Apsaalooke Maternity:

Traditional Practices Compared to the U.S. Techno-Medical Mode

James Del Duca

Montana State University-Bozeman

Abstract

This presentation explores the possibility that Apsaalooke

adoption of the techno-medical model of maternal and child health

care may not have been an improvement over Traditional Native

practices. Review of current research and World Health Organization

guidelines suggests that traditional Apsaalooke practices are in many

ways more supportive of mother and baby health than many currently

accepted clinical practices and policies in place at Indian Health

Service hospitals, clinics, and other conventional service providers.

Strengths and weaknesses of the respective systems are discussed and

suggestions are made toward a merged system to provide an optimal

continuum of care for Native mothers and babies.

Apsaalooke Maternity: Traditional Practices Compared to the U.S.

Techno-Medical Mode

In the days before the reservation, when the Apsaalooke were an

independent and sovereign nation, they had their own traditional ways

of managing pregnancy, childbirth, and infant care. These methods

were demonstrably adequate, as their nation thrived, and having

children was not considered to be an especially dangerous event. For

my picture of Apsaalooke maternity before the domination of Euro-

American society I am fortunate to have the words of Pretty Shield,

as recorded by Linderman. She describes pregnancy, maternity, and

infant care very matter of factly, and her account is supported by

the later accounts of Agnes Yellowtail (Voget, 1995) and Alma Snell.

(Snell, 2000)

Pretty Shield, who was her self a “Wise-woman” (a.k.a. midwife),

described various cultural practices relating to birthing. All the

knowledge needed to support the process of having and raising

children was present in the Apsaalooke community, with no dependence

upon outsiders, and this knowledge was passed down to the younger

generation without any American-style educational process. The

Apsaalooke women were sovereign over their own childbearing, and

childrearing. Among the many practices of the Apsaalooke, they

birthed at home, sometimes with the help of community midwives. They

then nursed their babies, quite commonly for several years. The

babies were carried in arms for the first six months of life, only

being placed in cradleboards, or back-slings for transport and

convenience. The babies also co- slept with their mothers, who kept

them close at hand for breastfeeding and supervision. (Linderman,

1935) These practices, as a system, apparently all worked well. No

evidence was found to suggest that Apsaalooke practices of the time

were in any way inferior to Euro-American. On the contrary, the

evidence supports the idea that the Apsaalooke practices were

actually superior.

While researching this paper not a single reference was found in

the historical literature about an Apsaalooke woman dying in

childbirth or as a result of pregnancy or delivery. While this does

not provide anything approaching a reliable statistic, nevertheless

one would have thought that there would have been some account.

Especially since Euro-American maternal and infant mortality of the

same period was considerable. Childbirth among the general U.S.

population was regarded as a very dangerous undertaking. In 1900 the

maternal mortality rate was 900 per 100,000 and infant mortality was

an astounding 10,000 per 100,000! (CDC, 1999) If anything approaching

these mortality rates had been present in the Apsaalooke one could

reasonably expect that there would have been mention in the oral and

literary histories of the tribe. The entire tribe had only 3500

members in 1833 (Lowie, 1935), and would have been clearly harmed,

and it would likely have been noted, had so many women perished.

Most Apsaalooke women today no longer give birth within their

traditional surroundings of home and family. No references to an

Apsaalooke of today giving birth at home were located. I do

personally know of one Apsaalooke man’s non-Native wife having

birthed children in their home. The Apsaalooke women presently give

birth in hospitals, attended by staff that practices the techno-

medical mode of health care, inside of the larger U.S. health care

establishment. It appears to be taken for granted by the Apsaalooke

that this is an improvement over traditional practices of the past.

This is certainly the import of the various IHS publications and

outreach materials that I examined while living on the reservation.

The current system and practices are accepted without question as

being best practice. The value of techno-medical treatment of acute

conditions and emergency situations is not being questioned here. It

is the value of techno-medicine in low-risk maternity that is in

doubt.

