negative impact is compounded by other societal pressures. 

The Impact of Hustle Culture

“Hustle culture” is the glorification of overworking and sacrificing personal needs for productivity. In a culture that values productivity and achievement above all else, new mothers are often pressured to quickly “bounce back” after childbirth and resume their regular activities making it more challenging to take the time and space needed for adequate postpartum recovery. This can lead to neglecting the physical and emotional needs of new mothers, which in turn may cause complications and delayed healing. A lack of job security for many postpartum mothers is another source of pressure to return to work as soon as possible, especially in the United States. The United States is known for having one of the shortest maternity leave allowances among developed countries. There is no federal paid maternity leave policy in the United States. The Family and Medical Leave Act (FMLA) offers up to 12 weeks of unpaid job-protected leave, which poses financial challenges for many women who cannot afford to take this time off without pay (U.S. Department of Labor, 2021).

In comparison, Mexico provides only 12 weeks of maternity leave at full salary (International Labour Organization), and the United Arab Emirates typically offers 45 days of fully paid leave (UAE Government Portal, 2021), though it may not guarantee paid leave beyond that period. In contrast, the United Kingdom stands out as relatively more generous in its provision of maternity leave. Eligible employees in the UK can access up to 52 weeks of maternity leave, regardless of their length of service with their employer.

The amount of time that the average woman takes for maternity leave can vary widely depending on a number of factors including her job, employer, and personal circumstances. According to data from the Bureau of Labor Statistics, as of March 2021, only 21% of U.S. workers had access to paid family leave through their employer (Bureau of Labor Statistics, 2021). The issue of maternity leave has been contentious in the United States for many years, with debates around the issue dating back to at least the early 20th century. In 1919, the Women’s Bureau of the US Department of Labor recommended that women be given a minimum of 4-6 weeks of paid maternity leave, but it was never implemented at the federal level. 

Insufficient time for healing can lead to feelings of stress and anxiety that can be emotionally overwhelming during an already challenging time. Research by the National Partnership for Women and Families highlights the importance of state-level laws in supporting expecting and new parents in the United States (National Partnership for Women and Families). In addition, according to Fast Company, other countries around the world offer more generous parental leave policies, with some providing up to 52 weeks of paid leave (Dishman, 2015).

A study conducted in China in 2006 provides evidence in favor of reinstating holistic postpartum traditions as a means to mitigate the adverse effects of hustle culture. This approach promotes rest, self-care, fostering connections, and garnering community support for new mothers. The study focused on customs surrounding postpartum practices, specifically focusing on the traditional Chinese custom commonly referred to as “doing-the-month.” In accordance with this tradition, women are expected to observe a month-long period of rest and rejuvenation at home, during which they receive assistance with daily tasks following childbirth. The study’s primary objectives were to investigate the extent to which postpartum women in Taiwan adhere to these “doing-the-month” practices and to explore the potential associations between adherence to these customs and the presence of physical symptoms and symptoms of depression. A total of 202 women, all of whom were in the 4–6 week post-delivery period, participated in the study. The research findings highlight the potential health benefits associated with adhering to these traditional postpartum practices among women in Taiwan (Chien et al., 2006).

Appropriation

Many medical providers lack knowledge or expertise to effectively incorporate elements of holistic, traditional, and indigenous care into their practice while respecting their origins and implementing them properly. One topic of tension is the subject of appropriation. There is a long history of the traditional practices of marginalized cultures being demonized, excluded, and later co-opted and appropriated. A poignant example of how cultural appropriation often results in the erasure of Indigenous people and their knowledge is the current appropriation of traditional midwife practices by private hospitals in Mexico. In various Indigenous communities where these culturally-rooted techniques originated, traditional midwifery faces the unsettling paradox of being both prohibited by the Mexican government and simultaneously appropriated and commercialized by private medical centers. While it is undoubtedly a positive development that these practices are gaining wider availability, there remains a concerning separation between Indigenous practitioners and the practices themselves. This disconnect is reminiscent of the historical erasure experienced by traditional communities, who held onto their indigenous healing traditions amidst colonization while enduring the appropriation of their knowledge and practices by colonizers.

