Last Year (2021) Accomplishments

In the start of the past year, pregnant mothers have been more compliant with prenatal appointments at LBJ OBGYN clinic. LBJ OBGYN have been seeing more pregnant women attending routine prenatal appointments and receiving various prenatal resources from local programs that promote early prenatal care and breastfeeding. This is not to say there were still challenges throughout the year due to COVID restrictions and redirecting of providers from both LBJ and DOH to work in COVID vaccination campaign efforts.

The Department of Health prenatal clinics were primarily closed throughout the year due to the shortage of Providers. DOH Prenatal Care Provider Dr. Mirella Chipongian was stranded in Fiji since 2020 as American Samoa borders remained closed during the pandemic. Dr. Chipongian returned safely to American Samoa on a special repatriation flight from Fiji in December 2021. This flight was arranged by the local government to repatriate stranded healthcare professionals and new recruits from Fiji who could assist in the healthcare workforce during mass COVID-19 efforts to the community and promote awareness to better engage the community against COVID-19.

The ASMCH staff, LBJ OBGYN and ASWIC worked together in providing health and nutrition education to pregnant women starting from their initial prenatal care visit to postnatal stage. This support was mainly provided through telephone calls for most of the year, as restrictions were put in place as the territory started to repatriate stranded residents from off-island.  Such restrictions limited in-person contact, so the usual ways of conducting prenatal health education and outreach were limited or prohibited altogether.  Pregnant mothers were given necessary information to make better and educated choices for adequate perinatal outcomes through social media or over the phone.

At LBJ OBGYN clinic, pregnant women were advised to attend routine prenatal care.  This was emphasized for high risk pregnant mothers.  Prenatal appointments were scheduled monthly during the first trimester of pregnancy (0-12 weeks), every 3 weeks during the second trimester (13-24 weeks), and every week during the third trimester (25-40 weeks). The duration of these prenatal appointments varied depending on the severity of the mother’s pregnancy. Pregnant women are at risk of getting seriously ill from COVID-19, therefore health education information was made available to all pregnant women and were strongly recommended to get vaccinated against COVID-19. The same messages and information were also provided for families of pregnant women, raising awareness on precautionary measures to avoid the spread of COVID-19 throughout pregnancy.

LBJ Nursery staff strongly encouraged mothers to breastfeed their newborns within the first hour after childbirth. Skilled nursing staffs were available to all mothers especially new mothers that needed guidance in breastfeeding for the first time. The ASWIC Program provided breastfeeding education to mothers with infants, through various options such as the “Warm Line”, a 24-hour breastfeeding coaching service for mothers who may encounter difficulty with breastfeeding. The Warm Line is staffed by ASWIC breastfeeding personnel who have been trained to provide dependable breastfeeding information and support. The ASMCH staff is working in alliance with DOH Well Baby Clinicians, LBJTMC and ASWIC in increasing awareness and promoting exclusive breastfeeding to the community.

MIECHV conducted home visits for pregnant women to educate them on breastfeeding, safe sleep, and nutrition. 58% of their clients received postpartum check-ups and 81 % received a postpartum depression screening. MIECHV strives to see more pregnant women to set and achieve goals that will improve their health and well-being.

American Samoa reported its first coronavirus case 18 months into the pandemic. DOH together with other government agencies worked closely with the COVID-19 Taskforce to boost COVID vaccination acceptance in American Samoa. ASMCH staff helped in various ways to raise COVID awareness and educate the MCH population about the importance of getting vaccinated; not only to protect individuals who were eligible to receive the vaccine, but also to protect infants and young children that are not eligible to receive the vaccine.

The infant mortality rate in American Samoa is 2.9 per 1000. There were 6 infant deaths in the past year due to childbirth-related complications. Respiratory Distress Syndrome was the main cause of death for 3 infants, intracerebral bleeding for 1 infant, severe pneumonia for a 3-month infant and possible aspiration for a 6-month old infant. ASMCH continues to work together with DOH partners: MIECHV, Helping Hands and Helping Babies Hear, as well as LBJ and DHSS to provide adequate care and services to collectively reduce infant mortality with a focus on reducing disparities.

Strengths

• With the consistency of prenatal care at LBJ,  mothers were becoming more compliant with prenatal care appointments.
   

• Survival rate of preterm babies increased due to more resources available such as medications and medevac services.
   

• With more resources available for neonatal care, there have been less newborns admitted in NICU and less infant deaths compared to the United States.  

• Electronic Health Record database is accessible between LBJ hospital and DOH clinics for intra agency referrals and care coordination.
   

• ASWIC is using Participant Centered Services to improve health outcomes for WIC participants.

• ASWIC participants are now utilizing an Electronic Benefits Transfer card and application called eWIC to conveniently purchase WIC foods and to check WIC balance.

Challenges

• Language barrier in health care causes misunderstanding between pregnant women and Providers in which it contributes to poor prenatal and perinatal care. DOH and LBJ need interpreting services for mothers who have limited English proficiency.

• Lack of available translated educational resources on nutrition and health education for new mothers and babies.

• Increase of drug use in pregnant women is becoming a prominent factor in the developmental health and overall wellbeing of infants and new mothers. 

• DOH Well Baby clinics in Amouli (East), Fagaalu (Central), and Leone (far West) are in need of Pediatricians.

• Some mothers cease to breastfeed their babies due to barriers such as embarrassment toward breastfeeding in public and early return to work or school postpartum.