Fearless 2.15.21: A conversation with a young mom and her doula

Good morning and happy Monday! We’re continuing our coverage of health care by highlighting a program at the Young Women’s Resource Center that pairs doulas with young moms. We also have two guest opinion pieces, one from Rachel Bruns on why she supports midwife licensure and one from Kristy Harrison on the importance of acknowledging the state of your mental health during the pandemic. If you're interested in learning more about health care topics that relate to gender issues, register to attend our Fearless Friday event that will be from 8 to 9:30 a.m. on Feb. 26. We’ll be hearing from three women who work in different areas of the health care field and you’ll have the opportunity to learn and connect in breakout sessions with others.

Lastly, I’m working on an upcoming story about the she-cession. I would love to speak with women who have filed for unemployment at some point during the pandemic or have left the workforce altogether. If this is you or you know someone who would like to share their story, please send me an email at emilyblobaum@bpcdm.com.

That's all for now, have a great week! Personally, I will be spending the week listening to Taylor Swift's sophomore album, "Fearless" (a great name, I might add) to prepare for the re-recorded and expanded version, set to drop later this spring.

- Emily Blobaum, Fearless contributing editor

The Young Women’s Resource Center offers a variety of free services and programs geared toward young moms, among other focus areas. One of the services matches the young moms with doulas to navigate the process of becoming a mom. Doulas are nonmedical professionals who serve as an extra resource or support system to people. Currently, the Young Women’s Resource Center has five contracted doulas, but they hope to have between 10 and 15. Jewelz Smith is a childbirth and perinatal specialist and is a doula who works individually with young moms at the Young Women’s Resource Center. Last year, she was paired with Izabella Guzman, a 19-year-old mom who gave birth to her son, Antonio, on Sept. 14, 2020.

The following is a conversation I had with Smith and Guzman about their experience working with each other. Remarks have been edited and condensed for clarity.

Let’s start with your pregnancy and birth and then work our way backwards. Izabella, what was your pregnancy like?

Guzman: My pregnancy was kind of crazy. I found out I was pregnant on Jan. 14, 2020, when I was nearly four weeks pregnant. I had gone in for an STD screening because there had been a situation. I didn’t realize that before they do the screening, you have to have a pregnancy test. The girl who administered it said that she’d be back in a few seconds with the results, but then a few seconds turned into 15 minutes. I was worried and thinking, "That’s odd." She came back and she told me that my pregnancy test was positive. I started crying. I didn’t know what to think because [Antonio’s] dad was going a separate direction. He didn’t believe me at first when I told him I was pregnant. It was hard telling my parents. They weren’t accepting of it because I was so young. Adoption was going through my mind because people were telling me that I wouldn’t be a good mom because I’m still young. But over time, I accepted that I needed him.

A lot of times, I wouldn’t feel Antonio kick so I would have to go get checked out. I was also really nauseous throughout my pregnancy. I worked 40 hours a week until I had my son so I could continue to have a stable income to provide for him when he arrived. So I feel that me overdoing myself is what caused my nausea and other complications. But other than that, it went pretty well.

I was working the 8 a.m. shift at Walmart on Sept. 12 when I started going into labor. I kept leaning up on the self checkout because I didn’t feel good. There was a shooting pain going up my back and my legs became very shaky. I felt the constant urge to go to the bathroom. At that point, management came into the bathroom and asked if I was OK. I told them that I thought I was in labor but I wasn’t sure because I had never had a baby before so I didn’t know what to expect. It was also two weeks before my due date. They let me go, so I just drove myself home. I waited it out at home as long as I could. I spent a lot of time on the toilet because it felt so much better to sit than to lay down. I did take a bath at home to relieve some pressure.

