For nine years — until COVID-19 swept in — Nurse VaSheeta Charles has been visiting pregnant and new moms and babies in their homes.
She checks their health and mental development. She talks with the moms about reading and early learning. And she connects families with social and health services, while advocating for them within the wider medical profession.
As part of a team from Multnomah County’s Healthy Birth Initiative, Charles fights for families within a larger healthcare system that affords African American and Black women lower quality healthcare, driving up their rates of cesarean sections and dropping their rates of breastfeeding.
But because of COVID-19, Charles said, that advocacy work has become both more difficult, and more important, than ever.
Right now, more of her clients are being rushed to deliver through c-section, rather than given time for natural birth, which coats newborns in protective bacteria. And after delivery, fewer women receive lactation support before they leave the hospital, making it less likely they’ll nurse, a process which seeds the baby’s immune system.
“It’s traumatic and stressful, especially when that wasn’t their plan,” Charles said.
At the same time, the face-to-face home visits where nurses work with new moms set health goals — and help them to advocate for themselves and their babies — have shifted to telehealth video and telephone conferencing.
“I feel like, ‘I wish I could have been there,’” Charles said. Before COVID-19, “if someone were being rushed to have a c-section, she could have called. We could have come and advocated for her.”
Charles sees just a thin silver lining in the shift to virtual visits: She’s at least been able to better connect with clients who previously had complicated schedules and struggled to keep in-person visits. And now, with more residents out of work (unemployment jumped from 4 to 14 percent in just one month) more people than ever qualify for the program.
Through video, she has watched a pair of twins learn to stand, shake their heads “No,” and say the word “apple.”
Charles tries to make visits fun. One boy likes to wear his SpongeBob pajamas to their meetings. So for their regular video visits, Charles wears her Christmas PJs, too.
“Video has been fun. You have this extra time,” she said.
It’s far from ideal, to be sure. When a mom is struggling, she might need a hand to hold.
“And if they’re socially isolated, if they’re experiencing domestic violence, it’s really hard to support them,” Charles said.
But she does whatever she can. The County continues to provide mental health and domestic violence services. That way, she said, “there is someone they can talk to who is culturally appropriate.”
She wants expecting and new moms out there to know, “We’re still here.”
Raising the bar
Healthy Birth Initiatives is among a suite of Multnomah County programs for new families still working — virtually — to help first-time and expecting moms through pregnancy, offer food resources and breastfeeding coaching, and support Black and African American moms, dads, and families with social and health services.
“Pregnancy and parenting is exciting and wonderful. And even in the best of times, it can be scary. New parents are sometimes not quite sure what to do,” said LaRisha Baker, director of Maternal Child Family Health programs at Multnomah County. “So if you are pregnant or parenting, and you’re feeling alone or confused — especially during this pandemic, or just need some extra support — we can help you.”
Multnomah County’s Maternal, Child and Family Health Services program provides culturally specific services and home visits during and after pregnancy. The programs were developed in partnership with communities to build on shared wisdom and empower families to correct health disparities and support cultural resiliency, reduce stress, improve access to resources, and support healthy birth outcomes and parent attachment.
Maternal, Child and Family Health Services support more than 600 families a year through four programs:
Healthy Birth Initiatives: Services include maternal and paternal home visits, health education and support groups, and go from pregnancy through the baby's first 18 months.
Nurse-Family Partnership: Specially trained nurses regularly visit first-time moms-to-be, starting early in pregnancy, continuing through the child’s 2nd birthday.
Healthy Families: Home visitors with diverse educational and cultural backgrounds are intensively trained and carefully matched with families to provide in-home parenting, coaching and support up to the child’s 3rd birthday
Healthy Homes Asthma Home Visiting: Nurse asthma educators make home visits to provide education, offer medication management and work with the child’s medical provider to enhance their asthma action plan. The six-month program is available for any child 18 or younger.
Veronica Ericksen forgets to take breaks. Working at an office set up in her living room, she shifts from phone visits to video conferences and back to the phone. The work day is broken up by preparing breakfast and lunch for her two teenage kids.