Current public health statistics report a reality that

questions the assumption that the techno-medical mode is best in all

instances. As an opening example, close to 30% of Native women give

birth by cesarean section, reflecting national rates regarded as

dangerous and without medical justification by the World Health

Organization. (WHO 2010) In the areas of breastfeeding and birth

care World Health Organization recommendations also run counter to

current U.S. techno-medical practices, but are in alignment with the

Apsaalooke practices of old; where midwife attended births (including

homebirths) and breastfeeding were the norm.

The WHO recommends, “…a woman should give birth in a place she

feels is safe, and at the most peripheral level at which appropriate

care is feasible and safe. For a low-risk woman this can be at

home…” The WHO also acknowledges the beneficial role of community

midwives and the harmful effects of the techno-medical mode of birth

management. Their message is that the most simple, low tech,

community based, least medically invasive practices are those that

should be supported. That means women having their babies at home

with experienced and educated community supporters who know how to

let natural, healthy processes take place. They also would recognize

when transportation to hospital would be called for and technical

intervention warranted. In contrast, the IHS does not have a single

home birth midwifery program in place.

The WHO also states, in regards to breastfeeding, “Exclusive

breastfeeding is recommended until six months of age, with continued

breastfeeding along with appropriate complementary foods up to two

years of age and beyond.” IHS hospitals, while giving

acknowledgement to the benefits of breastfeeding in their

publications, still supply free samples of infant formula. Further,

there was no statistical tracking of breastfeeding duration in either

of their publications reviewed for this paper. Investing resources

into a more active promotion of breastfeeding does not appear to be a

priority.

Reliance upon techno-medical practices is not yielding superior

results. In IHS hospitals the American Indian and Alaska Native

maternal mortality rate is reported as being 11.1 per 100,000 and the

infant mortality rate is 8.3 per 100,000. These numbers are from

2004, the most recent year that I found reported. (Indian Health

Service, 2010) By way of comparison, this statistic would place the

IHS system in 62nd place on the world list for infant mortality, and

in around 40th place for maternal deaths. I feel that I should mention

that the IHS numbers are not indicative of a situation unique to the

Native population within the U.S.A. The general statistics for the

U.S. place the nation in 32nd place from best or lower in both infant

and maternal mortality with numbers of 6.14 and 17 per 100,000.

(Time, 2010) Monaco is currently the healthiest place for babies,

with infant mortality of 1.78 per 100,000. (CIA, 2010) In the

industrialized world mothers appear most safe in Sweden and

Australia, with only 5 deaths per 100,000. (Lancet, The United

States is clearly behind in mortality-prevention performance.

A review of the midwifery record of The Farm community in rural

Tennessee is warranted here as a comparison. The Farm began as a

religious-based communal living venture in the early 1970’s and is

served by midwives from within the community, who are also educated

from within their group. Additionally, on occasion the midwives of

The Farm also serve the surrounding community of Amish farmers, who

are practitioners of homebirth. They are an example of how an

independent community can achieve better than national success rates.

In over thirty years of service, with over 2000 births (a more than

adequate statistical sample size), The Farm midwives have had zero

maternal deaths and only 8 infant mortalities. That is an annualized

infant mortality rate of 1.3 per 100,000, which is less than ¼ of the

national techno-medical result. Their rate of Cesarean delivery is

less than 1%! (Gaskin, 2003) I bring up The Farm’s record because

what they have achieved is well within the ability of today’s

Apsaalooke, who live in somewhat similar rural circumstances.

Mother-child attachment is another aspect of this area of

investigation. The traditional Apsaalooke practice of extended

breastfeeding, carrying babies in arms, and then in slings, and

sleeping with them in close contact, is congruent with current

research into the process of mother-child attachment and optimal

infant neurological and emotional development. Extended breastfeeding

is a complex process which benefits the mother and child on a

multitude of levels, including emotional development, healthy

attachment between mother and infant which fosters healthy future

relationships and behaviors, neurological development, and a lower

incidence of diseases in both mother and baby. Breastfeeding babies,

carrying babies close, and sleeping with babies are all practices

supported by current science as being good for both the mother and

infant. (Attachment Parenting International, 2010) Past Apsaalooke

traditional practices were all fully in alignment with these latest

research findings.