The next morning, I called Jewelz and let her know what my plans were. She told me to keep her updated. When I went in a few hours later, my contractions weren’t reading on the screen but they could tell that I was in a lot of pain so they didn’t send me home. The nurses came back and I had started dilating but my water still hadn’t broken. So I called Jewelz — she was in the middle of a nap. She made it to the hospital within 30 minutes to an hour after I called her. By the time she got there, things progressed really fast. I couldn’t have one medication because I’m allergic to morphine. So they just jumped to the epidural. We wanted to push the epidural off as long as we could. I didn’t really feel like my voice mattered to them; I felt like I was locked in a cage. But I was just really worried, so we automatically jumped to the epidural.

Smith: I think Izabella didn’t feel like she had a voice, but there were times where she did stand up for herself. As a doula, I can’t make the calls for a client but I can educate them and hopefully help them feel empowered enough to say yes or no to things. She’s quiet, but she found her voice in the process. It was an amazing birth. She was worried that she didn’t think that she did well, but of course she rocked it and is an amazing mama.

Guzman: Jewlez held my hand a lot. I was a big crybaby.

Smith: Labor is hard work!

So now, let’s back up. When did you two meet?

Guzman: One of my friends that I met on the DART bus was a participant here at the Young Women’s Resource Center. She told me about the Young Moms program because I had told her that I was pregnant. She told me that the Young Women’s Resource Center helped her and that if I was interested, I could come along with her. She told me that they provided supper meals. At the time, I was homeless. I didn’t have a place to go because my dad and I didn’t have a stable relationship. So she brought me here to the center in early February 2020 and introduced me to everybody. I didn’t originally want a doula. I was like, "I just met you, I don’t know who you are and I don’t want you in my delivery room." But I got close with Jewelz and she texted me multiple times offering to be my doula. I thought about it and I decided that I needed somebody in there with me.

Smith: We have a pool of doulas here at the center. When you have moms who are younger, our full-time staff tries to work with them because they can be more involved in their care plan with going to appointments. I felt that Izabella needed a doula because of her family situation. I was lucky to be her staff so I got to do individual support with her and learn about her outside of being her doula.

Izabella, you mentioned that you didn’t know what a doula was before coming to the Young Women’s Resource Center. Tell me what it was like learning about them.

Guzman: A lot of us didn’t know what doulas were. We just looked at each other when they were mentioned. That’s when Jewelz got the hint that she’d better explain it to us. I can’t remember what she said. To me, Jewelz was my support, she was like my backbone during my labor. She was always there checking up on me and asking if I needed anything. I was terrified at first because everything is out in the open when you’re having a baby. But I’ve come to realize that it’s a lot about me, but it’s also about the baby. They don’t care how you look when you’re in the hospital. They don’t care if you cry or if you scream in pain. I was concerned at first because I thought it would be awkward. But when I was in labor, I realized that Jewlez was focused on me and making sure that I was OK and prepared to have Antonio. She was constantly asking me if I wanted water, a Popsicle or ChapStick. She put wet towels on my forehead, rubbed my back and squeezed my hand. You know, the littlest things make a big difference.

So how many times did you meet before you gave birth? What did you talk about?

Smith: We talked about what we wanted early labor to look like. Izabella had said she wanted to stay at home as long as possible and know that you were in a safe place. She was able to do that. Then her goal was to wait off on medications as long as possible, and she did that as well. We talked about the process of early labor, active labor and pushing, but then what to do after the baby is born and when you get home. We walked through the plan, but also with the thought that not everything goes as planned so it’s good to know how you might have to adapt, just so you don’t feel as though you’re caught off guard. We want our moms to always feel like they’re empowered and educated and that they have a voice in their births. Young moms are a vulnerable population and we want their voices to be heard. Doulas act as someone to be there with them and support them through their pregnancy, birth and postpartum.

Guzman: Every time I came to the center for group, Jewelz would pull me aside to check in with me. Jewelz went out of her way to do more than just her job. I think of Jewelz as a friend that I never had. She’s not just a doula or an educator, she’s something more. She’s an inspiration to me.

Smith: You’re going to make me cry!

