for the Postpartum Support International Blog
July 31, 2017
This piece appeared previously on the Center for Health Journalism blog
It was during my second pregnancy when the changes really hit me. I had recently moved to the East Los Angeles neighborhood of Boyle Heights. This is where I now work as a perinatal case manager for Maternal and Child Health Access and where most of my clients live, but at the time I was unemployed. During the pregnancy, I noticed my anxiety and depression growing so strong they almost knocked me over.
I was training to be a mental health specialist and had been looking for a job for two years. My partner was also unemployed. Our home life was difficult. We were living in a roach- and mold-infested apartment. We did not have a bed, so we slept on the cold floor. Sometimes we did not have electricity or working gas. I was not receiving any prenatal care. I was enrolled in a Medi-Cal plan, California’s Medicaid program, and the plan did little to help me find a provider.
Our situation began to take a toll on me. I would spend many nights pacing back and forth in my apartment worrying about money and my baby. During the day, I had trouble getting out of bed and caring for my older daughter, Victoria, then 2-years old. My partner was also going through his own form of depression and he didn’t like being at home. His absences led to constant fights, and we even ended our relationship a few times during the course of my pregnancy. I felt a lot of blame and guilt for putting my children through all this. At times, I thought that maybe we would be better off dead. I didn’t know then that Medi-Cal covers mental health for depression and other mental health issues, including pregnancy-related.
Often I felt I was drowning or falling down through quicksand. I did, however, have a support system and I managed to reach out. I called friends and family and they allowed me to vent and cry. My family and friends dragged me outside my house to go walking or offered me warm tea. Writing and drawing in a journal offered an outlet to release my feelings. One friend would take me to receive donation-based acupuncture. Another friend reached out for financial help so I could pay a month’s rent and that person also provided me with a mattress.
A breakthrough came a few weeks before the birth of my daughter. My friends organized a “mother blessing” where they reminded participants that we were not alone. After the birth of my second daughter, my doula and friend organized postpartum support. As I recovered from the birth, friends and family stopped by to offer food, tea, childcare, housework, herbal baths, massages, and all the love a postpartum mom deserves.
Most of what I went through is similar to what I see my clients going through on a daily basis. The majority of mothers I see during my home visits work but still cannot afford to rent suitable housing in Los Angeles. Some live in overcrowded homes they share with family, or sleep on a different couch, courtesy of various friends, each night. Some stay in hotels or homeless shelters. These conditions only worsen their depression and anxiety. I often feel very helpless to improve their lot, since there are few housing resources for which I can provide referrals. The lack of affordable housing in these neighborhoods, especially for parents of young children, is a huge challenge.
Many women living in low-income neighborhoods suffer high rates of trauma and often give birth to children with chronic health conditions, such as heart malformations and other birth abnormalities. These conditions often require surgeries and constant medical appointments. But needed care can be hard to come by, for both mothers and children. My clients are mostly single mothers who cannot afford to ask for days off work because they will not get paid. Lisa, one my clients, told me, “I cannot afford to rest or get sick. I cannot get any more days off. I go in almost dying sometimes. I wish I could just have a day to rest.” I hear similar laments from many of the mothers I work with. The lack of paid sick days takes a toll on these families. If employers offered more paid sick days, these mothers would be better able care for their children without neglecting their own health. If mothers are not well and struggling to cope, how can they take care of their children?
For mothers, pregnancy can be a stressful, vulnerable time in a relationship. Rates of domestic violence rise during pregnancy, and expectant mothers don’t always know where to turn. While mental health providers in the area usually offer individual counseling, my clients often ask for information on support groups and couples counseling. As it stands, there are not enough culturally competent providers in this area who can meet the needs of these women.
As a perinatal case manager, I visit pregnant women and mothers who are considered high-risk every month to establish health goals for their family. Then, I try to help them meet their goals, providing them with the information, education, and resources available in the community. Many of these moms suffer from chronic medical conditions, a history of substance abuse, domestic violence or depression. Most of my clients have multiple issues to deal with; some have them all. I give monthly bus tokens for transportation to those whose income qualifies. I also provide them with a package of diapers and other essentials for their baby if they need them.
While my clients are always grateful for any assistance I can provide, it is still very limited. We used to be able to give more bus tokens to each family every month, but this year our funding was reduced. Mothers with big families may use up all the tokens in one trip. We also gave taxi vouchers but clients cannot carry heavy child car seats with them so they do not use this anymore. Transportation is a big challenge — clients often struggle to get to medical visits, the grocery store, and the laundromat, let alone medical and mental health appointments.
After they give birth, I provide women with lactation support, education on infant care, and help them establish a bond with their child. I also help them develop a plan for meal preparation before they give birth, as well as childcare for their older children. A postpartum plan helps minimize moms’ stress and anxiety during an already challenging time of life.
The women I work for strive to be good mothers but circumstances make this a difficult goal to achieve. They are doing their best with the education and support they have. Most are survivors of violence and trauma and want to provide a better life for their own children. These mothers need so much support to mother healthy children into healthy adults. Affordable childcare, safe and affordable housing, access to transportation, more paid sick days, adequate medical care including dental and mental health, and safe drinking water—all are in very short supply. These issues are basic. There needs to be a change in our culture — we need to find more ways to support parents so that our children can thrive.
Martha Escudero is a mother, Certified Mental Health Rehabilitation worker MHA, Certified Lactation Educator/Counselor UCSD, Certified Death Doula (The Twilight Brigade), and a LDIRs in health graduate. She is a birth doula who received her training from DONA International, an ICEA trained Childbirth Educator, and has a BS in gender, ethnicity and Multicultural studies from Cal Poly Pomona. She currently works as a Perinatal Case Manager for Maternal and Child Health Access in the East LA area.