Indigenous Maternal Health Safely Navigating Pregnancy and Parenting with Culture and Traditions

Indigenous Maternal Health: Safely Navigating Pregnancy and Parenting with Culture and Traditions American Indian and Alaska Native people experience disparities in pregnancy-related death and other maternal health conditions. Ongoing and historical trauma—due to colonization, genocide, forced migration, and cultural erasure—contribute to health inequities.

Despite these challenges, American Indian and Alaska Native people continue to be resilient and thrive. Many Native people draw strength from culture and tradition.

Their resilience is built through culture, spirituality, shared values, and a strong sense of identity. Culture serves as a protective factor in the health and well-being of American Indian and Alaska Native people.

Contents Pregnancy .................................................................................................. 3 Prenatal Care & Urgent Warning Signs .................................................. 4 Working with Indigenous Birth Workers ............................................... 5 Test for Infections .......................................................................................... 6 Gestational Diabetes ..................................................................................... 9 Assess Alcohol & Drug Use ....................................................................... 11 Tobacco Use ................................................................................................... 13 Monitor Your Mental Health ..................................................................... 14

Preparing for Your Baby’s Safety .......................................................... 15 Caring for a Newborn .............................................................................. 16 Safe Sleep Practices ................................................................................ 17 Nursing Your Newborn .......................................................................... 19 Additional Resources ............................................................................. 20 Sources ..................................................................................................... 21

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Pregnancy Traditional beliefs and practices hold that children are a gift from the Creator and that well-being brings harmony and balance. Pregnant individuals are honored and respected as they are the givers of this sacred life, and a pregnant person’s maternal instinct is to take care of themself and the life inside them.

The following practices are ways to protect your health and the health of your baby: Get Prenatal Care & Watch for Urgent Warning Signs Working with Indigenous Birth Workers Test for Infections Test for Gestational Diabetes Assess Tobacco, Alcohol, & Drug Use Monitor Your Mental Health

You Know Your Body Best If you are pregnant, it’s important to pay attention to your body and talk to your healthcare provider about anything that doesn’t feel right. If you experience something that seems unusual or is worrying you, don’t ignore it.

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Pregnancy: Prenatal Care & Urgent Warning Signs Prenatal care can help keep you and your baby healthy. Having a healthy pregnancy is one of the best ways to promote a healthy birth and getting early and regular prenatal care improves the chances of a healthy pregnancy.

Find a Trusted Care Provider: Your doctor, midwife, doula, or other birth worker can spot health problems early which allows for early treatment. Early treatment can cure many problems and prevent others. Indigenous birth workers also provide opportunities to incorporate your culture into the pregnancy journey and birth experience.

Prenatal Vitamins: Take a multivitamin or prenatal vitamin with 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day.

Also, choosing a variety of healthy foods like fruits, vegetables, whole grains, calcium-rich foods, and foods low in saturated fat will help you get the nutrients you and your baby needs.

If you experience any of these warning signs, get medical care immediately.

Severe headache that won’t go away or gets worse over time Dizziness or fainting Thoughts about harming yourself or your baby Changes in your vision Fever of 100.4º F or higher Extreme swelling of your hands or face Trouble breathing Chest pain or fast-beating heart Severe nausea and throwing up (not like morning sickness) Severe belly pain that doesn’t go away

Monitor Your Health Too: In addition to monitoring the health of your baby, make sure you are taking care of yourself too. Control diabetes, high blood

Baby’s movement stopping or slowing down during pregnancy

pressure, and other medical conditions. Talk with a care provider about what is a healthy weight and ways to achieve it. Get screened

Swelling, redness or pain of your leg

for possible infections and check-in with your mental health.

Vaginal bleeding or fluid leaking during pregnancy

Overwhelming tiredness This list is not meant to cover every symptom you might have. If you feel like something just isn’t right, talk to your healthcare provider.

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Pregnancy: Working with Indigenous Birth Workers A doula or birth worker is a trained professional who provides emotional, physical, and informational support services during the prenatal, labor, delivery, and postpartum periods. Doulas are non-clinical and do not provide medical care. Doulas work with you to determine how best to meet your needs. These individuals can be a valuable member to your birth team, in addition to your partner, family, labor nurse, midwife and/or doctor. Indigenous birth workers are also able to support and center cultural practices you want to incorporate into your journey.