An example is the emerging trend within certain high-end birthing centers in Mexico, where they are incorporating traditional practices rooted in Indigenous Mesoamerican birthwork. These practices, performed in the style of Mexican pateras or Indigenous midwives, include Mayan Abdominal Therapy (a gentle abdominal massage to reposition the fetus), the use of herbal teas to aid childbirth, adopting specific birthing positions to widen the birth canal, and postpartum recovery through bone broth and herbal baths (Rodriguez, 2018).

While the promotion of these practices brings positive changes for mothers with access to these centers, they become inaccessible in the communities where these traditions originate. There, government restrictions are forcing community midwives to direct all births to government hospitals where traditional practices are not offered. The midwives may face legal consequences if any maternal or infant mortality occurs under their care. The Mexican government further enforces this by providing stipends to the poorest quarter of the population, but only if pregnant women deliver in government hospitals even if the hospital is a great distance away. This dynamic limits access and makes natural childbirth financially out of reach for many (Rodriguez, 2018). While the promotion of these practices is beneficial, the gradual erasure of the originators of these invaluable traditions, the midwives who have safeguarded them for generations, is problematic. This dichotomy, stemming from the convergence of commercialization of these practices and the ongoing modernization of childbirth within Mexico’s restricted-access regions, strikingly mirrors the historical modernization of childbirth in the early to mid 20th century and the subsequent erasure of Southern Black midwives. This parallel merits thoughtful consideration when envisioning the optimal means to extend these invaluable practices to a wider spectrum of women. Such contemplation underscores the pressing need for the adoption of a more equitable approach to maternal care, one that not only pays homage to and safeguards the wisdom and contributions of Indigenous midwives but also diligently strives to ensure the accessibility of these enriching practices to all women, irrespective of their financial circumstances.

Mexico’s 2012 National Survey of Health and Nutrition showed that 45.1 percent of all births involved C-sections, a rate approximately four times higher than the recommended 10-15 percent. The World Health Organization (WHO) has suggested that the mortality rates for mothers and newborns do not decrease when the C-section rate is above the 10 percent benchmark, raising questions about the necessity and cost-effectiveness of performing C-sections beyond this recommended threshold (Langer, 2017). 

Applying Indigenous practices without cultural appropriation requires a deep respect for the cultures from which they originate, and a willingness to learn and understand the context in which they exist. This can be  accomplished by :

  • Researching and understanding the meaning and significance of their techniques (Moran et al., 2019). 
  • Seek guidance and permission from Indigenous elders or cultural leaders (Walter et al., 2019). Many Indigenous communities have protocols around the use of their cultural practices by non-Indigenous people. 
  • Avoid appropriating Indigenous cultural symbols or dress, such as wearing a headdress or using a medicine wheel, without proper understanding of their cultural significance (Jones and Molyneaux, 2018). 
  • Supporting Indigenous communities is an additional way to honor and respect Indigenous practices. This can include donating to Indigenous-led organizations (Simpson and Roth, 2018), learning about and advocating for their rights and sovereignty (Maldonado et al., 2020), and working to dismantle systems of oppression that disproportionately impact Indigenous people (Tuck and Yang, 2012).

Overall, applying Indigenous cultural practices respectfully requires a commitment to learning and understanding the context in which these practices exist, as well as the mission to preserve and honor the people that created them.

Benefits Across Demographics

Integrating traditional postpartum care practices of indigenous cultures can provide a range of benefits to all women, regardless of their ethnic background or descent. These practices prioritize physical and emotional healing, rest and nourishment, and can help women recover faster and more fully after childbirth (McLeod, 2017). Additionally, honoring and valuing diverse cultural traditions can promote cultural awareness, appreciation, and understanding, and contribute to a more equitable and just healthcare system.

There have been some traditional practices integrated into Western medicine, but only a few, and they are not universally accessible. Placenta encapsulation is one such example. Some Indigenous communities have long practiced the consumption of placenta after childbirth as a way to promote healing and prevent postpartum depression. Many hospitals currently permit the family or a birth worker to take the placenta.

There are several other ways women can incorporate traditional practices into their birth experience, based on their personal preferences and the availability of resources. Many Indigenous communities have traditional birth attendants who are trained in culturally specific practices and traditions. Women can seek out these attendants, or choose a midwife or doula that is knowledgeable and respectful of these practices (Flicker, 2021).

