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Horton C, Nynas J, Kelly C. Families first: rural maternity health collaborative group prenatal care curriculum. HPHR. 2024;85. https://doi.org/10.54111/0001/GGGG10
American Indian and Alaska Native (AIAN) birthing people are twice as likely to die because of pregnancy-related complications. Native birthing people have higher rates of comorbid medical conditions including obesity, cardiovascular disease, diabetes, substance use disorder, and mental health disease, making their pregnancies higher risk at baseline compared to non-native birthing persons. Their pregnancies are further complicated by unique structural determinants of health such as limited access to care, geographical isolation, systemic racism, and historical trauma related to colonization, forced migration, reproductive coercion, and cultural erasure. All of these factors are compounded and result in the increased incidence of maternal morbidity and mortality observed among Native communities. The incidence of severe maternal mortality is highest for indigenous people living in rural communities.
The Families First Rural Maternity Health Collaborative is an initiative aimed to bring culturally centered group prenatal care to the Native communities in Northern Minnesota. This novel prenatal care curriculum was developed in partnership with the Native American Advisory Council (NAAC) made up of local tribal representatives and community members. The NAAC was established to provide insight and help to tailor the curriculum to the beliefs and needs of these local communities and to ensure that culture was a core focus of every session. The framework for group prenatal care is unique in that the main themes are population specific based on particular health disparities afflicting the local communities, the curriculum is designed for rolling enrollment of attendees, and most importantly it is rooted in traditional cultural customs of the Ojibwe people. Although, this curriculum is culturally specific to the Ojibwe tribes in Northern Minnesota, it provides a framework for the development and implementation of group prenatal care that is grounded in culture and specific to the needs of the population it is intended to serve. As such, it may serve as a model for other native communities.
American Indian and Alaska Native (AIAN) birthing people are twice as likely to die as a result of pregnancy-related complications.1 Native birthing people have higher rates of comorbid medical conditions including obesity, cardiovascular disease, diabetes, substance use disorder, and mental health disease, making their pregnancies higher risk at baseline compared to their racial counterparts.2 Recent data reports that more than 60% of Native individuals enter pregnancy with suboptimal cardiovascular health, leading to greater odds of developing peripartum cardiomyopathy.3 Entering pregnancy with these comorbid conditions leads to a significantly higher risk for pre-eclampsia, gestational diabetes, postpartum hemorrhage, preterm birth, low birth weight, and intrapartum infection.
Native communities face a myriad of structural determinants of health which further exacerbates their risk of maternal morbidity and mortality due to limited access to care, geographical isolation, systemic racism, and historical trauma related to colonization, forced migration, reproductive coercion, and cultural erasure. These factors cause systemic barriers that create unequal social challenges for Native birthing people relative to non-native birthing persons, which leads to the glaring health disparities and pregnancy-related complications observed among these communities. Furthermore, the incidence of severe maternal mortality was even higher for indigenous people living in rural communities.2 It has been reported that traveling more than 20 miles for hospital-based maternal and infant care is associated with fewer prenatal visits, lower infant birth weights, and delivery at earlier gestational ages.4
The Families First: Rural Maternity Health Collaborative is a network of community partners working on initiatives to improve maternal and neonatal outcomes for communities throughout Northern Minnesota. Sanford Bemidji Medical Center (SBMC) is a regional provider of obstetric care in one of the poorest and most geographically isolated regions of Minnesota, resulting in a disproportionate number of high-risk pregnancies when compared to state and national data. Many patients at SBMC face multiple barriers in accessing prenatal care including financial instability, lack of insurance, long-distance commute to receive hospital care, lack of reliable transportation and childcare, long provider wait times, as well as unfamiliar providers and environments if patients must seek care at a distant hospital. Regional Indian Health Service (IHS) hospitals can provide basic perinatal care, but these services are significantly limited as these hospitals lack the resources necessary to support labor and delivery services, contributing to the significant health disparities seen in this population.