How to Partner with a Birth Worker:

Services Birth Workers Can Provide: Emotional and physical support Person-centered, culturally competent care Prenatal counseling and assisting in preparing for and carrying out birth plans Teaching and advocating on behalf of the birthing parent during appointment visits

Ask your healthcare provider for a referral Call your local Tribal clinic Visit the Oklahoma Birth Equity website (okbirthequity.org) Browse the Oklahoma Healthcare Authority Provider Portal (for SoonerCare) (oklahoma.gov/ohca/individuals /find-a-provider)

Facilitating and assuring access to resources that can improve birth-related outcomes Ongoing education with an emphasis on postpartum care and resources Supporting the whole birth team including a birthing parent’s partner, family members, and other support persons

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Pregnancy: Test for Infections It is important to test for sexually transmitted infections (STIs) if you are planning to get pregnant or are currently pregnant, especially if you have ever had more than one sex partner or your partner has had or currently has more than one sex partner. STI testing is a routine part of prenatal care.

Most STIs have no signs or symptoms. You or your partner could be positive and not know it. The only way to know your status is to get tested. This is important to prevent serious health complications for you and your baby. Testing is simple and often the infection is curable before delivery. It is important that both you and your partner are tested and treated for infections, so that you are not re-infected by each other. Testing for some infections, like syphilis, is recommended at multiple points during pregnancy and at delivery.

Getting tested and treated for infections will increase the chances for a healthy pregnancy and a healthy baby.

To access testing, you can ask your care provider to order testing, get tested at your local Tribal, IHS, or health department clinic, attend a community event where testing is offered, or order tests from a self testing service.

Self-Testing Services in Indian Country Native Test offers free HIV and Syphilis self-testing, as well as information on HIV preventative care (PrEP).

To order an HIV or Syphilis self-test kit, text “Native Test” to 55251 or visit nativetest.org

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Pregnancy: Test for Infections The following infections are sexually transmitted and both you and your partner need to be treated: Chlamydia: Chlamydia is the most common sexually transmitted infection. It often has no symptoms, but it can cause serious health problems, even without symptoms. You might have increased discharge, pain with sex or bleeding after sex. If you have chlamydia while pregnant and it is not treated, the infection can be passed to your baby during delivery. This can cause serious eye and lung infections in babies after they are born.

Gonorrhea: Gonorrhea is the second most commonly reported STI. Like, chlamydia, it often has no symptoms, but it can cause serious health problems, even without symptoms. You might have increased discharge, pain with sex or bleeding after sex. If it is not treated, the infection can be passed to your baby during delivery. This can cause blindness, joint infection or a life threatening blood infection for your baby.

Human Immunodeficiency Virus (HIV): HIV is a virus that attacks the body’s immune system and can lead to AIDS. HIV spreads through infected body fluids, like blood, semen and breast milk. It spreads mainly through unprotected sex or sharing drug needles, but can also pass to your baby during pregnancy, labor, birth or breastfeeding.

It is very important that you and your partner(s) know your HIV status. Every pregnant person should receive HIV testing early in their pregnancy and again before delivery. If you test positive for HIV, treatment during pregnancy can help protect your baby from getting HIV. With the use of HIV medicines and other strategies, a pregnant person with HIV can reduce the chance of passing HIV to their baby to 1% or less.

Syphilis: All pregnant people should be tested for syphilis at the first prenatal visit, even if tested before. Testing in the third trimester and at delivery can further prevent Congenital Syphilis, which occurs when a pregnant person passes a syphilis infection to their child, either during pregnancy or childbirth. Babies born to people with untreated syphilis may be stillborn or die as a newborn. Syphilis in babies can also cause permanent damage to the brain and other organs, that results in blindness, deafness, and lifelong disability. Syphilis and Congenital syphilis have increased sharply specifically in Indian Country.

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Pregnancy: Test for Infections Hepatitis B: Hepatitis B is a viral infection that attacks the liver. All pregnant people should be tested for this virus when they have their prenatal lab work done. Most individuals who have hepatitis B do not even know they are sick. If you have the virus, your baby will need to be given the hepatitis B vaccine at birth and another shot, called HBIG that helps the baby’s immune system. These shots help prevent your baby from getting hepatitis B. These shots work best when they are given within 12 hours after your baby is born. Babies with hepatitis B will likely develop a lifelong, chronic infection.

