A woman lost her firstborn child to Child Protective Services when she was 17, after having been abandoned by her abusive father. Part of the reason for losing the child then was poverty – no crib or medical insurance. She also had untreated mental issues. She has been in therapy since she was 18 and her therapist will support her now – 6 years later. She is now 3 1/2 months pregnant with her second child and understandably afraid of losing this child as well or that they’ll bring up her mental health issues from the past. This child’s father is not the same one as her first child’s father and is supportive of her. She gets SSI income and her boyfriend is a line cook. Because they are on a tight budget, she is buying what she can in preparation for her baby, as she can. How can she avoid a repeat experience ?

A response came from a woman who works in primary care settings. She has seen cases where if the parent previously lost a child to the Div of Health Services, that parent comes under heightened scrutiny. Suggestions –  If you are going a regular OB clinic or community clinic, show up for every single prenatal appointment, stay on top of scheduling. Make them aware of the regularity/consistency of your therapy appointments. I personally would not meet with or trust their social or behavioral health person – keep them at arm’s length until you get a good read as to whether they seem genuinely interested in helping with you. It seems you have good support already, so don’t even go there. If you feel you have to appease them and must meet with one, just be prepared to say all the areas you have covered already. Don’t express vulnerability or what you don’t have. Better to go through trusted community organizations if you need physical items, housing resources, etc. Expect to have to do a Urine Analysis at some point. Avoid using any substances including marijuana that might get you flagged.

I am a big fan of midwives and so I liked this suggestion – seek out a birth center or better yet a home birth midwife.  You can meet them for a consultation (no pressure to pick that one). Wait until you find one you think you could have a trusting relationship with. They won’t have access to all your medical records. They are more focused on supporting you as an individual. The less contact with nosy/intervention happy medical people, the better in your case. If you end up needing to birth in a hospital, a good midwife ought to be a good advocate for you in that setting, even though it is also a high risk setting for Div of Health Services involvement/hospital staff scrutiny.

If she is in a conventional medical care setting, the woman suggests be one step ahead with all the baby item planning. Having the car seat well in advance, like by 30 weeks, and schedule a car seat installation safety check (you can find them by searching “car seat safety clinic” they are often done at fire departments). If she signs up for WIC (which pays for formula), she needs to be aware that they are another scrutinizing entity that could represent a threat.

The biggest poverty factor to control for is housing stability. If you rent, is your lease month to month or year long? Being on good terms with your landlord can smooth inspections. Best have a Plan B. Make certain savings could cover a move, if needed. Or have a support network, one that would allow you stay with a stable family that is considered “safe”.

Additional suggestions from another with behavioral health work within a primary healthcare setting – No one can report a thing until the child is born. Be careful about what releases you sign. No one can talk to anyone about you without your release – unless it becomes a mandated report. If you sign releases, you are at risk. Therefore, any releases need to be very specific. Don’t sign blanket things like “service coordination.” Instead say what services you want coordinated.

This woman disagreed with some of the previous advice – I don’t agree with universally declining behavioral health services, because those services can be helpful for connecting with community based programs for things like car seats, help with food insecurity, clothing, etc. If your ongoing therapist is well connected, and knows what programs are available within your community, they may be able to serve in that role. In that case, it is appropriate to explain that you are in regular behavioral health care already.

There will likely be complete screenings as a routine part of your care to look at maternal stress/perinatal mental health concerns. They may also be helpful in holding the balance of psychotropic medication/medication choices, while you are pregnant, if that is part of your typical mental health treatment plan. You can consider signing a very specific and narrow release with your therapist, but generally, I would limit it only to things like medication, pregnancy health, dates of service. I would not allow your therapist to release your progress notes, progress summaries, treatment plans unless there is a compelling reason to do so.