The Families First Collaborative is aimed at developing a community outreach program to provide culturally centered group prenatal care (gPNC) for the Native communities of Northern Minnesota. The primary goals of this project are to expand access to perinatal obstetric care, enhance care coordination among community partners, and improve maternal and neonatal outcomes. The team chose to focus efforts on the needs of Native women given the relatively large Native population in this region and the significant health disparities these communities face.
A major focus of this initiative was to develop a novel gPNC curriculum that is grounded in traditional Ojibwe customs and specific to the communities served. The current standards of gPNC tend to be highly medicalized and based on widely utilized resources with little regard to people of color and traditional cultural teachings surrounding pregnancy, childbirth, and the perinatal period. March of Dimes was used to provide a framework for the curriculum to ensure that all prenatal care guidelines were met. This curriculum was tailored to reflect the local communities and the traditional customs of the Ojibwe people. To ensure that the development process was culturally informed from its inception, a Native American Advisory Council (NAAC) was established to help curate the content of this curriculum. The NAAC is made up of tribal representatives and community members established to inform decision-making related to incorporating culture into project initiatives and make this a core focus of the curriculum design.
The intended patient population is unique in that the pool of patients is relatively smaller than those who typically engaging in gPNC; therefore, the standard model of groups established based on approximate delivery date was not appropriate. The curriculum schedule was adapted to fit rolling enrollment of patients into groups and touch on topics relevant to all stages of pregnancy. The team decided on developing five rolling sessions for the curriculum based on the fact that women typically engage in gPNC on a monthly basis starting between 12-16 weeks gestational age, making for about seven or eight sessions on average throughout the pregnancy. This structure, with five primary sessions, was designed to provide redundancy and to ensure that all major topics are covered throughout the pregnancy.
Five primary themes were identified based on topics that address the needs of our local communities and integrate all facets of basic prenatal care. These themes include 1) Healthcare Maintenance and Anticipatory Guidance for Prenatal Care, 2) Pregnancy Concerns and Warning Signs, 3) Mental Health and Community Connectedness, 4) the Birthing Experience, and 5) Becoming a Mother and the 4th Trimester (Postpartum Period). This framework is to ensure that all major prenatal care topics get covered throughout pregnancy and that the conversation is relevant at all stages of pregnancy. Next, five subtopics for each major theme were selected that would serve as the topics covered in each session; the subtopics were specific to health concerns and disparities afflicting the target patient population. Cultural topics related to pregnancy and birthing were imbedded throughout each session from start to finish. A list of high yield talking points related to each theme and subtopic will be provided to the group facilitators, but the conversations will be driven by the patients and interactions within the group. A graphic with the proposed curriculum schedule and the list of talking points are included in the appendices below.
Another unique aspect of this curriculum schedule is that each session is intended to be grounded in the cultural customs held sacred by the local Native communities. Each session will start with smudging, a traditional blessing, and a community agreement touching on respect for individuals’ cultural beliefs. Culture, community, and a strong sense of identity serve as protective factors for the health and well-being of AIAN people.5 Weaving traditional healing practices within Western medical practices empowers patients to positively engage in their healthcare and lends to improved outcomes, which is the ultimate goal in our efforts to incorporate cultural customs into every aspect of this novel group prenatal care (gPNC) curriculum.
Please find the proposed curriculum skeleton, group facilitator curriculum guide, session outline and the Ojibwe cultural customs to be incorporated into our curriculum provided in the appendices below.
Group Prenatal Care (gPNC) is a patient-centered collaborative-care model for prenatal care. gPNC is not designed to replace traditional prenatal care but instead serves as an adjunct to improve care coordination and maternal outcomes. The current standard is that groups are established based on expected delivery date and generally meet in accordance with prenatal care guidelines (every 4 weeks for until 28 weeks, every 2 weeks from 28-36 weeks, every week from 36-40 weeks or until delivery).6 For an adapted rolling curriculum, the groups meet monthly throughout pregnancy and after 28 weeks additional visits with their prenatal provider are supplemented and scheduled appropriately to follow the standard prenatal care visit schedule.