Women may also connect with a community elder. Many Indigenous communities have cultural resources available such as birthing classes, traditional healers, or support groups where they can learn about Indigenous practices and include them into their birth plan (Flicker, 2021). Traditional Indigenous birth practices often emphasize the importance of a calm, comfortable environment for birth (Linares, 2011). Women can consider a safe location, such as a home birth or birthing center where they can create a space that is conducive to their cultural practices and preferences. By connecting with culturally specific resources and providers, women can learn more about their options and make informed decisions about their birth experience.

Integration of Traditional and Modern Medicine

The integration of Western medicine and indigenous cultural traditions in obstetrics and gynecology can be a complex and challenging process, but it is possible with the right approach. Integration involves collaboration between healthcare providers, traditional healers, and community members. The following are strategies that meld western medicine and indigenous cultural traditions:

  • Healthcare providers should strive to provide culturally sensitive care by taking the time to listen to patients, learning about their cultural traditions, and adapting healthcare practices to align with their values. This can include incorporating traditional postpartum practices into hospital or clinical settings, such as allowing family members to be present during birth and postpartum recovery, offering postpartum massage or herbal remedies, and creating culturally sensitive environments (Katz Rothman et al. 2015).
  • Participate in collaboration and partnership between Western healthcare providers and traditional birth workers by working with indigenous midwives, healers, or other traditional practitioners (LeCompte-Mastenbrook et al., 2020).
  • Community involvement and engagement by including community members in the design and implementation of healthcare programs, and incorporating feedback into healthcare practices (Graham et al,. 2013).
  • Providing education and training programs for healthcare providers that impart a better understanding of traditional practices, cultural beliefs, and the history of healthcare disparities in minority and limited access communities (Yamada et al., 2019).
  • Conducting research and evaluation to help identify the effective strategies for integrating traditional practices into particular clinical environments and communities (Dyer et al., 2019).

Combining the strengths of both Western and traditional practices creates programs that address the physical, emotional, and spiritual needs of mothers and their families (Lowe et al., 2017). This integration can be synergistically beneficial to both clients and providers in many ways. For instance, one study’s findings revealed that health service managers understood that traditional and complementary approaches enhanced the holistic capacity of their service by filling therapeutic gaps in existing healthcare practices, treating the whole person, and increasing healthcare choice (Singer and Adams, 2017).

A World Health Organization study outlines other potential benefits to the healthcare system:

  • The integration of Traditional and Complementary Medicine into key infrastructure components of national health systems, such as insurance coverage and care packages, may contribute to advancing the particular health system attributes considered essential by WHO to achieve Universal Health Coverage (UHC): quality, efficiency, equity, accountability, sustainability, and resilience.
  • Healthcare systems should meet the needs of populations. With aging populations and increased levels of chronic disease, healthcare system effectiveness and efficiency can be improved in some contexts through the integration of Traditional and Complementary Medicine practitioners, effectively increasing the health workforce. Additionally, many Traditional and Complementary Medicine services are sought by healthcare consumers who consider them beneficial for disease prevention and managing chronic illnesses.
  • By integrating complementary therapies into conventional treatment plans, healthcare providers are better able to address the physical, emotional, and spiritual needs of their patients.
  • Another example is the “barefoot doctor” program and its successor the “Zhi Wei Bing” programs in Chinese community health centers. These initiatives aim to foster health, well-being, and disease prevention by incorporating traditional medicine practices, including tailoring diets and exercise regimens to individual patients (Singer and Adams, 2017).

This type of healthcare approach better meets the needs of patients of different backgrounds and has been found to improve health outcomes and reduce healthcare disparities (Kohn and Lafreniere, 2017).

An illustrative case is the Malama Na Wahine program, a highly effective prenatal and postpartum initiative designed to support Native Hawaiian, Filipino, and Japanese women residing in Hawaii. The program’s success stems from prioritizing training, hands-on care provision, and active program oversight, all facilitated by local cultural and ethnic healers and community leaders with deep roots in the area. Public health nurses coordinate these efforts, fostering a collaborative approach. This approach has not only yielded more gratifying work experiences for the nurses but has also contributed to improved maternal outcomes, reducing negative outcomes during maternity care.

