The Red Cliff Band of Lake Superior Chippewa's community needs and readiness assessment highlighted the need for the Tribal Maternal, Infant and Early Childhood Home Visiting (MIECHV) program to focus on prenatal care, incorporating Ojibwe teachings about the "Four Hills of Life." Building upon recognition that indigenous communities traditionally had midwives to assist with delivery, and with blessings from grandmas, elders, and mothers, they decided to enhance the Parents as Teachers home visiting model by embedding a doula program. The thought was that the doula program could provide families the additional prenatal care that they wanted and in a way that built on the traditions of the community. As a result, doula home visitors now provide eight lessons on childbirth education (in addition to the content of the Parents as Teachers model) that focus on the sacredness of conception and pregnancy, the honor of bringing a new life into the tribal community, and families' thoughts about approaches to parenting. "The ZHV program uses cultural teachings and activities as the foundation and structure of the program with an aim to increase participation of fathers and extended family members in all aspects of service delivery, and to increase preconception/adolescent knowledge and health related to sexuality and healthy lifestyles. These adaptations and enhancements are provided through Red Cliff's culturally based Fetal Alcohol Spectrum Disorder prevention program, the coming of age and other pertinent ceremonies, and cradleboard-based teachings related to health and relationships. Specific adaptations to the PAT program include using community-based doulas as PAT home visitors and increasing prenatal home visiting intensity."
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