One baby at a time: Dakota midwife revitalizes Indigenous birth work, inspired to improve quality of rural healthcare

Autumn Cavender envisions more childbirth programs and traditional care center

It’s the middle of the night, and Autumn Cavender drives down a country road through the pitch-black darkness. It’s a familiar routine for Cavender, who explains that most babies are born between 11 p.m. and 4 a.m. As one of the few rural midwives in the area, she always has her bag prepared for the next birth.

Recently, Cavender was chosen as a Bush Foundation Fellow for her plans to revitalize Indigenous birth work. The fellowship, announced June 11, is among 24 awarded in the annual competition. Recipients receive grants of up to $150,000 each to fund leadership plans during the fellowship, which lasts from 12 to 24 months. Cavender will be a Bush fellow for the next two years.

The 34-year-old is from the Upper Sioux Community Pezihutazizi Oyate in Granite Falls, Minnesota. For the past 10 years, she has been working as a home birth midwife on her reservation.

As a midwife, Cavender implements traditional practices into her work, which can mean several things. This can include birthing outside the hospital, such as in a home, an earth lodge or outdoors, or in different birthing positions, such as squatting. Some choose not to implement any Western medical practices. Some ceremonies are kept secret from outsiders, but Cavender mentioned one when a healer or medicine man or woman smudges a household. For Cavender, who works with each patient to find the appropriate blend of traditional and Western medicine, it’s a mindset.

“It’s about the mentality,” said Cavender. “It’s about how you’re walking into this. It’s how your care team is respecting and coming across this. It’s about the first language that the baby hears. It’s about the intent and the prayers and the cosmovision, the metaphysical context that goes and surrounds this.”

While Cavender works primarily with individual patients, she is also a founding National Indigenous Midwifery Alliance member. Before the founding of the alliance, she saw a gap on a national level for Indigenous birth care. American Indian and Alaska Natives have almost twice the mortality rate as non-Hispanic whites, according to the Department of Health and Human Services Office of Minority Health. Native infants are also 2.7 times more likely to die from accidental deaths before the age of one.

She and colleagues nationwide came together to advocate for Indigenous birth work. Since its founding in 2017, the organization has received elder advice and input to understand practices occurring in tribal communities since pre-colonization. Depending on the tribe, this could include prayers to entities, ceremonial rituals, and how the placenta is treated and cared for. A big goal Cavender has for the NIMA is to promote the revitalization of traditional birthing customs.

Cavender’s introduction to midwifery was unusual. When she was 17 years old, she woke up from a bizarre dream she couldn’t quite remember. After she got out of bed, she told her mother, a scholar in Dakota history, that she wanted to become a midwife. “She looked at me and she’s like, ‘Oh, yeah, that’s funny,’” said Cavender. “‘All of your grandmas were midwives.’ And I was like, ‘Why am I just learning this now?’ I started there and never looked back.”

Later Cavender would move off her reservation to train under a non-Native home birth midwife in the Twin Cities. She completed her doula training under her mentor’s wing and started attending births. Many of the births she witnessed were those from her tribe.

“I’m practicing on the bodies of people who look like people from my community. It’s predominantly white midwifery students practicing on the bodies of mostly women of color.”

Autumn Cavender, midwife, 2024 Bush Fellow

One of the reasons Cavender began as a doula, someone who is employed to provide guidance and support to a pregnant woman during labor, was because she had doubts about becoming a midwife. “I kind of thought, maybe I’m not meant to be a midwife. Maybe a doula is what I’m supposed to do, and I really just kind of took up that role.”

Cavender quickly changed her mind and felt a sense of urgency after witnessing obstetrical abuse. Such instances included non-consensual vaginal exams, not informing the patients of the side effects of treatments and persuasion into sterilization as a birth control method. As a doula, she couldn’t advocate for her patients because she lacked the credentials.

“Because they have no medical training, they can’t tell a health care provider what they’re doing is wrong, or they risk getting kicked out of the room,” said Cavender. “I was being forced to watch these obstetrical traumas being inflicted on our people from our own community during this very crucial, very vulnerable part of their lives. And all I could do was hold their hand, and I felt complicit.”

To better serve the local Indigenous community, Cavender completed her bachelor’s degree in the Dakota language at the University of Minnesota. Throughout college, she taught Dakota and worked on Indigenous language revitalization and curriculum development.

After graduation, she traveled south to begin midwifery school at Maternidad La Luz in El Paso, Texas, in 2012. There, she primarily served patients coming across the border from Northern Mexico to have their babies. Students assisted between 70 and 100 births a month. Though Cavender didn’t know Spanish, she said she did her best to communicate and serve her patients with care.

“I’m practicing on the bodies of people who look like people from my community,” said Cavender. “It’s predominantly white midwifery students practicing on the bodies of mostly women of color.”

Sixteen years since she began birth work, Cavender now assists various people. While she applies traditional Dakota methodology into her work, she doesn’t force her beliefs onto clients. “I’m a community rural midwife, which means I serve a whole wide range of populations, not just Native folks. I serve plain Christians. I serve crunchy granola hippies.”

“It’s about the first language that the baby hears. It’s about the intent and the prayers, and the cosmovision, the metaphysical context that goes and surrounds this.”

Autumn Cavender, midwife, 2024 Bush Fellow

Those who seek Cavender for her Indigenous birth work appreciate her expertise. While she is glad she pursued her passion and culture in her work, it hasn’t been easy. “There wasn’t anybody to teach me how to be a Dakota midwife,” she said. “I had to piece together stories from my grandmas and other people and roles that my community needs me to do at this moment.”

Cavender has received positive responses from the community. Often, clients ask for her because they have a specific type of birth in mind. Many of Cavender’s Indigenous clients come to her childbirth education classes for cultural knowledge. “They’re coming for stories. They’re coming for songs. They’re coming for specific ceremonial practices or advice on diet or looking for traditional medicines to resolve certain issues.”

As a part of her Bush Foundation fellowship, Cavender wants to continue the momentum and build on her work in ways that help bring culturally based childbirth programming to more communities. Depending on what she learns from elders, healers, midwives and other birth workers she works with, she hopes to grow her understanding of different care treatment methods with those working on similar issues across other Dakota/Lakota communities. She is envisioning a new birth center based on Dakota/Lakota practices.

Despite how often Cavender witnesses births, each one leaves her in awe of life. “Every single time I’m watching a baby come and I’m looking at somebody, and I’m like, there’s no way that’s going to fit out of there,” said Cavender. “I watch it happen, and the baby is born, and the baby comes out. Babies love to live and be present. It’s this ongoing, loving amazement of birth.”

References:

Infant Mortality and American Indians/alaska natives. Office of Minority Health. (n.d.). https://minorityhealth.hhs.gov/infant-mortality-and-american-indiansalaska-natives

Dateline:

BISMARCK, N.D.