Māori women are far more likely to experience perinatal distress. Reclaiming traditional practices has helped many wahine Māori find better mental health outcomes, writes Arihia Latham.

The story of Hine-tītama, the guardian of the dawn, becoming Hine-nui-te-pō, the atua of death, resonates with my experiences of becoming a mother. She was the child of Tāne-mahuta and the first woman, Hine-ahu-one. She was the kaitiaki of the gateway from night to day, the transition between light and dark. She is the red sky in the evenings and its orange glow in the morning. 

But when she discovers her husband Tāne is also her father, she chooses instead to leave her life in the world of light and embody the long night, te pō, and become Hine-nui-te-pō, the goddess of death. This is not a story about paternity, or relationships, but more one of a woman going through a mighty transition. Child bearing is an embodiment of this transition: there is often an incredible gift, and for some a feeling of loss. For all it is a transformation.

For many mothers, the process of transition from being childless to being a child bearer or carer is far from easy. There is a sense of walking closely between life and death, both physically and emotionally. Loss and grief are very real things hovering at the edges of the experience: infertility, miscarriage, developmental or chromosomal diversity, surrogacy, stillbirth and adoptions. This is not an easy road. 

Sometimes, though, it isn’t as tangible as that. Sometimes it is a feeling that arrives and doesn’t leave. It might look like anxiety, apathy, sadness or anger. Sometimes there is something unlocked inside us when we walk into the realm of the mother, and it isn’t always what we imagined.

I only really understood the depths of this transition when I was 28 weeks pregnant with my third child and experienced perinatal distress. Here I was, carrying the dawn of a new life and yet I was consumed by thoughts of death. 

The pathway for Māori women can be especially difficult. At four weeks postpartum, one in seven Māori mothers experience postnatal depression, compared to one in 16 non-Māori mothers. And between 2006 and 2016, 57% of the women who died by suicide in pregnancy or within six weeks of giving birth, were wāhine Māori.

Of course we are dancing around the C word here. Colonisation has a lot of responsibility in these statistics. Through colonisation and the resulting urbanisation of Māori, the traditional support systems that existed in hapū and marae, and access to the knowledge held by kaumātua, just aren’t there any more. 

The Tohunga Suppression Act 1907, designed to suppress traditional Māori healing practices, remained law until 1962. As a result of its enactment, most of our traditions around pregnancy and birth were lost or at least muted.

The gaping hole that colonisation can leave in our own cultural practices can be traumatic in itself. This has meant many Māori women feel forced to step away, or to completely leave our own cultural practice when it comes to pregnancy and birth. But when traditional practices are handed down through whānau, this knowledge can be like a lifeline, the umbilical cord to your past and your future.

What does this look like for Māori whānau who are inevitably immersed in western medical practices during pregnancy and birth and are still wanting to maintain tino rangatiratanga of their birthing practices? If we understand and feel understood, if we feel safe and feel that our cultural practices are safe, then the chances of our birthing experience being positive are far more likely. 

However, if our worldview or practices are dismissed or undermined, and if the communication and support in this transition is not well managed, then the resulting experience can be traumatic. This is where it is vital to have more Māori doctors and midwives, and crucial to have more education for all health practitioners on being a good treaty partner.

Part of claiming my own tino rangatiratanga was choosing home birth and having one trusted lead maternity carer. My midwives were all chosen because they fully respected and supported the Māori practices I needed at my births, even though they weren’t Māori themselves. It wasn’t always straightforward and I had to know what I wanted and at times fight for it. Birth is a challenge for any person. Feeling the need to fight for your own traditions is an extra challenge on top of that, one not everyone has the language or knowledge or energy to do.  

When you are hapū, it’s like you are about to travel to a new country called Parenthood. The hard part is that you have no idea what the road to get there is going to be like. You might have this language at home that talks about aroha and whakapapa, and then you end up giving birth in a place that uses language like epidural and induction. The way that journey to parenthood is managed largely depends on how effectively those two languages can be translated to each other.

I first heard Dr Ocean Mercier speak at a conference about a concept called “cultural border crossings”: indigenous knowledge and western science are often talking about similar concepts, but the crossing between the two can leave the indigenous person feeling misunderstood or only seen for their identity rather than their knowledge and mana. Mercier talked about how often she had to fight to be seen as a physicist in her own right, when peers couldn’t get past the cultural bias they already had toward females and Māori.

When I approached her, frothing with ideas around our birthing culture, she agreed that this concept of crossing over cultural borders happens in the medical system too. Māori women are often seen as statistics and liabilities before they are seen as wāhine toa. Their whakapapa and matauranga are not acknowledged because there is not enough training given to the medical staff. If maternity care celebrates and makes space for our cultural knowledge then our crossing into the western medical model might feel really positive. But if we feel unsafe or judged or disregarded, our crossing may be painful – and that pain can be lasting.