Sessions are planned for 2-2.5 hours with the first half an hour dedicated to individual check-ins with a prenatal provider. This allows time for participants to socialize and prepare for the session. One example activity to include during this time would be having a board with a list of the topics for the session and having individuals put sticky notes of questions, concerns, or other talking points related to each topic. This activity can serve to engage participants, facilitate a group-led discussion, and provide space to address specific questions and concerns.
Once the group convenes, the session will open with a traditional blessing and smudging. Circles represent everlasting connectedness and promote inclusion so participants will arrange in a circle for the session. After starting in a good way, the community agreement will be reviewed, and group facilitators will moderate group discussion for the topics of the day.
Building relationships is of utmost importance to tribal communities. When attempting to conduct similar projects it is important to be intentional when attempting to engage these historically marginalized communities in this type of collaborative work. This type of relationship building takes time and sustained, meaningful engagement from all stakeholders; this process should not be rushed and should focus on building on the strengths of the community.
Modern medicine is always evolving, and this curriculum is envisioned to adapt to changes in clinical guidelines and community needs. When attempting to implement such community-based gPNC, it is important to continually evaluate the success of these initiatives and determine areas of improvement. One area of improvement for the original curriculum design is consolidating the themes and subtopics to allow for more engagement in the discussion for topics covered. A better framework for a rolling curriculum schedule may be consolidating the content into three major themes as opposed to five and then identifying five subtopics under each theme, one for each of the five rolling sessions. This alternate schedule design would then allow for more in-depth discussion of fewer topics with three topics covered per session. The team has not yet had the opportunity to evaluate the effectiveness or patient feedback on the curriculum design, but it is envisioned that adaptations will be made to the curriculum based on these findings.
Native communities are afflicted by egregious health disparities and Native birthing people are disproportionately affected by the high maternal morbidity and mortality that plagues people of color in our country. Culture and community can have a significant positive impact on a Native person’s health and incorporating these themes into a patient centered care model could help to mitigate some of the disparities affecting Native individuals.5 The model of gPNC organically builds community among participants and the curriculum development process provides an example of intentionally incorporating culture into all aspects of this type of care model.
Maternal morbidity and mortality in the United States is a public health crisis that will require sustained efforts and innovative initiatives to address this issue. gPNC provides an opportunity to partner with communities to bring patient-centered care to underserved populations. This care model can serve to incorporate community and social support into prenatal care. The proposed development process provides an example for how to intentionally partner with communities to center cultural customs as the foundation of care. Integrating community and culture into patient care can improve outcomes and communities should be empowered to implement this type of programing to improve patient care for pregnant and underserved populations.
This project is just starting, but already provides a valuable framework to design gPNC that is community focused and rooted in traditional customs specific to the populations it is intended to serve. This provides an excellent opportunity to engage patients in healthcare that aligns with and emphasizes their values as individuals, a process which shows promise for improving health outcomes for these vulnerable communities. Integrating community and culture into patient care can improve outcomes and communities should be empowered to implement this type of programing to improve patient care for pregnant and underserved populations. The team is grateful for the funding provided to pursue this project and looks forward to future efforts, including additional resources allocated for communities to pursue such community-based initiatives to improve maternal morbidity and mortality.
Figure 1 Description – The above graphic provides a framework for our rolling curriculum schedule. The 5 main themes are included on the left and are color coded to match the particular subtopic covered during each of the 5 sessions. In general, all 5 major themes will have a specific subtopic covered during each session, making for 5 topics discussed during each session.