Guzman: There’s a lot of staff here, but I feel like I connected with Jewelz. She was constantly asking me if I needed food or shampoo. A lot of moms need that support. I was hardheaded and didn’t want to accept her love and support at first, but when I did accept it I realized that I’m not alone and that I will get through it. They know that some young moms are by themselves and they want to do whatever they can to help them. They may not be able to pay our rent for us, but they can provide diapers, wet wipes, toilet paper, formula and clothing for my son and I. When I first came, I was scared to open up. It’s nice to have a support person when you’re having a bad day or run into an issue.

Smith: In my doula role, we try to meet with clients three times before their birth at an individual level. We talk about birth plans and things that could be traumatic while giving birth and what their options are. Izabella and I got to meet a lot more than that.

If someone told you there was a cost-effective and evidence-based solution to Iowa’s rising maternal mortality and morbidity rate, would you want to see it implemented? That solution is the midwifery model of care. A recent study by Lancet Global Health estimates that even a modest increase in midwife-led care globally could avert a fifth of maternal and neonatal deaths and 14% of stillbirths globally by 2035.

Unfortunately Iowa is in a minority of states that continue to hinder the ability for midwives to practice, ranking 42nd on midwifery integration, which research suggests is a key determinant of optimal maternal-newborn outcomes.

If you are not familiar with the general state of maternal health, here are some quick stats:
Iowa’s maternal mortality rate has continued to climb and the U.S. maternal mortality is higher than comparable countries.
Access to maternal health care options in Iowa has continued to decline, with 35 hospitals closing labor and delivery units since 2000.
Iowa is facing a shortage of physicians who practice obstetrics and ranks 50th for access to OB-GYNs per capita.
A Black person in Iowa is six times more likely to die from a pregnancy-related cause than a white person. In the U.S. overall, Black people are three to four times more likely to experience a pregnancy-related death than a white person.
The cesarean rate for a first-time, "low-risk" pregnant Black person in Iowa is 32%, compared to 23% for a white person. The ideal cesarean rate for a given population is between 10% and 20%.

While some may view these as solely health care issues that primarily affect women, they are also career and small business issues primarily impacting women. People who want to enter and stay in the obstetrics field as midwives face both a state regulatory environment and hospital environment that make it harder to practice compared to most other states. Keeping people (almost exclusively women) from effectively practicing midwifery decreases the quality of maternal health care options available to Iowans.

Some of the solutions to maternal health issues in Iowa are to increase the number of family physicians practicing in rural communities with certification in OB-GYN services and improve the quality of care at the existing hospitals with labor and delivery units. Promising steps have begun on both fronts with a new rural initiative from Broadlawns and the launch of the new Iowa Maternal Quality Care Collaborative safety bundles. I fully support and applaud these initiatives, but to improve both maternal and newborn outcomes, Iowa must also create an environment that is supportive of midwives and out-of-hospital births.

Rachel Manuel Bruns is a maternal-child health advocate and volunteer chapter leader for the International Cesarean Awareness Network (ICAN) of Central Iowa. Professionally, Rachel is deputy director for America’s Service Commissions, which supports national service and volunteering throughout the country. She lives in Des Moines with her partner, two children and two dogs. Rachel can be contacted at rachel.m.bruns@gmail.com.

Early in the pandemic, I heard an expression that we are all in the same storm but not in the same boat. For me, this has meant that we all have been affected, yet our experiences are unique. Each one of us is facing different struggles as we work to cope with this prolonged stressor. It has presented us an opportunity to attend to our mental well-being and to explore ways to help ourselves.

I am a mental health therapist and when I talk with individuals, I am listening for clues. I am interested in a person’s ability to notice feelings, to routinely ask oneself, "What am I feeling?" or "What am I experiencing right now?" I view this attentiveness as an initial step to emotional self-care. The second set of clues I explore is what a person’s reaction is. Does the person accept these feelings, ignore them, dismiss them or criticize the feelings?

I believe that it is important to acknowledge and accept our feelings with a spirit of compassion. In the best of circumstances, it is hard to be a human, and I believe that our internal talk should mostly be compassionate. Once we acknowledge our feelings, we can ask ourselves, "What can I do to help myself?" and "What are my options?" In the language of a therapist, this is when we talk about coping skills.