It is therefore not unreasonable to conclude that U.S. techno-

medical clinical practices and Euro-American cultural hegemony is

currently having a mixed effect upon maternal and child health of the

Apsaalooke. While high-risk births that require hospital care are

surely having better outcomes due to techno-medical interventions,

low-risk births are being needlessly medicalized. Other maternal

practices adopted from Euro-American society are exactly the opposite

of what the WHO and others regard as most beneficial.

Most Apsaalooke women today no longer breastfeed their infants

for the first several years of life, or carry their children in arms

for their first half a year as was normal practice for Pretty Shield.

In the many years that I lived in the Apsaalooke community I never

heard of an Apsaalooke homebirth. I have observed only a very few

women breastfeeding, less than five as I recall. I have only rarely

seen a child sling or baby carrier in use, with infants today being

shuttled around in car seats without mother-baby contact. Co-sleeping

with baby is discouraged in the U.S., being viewed as increasing the

risk of SIDS (Sudden Infant Death Syndrome). This is despite the

knowledge that in other, co-sleeping cultures, the SIDS rate is lower

compared to that of the U.S.A. In addition, neuroanthropological

researchers have determined that cosleeping and babywearing are

natural continuations of millions of years of biological evolution,

and are instrumental in normal, healthy neurological development.

(Joyce & McKenna, 2008) Hospital birth, formula feeding of babies,

isolating babies in carriers (more than for safe automobile travel),

and isolating sleeping babies in cribs are all learned cultural

practices that came from outside of Apsaalooke society, and which are

all questionable in the light of current research. These are also

all practices that have eroded the sovereignty of Apsaalooke women

over their own biological processes and families. Healthcare

providers are usually from outside the community. Some providers are

Apsaalooke who have left the area to learn their skills from non-

Apsaalooke that are regarded as superior authorities, and have

abandoned traditional practices as a result. Community independence

and women’s reproductive sovereignty have been exchanged for techno-

medical outside control and dependence. Community health is suffering

accordingly.

In conclusion, the evidence examined here suggests that the

Apsaalooke women would do well to return to their traditional

practices, or updated versions of them. The Apsaalooke maternity and

childrearing culture was modified for poor reasons and the long-term

outcome has been negative. A successful holistic mode would consist

of traditional Apsaalooke cultural practices combined with updated

homebirth midwifery skills closely aligned with the proven methods of

The Farm. Apsaalooke midwives would know when transport to hospital

is warranted, and the IHS facility would remain available for these

instances, but home birth would return as the norm. The negative

practices currently in place would be educated against and eventually

abandoned through replacement with improvements supported by both

traditional culture and science. It is well within the realm of

possibility for Apsaalooke practices to return to their previous

superior position in regards to maternity and infant care. The four

practices described by Snell, Yellowtail and Pretty Shield of

midwife-attended homebirths, babywearing, co-sleeping, and extended

breastfeeding were cultural practices that were perpetuated because

they created the best outcomes, meaning highest survival rates for

mother and child. What was best practice over one hundred years ago

is still best practice today. Abandoning these best practices was a

mistake that has resulted in poorer health and loss of community

independence and sovereignty. Reinstatement of Apsaalooke women’s

sovereignty in this aspect of their lives is clearly well warranted

and long overdue.

References

Attachment Parenting International (2010). The benefits of babywearing.

Retrieved from

http://www.attachmentparenting.org/principles/intro.php

Center for Disease Control (1999). Achievements in Public Health. Retrieved

from

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

Center for Disease Control (2007). Maternal mortality and related concepts.