Kahurangi Ross is one of 6% of midwives that identifies as Māori. Twenty years of working with māmā has opened her eyes to the difficulties faced by many wahine Māori, particularly the teenage and younger mothers she works with, going through pregnancy, birth and motherhood in a system that prioritises western approaches and understandings of healthcare. 

She also experienced firsthand the importance of a connection to tikanga. During her first pregnancy, with her daughter Anahera, she initially struggled with the fact she’d have to give birth in hospital because of a low iron count. But after she sought “aunty wisdom” and rongoā she was able to give birth at home using traditional Māori practices. 

“Having tikanga Māori support through the birth and early postpartum period grounded me as I was able to do those things specific to our people like iho muka (the tie for the umbilical cord made of inner flax fibre), hue for ipu whenua (the gourd for storing and burying the placenta), karakia sorted by my cousin, hakari (feast) to celebrate after things had calmed down post birth,” she says. 

But after her daughter Anahera died when she was just three and a half years old, Ross had to fight to keep her family together. She had an eleven month old son Te Au Moko and was hapū with twins when her daughter died. After she gave birth to one healthy baby, Awatea, and one still born, Te Ahi Kaa, she was suffering from severe postnatal depression at the same time as grieving for her daughter and baby. 

In te ao Māori it was natural that her grief was vocal and visible, and it was important for her babies to be part of this process. For Pākehā health officials, that expression of her grief showed she was not in a fit state to care for her existing children.

“I had to fight tooth and nail and stand strong in who I am as a Māori woman to keep my babies from being taken by the system. I knew they were the key to my healing – if I lost them, that would have been it,” she says.  

“This fear is common for many Māori māmā when reaching out to talk about perinatal distress.”

That anxiety in Māori mothers – that the system might work not for them but instead against them, to separate them from their children – can have cascading effects for their perinatal health. But many are often too scared to ask for help, says Ross. 

“I felt like a guardian to them, because I understood them and their sadness. This fear and grief is unique to Māori women,” she says. 

She has seen the impacts of intergenerational trauma on whānau. The ripple effects of colonisation can become tidal if there is no repair, no return to ways that feed the wairua as well as addressing physical and emotional difficulties. 

In her work she sees the importance of the sense of connectedness, essential for Māori, to tīpuna, to the natural world and beyond. If this connection is broken or damaged, it can adversely affect the well-being of the mother and child. But if it is strong, it has healing and strengthening capacity. As a midwife she has encouraged many mothers to reclaim traditional practices as part of their birth plans.

The concept of whakapapa is an important one. Our sense of connection to those that have gone before us is galvanising: the names of our tīpuna fortify our sense of well-being. Ross says that naming can be a huge reclamation of whakapapa and she advocates for mothers to find the power of naming in te ao Māori.

“I’m not sure that non-Māori people look at names like we do. It’s keeping our whakapapa alive through our children, it’s keeping us alive,” says Ross. 

When her baby was born in April, Rawinia Parata felt the same opportunity to connect her son to their whakapapa. Her pēpi carries a name going back to Hawaiiki as well as tīpuna names from both sides of her family. 

“I named him Te Ana Whakairo Makahuri Lockwood Parata,” she says. “Te Ana Whakairo is a spiritual place in Hawaiki and a label marked on the soldiers’ graves in Karitane where my Papa is from. Makahuri is the tīpuna that connects his father and myself through whakapapa. Lockwood was my paternal great-grandmother’s surname, one that my whānau and I do not carry.”

This was an important way to honour her whānau, especially because they couldn’t be at her birth during lockdown level four. Covid-19 added yet another layer to this already unknown traverse of birth. The restrictions put in place to protect Aotearoa’s health meant women giving birth with both traditional and modern practices were having to make compromises. When Parata was 37 weeks pregnant, she decided she wanted to have a home birth, but she knew she couldn’t have her family with her. 

Ahead of her birth her whānau offered karakia via live chat, calming her fears and connecting her to family despite their distance. When Parata went into labour, within 10 minutes her contractions were on top of each other. Their daughter was in her highchair eating lunch beside her as she gave birth to their son.

“I did a karakia and asked my Nanny to be with me. I felt her near me the entire time. My home in Ruatoria has a view of our ancestral mountain, Hikurangi. I called upon his strength and found that being home with a view of my maunga, and with the collective wairua of my whānau and grandmother I was able to stay calm and embrace the pain of labour instead of panic and fight it,” she says. 

Postpartum was more difficult, without whānau there to help when they were needed most.

“It was very isolating. Had things been different I would have asked my sisters to be present for the birth, I missed the presence of women.” 

Difficulty in accessing traditional birth practices and midwives with tikanga Māori knowledge contributed to Miriama Gemmell’s perinatal distress both before and after the birth of her second child. Four years on, she is still in the process of healing. 

