How one Los Angeles mother overcame maternal depression and now helps others do the same

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 Medi-Cal, California’s Medicaid program, and the plan did little to help me find a provider.

Our situation began to take a toll. I would spend many nights pacing back and forth 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, who was 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 us to fighting constantly, and we even ended our relationship a few times during the course of my pregnancy. I had a lot of blame and guilt from having put my daughters through all this. At times, I thought that maybe we would be better off dead. I didn’t know then that Medi-Cal for pregnant women covers mental health for depression and other issues.

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. 

Often I felt I was drowning or falling into quicksand. However, I did have support through these times and I did 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 teas. 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 asked around for others to help me pay my rent one month and they also provided me with a mattress. The 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 daughter, my doula and friend organized an informal postpartum support team. While I was recovering from giving birth, friends and family stopped by to offer food, teas, childcare, housework, herbal baths, massages, and all the love a mom who has just given birth deserves.

Most of what I went through is similar to what I see my clients going through on a daily basis. Most of the mothers I see during my home visits work and still cannot afford to rent suitable housing in Los Angeles. Some live in overcrowded homes they share with family, or sleep in different people’s couches for the night, or 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 I can provide for them. The lack of affordable housing in these neighborhoods, especially for parents of young children, is a huge challenge. I can’t solve all these problems for the mothers I work with, but in my work, I try to do for these parents what my friends did for me when I was feeling so overcome. I offer love, support, and a sense that they are not alone. That, I believe, can go a long way.

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 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 this period, and expecting 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 providers who can meet the needs of these women, who speak their language and understand the world they live in. And like me when I was depressed, many women don’t know what mental health is on offer.

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.

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 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 laundry mat.

After they give birth, I provide 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 the 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 in order to nurture healthy children into healthy adults.

Martha Escudero is a perinatal case manager for Maternal and Child Health Access in Los Angeles.