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Tackling Preterm Birth with Talking Circles

APRIL 10, 2023
Dr. Jennifer Gubbels, 2018 SD Mother of the Year, with her fellow Augustana University team members
Dr. Jennifer Gubbels, 2018 SD Mother of the Year, with her fellow Augustana University team members (Karla Abbott, Sandie Hoover-Kinsinger, and Beth Boyens) and the mothers and elders of the Cheyenne River Reservation .

The elders (all women) and the pregnant moms came in quietly, some with children in tow. We shared a meal of buffalo soup and fry bread with them, prayed a traditional Lakota prayer, and then began the talking circles.

We marveled at the beauty of the sunset as we drove on the lonely highway north towards Eagle Butte, SD.  It was a magnificent canvas of pinks, light blues, and yellow light spreading over the prairie, continually changing minute by minute.  As we drove up and down the buttes and bluffs we decided it was a good omen for the talking circles we would be conducting with pregnant women and women elders on the Cheyenne River Reservation.  We drove five hours from Sioux Falls, SD, to reach our destination–a lone town in the middle of a vast area of seemingly uninhabited land in north central South Dakota. During the last hour of the drive, every once in a while you might see a ranch house along the road, or see a sign for a town (Cherry Creek, SD) down an even curiously smaller road.  This land seems to not have changed at all since glaciers formed it—it feels as if one is driving back in time.

We drove to Eagle Butte to talk to women about pregnancy because of a startling statistic: in South Dakota, native women  have a 45% higher preterm birth rate than white women. We know that access to health care and nutrition are factors that contribute to this disparity, but we were interested in something else–stress.  Our goal was to talk to pregnant women and elders about how they deal with stress and to determine what could be done to support them.

It has been shown in several studies that stressors, including low socioeconomic status, domestic abuse, and depression can contribute to preterm birth.  In addition, we know that, during pregnancy, women’s experiences of stress can be passed on to the baby in the form of epigenetic changes. Epigenetics are changes to the pattern of expression of DNA based on environmental factors.  Therefore, the environment that the mother experiences while pregnant can affect how and when the fetus’s DNA is expressed. The trauma and stress that has been endured by Native peoples (and that they continue to endure) is passed on to their children in epigenetic changes to their DNA that predisposes them to higher rates of diabetes and cardiovascular disease.  Native people understand this concept of inherited trauma well; they live it and see its effects every day. Although the rest of the world is just beginning to understand the generational effects (both biological and social) of severe stressors, in Eagle Butte on Cheyenne River Reservation, the fight against drug addiction, poverty, domestic abuse, a severe lack of reliable day care, and unemployment is a daily battle.  

The elders (all women) and the pregnant moms came in quietly, some with children in tow.  We shared a meal of buffalo soup and fry bread with them, prayed a traditional Lakota prayer, and then began the talking circles.  We heard about how hard it is to be pregnant, but also how amazing and wonderful it is. We heard that they as women feel the burden of responsibility for raising their children well, even when the fathers are often not in the picture.  The severe lack of reliable day care (no day care center in town and in-home services may not be trustworthy) is a huge obstacle that prevents some moms from working, even if they could find a job. When we asked where they imagine themselves in 10 years, many said it was difficult to think that far ahead; however, they envision themselves going back to school, living in a house, having a job, and having their children well-cared for.  Simple wishes—that their basic needs are fulfilled—for happiness.

In the talking circles, the elders also spoke of their life experiences.  These beautiful women had incredible stories to tell of resilience, addiction, hardship, and single parenthood.  Many of them (in their 50s and 60s) were still caring for their grandchildren—one elder had just adopted her three-month old grandson.  As children, some of the elders attended boarding schools; such schools generally closed in the 1970s. The U.S. government opened such schools to assimilate Native people into white culture, they forced families to send children as young as 4 or 5 to boarding schools for 9 months out of the year, away from their families, and in the care of teachers, priests, and nuns whose job was to “take the Indian out” of them.  

As we heard from the elders that they were forbidden from speaking Lakota–and if they did speak it, they were slapped with rulers. They were forbidden to practice their spirituality. Said one woman, “They made me not want to be brown. I didn’t want my skin to be brown.” She continued, “Since I was raised in boarding schools and everyone was so strict, the priests and the nuns were so strict, that’s how I raised my kids.  I was strict with them. No one ever hugged me or kissed me or told me they loved me, and so that is what I did with my kids.” We heard from these women that it has taken years for them to overcome what they were taught as children, which was to suppress their Lakota ways and traditions. So, they did not teach Lakota ways to their children because of their experiences in the boarding schools. It is only recently that these elders have been able to overcome these feelings, restore the pride of being Lakota, and begin to want to teach their grandchildren Lakota traditions, language and values.  

The elders told us stories of domestic abuse that made our hair stand on end.  They told us about trying to make a straight path for their children while still stumbling themselves.  We heard about addiction to alcohol, trying to find and keep jobs, being homeless, and in general a day-to-day struggle for survival.  Experiences of suffering can, however, provide large doses of wisdom. And these elders were full of wisdom. When asked what their vision of a strong woman is, they said someone who listens and doesn’t judge, one who lets go of control of others, one who tries to understand others, one who is quiet.  When asked how they deal with stress, they spoke of prayer, of getting in touch with their Lakota spirituality, and most importantly, cultivating an inner peace in knowing who you are, and loving yourself right there.

We asked all of the women what might be most helpful to support pregnant women and new mothers on the reservation. To our surprise, they said that these talking circles were helpful.  They wanted more of these meetings and suggested that the future meetings of women should be led by the elders. We weren’t quite expecting that they would ask to have the meetings continued—we didn’t, I suppose, realize that our information gathering about the experience of pregnancy on the reservation was, in and of itself, an intervention that was helping women.  We knew when we went there that we couldn’t take away their stressors. The problems there are so deep, so big, and so overwhelming that most people may think, “why bother?” However, what we learned is that something as simple as gathering women together to talk, to support each other, to laugh, to coo at each other’s babies, to tell a young mother she’s doing a good job, to listen to an elder tell a Lakota story, is perhaps more valuable than free diapers or an informational parenting brochure.  We were also happy that they wanted to lead the talking circles themselves. Our role here is to provide the scaffolding, paint, and brushes. They will paint their story of healing themselves—it’s the only way to true healing.

As we drove home, this time late at night, we were filled with admiration for those who have dealt with so much hardship, and yet are so strong. Because they have suffered so much, they have a keener sense about what really matters:  healthy relationships with others and a deep understanding of the value knowing who you are, which leads, then, to loving yourself. Perhaps these are lessons we can all learn from the Lakota people.

Headshot of Dr. Jennifer Gubbels, 2018 South Dakota Mother of the Year®