Postpartum Support for Low-Income Families

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Christmas time was upon me as I looked down at my 7 month pregnant belly. Tears welled up in my eyes and panic started to grip me as I wondered if I would be bringing my baby home to a bedroom shared by my mother and grandmother (you read that right, one master bedroom shared with my mother, grandmother, my husband, the family dog, and my big belly). Or worse, into a car, or some other temporary shelter. A series of happenstance lead us to this place. Although my husband and I were both very thoughtful, budget conscious, clean, God-centered, hard-working people.. Life throws curve balls to the best of us. Fast-forward to the roaring month of March when we brought our tiny princess home to a precious double bedroom in a shelter for families at risk of homelessness. As I look at my princess, born into poverty, just like our King Jesus.. I am humbled that we had all the necessities, and none of the barn animals! I wonder what it was like for Mary as she spent those first two (or so) years in flight, travelling for the census and then running from Herod’s army. Did she have anyone to teach her how to be a mother? My own family were not allowed to come visit me in the shelter as everyone who entered had to be background checked, vetted, and limited for obvious and good reason. In any case, that hurt, and still does. I had nobody I trusted to teach me how to raise my child. Breastfeeding was ridiculously painful in every way, but especially emotionally. I just wanted what I thought was a normal postpartum experience, where close family and friends came to dote on the new mother and baby.  It was also not easy to open my doors and have a 35 person household of people from all different walks of life enter our newborn family bubble… but at least I had a few experienced ears to bounce my new mother concerns around with. My overwhelming feelings of matresence were compounded with the stresses of shelter rules, being financially strapped, having a terrible first pediatrician, and a disappointing birth experience. 

 

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“If only everyone had a postpartum doula” wonders a recent headline from the New York Times that briefly highlights the role of the postpartum doula and how they benefit families across the board. Other articles in this vein are finally popping up everywhere, revealing a desire for postpartum support among women and families in all realms of social strata. Long before even meeting my husband, I had the desire to become a postpartum doula, and to do something special with it for families in financial crisis. In this essay, I will focus on how a postpartum doula can be a beacon of light for families who are experiencing poverty, and how finding ways to serve them deserves our thoughtful consideration. 

Families in poverty need access. They need someone to help them access information and services with the flexibility of time and transportation that they often lack themselves. Extended families may also be lacking in time, income and resources to help especially if they are within a generational cycle of poverty. Just having access to childcare that doesn’t cost them their whole paycheck, or more, can be nearly impossible. 

The stressors in low-income families with newborns are two-fold: practical and emotional. Being financially burdened and strapped outcasts them from needed support, healthcare options, good nutrition, and child care. Feelings of inadequacy run rampid between mothers and fathers who feel they cannot provide the life they imagined for their children. More often than not, they receive unfair treatment from health care providers, and others who are supposed to be working for their best interests due to underlying prejudice and fear. The stress between partners grow as there is no money for a break, self-care, date-night etcetera. Postpartum doulas are there to ease the stress in a number of ways. By listening, honoring, respecting and affirming parents they can build up morale and encourage hope. Postpartum doulas can guide parents toward finding better healthcare options within their network, by building relationships, helping them navigate their insurance, conversations with social workers, and knowing the recommended providers in the area. We can also be present at appointments to advocate for the parents and baby. 

Nutrition is a big factor in helping postpartum women heal and families thrive. Obviously, being depleted of funds also means having a tight budget for food and, unfortunately, healthy food is the most expensive. Doulas can point families to food pantries, WIC and other helpful nutritional supports. While the postpartum doula is there, she can share recipes for great nutritional meals on a budget. Having the time and energy to cook may seem nearly impossible for some women who are facing all the stressors listed above. A postpartum doula can offer to cook meals, or set up a meal-train to ensure that mom and family are well fed during the first few weeks postpartum. 

Families struggling financially may not have the best options for childcare. Doulas can help parents assess their child-care needs, apply for child-care assistance and search for quality child-care options. Doulas can be an extra set of hands for the older children while mama feeds newborn, or they can watch the whole clan while mama enjoys a slice of time for herself. Just having this support may be all mom needs to relieve some stress and feel herself again. 

Doulas can help mom navigate the full-time job of getting the state assistance that is available to them. Just thinking about tackling this project within the postpartum period is overwhelming. Pulling documents together, making and keeping appointments with a newborn-in-tow (possibly other children), facing the financial facts and the judgements of people handling your “case” can be quite a daunting task. Having a doula’s support, even just a listening ear, can make all the difference. 

Marriages can find themselves on rocky ground within the postpartum period as the family’s dynamics go through a period of re-adjustment. Within a family facing poverty, these days are wrought with financial stress as well. This can create a double edged sword that is almost impossible survive. A doula is there to listen, offer insight, connect the family to counseling as necessary, and offer moments of peace for the parents to breath and connect.

Of course, in addition to all the practical support, a doula brings a wealth of comfort, stress relief, and postpartum care options including: baths, music, prayer, meditation, massage, aromatherapy (at client’s direction & discretion of course), a safe space to feel all the feelings with matching empathy, and encouragement to keep going. 