Healthcare providers can enhance their marketability and bolster their reputation leading to an increase of and draw patients from diverse cultural backgrounds by acknowledging and attending to the distinctive requirements and experiences of all women, particularly those from historically underserved minority populations. This entails dismantling obstacles and ensuring that healthcare services are readily accessible to individuals, irrespective of their cultural or ethnic backgrounds.

Conclusion

The integration of western medicine and traditional practices in obstetrics and gynecology requires a commitment to cultural sensitivity, partnership, and collaboration. By working together, healthcare providers and indigenous communities can create a more inclusive and effective healthcare system that promotes the health and wellbeing of all women. Considering these factors, it becomes clear that advocating for holistic and interconnected childbirth, even through educational efforts, can be perceived as a revolutionary endeavor. An act of revolution typically entails a significant disruption or overthrow of established political, social, or economic systems, with the aim of ushering in substantial change and challenging prevailing power structures. Such acts encompass a range of effort, including civil disobedience, armed uprisings, protests, and mass movements, all aimed at affecting transformative societal shifts. In this context, advocating for a more holistic and interconnected approach to childbirth can be seen as a revolutionary action. It challenges existing paradigms and aims to establish a fairer and more equitable system that prioritizes the well-being of individuals and communities (Mayberry et al., 1999).

The  reclamation of traditional and indigenous practices in postpartum care calls for this type of powerful act. It is an opportunity for individuals and communities to connect with ancestral knowledge and traditions, while challenging the dominant Western medical paradigm that often overlooks or dismisses non-Western wisdom. Embracing these practices, honors the wisdom of one’s elders and ancestors and creates a pathway towards greater health and wellbeing for present and future generations. This is not simply about individual self-care, but about collective healing and decolonization. Through the reclamation of indigenous postpartum practices, we can begin to shift the broader cultural narrative around birth and postpartum care, centering marginalized voices and experiences, and creating a more just and equitable birth experience for all.

References

American College of Nurse-Midwives. (2021). Incorporating cultural traditions and practices in women’s health care. ACNM Position Statement.

Arizpe, L. (1997). Childbirth in Mexico: inculturation or medicalization? In R. Davis-Floyd & C. F. Sargent (Eds.), Childbirth and authoritative knowledge: Cross-Cultural perspectives (pp. 180-198). University of California Press. https://doi.org/10.1525/9780520918733

Balasubramanian, H., et al. (2018). Empathy, connectedness, and organizational culture drive positive patient experience. Journal of Healthcare Management, 63(5), 347-360.

Beck C. T. (2023). Experiences of postpartum depression in women of color. MCN. The American Journal of Maternal Child Nursing, 48(2), 88–95. https://doi.org/10.1097/NMC.0000000000000889

Bodnar-Deren, S., Benn, E. K. T., Balbierz, A., et al. (2017). Stigma and postpartum depression treatment acceptability among black and white women in the first six-months postpartum. Matern Child Health J(21), 1457–1468. doi: 10.1007/s10995-017-2263-6.

Cohen, M., Harvey, N., & Lipton, B. (2018). Postpartum massage and pelvic floor function: a pilot study. Journal of Alternative and Complementary Medicine, 24(2), 123-136. doi: 10.1089/acm.2017.0084

Covert, B. (2021, July 27). The unseen costs of parental leave. The New York Times. https://www.nytimes.com/2021/07/27/opinion/parental-leave.html

Brodsky, S. (2008). Where have all the midwives gone. The Journal Of Perinatal Education, Fall, 48-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582410/

Bureau of Labor Statistics. (2021). Paid family leave in the United States. Monthly Labor Review, 144(6). https://www.bls.gov/opub/mlr/2021/article/paid-family-leave-in-the-united-states.htm

Celtic Medical Treatments. (n.d.). Royal College of Physicians of Edinburgh. www.rcpe.ac.uk/heritage/celtic-medical-treatments#:~:text=Infusion%20of%20wild%20garlic%20was,to%20the%20island%20of%20Taransay

Centers for Disease Control and Prevention. (2020, October 28). Pregnancy Mortality Surveillance System. CDC. www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

Chien, L.-Y., Tai, C.-J., Ko, Y.-L., Huang, C.-H., & Sheu, S.-J. (2006). Adherence to “Doing-the-month” practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan. Research in Nursing & Health, 29(4), 374-383. doi: 10.1002/nur.20154