It’s the first time in 14 years as a home-visiting nurse that she’s had to stay physically away from the women and children she serves — and at a time when those new parents need more support than ever.
Being home with young children without childcare support, while enduring lost jobs and wages, and extended social isolation, is taking a toll on Ericksen’s clients. Most are Latina and many speak primarily Spanish. Many of her clients live in east Multnomah County and work in the food sector and agriculture —work that disproportionately exposes them to COVID-19.
“There's a lot of community rumors about whether I need or don’t need a mask, or whether we can still get together,” she said. “Community gatherings are such a part of our culture, that it’s really hard to receive messaging around social distancing and restrictions about getting together with family.”
Alongside a general distrust of government, those barriers can be difficult to break.
Ericksen finds herself playing the same roles, virtually, that she always has: educator and liaison. She shares common COVID-19 messaging on face coverings, hand washing and physical distancing. She also helps families connect to virtual church services and Spanish-language praise music.
Lactation support has been one service she would prefer to offer in person.
“There are many, many questions that come with breastfeeding and that fear of not producing enough,” she said. “A lot of strategies we use are one-on-one. Tips to get the baby to latch, weighing the baby — all of those are hands on. And assessing sore nipples. No one wants to show me over the phone.”
Without access to lactation support at birth and without an advocate at their sides, expecting parents are urged to write out their birthing plans, while Erickson helps them practice asserting themselves with providers — whether that’s asking to give the body time to give birth naturally, or asking to hold the baby right after she is born.
“I’m focusing on the birth experience, focusing on advocacy,” she said, “having them write it down: This is what I want.’ Advocating for moms to say, ‘If you need to see the baby, she’s right here.’ All that can happen right there while the baby is in mom’s arms.”
Like Erickson, Louisa Kaplan worries about COVID-19’s long-term effects on new mothers who don’t get in-home visits and lactation support in the first hours and days after birth.
If a baby doesn't learn to latch, and the mom struggles to pump enough milk, her supply can dwindle.
“The first two weeks, things can be tweaked with a supportive person... but if she’s not breastfeeding well at two to three weeks, it's hard to have any duration, which is where we see long term benefits,” Kaplan said. “So we’re going to jeopardize thousands of tiny little immune systems at a time when moms really want to breastfeed to protect their babies' immune systems.”
Kaplan has worked as a community health nurse for 14 years. For now, she’s doing what she can from a distance. But even through video conferencing and telephone calls, the relationships she builds with families quickly become intimate.
“The postpartum period is physically intimate. Folks are a hot mess, we all are,” Kaplan said and chuckled.
She gets so many questions: Am I normal? Is my baby normal? Why does this hurt? Why won’t my baby latch on? I'm changing diapers and I don’t think I’m doing it right.
Now, in addition to fear and uncertainty of new parenthood, comes the grief of COVID-19. People are grieving — jobs, relationships, life as we knew it.
“It’s not often when you go through the same thing as your clients, at the same time,” Kaplan said. “I spend hours each day in intensive conversations, and I am also experiencing a pandemic, and I’m a mom. So it’s intimate in a different way.”
Kaplan must now also find new ways to say goodbye.
This spring, brought another cohort of families who graduated from Nurse-Family Partnership. After about 50 in-home visits during the most intense two years of a mother’s life, Kaplan usually sends the family off with a party, a visit to the zoo, or a picnic in a park.
“I’ve done a lot of drop and dash,” she said.
A Tonka dump truck. A stack of books. A scooter with a ribbon. A thank you letter with a family picture. A graduation certificate for a client who hadn’t graduated from anything else before.
“Something to let them know this is meaningful,” she said, “and I’m proud of you, and I’m going to miss you.”
The services — offered in multiple languages — prioritize residents who identify as Black and African American, People of Color, those living on a low income, and who are first time parents.
These programs are accepting new clients. Learn more by dialing 503-988-3520.