Trichomoniasis (Trich): Trich is a common STI. Testing is important because 70% of people with this infection do not have symptoms. Pregnant people with trich are more likely to have their babies early or babies with a low birth weight Human Papillomavirus (HPV): Pregnant people with HPV can get genital warts or develop abnormal cell changes on the cervix. Routine cervical cancer screening can help find abnormal cell changes. Routine cervical cancer screening should continue even during pregnancy.

Herpes: Genital Herpes is an STI that can cause blisters in the genital area and flulike symptoms. Genital herpes infections can lead to miscarriage or make it more likely to deliver your baby too early. You can pass herpes to your baby during delivery, leading to a deadly infection in your baby (called neonatal herpes). If you have genital herpes, you may need to take anti-herpes medicine towards the end of your pregnancy. This medicine may reduce your risk of having signs or symptoms of genital herpes when you deliver.

Bacterial Vaginosis (BV): BV is a vaginal infection that is not sexually transmitted. but most often occurs in those who are sexually active. BV is a result of an imbalance of "good" and "harmful" bacteria in a vagina. Treating BV during pregnancy is very important. If you are pregnant and have BV, your baby is more likely to be born early (premature) or at a low birth weight.

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Pregnancy: Gestational Diabetes Gestational diabetes can develop during pregnancy, even if you don’t already have diabetes. Every year, 5% to 9% of U.S. pregnancies are affected by gestational diabetes.

In 2020, there were over 3,000 cases of gestational diabetes in Oklahoma. Studies have shown that Native Americans are disproportionally affected by this condition.

Managing gestational diabetes can help make sure you have a healthy pregnancy and a healthy baby.

Symptoms: Gestational diabetes often doesn't have any symptoms. If you do have symptoms, they may be mild, such as being thirstier than normal or having to urinate more often. You'll need to be tested to know for sure if you have gestational diabetes.

Risk Factors: While Natives are already at an increased risk, other risk factors include: Having had gestational diabetes during a previous pregnancy Having given birth to a baby who weighed over 9 pounds Being overweight Having a family history of type 2 diabetes Having polycystic ovary syndrome (PCOS)

Prevention: Before you get pregnant, you may be able to prevent gestational diabetes with lifestyle changes. These include losing weight if you're overweight, eating a healthy diet, and getting regular physical activity. Don't try to lose weight if you're already pregnant. You'll need to gain some weight for your baby to be healthy.

Testing: It's important to be tested for gestational diabetes so you can begin treatment to protect your baby's health and your own. Gestational diabetes usually develops around the 24th week of pregnancy. You'll probably be tested between 24 and 28 weeks. If you're at higher risk for gestational diabetes, your doctor may test you earlier.

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Pregnancy: Gestational Diabetes Being diagnosed with gestational diabetes can be scary. Luckily, there are many things you can do to keep you and your baby healthy both during and after pregnancy.

Go to all your prenatal appointments so your health care provider can keep you and your baby healthy.

Gestational diabetes can cause your baby to be larger than normal when you are pregnant. It may cause your baby to have low blood sugar, yellowish skin (jaundice), or trouble breathing at birth. Keeping your prenatal appointments and managing your blood sugar can prevent these conditions.

Learn about changes you must make to your daily meals.

When you have gestational diabetes, the sugar in your blood can become too high.

Changing what you eat can help keep your blood sugar at a safe level. It is important to receive nutritional advice and come up with a plan that will help you manage your meals.

Include safe exercise activities in your daily routine.

Getting 30 minutes of exercise a day five days a week can also help control blood sugar levels.

Ask your health care provider how much weight gain is right for you.

Staying within your weight gain range can help control your blood sugar levels and keep your baby healthy.

Check your blood sugar levels regularly.

Write them down to bring to your appointments. You may not have to use medications if you check your blood sugar levels often and control them.

Take insulin or other medications as prescribed to control your blood sugar.

Sometimes healthy eating and exercise are not enough to control blood sugar levels. You may need to start using insulin or other medications to help prevent health risks to you and your baby.

Plan to return for your postpartum checkup after your baby is born.

Your diabetes may not go away after the baby is born. Diabetes is a serious disease that may make it difficult for you to care for your baby if it is not treated. Take care of yourself so you can care for your baby. Ask your health care provider to perform the postpartum blood sugar check.