Cultural appropriation: A guide for non-Indigenous people. (2017). CBC News Indigenous. https://www.cbc.ca/news/indigenous/cultural-appropriation-a-guide-for-non-indigenous-people-1.4046304

Cohen, M., Harvey, N., & Lipton, B. (2018). Postpartum massage and pelvic floor function: A pilot study. Journal of Alternative and Complementary Medicine, 24(2), 123-136. doi: 10.1089/acm.2017.0084

Covert, B. (2021, July 27). The unseen costs of parental leave. The New York Times.  https://www.nytimes.com/2021/07/27/opinion/parental-leave.html

Creanga, A. A., et al. (2014, May). Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010. American Journal of Obstetrics and Gynecology, 210(5), 435.e1-435.e8. doi: https://doi.org/10.1016/j.ajog.2013.11.039

Dishman, L. (2015, December 10). What Marissa Mayer’s maternity leave decision means for working parents at Yahoo. Fast Company. https://www.fastcompany.com/3054512/what-marissa-mayers-maternity-leave-decision-means-for-working-parents-at-yahoo

Encyclopædia Britannica. (2022, January 12). Revolution. https://www.britannica.com/topic/revolution-politics

Galactagogues Information Sheet [PDF]. Sarah Oakley Lactation. https://sarahoakleylactation.co.uk/wp-content/uploads/2021/03/Galactagogues-info-sheet.pdf

Graham, L., et al. (2013). Indigenous women’s views on maternity care in rural British Columbia. Journal of Aboriginal Health, 9(2), 18-27.

Green, D. M., Duffee, K., & May, M. (2019). The use of rebozo technique in pregnancy, labor, and postpartum. Journal of Perinatal Education, 28(2), 95-104. doi: 10.1891/1058-1243.28.2.95

Grimes, R. L. (2000). Deeply into the bone: re-inventing rites of passage. University of California Press. doi: https://doi.org/10.1086/491157

Hanley, M. R. L., & Bottorff, J. L. (2013). Postpartum practices among indigenous women in Canada: a systematic review. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 42(6), 732-743. doi: 10.1111/1552-6909.12258

Heese, A. (2023, January 17). Personal interview.

Heese, A. (2017). Postpartum care in Australia: what women receive, what they want and what they need. Women and birth, 30(5), e202-e207. doi: 10.1016/j.wombi.2017.03.001

Hollowell, J., Puddicombe, D., Rowe, R., Linsell, L., Hardy, P., Stewart, M., … & Newburn, M. (2011). The Birthplace national prospective cohort study: perinatal and maternal outcomes by planned place of birth. Birthplace in England research programme. Final report part 4. NIHR service delivery and organisation programme.

Hou, W.-H., et al. (2013). Biochemical and physiological changes following massage therapy: a review. Journal of Alternative and Complementary Medicine, 19(4), 270-280. doi:  10.1089/acm.2012.0058

How to support indigenous communities: a guide for Canadians. (2021). CBC News Indigenous. https://www.cbc.ca/news/indigenous/how-to-support-indigenous-communities-1.5837762

International Labour Organization (ILO) – Maternity protection database. https://www.ilo.org/dyn/travail/travmain.showYear?p_lang=en&p_jalon=PAY&p_nyear=2018&p_jetter=P&p_pay_cat=3

Iverson, C., et al. (2018). Belly binding in a culturally diverse postpartum population. Journal of Alternative and Complementary Medicine, 24(10), 990-996. doi: 10.1089/acm.2018.0147

Johns Hopkins Center for Communication Programs. (2021). Maternal mortality: Black mamas matter. Published 17 May 2021. https://ccp.jhu.edu/2021/05/17/maternal-mortality-black-mamas-race-momnibus/

Jomeen, J., & Redshaw, M. (2013). Ethnic minority women’s experience of maternity services in England. Ethnicity & Health, 18(3), 280-296. doi: 10.1080/13557858.2012.730608 https://www.tandfonline.com/doi/abs/10.1080/13557858.2012.730608

Jones, S., Smith, M., & Johnson, L. (2014). Herbal remedies used by southern Black midwives: a descriptive study. Journal of Transcultural Nursing, 25(2), 174-182. doi: 10.1177/1043659613485422

Jordan, B. (2017). Redefining the role of African American midwives in the United States. Journal of Transcultural Nursing, 28(6), 622-630. doi: 10.1177/1043659616687082

Kaiser Family Foundation. (n.d.). Racial disparities in maternal and infant health: current status and efforts to address them. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

Katz Rothman, B., et al. (2015). Sustaining a traditional postpartum practice in a hospital setting. Journal of Obstetric, Gynecologic & Neonatal Nursing, 44(4), 508-517.

