By Daniela Vargas

As a public health nurse, I work in reproductive justice, prenatal and postpartum care at a Federally Qualified Health Center (FQHC) in San Francisco. I am aware that my job comes with a high responsibility as I am assessing for social and structural determinants of health as women begin their prenatal care. In the wake of COVID-19, my work has become more critical as basic needs like food, shelter, baby supplies, legal support, mental health and safety are now even higher for Latina mothers than ever before. The barriers in accessing healthcare, food and shelter that were there for Latinx patients prior to COVID-19 became even wider gaps when “Stay at Home” or “Shelter In Place” policies were first enacted in the City of San Francisco along with eight Bay Area counties even before the State of California and other states followed.

The first question I ask the mothers coming into the clinic is  “How are you and how is your family?” The answer is usually “We are okay, we are doing the best we can,” as they hold onto their composure. My second question is always, “Do you and your family have food to eat?” And that is when many of the reactions of these mothers change. The eyes of these mothers say it all, often filled with tears telling me that they are happy to become mothers but that since the “Stay at Home” policies began, it has caused major instability preventing them, their partners or families from working. Many of these Latina mothers are immigrants from Mexico, Honduras, El Salvador, and Guatemala. Some of them are here as permanent residents but the majority are undocumented, either newly arrived seeking asylum or have been here for several years.

These Latina mothers talk about “Stay at Home” with me while mentioning how afraid they are to come to their visits and how they don’t even want to leave their homes even to get fresh air. My nursing visits that are spaced out for 30-minute slots, are now going over time with the complexities that Latina mothers are facing in the middle of the COVID-19 pandemic. I am used to holding the hands of patients or giving hugs when patients ask to give them to me but with social distancing, I have to stay 6 feet away and wear a mask. This has changed how I am able to provide human connection.

The one thing that has not changed, has been the ability to cry with my patients as they tell their stories of how COVID-19 has disrupted their ability to work and pay their expenses which they must do so  that they can prove to immigration officials that they can make it in this country. Many of them allude to the recently revised “Public Charge” regulation that has scared Latinx families from accessing services in fear that the federal government will not allow them to remain if they do so.. These mothers feel hopeless and scared that they might not be able to feed their families or pay back the rent money they owe since they haven’t been working. Latina mothers feel time is running out for them since they will have to take leave from work to care for their baby. For those who are undocumented, these mothers cannot apply for unemployment or get paid maternity leave.

Working with mothers and their babies while seeking prenatal care has other new challenges in the wake of the COVID-19 pandemic. Black, Indigenous and People of Color (BIPOC) birth workers have worked hard to integrate comprehensive and supportive structures in birthing for vulnerable populations such as Latina mothers. But with all focus going to COVID-19, many of those structures have been deeply modified or no longer present. Centering pregnancy or prenatal education sessions are being done remotely or cancelled. In-person prenatal services have been moved to telephone calls to prevent COVID-19 exposure. Prenatal education funding is also being rerouted towards COVID-19 efforts. Unlike elective procedures that have been put on hold due to this pandemic, prenatal cannot be paused. Instead of diverting from comprehensive prenatal education due to the pandemic, we need be providing more prenatal/postpartum educational services around pregnancy and COVID-19 and in-depth needs/health assessments with expecting Latina mothers about the insecurities they are facing and doing so in bilingual formats I feel that even more than ever, we have to be more vigilant regarding the health of Latina mothers, their babies and families.

Before these Latina mothers leave our clinic, they are given a bag of food, basic necessities, a small grocery gift card, and are enrolled in food access programs. I tell them, “if you need anything, please call me.” They respond, “Claro que si enfermera, muchas gracias,” translated as “Of course nurse, thank you so much.” They lean in to hug me but I have to pull back because of social distancing. Daily, I leave the clinic with my mask on and tears rolling down my face hoping that this pandemic improves so that the mothers I care for can feel safe to access the things that are most basic to all of us, most especially food.

Daniela Vargas, MSN, MPH, MA, RN, PHN is a DNP-Population Health Leadership student at the University of San Francisco School of Nursing and Health Professions and alumna of the graduate Bioethics & Health Policy Program at Loyola University Chicago. She works as a Public Health Registered Nurse serving the Latinx community in San Francisco, CA at a Federally Qualified Health Center (FQHC) and provides prenatal care and education as well as a comprehensive women’s health services to a primarily Spanish-speaking population, many of which belong to the Undocu community.