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Main Themes | Session Topics | Conversation Starting Points |
A) Healthcare Maintenance & Anticipatory Guidance | 1. Prenatal Care Overview
| What to look out for trimesters 1,2,3 Anticipated prenatal testing checkpoints and US appointments Genetic testing; when to consider? Important vaccines (including family, anyone in contact with baby) Safe meds Things to avoid |
2. Healthy habits & Physical Activity in Pregnancy | Exercise and health habits. What is okay? What to avoid. Importance of staying active→ reduces aches and pains, decreases likelihood of GDM, maintains strength and endurance important for birth and raising children Body changes in pregnancy→ setting expectations and self-compassion No hot-tubs or soaking in hot bath Oral Health in pregnancy (talk about access to dental services, increased risks of tooth decay during pregnancy) | |
3. Discomforts of Pregnancy | Centering Activity: Common discomforts→ each person has a common discomfort post-it note on their back; walk around and offer suggestions for how to alleviate discomfort→ when guessed correctly what your discomfort is, you sit down. 2nd activity→ charades Discussion points: What discomforts have you experienced in pregnancy this time or previous? What to expect in the first pregnancy vs subsequent pregnancies (ie increased ligamentous pain, could be increased pain in 2nd pregnancy, etc) What can you safely use to ease pain? (heating pads, stretching, exercise, OTCs) PT options in pregnancy and postpartum. Group activity: movement to protect your back, modified kegel exercise demonstration for lower back stability, circle stretching, introduce chair/prenatal yoga and how to find info/sessions/online resources for stretching and strengthening | |
4. Diet and nutrition | Expected weight gain Centering Activity: Creating a healthy plate using images and serving sizes → facilitates discussion about healthy options Recipe share, importance of being aware of your sugar intake, how to eat more fruits and veggies, importance of lean meats and healthy fats, fish, whole grains like wild rice Traditional foods→ could have this session catered by local Native chef. Discuss traditional food ways. | |
5. Breastfeeding | What have you heard about Breastfeeding? Concerns? Fears? Success stories? What does breast milk contain? Benefits of breast milk? How does it work? Frequency of pumping, feeding, maintaining supply Support for breastfeeding → lactation specialists, OB nurses, partners Order breast pump when appropriate & provide support resources | |
B) Pregnancy Concerns & Warning Signs | 1. Aches & Pains of Pregnancy | Group activity/mediation: Body scan paying attention to the whole body (can be done seated, or lying on blankets/yoga mats; noticing and acknowledging areas of tension, pain, discomfort, feeling baby move; take notice of what is normal, what is new, and anything concerning? Bleeding during pregnancy, acute abdominal pains, difficulty breathing, chest pain, blood clots → when should you call your OB nurse, go to clinic, go to the ER? Bladder infections and BV, breast pain, mastitis Pain limiting mobility/function during the day |
2. GDM and pre-existing DM | Reinforce importance of healthy habits and nutrition to prevent GDM What do you know about GDM? Do you know someone who has had it? What are you concerned about? What makes GDM different from DM? Pregnancy with DM, adjusting diet, weight, and medications Glucose tolerance test and follow up Using insulin during pregnancy Effects on baby→ macrosomia, blood sugar testing after delivery (expect some pokes to baby and why we worry about hypoglycemia) | |
3. HTN & Preeclampsia | Aspirin ppx when appropriate What does the group know about HTN (connect with high blood pressure and define terms) Review personal BP measurements thus far Discuss why HTN may be a concern during pregnancy even though it is not before pregnancy. When does it usually show up during pregnancy? Common and routine screenings for Pre-E, and HTN Warning signs/symptoms of Pre-eclampsia OB triage and nurse calls for concerns of high BP or Pre-E | |
4. Preterm Labor | Can the group describe what contractions feel like? True vs Braxton Hicks contractions? Signs that labor is starting? Kick counts. | |
C) Mental Health & Community Connectedness | 1. Prioritizing maternal mental health | What does mental health mean to you? How do you keep yourself well? How do you find time to dedicate to yourself as a mother? Feeling/ emotions wheel handout→ an intro to naming emotions, understanding complex and overlapping emotions Picking a response to feelings/ choosing behaviors we want to use What makes us feel strong, wise, brave, trustworthy, loving, happy? |