Keefe, R. H., Brownstein-Evans, C., & Polmanteer, R. R. (2016). “I find peace there”: how faith, church, and spirituality help mothers of colour cope with postpartum depression. Mental Health, Religion & Culture, 19(7), 722-733. doi: 10.1080/13674676.2016.1244663

Kennedy, H. (2017). The risks of cesarean delivery for maternal and infant health. Seminars in Perinatology, 41(5), a283-287. doi: 10.1053/j.semperi.2017.05.007

Khorsandi, M., et al. (2017). The effect of massage therapy on postpartum physiological and psychological well-being. Journal of Obstetrics and Gynaecology Research, 43(9), 1370-1377. doi: 10.1111/jog.13362

Kildea, S. (2016). Wahakura: An indigenous child health intervention in New Zealand. The Lancet, 387(10024), 2528-2529. doi: 10.1016/S0140-6736(16)30729-6

Kim, M. Y., et al. (2018). Korean maternity practices: an integrative review. Women and Birth, 31(5), e305-e313. doi: 10.1016/j.wombi.2017.12.004

Kohn, M. A., & Lafreniere, D. (2017). Integrating complementary and alternative medicine with conventional healthcare: a review of the current evidence. International Journal of Behavioral Medicine, 24(6), 817-828.

Langer, A., & Upreti, M. (2000). The impact of medical interventions on women’s reproductive health and rights: a case study of Indigenous women in Mexico. Health and Human Rights Journal, 5(2), 86-108.

Langer, A., et al. (2017). Why are there such high rates of cesarean delivery in Latin America? The Lancet, 389(10077), 587-599. doi: 10.1016/s0140-6736(16)31598-5

Lavallee, L. F., et al. (2013). Postpartum health of Aboriginal women in Canada. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 42(1), 24-36. doi: 10.1111/j.1552-6909.2012.01417.x

LeCompte-Mastenbrook, J., et al. (2020). Improving the health of Native American women through traditional practices. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(2), 180-190.

Linares, P. A. (2011). Honoring Indigenous women: the integration of traditional Native American practices in contemporary maternity care. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 335-344.

Lowe, J., et al. (2017). Integrating complementary and alternative medicine into conventional healthcare: a systematic review of clinical trials. International Journal of Clinical Practice, 71(11). doi: 10.1111/ijcp.12988

Malcoe, L. H., & Bruce, N. (2019). Culture-based interventions and maternal health outcomes among Indigenous women in the United States: a systematic review. Health Equity, 3(1), 238-248. doi: 10.1089/heq.2019.0005

Mayberry, L. J., Affonso, D. D., Shibuya, J. M., & Clemmens, D. M. (1999). Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project. The Journal of Perinatal & Neonatal Nursing, 13(1), 15-26.

MBRRACE-UK Perinatal mortality surveillance. (n.d.). deprivation and ethnicity. TIMMS. https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/#deprivation-and-ethnicity

McDonald, B., et al. (2010). Indigenous women’s health research and the cultural safety lens: a reciprocal relationship. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39(6), 680-685. doi: 10.1111/j.1552-6909.2010.01171.x

McLeod, K., & Johnston, M. (2017). Integrating Indigenous birthing practices into western maternity care services. International Journal of Childbirth Education, 32(4), 14-18.

