Outside a clinic in Watsonville, Ines (who asked not to use her last name) checks in with an expectant mom after a prenatal visit. A Mixtec farmworker from Oaxaca, Mexico, Ines trained as a doula this year so she can support other Indigenous women in the Watsonville area during pregnancy and childbirth.
She says when she gave birth in the US, she struggled to make her concerns heard because she only spoke Mixtec at that time.
“The experience I had before was very difficult because I was alone,” Ines said in Spanish through an interpreter.
She felt that her lack of Spanish was a hindrance to getting proper care and swallowed her fears quietly.
“Sadly, there are many women who don’t speak Spanish well or don’t fully understand it, and we get looked down on for that. So sometimes we stay quiet out of fear or embarrassment, thinking, 'What are they going to say?' or 'I can’t say it right.'"
After her experience, Ines decided to do two things: learn Spanish and train as a doula, a non-clinical birth worker who provides emotional and physical support during and after pregnancy.
“Even if it's just a small grain of sand, just being there, accompanying someone, giving a little massage, giving a glass of water, that’s what I want to do,” she said.
Even if it's just a small grain of sand, just being there, accompanying someone, giving a little massage, giving a glass of water, that’s what I want to do.Ines, a Mixtec doula
That is a source of comfort to Virginia, a pregnant farmworker who Ines accompanied at today’s ultrasound. Virginia – who asked only to give her first name – is Mixtec and knows a little Spanish.
“When I gave birth the first two times there were no translators who spoke Mixtec,” she said. “My doctor spoke English and understood very little Spanish.”
For many pregnant farmworkers, prenatal visits can be lonely, as the people in their immediate support systems are often also working in the fields during those times. So it's a huge help when someone like Ines can accompany her and also explain in Mixtec what the clinicians tell her.
Ines and 11 other farmworker doulas were trained by Maria Bracamontes, a nurse midwife at both Watsonville Community Hospital and the non-profit clinic Salud Para La Gente.
In her six years as a midwife in Santa Cruz county, Bracamontes has cared for Indigenous patients who do not speak Spanish either fluently or at all. Many struggle to explain their concerns and fears to clinicians, especially during labor.
“ I've definitely seen things not go so well sometimes,” she says.
Bracamontes, whose family is from Oaxaca and doesn't speak Mixtec, saw the need for more birth support, including translation. She had founded a non-profit organization, Campesina Womb Justice in 2020, to support farmworkers in the Pajaro Valley. As she spoke with some of them, she asked if they could also serve another purpose: to help bridge a serious gap for Indigenous women.
“I really wanted to offer the doula training that really reflected the Indigenous way of caring for each other, because I think it is the best model of care for this community.”
An estimated 60,000 people in the Monterey Bay region speak Indigenous languages, including Mixtec. Some hospitals and clinics offer Spanish translation options via in-person interpreters, phone and video remote services, if patients request.
But maternal health researcher Juliana Franco says although pregnant Indigenous patients may have a Spanish interpreter, they can still face barriers to healthcare.
“The farm workers I've spoken with don't want to be a burden, so they just make do,” said Franco.
She leads Dar a Luz, a project of WorkLife Law at UC Law San Francisco, researching maternal health access for pregnant farmworkers.
“When there is someone from their community who does speak their language, you can tell there's relief.”
Dr. Cristina Gamboa, an OBGYN at Watsonville Community Hospital and Salud Para La Gente, agrees that doulas can help bridge the gap in healthcare access. But she wants more systemic change to improve maternal health outcomes for Indigenous patients.
“It is all of our jobs to care for people and not just find quick solutions that don't allow us to really get to the root of why birthing indigenous persons have different experiences, or have a particular experience that maybe is not the same as a white birthing person.”
Close to 75% of the patients Gamboa sees are non-English speaking. The majority speak Spanish and a subset, about 14%, are Mixtec speaking.
On a cool fall evening, Ines joined other doulas at Pinto Lake County Park in Watsonville, for their regular check-ins, also called Campesina Circles. They talked about the end of the harvest season and concerns for moms who feel scared to go to the hospital, especially amidst increasing immigration enforcement around the country.
The next step for the doulas is to become formally certified, so they can be official healthcare workers for their community.
“If you’re a Mixtec or Indigenous woman, you don’t really have a voice in this country,” Ines said. “But I am proud of the work we are doing.”
Translation provided by Dolores Marquez.