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Pregnancy: Assess Alcohol and Drug Use If you use alcohol or drugs, quit or cut back as much as you can. It's safest not to use them at all. During pregnancy, everything you eat, drink, or take into your body affects you and your growing baby. Using alcohol or drugs while you're pregnant can cause serious problems. It can cause problems for you during your pregnancy and when it is time for your baby to be born. It can also affect your baby both before and after birth. If you have a hard time quitting or cutting back on your own, treatment can help.

Pregnant people who struggle with substance use can recover and have a happy, healthy baby.

Starting the road to recovery is important to prevent the side effects that drugs and alcohol can have on you and your baby. The result of alcohol and drug use during pregnancy can have effects on your baby in the short-term, at birth, but also in the longterm as they grow and develop.

Side Effects on Babies/Infants of Alcohol and/or Drug Use During Pregnancy Birth Defects

Physical and mental development

Low Birth Weight

problems

Withdrawal at Birth

Heart problems

Fetal Alcohol Syndrome:

Learning and behavior problems

the range of alcohol effects on a fetus, potentially impacting how their heart, lungs, and brain work

Delayed motor skills Breathing problems

Know your Rights Federal rules now require a Plan of Safe Care for babies exposed to opioids or other drugs before birth. Plans of Safe Care are meant to help keep your family together.

Build your Plan of Safe Care with your treatment provider to set realistic expectations.

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Pregnancy: Assess Alcohol and Drug Use Steps for Recovery Talk to Your Healthcare Provider About Treatment Options

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Whether its your doctor, nurse, doula, or midwife, find someone you trust to ask about the first steps to start treatment. Depending on the substance(s) you use, certain medications can help alleviate cravings and withdrawal symptoms, setting you up on the road to recovery. Early care is important to minimize the risk of complications of substance use during pregnancy.

Connect with Your Culture & Community Your cultural teachings and traditions are powerful. Try connecting and participating in these practices to ground yourself, relieve stress, tend to your body and spirit, and ultimately, heal. Reach out to a trusted Elder or Auntie for guidance and knowledge. Work on traditional art, like beading or basketmaking. Connect with your culture and community during this healing journey to build up a lasting support system.

Talk to Someone Talk to trusted friends and family members about your journey and supporting your changes. Meeting with a counselor can also be beneficial to develop ways to make changes in your life and provide support if you are also experiencing anxiety or depression. Look for a group that is kind and helpful about substance use and pregnancy. Groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) may work for you.

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Take Good Care of Your Body Support your physical health by eating healthy, getting enough sleep, exercising, and taking recommended prenatal vitamins. Make sure to also go to your prenatal visits to ensure a safe pregnancy.

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Pregnancy: Tobacco Use Smoking and tobacco use (including e-cigarettes and vapor products) – or even being around other people who use tobacco – exposes your baby to harmful chemicals that can have a lifelong impact. Quitting smoking at any time during pregnancy – especially early on – can give your baby a healthier start in life.

By quitting tobacco, you can: Reduce the risk of miscarriage Reduce the number of illnesses that both you and your baby have Avoid your baby having to go through nicotine withdrawal Decrease your baby’s risk of sudden infant death syndrome (SIDS) Assure your breast milk will be healthier for your baby Increase the chance of your baby having healthier lungs Increase the amount of oxygen your baby gets, helping the baby grow Reduce the chance that your baby will be born too early, before the lungs and other organs are fully formed

The Surgeon General concluded that there is no safe level of secondhand smoke exposure and eliminating tobacco use in indoor spaces and cars is the only way to fully protect children from exposure to secondhand smoke. Smoke permeates the entire house/car and lingers long after the product has been extinguished, so tobacco use in certain rooms, at certain times, or by a window or fan is not safe.

The Oklahoma Tobacco Helpline is here to help you quit, providing FREE nonjudgmental support, as well as tobaccocessation resources and tips to quit smoking. Plus, it’s available 24 hours a day, 7 days a week. Even if you have tried before, there are new tools and medications that can help you quit tobacco for good.

Save money to buy more things for your baby and yourself

OKhelpline.com

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Pregnancy: Monitor Your Mental Health Postpartum depression is a medical condition that many people get after having a baby.

It affects up to 1 in 8 of people after giving birth. According to studies, this prevalence is even higher in American Indians and Alaska Natives. It is important for you to monitor your mental health, as these conditions can develop within the first year after childbirth.