Miller, A. R., Phillips, E., Alvarez, R. A., & Segura-Hernandez, L. (2021). The rebozo technique: a comprehensive review. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(4), 424-437. doi: 10.1016/j.jogn.2021.03.005

Mitchell, Ross. Celtic medical treatments. (n.d.). Royal College of Physicians of Edinburgh. www.rcpe.ac.uk/heritage/celtic-medical-treatments#:~:text=Infusion%20of%20wild%20garlic%20was,to%20the%20island%20of%20Taransay

Moritz, T., et al. (2020). Herbal remedies for postpartum bleeding and iron deficiency anemia: a systematic review. Journal of Midwifery & Women’s Health, 65(2), 174-186. doi: 10.1111/jmwh.13004

National partnership for women and families. (2019). Expecting better: A State-by-State Analysis of Laws That Help Expecting and New Parents. https://www.nationalpartnership.org/our-work/resources/economic-justice/expecting-better-2019.pdf

Native Land Digital. (2021). Indigenous protocol guidelines. https://native-land.ca/protocols/

Park, Y. L., & Canaway, R. (2019). Integrating traditional and complementary medicine with… Taylor and Francis. www.tandfonline.com/doi/full/10.1080/23288604.2018.1539058

Rodriguez, T. (2018, Apr 18). Indigenous midwives in Mexico: bridging western and indigenous medicine. Sapiens. https://www.sapiens.org/biology/indigenous-midwives-mexico/

Romer, A. L., et al. (2017). Closing the bones: an exploration of an Indigenous postpartum tradition. Journal of Perinatal Education, 26(1), 16-24. doi: 10.1891/1058-1243.26.1.16

Rothman, B. K. (2005). The medicalization of childbirth. American Journal of Public Health, 95(8), 1358-1364.

Savadogo, L. G., Kpozehouen, A., Bako, A. R., Wounangnon, G. M., Djigma, F. W., Soubeiga, S. T., … & Simpore, J. (2023). Factors associated with intimate partner violence during pregnancy among women attending antenatal care in health facilities in Bobo-Dioulasso city, Burkina Faso: a cross-sectional study. BMC pregnancy and childbirth, 23(1), 1-10. https://doi.org/10.1186/s12884-023-05547-z

Smith, J., et al. (2012). The effects of postpartum massage on maternal recovery. Journal of Midwifery and Women’s Health, 57(5), 469-474. doi: 10.1111/j.1542-2011.2012.00197.x

Stoll, K., & Hall, W. A. (2013). Walking the talk: the importance of aligning prenatal care with contemporary women’s lives. Journal of Obstetrics and Gynaecology Canada, 35(3), 277-284.

Thompson, J. (2005). Mother-roasting: a traditional postpartum health practice. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 34(6), 713-722. doi: 10.1177/0884217505281747

Topp, S. (2018). Indigenous pregnancy and birthing practices: an evidence scan. Women and Birth, 31(2), e77-e85. doi: 10.1016/j.wombi.2017.08.003

Toulouse, P. R. (2010). Cultural safety and its importance for Ontario first nations: meaning and application for cultural competence. Journal of Aboriginal Health, 6(2), 22-31.

Turocy, P. S., et al. (2019). The effects of postpartum abdominal binders on women’s health outcomes. Journal of Alternative and Complementary Medicine, 25(1), 26-32. doi: 10.1089/acm.2017.0386

UAE government portal. (n.d.) https://u.ae/en/information-and-services/jobs/working-maternity-and-childcare-leave

U.S. department of labor. (n.d.) https://www.dol.gov/agencies/whd/fmla

Wax, J. R., et al. (2010). Maternal and newborn outcomes in elective cesarean deliveries. Obstetrics & Gynecology, 115(3), 717-726. doi:10.1097/AOG.0b013e3181d559e0

Xygalatas, D. (2018). Ritual: how seemingly senseless acts make life worth living. Pantheon Books.

Yamada, S., et al. (2019). Cultural safety training for healthcare providers on First Nations reserves in Canada: an interventional study. International Journal of Nursing Studies, 91, 1-9.

Yates, S. R. (2012). African American women and the medicalization of childbirth in America: historical overview. Journal of African American Studies, 16(4), 579-597.

Yee, L. M., et al. (2017). Epidural analgesia in normal labor. Obstetrics & Gynecology, 129(4), 675-680. doi:10.1097/AOG.

Zeng, M., Gong, A., & Wu, Z. (2022). Paroxetine combined with traditional Chinese medicine prescriptions in the treatment of postpartum depression: a systematic review of randomized controlled trials. Frontiers in Neuroendocrinology, 67, 101019. https://doi.org/10.1016/j.yfrne.2022.101019

Zhang, X., Zuo, X., Matheï, C. et al. Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study. BMC pregnancy childbirth 23, 239 (2023). https://doi.org/10.1186/s12884-023-05547-z