Sixteen-year-old Rebecca Montgomery wants her boyfriend Jesse to be with her for their daughter’s birth in December. She would also really like her mother present for the labor and delivery. However, she’s allowed only one visitor under current hospital policies to combat the spread of the coronavirus.
“My mom is my best friend. I’ve always wanted her to be there to meet her grandbaby and support me,” said Montgomery. “It’s hard that she might not be able to.”
While the coronavirus pandemic has created additional strains and stresses for all pregnant people, teen parents face particular challenges to their mental and physical well-being, and that of their babies. Still children themselves, teenagers have needs that differ from older parents, and the pandemic has made their pregnancies even more challenging.
“One of the things we’ve heard from all of our moms—of any age—is fear around what delivery will look like at the hospital in [the] time of COVID,” said Amanda Jensen, program supervisor for the Nurse-Family Partnership (NFP) in Mesa County, a nonprofit that provides support to new mothers.
For pregnant teens, “frequently, their mother is their main support,” Jensen added. “It’s harder than any other age group. They typically want more people around them, involved with their childbirth. COVID-19 restrictions are hugely disappointing to them—it changes what that will look like.”
Montgomery is a NFP client who doesn’t drive and lives with her mother in Clifton, Colo., an unincorporated community near Grand Junction. To keep herself and the baby safe during the pandemic, she spends most of her time alone at the house, while her mom works and 19-year-old Jesse—who lives with his parents—holds down two jobs, one of which is in a restaurant.
The young couple hope to move in together, but “need to find a cheap apartment without me having to work,” Montgomery said. “He might come stay temporarily with me and mom after she is born.”
The teenager spends her days trying to keep busy cleaning, cooking and watching television. In a spare bedroom, Montgomery has collected baby clothes, a bassinet, car seat, swing, diapers, wipes and a toy mat—items she bought on sale or second-hand.
“It gets lonely because my boyfriend works a lot, and my mom is gone,” she said. “It can be depressing. I’m doing more screen time.”
Montgomery had a job working in the kitchen of a Grand Junction nursing home when she discovered she was pregnant. After she told her boss she was expecting, he treated her “terribly,” so she quit, she said.
She met Jesse through his sister, a friend of Montgomery’s. They got pregnant despite using birth control, she said.
“Both of us were dumbfounded, not excited—grieving, almost,” she recalled. “It was sad, bad. I didn’t want to be young, pregnant and struggling.”
After the initial shock, “We decided then to be together,” she said. “We only felt comfortable with keeping it. My mom was good when I told her. She was not happy, but she was supportive from the get-go.”
Montgomery attended her first ultrasound screening by herself, when pandemic-related restrictions did not allow partners to be there. Jesse has accompanied her to appointments since the rule was lifted. She said she feels “lucky” because she has pregnant friends who were not permitted to bring their partners to their prenatal care visits.
Jesse visits daily; they walk their dogs down by the Colorado River, not far from Montgomery’s home. She seldom sees her girlfriends, who she said typically don’t wear masks or seem to take the pandemic seriously.
“I’m scared to go to the store,” Montgomery said. “It’s overwhelming. I’ve had friends who’ve had family members pass from the virus. My mom’s co-worker was in the hospital with COVID for eight weeks. It’s terrifying to think of me or the baby getting it. Especially when she comes—I’ll be scared to take her out.
“I feel more alone. I can’t have friends over, or go out and get dinner. I’m staying alone, inside all the time. It’s hard.”
The Mesa County NFP is one chapter of a statewide iteration of an evidence-based national program that pairs a registered nurse (referred to as a nurse home visitor) with a first-time mother for weekly in-person visits from during pregnancy until the child reaches age 2.
“It’s a relationship, it’s not just clinical,” said Jensen. “We focus on the relationship between nurse and client, and our client’s heart desire. We’re building up the client, identifying goals and the steps to get there.
“COVID changed all this. Since mid-March it’s been exclusively telehealth. Now, we’re meeting with clients on video, on the Zoom platform, instead of in person.”
Approximately 30% of NFP’s clients are age 19 or younger. Many are trying to complete high school, and are still growing developmentally themselves, said Jensen.
Helping both clients and nurses overcome technology barriers has been challenging, Jensen said. The program provides smartphones to clients who don’t already own one, and helps them secure Wi-Fi service, internet access and a data plan.
Pre-pandemic, nurses would typically visit the clients’ homes, where they discussed client-led topics and concerns, such as breastfeeding or how to prepare for labor. The nurse could also physically assess the infant and observe the mother performing parental duties, offering advice as needed.
NFP is now trying to recreate the visit via an hour-long phone call, which is limiting, Jensen said.
“A lot of nurses are getting creative to continue to meet clients’ needs in the new mode,” she said. “We don’t know how long we will go this way. We’re trying to get as comfortable as we can in this telehealth model.”
The lack of in-person nurse visits, as well as the end of some in-person schooling, have been extra challenging for teen moms who have lots of questions and are accustomed to being around adults more, Jensen said. It has reduced the number of supportive people in their lives to answer questions, address issues that may come up, or be able to assess a teen mom’s well-being.