If you are pregnant or a parent to a newborn and are experiencing strong feelings of sadness, worry and tiredness,

you are not alone.

What is Postpartum Depression (PPD)?

Postpartum depression is strong feelings of sadness, anxiety, worry, and tiredness that last for a long time after giving birth. These feelings can make it hard for you to take care of yourself and your baby. PPD can happen any time after childbirth. It often starts within 1 to 3 weeks of having a baby. It needs treatment to get better.

Remember, PPD is not your fault. It does not make you a bad person or a bad parent.

PPD vs. Baby Blues Baby blues are feelings of sadness you may have after having a baby. Baby blues can happen 2 to 35 days after you give birth and can last up to 2 weeks. You may have trouble sleeping, be moody or cranky, and cry a lot. If you have sad feelings that last longer than 2 weeks, tell your healthcare provider. They can check to see if you may have PPD.

If you are experiencing PPD and need to talk to someone, call or text (24/7): National Maternal Mental Health Hotline 1-833-TLC-MAMA (1-833-852-6262) Suicide & Crisis Lifeline - 988

You may have PPD if you have five or more signs or symptoms that last longer than 2 weeks.

Feeling depressed most of the day every day Feeling shame, guilt or like a failure Feeling panicked or scared a lot of the time Severe mood swings Having little interest in things you normally like to do Feeling tired all the time Eating a lot more or a lot less than is normal for you Gaining or losing weight Having trouble sleeping or sleeping too much Having trouble concentrating or making decisions Having trouble bonding or not having any interest in the baby Fear of harming your baby, your partner or yourself

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Preparing for Your Baby’s Safety Crib Firm mattress without gaps between crib sides Crib with slats no farther apart than 2 3/8 inches No pillows, toys, blankets, or bumper pads Use tight-fitting sheet made for the mattress No drop-side rails No decorative cutouts in the crib headboard, footboard, or walls Bassinet/Cradle Firm, thin mattress with no gaps between it and the sides Sides high enough so baby cannot fall out Stable and cannot be knocked over Cradle that cannot swing high enough to overturn Dressing or Changing Baby Placed on table, crib or floor, Uncluttered and firm surface,

Bathing Baby In bath tub made for babies, can be placed in a big tub or regular bathtub Non-slippery surface Do not use a baby bath seat because it can easily tip over.

Make sure everyone involved in bath time knows to never leave the baby alone.

Infant Car Seat Choose a seat that meets or exceeds Federal Motor Vehicle Safety Standard 213 (see label on seat).

Do not use a car sear that has been in a crash before - know the history.

Check expiration date Learn how to install the seat and use the harness before your baby’s first ride.

Install in the back seat of vehicle, rear facing, at a 45-degree angle Use directions in the car seat manual or visit a child car seat inspection station to have a trained person help you learn how to install the seat securely

Stable, Non-slippery surface

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Caring for a Newborn Baby’s Bath Shallow water Test temperature first on inner wrist Hold up the baby’s head.

Never leave baby without adult supervision Dressing or Changing Baby Do not leave the baby alone on any elevated surface.

Keep powder, lotion, or other uncovered materials, caps, small objects, out of the baby’s reach.

Carriage/Stroller Make sure baby is securely placed and strapped The stroller back should be reclined at about 45°. This keeps their chin off of their chest and their airway from being blocked.

Keep their face clear of blankets.

Crying Crying is normal and may increase each week until your baby is around 2 months old.

NEVER shake a baby. Shaking a baby can cause blindness, permanent brain damage, even death.

If you feel upset or frustrated, it’s okay to put baby in a safe place and take a break.

Car Safety Use rear-facing infant car seat and place in back seat of vehicle NEVER LEAVE BABY IN CAR ALONE, not even for a minute!

Baby must always be in properly buckled car seat, which should be at 45 degree angle Keep objects in car secured so as not to injure baby during sudden stops Back or Front Carry Pack Correct size and material for age of baby Keep baby’s head supported Check that baby does not slide inside and have trouble breathing Make sure pack is tied securely to person carrying baby Baby securely placed and strapped Safe Environment Do not smoke or take drugs or alcohol while caring for baby Do not use tobacco products (including e-cigarettes and vapor products) around baby Do not drink or handle hot liquids while holding baby Maintain a functioning smoke alarm Keep home temperature about 70° Learn infant CPR Upload Poison Control number into phone: 1-800-222-1222

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Safe Sleep Practices Where is the Safest Place for Baby to Sleep?