She wasn’t able to find a Māori midwife. After giving birth, when she was in the post partum haze of sleeplessness and learning how to parent, she wished for a community of aunties to come and hold the baby and teach her the old ways. She feels angry at the ongoing consequences of colonisation, where the pathway to repairing what has been lost is such a painful process.

“I would have loved to have had a traditional muka ritual and oriori after each baby’s birth. But my mother is Pākehā and doesn’t know about any of that and nor do I,” she says.  

Giving birth and raising children made her long for a society that was still built on community. She wishes she could have been surrounded by her extended family, who could contribute to the lives of new children and her well-being as a new mother. 

“Why don’t we live like this? I feel really angry that the western idea of prosperity and success squeezed out the communal Māori one and has driven us all into private residential silos,” she says. 

Bringing te ao Māori into her family’s life has helped Gemmell heal. Starting the day with a mōteatea with her children and then cuddling them to sleep with a karakia has allowed her to embrace her Māoritanga. Connecting with other Māori māmā who understand what it means to stand in this world without their culture, and like her are trying to instill in their children what they didn’t get, has also been huge support. Having people around her with a similar experience feels like a korowai of understanding that allows her to keep putting one foot in front of the other.

All these māmā acknowledge that the process of becoming a mother, reclaiming or standing strong in their Māoritanga and keeping their hinengaro healthy is an ongoing experience. It’s not a magical transition – the crossing can feel treacherous because it is made holding the iho of all of our tīpuna before us. The cord vibrates with the pain of our history, and it hums with the promise of healing, one birth, one karakia at a time.

Kelly Tikao’s master’s thesis is called ‘Iho, a cord between two worlds’ and examines the potential of Māori health practices to support the health outcomes of Māori whānau. Her study looked at ways to improve Māori hauora by integrating traditional Māori birthing practices into all maternity services, bridging the gap between Māori and non-Māori inequalities. 

Her work found that women are buried in guilt from their disconnection with their culture, a situation which amplifies the pressure of motherhood. 

“The want to know things Māori and the guilt for not knowing, not speaking enough te reo Māori, not practising enough tikanga and kawa, a sense of slipping with your own values plays havoc on how you feel about yourself as a wahine Māori, hākui and hapū member,” she says.  

“Adding this to the general guilt held as a māmā can make parenting difficult and stressful. [Beliefs about] what we should be can cloud over what we are doing awesomely.”

She says that her aim is to ensure whānau Māori have a positive and enriched birth experience. Her own healing as a māmā came in returning to her turangawaewae and connecting with traditional understandings of the world. Her first two children were born before this return home, though – and so she worked hard before their births to surround herself in traditions and people that would offer her that iho, that cord to home.

“I felt incredibly connected to the whenua and had key support people who reflected so strongly my turangawaewae and guided me with tikanga that held my feet firmly to Papatūānuku,” says Tikao.  

I have the privilege to work with all the fourth-year medical students at the University of Otago Wellington. We talk about te ao Māori and how all doctors can learn from many of the concepts intrinsic to health. I teach them some rongoā, and I touch on colonisation and how we all have a chance to repair it through the health system. It’s a small step in the right direction and I’d love to see it embraced across all of our health training.

There is the promise to integrate our tikanga more thoroughly with medical practices. There are many amazing health practitioners, te reo teachers and weavers working toward this future. Those who grow hue, who plait muka, who weave whāriki and wharekura. Those who teach karakia, who make rongoā, who take us home to our maunga, our awa and our marae. 

Understanding maternal mental health is like understanding whakapapa. It is complex, it is connected and it is a living changing reality with every new baby that makes its way to te ao mārama. 

I know my journey to postnatal health is intrinsic to my identity, to feeling connected and feeling part of something bigger. It’s a border crossing that hasn’t ever felt easy. This place called Parenthood is possibly as messed up as Earth, only crazier because the people that run it never sleep and often throw tantrums despite carrying the names of their tīpuna. 

The iho that holds us and connects us to our children and to our ancestors is the lifeline, even if sometimes its presence doesn’t feel as useful as a nap or someone folding our washing. Through whakapapa we connect back to Papatūānuku and Ranginui, so even when the laundry is piling up and it’s baked beans for dinner, there is always a tangible reminder of that directly outside my door. 

I know I can take a moment to stand on the earth, breathe deep and remember my place in that big complex beautiful picture. I can feel the woven korowai of whakapapa surrounding me. This cloak has its own weight. The weight of the traditions my tīpuna lost, the way we kept going anyway, the way we are reclaiming our voice again. This reclamation of our Māoritanga is like being handed the map to this border crossing – it’s not always straightforward or easy to follow, but it plays a big part in finding our way.

When my babies would wake me on the darker side of dawn, rustling for their sustenance, I would whisper in the day and acknowledge Papatūānuku, Ranginui and the vital life between them. The peace this called for slowly coerced my tired mind into snatching a moment more sleep or rising with the primordial sounds of the universe – and eventually, some days, just like the dawn, it sparkled with promise.