Eighteen-year-old Zowie Meador, of Parachute, Colo., is due to deliver her baby on Feb. 12, and currently spends a lot of time alone. She said she finds wearing a mask while pregnant makes it difficult to breathe, as has smoke from ongoing wildfires.
“I wear [a mask] when I have to,” she said. “I stay home more.”
Meador lives with her parents and sees her boyfriend, who’s also 18, at least once per week. He resides with his parents while studying for his GED and looking for a job. They’d like to stay in Parachute, or nearby Rifle, if he can find work. With the COVID-19 pandemic, “there are not a lot of job opportunities right now,” Meador said.
Currently, Grand Junction’s two acute care hospitals allow only one visitor during labor and birth, and that person must wear a mask at all times, said Karen Martsolf, a spokesperson for Community Hospital. Area hospitals coordinated to maintain the same visitor restriction policies to help reduce confusion and better ensure compliance, according to Terri Cavanaugh, a spokesperson for St. Mary’s Medical Center, the other acute care hospital in Grand Junction. Valley View Hospital in Glenwood Springs also delivers babies, allowing two visitors to be present during labor, and then one visitor after birth. (Meador is planning to deliver her baby at Valley View.)
Either Meador’s boyfriend or mother drives her to prenatal appointments in Silt or Glenwood Springs, some of which she attended alone due to COVID-19 restrictions in place at the time. Like Montgomery, Meador hopes that both her mother and her boyfriend can be with her during childbirth.
“That would make me a very happy human,” she said. “But because of COVID, I don’t know.”
Some families of NFP clients have lost jobs during the pandemic, including parents of pregnant teens who often rely on family for some financial support, said NFP Nurse Home Visitor Melanie Duyvejonck.
“I definitely have moms who have quit their fast-food jobs because they’re scared,” Duyvejonck said. “They’re in crisis mode, and dealing with anger about the situation. Everything was already hard in life. Now, it’s harder.”
Unemployment benefits help, as well as waived requirements to renew food stamps and Special Supplemental Nutrition Program for Women, Infants, and Children benefits in-person. Recipients can now renew those benefits over the phone, which has eased one of the many new burdens, especially for the many teenage NFP clients who don’t own cars, Duyvejonck said.
The pandemic has made feelings of isolation for pregnant teens more intense, and it’s now harder to address issues of depression and intimate partner problems, Duyvejonck said. Typically, nurses do “intimate partner assessments” with NFP clients during the early months of pregnancy, which is difficult over the phone because there are no guarantees that the client is speaking privately, without either a partner or parent listening in on the conversation—especially true for expecting teens living at home.
“I have definitely seen more depressive symptoms,” Duyvejonck said. “Some [clients] have disengaged from the program. That’s really hard. Our goal is to reach moms most in need—and those are the hardest to reach.
“Some people do not thrive with visits over the phone or internet. Some are self-conscious seeing themselves on the screen. We are feeling that [self-consciousness], too—imagine how our teenagers are feeling.”
Hilltop’s B4 Babies & Beyond is a Grand Junction-based program that helps families access affordable health care coverage. Meador said B4 Babies & Beyond helped her find a dentist and apply for Medicaid.
Mellisa Sedillo, the B4 Babies & Beyond client specialist and bilingual liaison, drives a van to pick up pregnant, monolingual Spanish-speaking clients and takes them to their prenatal appointments, where she typically stays and translates for the client and provider. Two of her clients this year included a 16- and 17-year-old.
Sedillo’s program was shut down for three months after the pandemic hit, which meant clients lost their interpreter with whom they’d established a bond. Instead, interpretation became virtual, with a different person appearing each time on a computer to do the interpretation.
“It was hard because in the beginning I had started with them,” Sedillo said. “Then, they had to share their feeling and concerns with someone on an iPad.” That is especially difficult culturally for Hispanic women when the interpreter is a male previously unknown to them, she added.
After accompanying a woman for nine months, Sedillo would often be invited to the birth. While the transportation and interpretation services have resumed, Sedillo no longer attends births due to the current one-visitor policy at Grand Junction hospitals.
Montgomery said she is nervous about her upcoming birth due to COVID-19 “going around” and the probability of her mom not being able to be in the room with her. She said she hopes there’s not a spike in cases that would require her to wear a mask during labor. And while she’s doing all she can to stay at home and be safe, her mother and her boyfriend have to work, so there’s still a risk, she said.
“I’m only 16 and it will be a big adjustment to have a child,” she said. “My mom and Jesse both work a lot. It will be on me.”
Meador didn’t sign up for NFP because she’s too busy working full-time at the McDonald’s in Rifle and doing schoolwork online before work—and, sometimes after work as well, when her shift ends at 10 p.m. It would have been difficult to add more to her schedule, she said.
As far as the future goes: “I hope I’ll be a successful mother and the baby will be happy, more than anything.”