With the picture we’ve painted so far, it seems to follow that postpartum depression would be more prevalent among poor women. In fact, “According to this study, 56% of low-income mothers showed signs of depression at some point between two weeks and 14 months after giving birth.”(Poverty Raises Risk of PPD) When you imagine what daily life is like for those in poverty, especially in this day and age, where the genuine village atmosphere is more or less unattainable, -especially if your friends and family are just struggling to survive as well-  it is obvious why they would have higher rates of PPD. In the abstract write up for “A_Situated_Analysis_of_Postpartum_Depression_Among_Mothers_Living_in_Poverty” the list of conditions contributing to PPD among poor mothers is as follows: 

      1. “1) mothering as overwhelming, which captures how mothers related their symptoms to parenting demands; 2) mothering alone, which describes how mothers understood their depression in relation to their emotional and environmental isolation; 3) juggling, which underscores how women experienced their symptoms in the context of multiple and demanding responsibilities; and 4) worry, which captures how women grounded their anxiety features of PD in relation to their daily circumstances” (A_Situated_Analysis_of_Postpartum_Depression_Among_Mothers_Living_in_Poverty) 

 

Commiserating with all of the reasons why poor women are at high risk for postpartum depression, are the reasons why they will not seek help for themselves- and why they may even reject it. According to Divya Kumar, Co-founder of The Every Mother Project and Postpartum Doula at Southern Jamaica Plain Health Center in Boston,  “Different moms have a different hierarchy of needs, and addressing their own mood and mental state may be seen as overly indulgent when there are bigger fish to fry.” .. and.. “some communities may view postpartum depression and related illnesses as unacceptable—or as something that happens to other people.” (Postpartum Progress: Underserved Women PPD 5 Things You Should Know)

So, How can postpartum doulas help? A postpartum doula can be a first auxiliary to preventing and discerning PPD. Doulas provide a consistent, open line of communication that is non-judgmental, familiar, and allows for more comfortable sharing and connecting. Taking on some of the household duties, chores, and even child-care demands so mother can have some space can offer a tremendous relief to someone suffering from baby blues and may even be a key in PPD healing and prevention. Doulas provide an anchor of empathetic encouragement while acknowledging real concerns, all the while reminding families of their continuing support and pointing them in the direction of attaining counseling and other professional support as needed. 

An exploration of the ways in which impoverished women can benefit from having a postpartum doula wouldn’t be complete without a discussion around feeding the new baby. Breastfeeding is rightfully considered the ultimate food for baby, and is the primary food source for infants-toddlers in most places around the world where they experience extreme poverty. The WHO is very blunt about their opinions around breastfeeding, and especially why it’s the first option in times of poverty and crisis. The facts remain in unanimous agreement that breastfeeding offers vital and unmatched nutrition, immune support, and other amazing benefits to the baby, and mother as well. To this end, it is also known that breastfeeding is more successful with a team of postpartum support. All that being said, there are a number of reasons why formula is needed and postpartum doulas are masters at giving non-judgmental, holistic support for whatever path mama chooses. We are there when the tough decisions have to be made, and while we offer sound education in the facts, we also realize that first and foremost, mama and baby must be well. We are well-versed in breastfeeding, bottle feeding, and formula. We can help the mother work with WIC to get the right formula for her baby, and troubleshoot when there are issues. 

Breastfeeding was something I’ve always known I would do and I was pretty stubborn about it. This dedication to breastfeeding amidst a pediatric culture that benefits from offering formula at the first thought of insufficient supply, together with the label of “homeless living in shelter” almost cost us guardianship over our precious baby girl. These are the kinds of things women living in poverty deal with. Even though I was completely cooperative and supplemented as much as my daughter could want. I was constantly belittled, spoken down to, and absolutely oppressed. The stigma of “mother living with her first child in a shelter” was held over my head and I was not being heard, even though I was educated and knew the facts. This oppression stunned me and I began to feel completely demoralized. With no direction offered for how to make breastfeeding work for me and my girl, other than to supplement with formula, I knew something was not right and I began a search for a new pediatrician. When we switched doctors, we got a letter from the department of health and human services stating they were coming to visit us to assess the situation due to our daughter’s “failure to thrive” diagnosis. This broke me.. But that appointment came and we were given firm pats on the back for parenting a perfectly happy, healthy and totally thriving baby!  The social worker praised us for being so conscientious and proactive in her health care and for finding my daughter better medical care. She left happy for us that she was able to soothe our bleeding hearts, but also quite annoyed that the report had been sent in the first place, when there are so many critical reports that needed her attention. I often wonder how these experiences would have been different had we been able to invest in a postpartum doula. 

 

Going forward, we must try to find ways to improve the lives of our brothers and sisters living in poverty. Please note that there are so many impoverished families that are educated, strict with their budget, absolutely clean (no drugs/alcohol problem), faithful, hard-working, and yet completely broken by their circumstances. Be the hand that reaches out to help when so many hold labels over their heads. Postpartum doulas can be a lighthouse to perinatal families experiencing poverty by throwing out the labels and just serving their families with joy.

 

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