Retrieved from

http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf

Central Intelligence Agency (2010). World fact book. Retrieved from

HYPERLINK "https://www.cia.gov/library/publications/the-

world-" https://www.cia.gov/library/publications/the-world-

factbook/rankorder/2091rank.html

Gaskin, I.M. (2003). Ina may’s guide to childbirth. New York, NY: Bantam

Dell

Indian Health Service (2003). Regional differences in indian health. Washington,

DC:

U.S. Dept. of Health and Human Services

Joyce, E. & McKenna, J. (2008). Neuroanthropology. Cosleeping and

biological

imperatives: Why human babies do not and should not sleep alone. Retrieved

from http://neuroanthropology.net/2008/12/21/cosleeping-and-

biological-imperatives-why-human-babies-do-not-and-should-not-

sleep-alone/

Garenne, M.& McCaa, R., (2010). The Lancet. Maternal mortality from 181

countries.

Retrieved from HYPERLINK

"http://www.thelancet.com/journals/lancet/article/PIIS0140-"

http://www.thelancet.com/journals/lancet/article/PIIS0140-

6736%2810%2961950-2/fulltext

Linderman, F.B. (1972). Pretty shield: medicine woman of the crows. Lincoln, NB:

University of Nebraska Press

Lowie, R. (1935). The crow indians. Lincoln, NB: University of Nebraska

Press

Snell, A.H. (2000). Grandmother’s grandchild. Lincoln, NB: University of

Nebraska

Press

Time Magazine (2010). Retrieved from HYPERLINK

"http://healthland.time.com/2010/04/14/fewer-"

http://healthland.time.com/2010/04/14/fewer-

women-dying-during-pregnancy-childbirth/

Voget, F.W. (1995). They call me agnes. Norman, OK: University of Oklahoma

Press

Slides

Four Traditional Native practices, mentioned in Pretty Shield, They Call Me

Agnes and Grandmother’s Grandchild, that promoted mother, child, and family

health are: midwife-assisted homebirth, breastfeeding infants,

carrying baby close, and co sleeping.

World Health Organization recommendations for today include: midwife-

assisted home birth, and breastfeeding infants. Attachment Parenting

researchers advocate carrying baby and Notre Dame researchers

advocate co sleeping. Traditional practice is endorsed by current

research.

Techno-medical System (American Academy of Pediatrics and American

Congress of Obstetricians and Gynecologists) recommendations

regarding the Four Traditional practices are: homebirth is judged

unsafe, co sleeping is described as unsafe, breastfeeding is only

recommended until 12 months, co sleeping is judged as unsafe.

Was the Traditional system successful at efficiently sustaining

mother/child/family health?

Is the Allopathic system successful as successful at efficiently

sustaining mother/child/family health? Not according to the evidence.

Who benefits and loses from the present paradigm? Who should the

system empower? Are Native mothers aware of their choices?

What are the strengths and weaknesses of the Allopathic care model?

What are the strengths and weaknesses of the Traditional system?

What would a merged optimal system look like? The empowered

continuum concept.

References repeated from paper.

Informational Notes On The Slides

Apsaalooke women Pretty Shield, Alma Snell (Pretty Shield’s grand-

daughter), and Agnes Deer Nose are quoted describing midwife-attended

births, extended breastfeeding (up to three years), carrying babies

in arms until six months, and co sleeping as being normal practices

with positive outcomes.

WHO advocating midwife attended births, long-term breastfeeding

HYPERLINK

"http://www.who.int/features/factfiles/breastfeeding/facts/en/index3.

html"

http://www.who.int/features/factfiles/breastfeeding/facts/en/index3.h

tml

University of Notre Dame Neuroanthropology article advocating

co sleeping HYPERLINK

"http://neuroanthropology.net/2008/12/21/cosleeping-and-

biological-imperatives-why-human-babies-do-not-and-should-

not-sleep-alone/"

http://neuroanthropology.net/2008/12/21/cosleeping-and-

biological-imperatives-why-human-babies-do-not-and-should-

not-sleep-alone/

According to this article “In Japan where co-sleeping and

breastfeeding (in the absence of maternal smoking) is the

cultural norm, rates of the sudden infant death syndrome are

the lowest in the world.”`

The practice of Attachment Parenting methodology as developed

by Sears describes the benefits of babywearing. HYPERLINK

"http://www.askdrsears.com/html/5/T051100.asp#T051103"

http://www.askdrsears.com/html/5/T051100.asp#T051103

The American Academy of Pediatrics lists a multitude of reasons for

the low

rate of breastfeeding in the U.S. Among them are commercial

promotion of formula in hospitals and in the media.