2. Substance Use | Seeking support and treatment for SUD, peer support options and structure, support for partners and families with SUD Effects of substances on baby’s development Neonatal Abstinence Syndrome → Eat, Sleep, Console; address stigma, normalize for moms taking required medications (eg Suboxone) Provide resources for treatment and support | |
3. Domestic Violence & Abuse | Reflection: What does a healthy relationship look like? Centering Activities: -Cycles of Abuse→ small groups arrange cards into how a cycle might play out -Agree-disagree movement activity: read off statements one by one and group moves to agree vs disagree with statement about DV→ aim to dispel myths, normalize cyclical experience, facts about incidence Helping someone in an abusive relationship -community specific resources for people in abusive relationships -Imagine a scenario of a friend in an abusive relationship→ what might you do to help, what can you suggest? How do you provide support? Importance of patience and withholding shame and blame, how to be a resource and support | |
4. Community Support & Resources | Provide local community and cultural support resources “Resources you have used in the past” What is it like to apply to/seek out community resources? Who can help? Reflection: How is our community strengthened when we come together to support each other and share resources or skills? Culture and community support | |
5. Baby blues vs postpartum depression | Review common times for onset of symptoms Likelihood due to comorbid anxiety/depression/psychiatric concerns Reflection: What is it like to experience postpartum depression? How does this impact your relationship and bonding with your baby? Where can you seek help? Connect to earlier discussion on emotions and feelings→ noticing something is off, recognizing there is nothing wrong with you for feeling this way, and there is support. Group share: Have you had feelings/thoughts that surprised or concerned you about being pregnant, what it might be like to be a mom, having an infant? | |
D) The Birthing Experience | 1. Support People | Discuss community support/resources Establish support person for group Confidentiality for participation in the group Expectation to participate in activities with moms when present |
2. Traditional birthing practices | See Ojibwe Cultural Customs Table, included below in appendix 4 | |
3. Stages of labor & real vs false labor | Real vs False labor cue game · Participants move to different areas of the room based on prompts for real vs. false labor→ discuss together concerns and why one place over the other Stages of labor. What to expect (induction vs spontaneous vs c-section). Birthing center tours if applicable. | |
4. Pain management in L&D | Pain management topics – meds, positions, counter-pressure, movement, nitrous, saline injections, tubtime, mantras, pressure points, etc. Opportunity for movement and positioning practice with birthing balls, etc. demonstration of partner supported techniques for pain management (with support person) Reflection option–> what worked for you the best? What is it like to have an epidural? Worries about pain during labor? Introduce resources to learn more about meditative/hypnotic/breathing practices (could practice breathing exercise to build on self regulation/coping skills from prior session→ good starting exercises, 4-square breathing, counting with breathing, visualization practice) Introduce the use of mantras for intention and positive thinking ie. My body knows what it’s doing, My body is strong, I will trust myself and my body, etc. | |
5. Birth plan | Reflective activity: Setting intentions and experiencing the bodily ritual of birthing as a way to begin a new chapter of motherhood (What would it look like if we treated birth as a ceremony?) Labor preferences→ you have power to participate in the experience, labor does not just happen to you. L&D nurses are there to help. Resources available during L&D, positioning, movement, tub, aroma therapy Placenta preferences Important cultural practices → what is important to you/what was important for you to have available during labor and delivery? Planning for the unexpected and unplanned→ adapting to change in plans/ responding to complications | |
6. What to expect during L&D | Watch virtual tour Discuss scheduling tour with Erin Who to call if questioning labor What to expect upon arrival to L&D (spontaneous, induction, vs c/s) Visitor policy What to pack (bring breast pump for nurse training) | |
