COMPAÑERAS PROGRAM: Companions for At-Risk Pregnant Women

Maria Vierra

For many women living in Marin County, pregnancy and birth are a joyous time shared with partner, family and friends. But for many Latinas who are recent immigrants, pregnancy can be a time of uncertainty and apprehension. In the low-income, primarily Latino “Canal” neighborhood of east San Rafael, many expectant young mothers are new to the United States, speak limited English, and lack the support of family and friends left behind in their country of origin. Some have experienced domestic violence, social isolation, rape or other major trauma, either in their home country or locally. As a result, many of these women are depressed and anxious as they face the prospect of pregnancy and delivery alone in an unfamiliar country.

Canal Alliance--a nonprofit organization located in the Canal neighborhood that has been serving Marin’s low-income Latino immigrant community for 30 years--began the Compañeras program several years ago to address the needs of at-risk pregnant Latinas. Based on the Latin American Promotora (promoter) model of using peer health educators/community health workers to reach out to people within their own communities, the Compañeras (companions) program connects bilingual, bicultural community volunteers with pregnant Latinas. The compañeras provide education and emotional support for a minimum of one month before the birth, during labor and delivery, and at least one month after the birth.

Recent research indicates that prolonged stress or trauma experienced by pregnant women can cause chemical changes in a fetus’s body that can affect brain development and lead to behavioral or intellectual problems later on.[1] The goal of the Compañeras program is to reduce mothers’ stress levels and increase their well-being so they are better able to bond with their infants and create a healthy environment for them. Infants in the program are more likely to be born healthy and to thrive.

Made up of two coordinators and a core of 6-8 active compañeras, the program serves approximately 50 women each year, many of whom are referred to the program by Marin Community Clinics after being identified as at-risk for depression or having a high-risk pregnancy. The compañera conducts prenatal and postpartum home visits to assess the safety and stability of the environment for mother and baby, provides emotional support, and in many cases accompanies the mother to the hospital delivery room to serve as both interpreter and coach during labor and delivery.

For many monolingual women, the experience of labor and delivery while being unable to communicate with hospital staff is particularly terrifying. Having the compañera present to interpret instructions and information from hospital staff and provide encouragement and support in the mother’s own language is particularly important to relieving stress and improving the birth experience.

One tragic local story illustrates the importance of the Compañeras program in providing both practical and emotional support to monolingual parents. In this case, the unborn baby had been diagnosed with a chromosomal disorder and was not expected to live much past birth. The baby’s parents, Miguel and Lety (not their real names), had known for some time that their child would not live, and they were grief-stricken as they waited for the baby to be born. Although a hospice counselor was present, the counselor did not speak Spanish.

Isabella (not her real name), the compañera who attended the birth, interpreted for the couple and helped them make necessary arrangements for the baby’s body. After the baby was born, Isabella stayed with Miguel and Lety at the hospital until their child died almost 20 hours later. Throughout this time, Isabella served as an intepreter between the couple and medical staff and ensured the couple had privacy. Later, she helped them make arrangements with a local funeral home, a task that would have been doubly hard for them since neither speaks English.

Isabella attended the funeral and burial to provide additional support. She remains in regular contact with the couple, who have expressed deep gratitude for her support, friendship and help in making a tragic event less traumatic.

In cases like this one, the experience can be nearly as intense for the attending compañera as for the delivering mother. To help cope with the emotional stress they sometimes experience, compañera volunteers check in regularly with each other to share their experiences and provide practical advice and peer support. Although tragedies do occur, most mothers and infants come through their birth experience healthy and ready to bond to each other. Compañera volunteers consistently express gratitude at being able to help mothers through the process and witness the mother’s joy when the baby is placed into her arms. As a result of their shared experience, some compañeras and mothers develop friendships that continue over many years.

In addition to providing peer and labor support, the Compañeras program provides follow-up case management with all new mothers to ensure they are in a stable home situation, are aware of other services they can access--such as the Canal Alliance’s food pantry, baby clothing and equipment, rental assistance, and support groups--and to ensure that they have made their “well baby” doctor’s appointment.

The Compañeras program has been so successful that Canal Alliance recently launched a similar program in collaboration with Novato Youth Center and Bay Area Community Resources to train a core group of promotoras to provide peer health education and outreach in the areas of mental health and substance abuse prevention. Canal Alliance has also provided training for the promotoras to offer domestic violence prevention outreach. Through this innovative and highly effective Promotoras model, Canal Alliance hopes to improve the health of Canal residents and decrease the health disparities between the Canal neighborhood and other areas of Marin.

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Ms. Vierra is the grant manager for Canal Alliance.

Email: mariav@canalalliance.org

For more information about the Compañeras program, contact Sandy Ponek at sandyp@canalalliance.org or 415-306-0422.

References

1. Shonkoff JP, et al, “Neuroscience, molecular biology, and the childhood roots of health disparities,” JAMA, 301:2252-59 (2009).