Women's Health Stories from the Field

Notes From the Field: Thoughts on a Home Visit

Abby Pike, CNM

I recently did a postpartum home visit for C, a 22 year-old woman who had just given birth to her third child. C previously lived in Guatemala in a small town with her 5 year-old boy and 3 year-old girl. Her husband used to drink and beat her. However, in her words, through divine intervention, he sobered up and stopped abusing her. He started to do work on the house, fixing things up, and making amends with his family. Then he was hit by a car and fell into a coma; he never awoke. At his funeral, his mistress verbally abused C and fronted as his wife, flaunting it in her face. The creditors for the housework came around and C couldn't pay. They raped her in front of her children. She became pregnant and couldn't afford an abortion. She continued with the pregnancy, trusting that it was God's will. The mistress bragged all over town about the rape, defaming C's name. C felt like she had to flee. She left her children with her mother and made her way up to the US border with her brother. Immigration saw them coming, and though her brother got away, C was caught and incarcerated in Phoenix for 2 weeks. She was let out and given a court date to appear and defend her case. A woman she met in prison had a sister out here and gave her a call. Someone the sister knew came and got them in Phoenix. C now owes $200 for this ride. Though she started out staying with the prison friend, she is now staying with some other women from the church she has been going to. They had a baby shower for her, but she is still in need of more clothes for the baby. She didn't qualify for Medical, so she's on a cash plan, knowing full well that she can't pay. She refuses additional services such as colposcopy for her abnormal pap smear. I visited C at home, two days postpartum. She was staying on a mat made of a folded comforter, sharing it with her newborn. She was recovering well physically from an easy birth. Her nipples were sore and cracked from breast feeding, but she knew that was part of the deal the first week and accepted the pain with a shrug. She had a way about her as if she was just going through the motions. She had an expert mother inside of her that had already cared for 2 babies, and instinctively knew what to do. She was emotionally dissociated though. She held her baby and was loving towards him, but never smiled and had an empty look in her eyes. I did my best to offer an open space for her to talk about how she was feeling, offer resources, and point out all the ways she was mothering so well. But what could I possibly do to make a real difference in her life during this home visit? I tried to work with her faith and her connection to her church as a strength of her situation. I don't know what will make a difference to her, whether her life is better here, whether the life of her baby will be better here. I don't know what the answer is, but it is something that I have been thinking about since meeting her. As a new graduate I am so fixated on my clinical skills, fretting over fundal heights and timing of antepartum testing. I think with repetition these skills will become something I can count on. The part that I have to look further into myself for is how to be "with woman" in the midwifery sense; how to find universal common ground and be able to connect with women and support them in whatever situation they are in, regardless of where I am in my life and career.