There are some coping skills that are mostly helpful. It is helpful to breathe. There are times it is helpful to be highly present or mindful, and other times that it may be helpful to distract ourselves. Our unique coping skills are often identified through experiences, such as noticing that a walk outside lifts our spirit. It is helpful to try different things and notice how one feels.

The challenge with the pandemic is that for many people, keeping yourself safe has served to limit our coping options. We may be missing our social outings, the gym, yoga classes, family gatherings or travel. We are social beings, and having prolonged limits to social interaction is unnatural. Even those of us who consider ourselves to be introverts still need to have some human contact. While we often have to go without face-to-face contacts, we can try some creative ways to connect.

We are having to be patient and to remind ourselves that our situation is temporary. Our perspective is the one thing over which we can exercise some control. I enjoy reading about people in history who have found ways to get through difficult times. These are stories of human resilience. We have faced and have witnessed many challenges this past year. It is said that crises can bring opportunity. It will be interesting to see what we learn and how we can create opportunities. My hope is that we can continue to build resilience as we weather this storm.

Kristy Harrison, MSW, LISW, is a clinical social worker with over 20 years of clinical experience. She works for Compass Clinical Associates in Urbandale. Her practice areas include anxiety, depression, mood regulation issues, relationships, trauma and managing life stressors.

The Iowa House has passed a package of bills aimed at making child care more affordable and available. Read this Des Moines Register piece to see what they’d do if enacted. The child care cliff effect is one of the main issues to be addressed, the Business Record reports.
The majority of Iowans who have received the COVID-19 vaccine are women. Men make up just under half of the state’s population and 52% of COVID-19 deaths, but data shows that they account for just 32% of vaccinations administered.
Belin McCormick has announced Espnola "Nola" Cartmill as the new president of the law firm.
At 31, Bumble CEO Whitney Wolfe Herd became the youngest woman to take a company public when she rang the Nasdaq opening bell Thursday morning.
The city of Iowa City awarded $360,000 in pandemic relief grants to 27 businesses, the majority of which are owned by women and people of color.
Pope Francis has appointed women to two Vatican posts previously held only by men. This is significant because women historically have not been included in decision-making and leadership of the Vatican, and have not been and still are not allowed to be priests.
Shenandoah-area newspaper columnist Evelyn Birkby, whose column, "Up A Country Lane," published every week for seven decades, died at age 101.
Mary Wilson, one of the co-founders of the Supremes, died at the age of 76.
Members of Congress, led by Rep. Lauren Underwood, have introduced an updated Momnibus Act, taking aim at the nation’s epidemic of pregnancy-related deaths, a crisis that disproportionately affects Black people.
The Central Iowa chapter of the Susan G. Komen Breast Cancer Foundation says it will disaffiliate with the national group and shut down all operations.

On Leadership: The pandemic’s economic effect on women hurts us all (Business Record). How some employers and governments are supporting working parents (New York Times). Watch: Female officers in the Minneapolis Police Department fight for gender equity and police reform from the inside (PBS Independent Lens). For some women, the pandemic means rethinking the route to motherhood (Wall Street Journal). How society has turned its back on mothers (New York Times). Student moms bear costly double burden of child care costs, student debt (The Fuller Project). These women were on the cusp of something big. Then came coronavirus (The Lily). Watch: 9 to 5, the story of a movement (PBS Independent Lens). Could direct payments to moms solve the crisis facing women? (Fortune). How one woman helped to break the garage’s glass ceiling (New York Times). Mentorship program helps Linn County youths blaze their own trails (Cedar Rapids Gazette). At least 9 far-right insurrectionists have a history of violence against women (Huffington Post). Neglecting yourself doesn't make you a better mother (New York Times). ‘I’m running for my life. I cannot talk to you right now’: 23 women in Congress recall the Capitol riot (The 19th).

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