The American Academy of Pediatrics recommends sharing a room, but not a bed with your baby as the safest option.

Keep baby’s bed right next to your bed so it is easy to put baby in the crib, portable crib, or bassinet after feeding.

Sleeping Position Always place your baby on their back to sleep at all times, even for naps, unless baby’s doctor tells you to do something different for the baby’s health Placing baby on the side or stomach increases the chances of Sudden Infant Death Syndrome (SIDS) Tell everyone caring for your baby to place baby to sleep on the back at all times, even for a nap.

Do not use: Bumper pads Quilts Comforters Duvets Blankets Stuffed animals Sheepskins These items are dangerous and can result in suffocation or strangulation.

A Safe Bed for Baby Should Have: Railings that are no more than 2 3/8 inches apart (a soda can will not fit through railings) A firm mattress with no incline that fits snugly in the frame with a fitted sheet that is tight around the mattress

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Safe Sleep Practices Do not put your baby to sleep on or in: Sofas, adult beds, car seats, swing, bouncer, recliner, futons, or chairs These places are unsafe for your baby to sleep due to: Baby can roll out of your arms and onto the floor Baby can be suffocated between pillows, bed covers, or between adults in an adult bed An adult, child, or pet can roll over onto the baby accidentally How should baby be dressed for sleep?

Do not overheat or overdress baby Make sure your baby’s head and face remain uncovered during sleep Baby can be swaddled until they start learning to roll over, or use a sleep sack (also known as a wearable blanket with a zipper) instead of swaddling.

If it is cold, layer the baby’s clothing. (For example, add a t-shirt and socks under his or her sleeper.)

Keep the room temperature comfortable (68° to 72°F).

Cradleboards For generations, cradleboards were the traditional carriers/surfaces to keep babies safe while sleeping. While designs may vary, in general, cradleboards are handmade, framed, flat baskets where the baby is placed on their back How to Use with Safe Sleep Practices: Do not swaddle or fasten your baby too tightly; baby needs to breathe easily and should not be overheated.

The healthiest position is when your baby’s legs are not tightly together and straight, but rather flexed at the hip with legs apart (naturally), promoting healthy, natural hip development. It is important NOT to keep baby’s hips held tightly together as being swaddled in this way for long periods of time could cause hip dysplasia or dislocation.

Just like a car seat - baby should not be left in the cradleboard for long periods of time.

Always place the cradleboard flat on the floor, away from anything that could fall on baby.

Do not lean the cradleboard against walls or anything else when baby is inside

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Nursing Your Newborn Benefits for Your Baby: Provides the best source of nutrition for most babies Lowers risk of illnesses such as ear infections, diarrhea, and respiratory infections Lowers risk of allergies and asthma Lowers risk of sudden infant death syndrome (SIDS) Lowers risks of obesity and type 1 diabetes Benefits for You: Helps you lose your pregnancy weight faster Causes your uterus to return to its normal size sooner Lowers your risk of breast cancer, ovarian cancer, type 2 diabetes, heart disease, high blood pressure, and postpartum depression Save money on medical costs and feeding supplies

Breastfeeding Tips & Tricks: Use skin-to-skin contact to help control baby’s heart rate, breathing, temperature, and blood sugar. This can also help to increase your milk supply.

If possible, try to breastfeed your baby within the first 1 to 2 hours after birth. Breastfeeding early and often allows your milk supply to increase and meet your baby’s growing needs.

Try to avoid pacifiers until your baby is regularly latching onto your breast to avoid confusion (around 3-4 weeks).

Breastfeeding is a process that takes time and practice. If you are having difficulty, do not be afraid to reach out to someone for help.

Your baby’s health care provider, your lactation consultant, your breastfeeding peer counselor, or even you partner and family can provide help and support during your breastfeeding journey.

Breastfeeding questions?

Call the toll-free Oklahoma Breastfeeding Hotline at 1-877-271-MILK (6455) or text OK2BF to 61222.

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Additional Resources Heartline - Find community resources (food, housing, financial, etc.).

988 Suicide & Crisis Lifeline - Trained counselors available 24/7

Call 2-1-1 Text your zip code to 898211

Call or text 9-8-8 988lifeline.org

heartlineoklahoma.org Women, Infants, & Children (WIC) - Enroll for benefits, view eligible food lists, nutrition education, etc.