HYPERLINK

"http://pediatrics.aappublications.org/cgi/reprint/100/6/1035

"

http://pediatrics.aappublications.org/cgi/reprint/100/6/1035

Regarding co sleeping, they deem it unsafe citing a higher

risk of SIDS, but the research states that brestfed infants

were in a separate, lower risk category. Also notable is

that the study did not examine the mattress materials

associated with mortality. To my knowledge no study has yet

done this. HYPERLINK

"http://pediatrics.aappublications.org/cgi/reprint/118/5/2051

?

maxtoshow=&hits=10&RESULTFORMAT=&fulltext=bed+sharing&searchi

d=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT"

http://pediatrics.aappublications.org/cgi/reprint/118/5/2051?

maxtoshow=&hits=10&RESULTFORMAT=&fulltext=bed+sharing&searchi

d=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

The American College of Obstetricians and Gynecologists are

solidly anti-homebirth. HYPERLINK

"http://www.acog.org/from_home/publications/press_releases/nr

02-06-08-2.cfm"

http://www.acog.org/from_home/publications/press_releases/nr0

2-06-08-2.cfm

The Apsaalooke flourished when relying solely upon their traditional

practices. The family and community were their own, effective health

care providers with no dependence upon outsiders. As a system, the

Allopathic way of supporting healthy Native mothers and babies

appears to be of significant benefit to parasitic elements, i.e.

professionals from outside of the community, corporations supplying

products and services, administrative bureaucracies, medical facility

staff, etc. It’s great for emergencies and acute care! It does not

educate women and families as independent health care providers for

their own families.

Brestfeeding rates among Native populations is in the U.S.A. are

apparently unknown or unpublished. I couldn’t find any statistic on

the IHS or any other website. The IHS does not support homebirth.

Babywearing is not promoted. Co sleeping is discouraged as per AAP

recommendations. Native maternal and baby health for normal

pregnancies has deteriorated when compared to the days of reliance

upon Traditional practices. The cesarian rate for Native women is

now 27% as compared to 0% with Traditional practice.

The present system encourages dependence upon and participation in a

system which is not creating or sustaining optimally healthy, self-

reliant, independent Native women and children. The system

perpetuates itself, while healthy women forget that they can have

their babies at home, feed them from their own breasts, and raise

perfectly healthy children. Have Native women been made afraid of

what their grandmothers took for granted as an innate power and

ability?

Allopathic care is great for acute care and emergencies. It’s

extreme methods and narrow focus do not promote or even comprehend

holistic health, or an empowered and self-reliant community. It is a

hierarchical power structure where the patient gives over their power

to the “professional”. Money, power, and knowledge is concentrated

in the class of medical professionals and the client class becomes

progressively more ignorant and dependent.

The Traditional system was not equiped to deal with abnormal

pregnancies, acute emergencies and complex pathologies. It was fully

capable of handling normal maternity, child care, and family

function. This includes educating the next generation on all the

skills and knowledge needed to successfully function as independent

families and communities in all normal circumstances.

A continuum of care based upon the WHO guidelines of keeping things

as simple as possible would effectively institute and support

homebirth, brestfeeding, babywearing, and co sleeping as well as

educating women to the level of effective health care providers to

their families under normal circumstances. Doctors and hospitals

would be available to treat emergencies and conditions beyond the

scope of Traditional practices. Women, their families, and the

community would be supported in doing all that they can for

themselves in a successful and effectice way while still having the

available resource of allopathic medicine. Thus a true continuum

would be present extending from no-tech Traditional to high-tech 21st

century techno-medical.

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