E) Becoming a Mother and the 4th Trimester (Postpartum Period) | 1. The family I want to have | Family planning & birth control postpartum; intro to goals of parenting/reflection on family dynamic past/current/future Centering Activity: self assessment in journal on family roles, dynamics and responsibilities in household growing up, who will take on responsibilities in your family? Feeding baby, changing, taking to appointments, care during the day, what kind of discipline do you imagine using, what roles will spirituality/religion/culture play in your family? How do you hope to parent? What does being a good parent/ having a strong healthy family mean to you? |
2. Self-regulation/coping skills | What are coping skills? Differentiate stress relieving activities practiced in down time from coping skills which can be used in a moment to help recenter/redirect and continue to participate in a situation. What coping skills do you have? How does this help to make it through frustrating, stressful, or challenging situations? How have you used coping skills during parenting/work/school/living with other people? | |
3. Parenting skill-share | Let’s hear about it all, the joys, frustrations, wins. What is potty training like? Working on getting your child to sleep through the night? What do you do to help address bad behavior and encourage good? punishment/rewards? Who helps you parent? Where do you look for help when you feel overwhelmed? Who makes up your “village” to raise a child? Best and most challenging thing about being a parent? Centering Activity: Postpartum priority setting, balancing daily responsibilities | |
4. Early infant cares | Pick a pediatrician and importance of PCP and preventative care Neonatal visits (what to expect scheduling wise) Circ? Feeding & expected weight gain (formula instructions vs anticipated breastfeeding) What do you still want to know about breastfeeding? Sleep guidance, safe sleep, safer co-sleeping options Safety at home (car seats, baby proofing, smoke exposure, guns, water precautions, pets, etc.) -scenario game “game of life”→ to seek care vs not to seek care for common infant concerns/complaints→ how typical concerns may play out, ie baby’s first URI→ expected time of runny nose, cough, etc. | |
5. Early development in the first months | Fetal brain development → what baby will respond to at different stages, black and white vs colors, sounds, textures, conversations with parents and family members Read & sing daily (language development) [Book giveaway? Brenda Child book?] What are the best ways to calm a baby? Soothing techniques, swaddling, rocking, stroller or car seat, walking, snuggling, burping, breastfeeding Centering: swaddling, side-lying, shh-ing, swaying, and sucking | |
6. Cultural traditions in early childhood | Naming ceremony Cedar bath as first bath Snow bath Living by your values→ identifying personal and community values, ranking list and discuss how to demonstrate values with your child No baby shower prior to delivery, given cultural beliefs surrounding maternal and neonatal mortality. Gifting celebrations occur after day 4 of life and at naming ceremonies. |
Table 1 Description – The above table includes all major themes and subtopics for each theme. For each topic, a list of possible talking points and important things to cover are included in the third column. This table is intended for use by group facilitators to help guide session conversation. The list is in no means comprehensive but intended to serve as a guide and starting point for group facilitation.
Group Session Outline | ||
Time | Agenda | Description of Activity |
-15 min | Facilitation set-up | Arrange chairs/tables in a circle – ensure all are part of the circle Set up smudging materials and medicines (center of circle) |
5 min | Opening Statement | Read cultural statement Smudge around the circle (led by doula/native representative/anyone comfortable) Review group guiding principles (needed everytime? Or do we want to put this statement on a poster that is displayed in the group space?) |
30 min | Check-in & Individual Assessments | Group intros → Sit in circle, set intention/expectations, Reflection question; gratitude practice; “Rose, bud, thorn”; ice-breaker; etc. (keep brief) Check-ins about current concerns/challenges/questions Individual private health assessment, others socialize and talk about above prompts, with snacks and refreshments |
~1 hour 30 min | Main activities | Cover session topics (timing will depend on each session and group-directed conversation) Educational Session Topics & Discussions Demonstrations/Activities |
5 min | Closing Statement | Next session info and other announcements Closing blessing |
Table 2 Description – This table provides an example of the structure for conducting group sessions. Total time of session will be 2-2.5 hours in duration. This particular example includes references to the cultural themes incorporated into each session.