Call 1-888-655-2942 oklahoma.gov/health/wic Oklahoma Center for Poison & Drug Information Call 800-222-1222 Text POISON to 797979 oklahomapoison.org Oklahoma Child Care Resource & Referral Association - Search for child care Call 888-962-2772 oklahomachildcare.org Oklahoma Breastfeeding Hotline & Resource Center Call 877-271-6455 Text OK2BF to 61222 obrc.ouhsc.edu Maternal & Child Health Service, Oklahoma State Dept. of Health (OSDH) Call 405-426-8113 oklahoma.gov/health

National Maternal Mental Health Hotline free, confidential help for people who are pregnant or just had a baby (24/7) Call or Text 1-833-TLC-MAMA (1-833-852-6262) Postpartum Support International Postpartum depression helpline & resources Call or Text 800-944-4773 postpartum.net Oklahoma Coalition Against Domestic Violence & Sexual Assault - Help with safety planning, emergency shelters, & crisis intervention.

Call 800-522-7233 (24/7 hotline) ocadvsa.org Native Test - Free HIV tests, HIV prevention information, and Syphilis tests Text “Native Test” to 55251 nativetest.org Indian Health Services - Resources for Patients & Families ihs.gov/mch/patientresources/

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Sources: 1. Centers for Disease Control and Prevention. Disparities and Resilience Among American Indian and Alaska Native People who are Pregnant or Postpartum, 2024. www.cdc.gov/hearher/aian/disparities.html 2. Indian Health Services. Screening, Prenatal Care, and Treatment. www.ihs.gov/opioids/maternalchild/screeningtreatment/ 3. Centers for Disease Control and Prevention. Signs and Symptoms of Urgent Maternal Warnings Signs. www.cdc.gov/hearher/maternal-warning-signs/index.html 4. Oklahoma Healthcare Authority. Doula Services. oklahoma.gov/ohca/providers/types/prenatal-andperinatal-services/doula.html 5. Centers for Disease Control and Prevention. Sexually Transmitted Infections (STIs). www.cdc.gov/sti/index.html 6. March of Dimes. HIV and Pregnancy. www.marchofdimes.org/find-support/topics/pregnancy/hivand-pregnancy 7. HIVinfo.NIH.gov. Preventing Perinatal Transmission of HIV. hivinfo.nih.gov/understanding-hiv/factsheets/preventing-perinatal-transmission-hiv 8. Centers for Disease Control and Prevention. About Gestational Diabetes. www.cdc.gov/diabetes/about/gestational-diabetes.html 9. Gregory E , Ely D. Trends and Characteristics in Gestational. Diabetes: United States, 2016–2020.

National Vital Statistics Reports. 2022; 71(3).

10. Northwest Portland Area Indian Health Board. Indian Country ECHO. Family Care Plans Toolkit. www.indiancountryecho.org/family-care-plans-toolkit/ 11. Oklahoma Mental Health and Substance Abuse Services. Pregnancy. mentalhealth.networkofcare.org/oklahoma/HealthLibrary/Article? docType=na&articleId=hw197814#tn9075 12. Oklahoma State Department of Health. Tobacco Use and Pregnancy. https://oklahoma.gov/health/health-education/children---family-health/improving-infantoutcomes/smoking-and-pregnancy.html 13. Oklahoma State Department of Health. Maternal Mental Health. oklahoma.gov/health/healtheducation/children---family-health/improving-infant-outcomes/maternal-mental-health.html 14. March of Dimes. Postpartum Depression. www.marchofdimes.org/findsupport/topics/postpartum/postpartum-depression 15. American Academy of Pediatrics. Safe Sleep Campaign Toolkit. www.aap.org/en/newsroom/campaigns-and-toolkits/safe-sleep/ 16. First Nations Health Authority. Infant Safe Sleep Cards. www.fnha.ca/WellnessSite/WellnessDocuments/HOB_SafeSleep_IllustratedCards.pdf 17. Oklahoma State Department of Health. Injury Prevention for Babies. oklahoma.gov/health/healtheducation/children---family-health/improving-infant-outcomes/injury-prevention-for-babies.html 18. Office on Women’s Health. Your Guide to Breastfeeding. womenshealth.gov/patientmaterials/resource/guides

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