Ojibwe Cultural Topics | Notes |
Traditional Medicines | Tobacco [asemaa] – symbolizes harmony, peace, and connection to our ancestors and mother earth · Ceremonial vs commercial uses of tobacco Cedar – protection, restoration, and healing Sage – cleansing and releasing of negative energy Sweetgrass – sacred hair of Mother Earth; sweet aroma symbolizes kindness and love; healing and calming effect; 3 bundles of 7 strands make up a braid of sweetgrass the first bundle representing the 7 generations before us, the second bundle representing the 7 sacred teachings, the third representing the next 7 generations Discuss how/where/when to harvest and prepare. |
Moss after Birth | Place newborn on a patch of moss after birth to connect them back to Mother Earth Can also cover newborn in patch of moss during skin to skin |
Cedar Bath | Cedar tea is prepared and used for firth bath of newborn Parents actively participate in this first bath experience, including father, not just nursing. May also include catnip tea |
4 Seasons Teaching | Spring = East, New Life, Birth, White on Medicine Wheel Summer = South, Coming of Age, Adolescence, Youth, Yellow on Medicine Wheel Fall = West, Adulthood, Red on Medicine Wheel Winter = North, Elder years, Life in Full Circle, Black on Medicine Wheel |
Medicine Wheel | Many interpretations, community teaching on the 4 aspects of health; spiritual, physical, mental, and emotional to address the whole wellness of persons. Aligns with the seasonal teachings above. |
NO Baby Showers before birth | No baby showers before birth due to superstitions surrounding high rates of infant mortality, so this feast provides an opportunity for the community to shower the baby and family with gifts |
Birthing Ceremony | Feast held by parents 4 days after birth Elder will typically preset child with an Eagle feather, hung by where sleep for protection |
Naming Ceremony | Each parent is encouraged to identify at least 1 namesake but can ask up to 7 Parents ask namesake to participate in naming ceremony by presenting tobacco Parents host feast for the ceremony, which can be help any time after birthing ceremony and typically takes place within 1 year of birth |
Traditions surrounding the placenta | Parents may wish to keep placenta for ceremony Placenta may be buried on the North side of a Maple tree with tobacco. A maple tree because this is believed to be the tree of life. It is buried on the North side because seasonal teachings say life comes full circle in the North. Some tribes will bury it on the East side because this is believed to signify Spring and the celebration of new life/birth. Some tribes prefer white pines which symbolize longevity. |
Snow Bath | Parents place/cover infant in first snowfall after birth, a tradition believed to bring strength and good health to the infant. |
Cultural Crafts Relevant to pregnancy, birth, and newborns | Cradle boards Rope swings Moccasins Dream catchers Medicine bags Ribbon skirts (F)/shirts (M) Could offer post-group craft hour Be careful not to gift items prior to birth given beliefs about birth superstitions (no baby showers) |
Table 3 Description – The above table includes a list and descriptions of some traditional Ojibwe customs surrounding pregnancy, birth, and the postpartum period. This list is not comprehensive but includes some of the topics relevant to the curriculum development for this project. The above information is sourced from the book The Cultural Toolbox: Traditional Ojibwe Living in the Modern World by Anton Treuer and oral teachings from local Ojibwe Elders.
I want to acknowledge all the authors who contributed to this manuscript and thank them for their time. I want to thank those involved on the Native American Advisory Committee for their time and efforts in helping to develop this group prenatal care curriculum framework; your insights were invaluable in the development of this project. We thank the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) and the Rural Maternity and Obstetrics Management Strategies (Rural MOMS) Program for providing funding for this work.
The authors have no relevant financial disclosures or conflicts of interest. All authors listed have contributed to this manuscript and grant HPHR/BCPH permission to review and publish this work. This manuscript is not under consideration by another publication and has not been previously published elsewhere.
The authors have no relevant financial disclosures or conflicts of interest. All authors listed have contributed to this manuscript and grant HPHR/BCPH permission to review and publish this work. This manuscript is not under consideration by another publication and has not been previously published elsewhere.
Dr. Horton is a recent graduate from the University of Minnesota Medical School interested in obstetrics and gynecology. Her clinical interests include Native American health, health equity, and public health advocacy. She is passionate about addressing the maternal health crisis afflicting rural communities and birthing people of color through various public health initiatives. She will be starting her training at Temecula Valley Hospital as a surgery preliminary resident and plans to pursue OBGYN residency in the upcoming match cycle.
Dr. Nynas is a board-certified obstetrician-gynecologist affiliated with Sanford Health of Northern Minnesota in Bemidji, MN. She graduated from the University of Minnesota Medical School and completed her OBGYN residency at St. Joseph Mercy in Ann Arbor, MI. She provides comprehensive obstetric care including the treatment and initiation of medication for addiction treatment. She teaches medical and advanced practice professional students at Sanford Health of Northern Minnesota. Her clinical interests include improving access, quality, and coordination of care for the patients and communities in Northern Minnesota.
Dr. Kelly is a recent graduate from the University of Minnesota Medical School, currently completing her family medicine residency at The Family Medicine Residency of Western Montana. She is interested in providing broad spectrum family medicine and serving rural communities.
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