Â鶹ѧÉú¾«Æ·°æ

Kirtly: Welcome to the "7 Domains of Women's Health," and our continuing conversations on the fourth trimester. Today, we'll be thinking about the financial domain.

I'm Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah. And with me is Dr. Katie Ward, a women's health specialist with a doctorate in nursing practice and an advanced degree in anthropology and a big thinker about women's health.

For much of my career, I listened to women who did not want to have a child right now and women/couples who were struggling to meet the financial burden of fertility treatment to have a child they wanted, often through in vitro fertilization.

So more and more couples are not choosing to have children, and the number one reason is financial. People are concerned that they're not financially ready to have a child.

When we planned our pregnancy down to the minute, although my husband didn't really know what the minute was, but that was okay, I thought it was going to take a lot longer to get pregnant.

We arrived pregnant from Boston to our new jobs here in Utah with a huge educational debt and a first and second mortgage on our little house and a car that I could see the road underneath the floorboard and the battery was propped up on a wooden plank in my car because it was all rusted out. My whole bottom of the car was rusted out.

We had no money. We had to borrow the down payment for a car that would be safe. And lucky for us, banks were willing to throw money at 12% to 14%, because that's what the rates were at that time, because of our training and our future economic stability.

But we weren't stable now. Every penny of our first paychecks after the first and second mortgage and paying back Harvard Medical School and paying for the car was saved for childcare.

No fancy stuff. A cheapy stroller and a car seat was a baby shower present. All of the clothes that we were given were too small for our huge newborn, so off to the secondhand store I went. And the first thing I did was to buy life insurance for me because if anything happened to me with the birth or after the birth, my husband would be homeless with a new baby. But we did have family backup.

So, Katie, there's my little sad fourth trimester story. It wasn't sad, it was happy. He was a great happy baby, happy mom. And I went back to work in a month because I needed the money.

Katie: Yeah, I think I had that same car with the rusted-out floorboard.

Kirtly: Yes. It's always a little disconcerting to see the line underneath your feet.

Katie: Right. I had to park it going downhill so that I could just let it roll and pop the clutch. Those were the days.

I had two really different fourth trimester experiences in terms of the financial impact, and it does give me a real perspective on what mothers are facing.

So I don't want to make it too much about my sad story, but my first pregnancy happened when I was 17. It was not what I was planning on. I actually clearly hadn't given it much planning at all.

But in that fourth trimester, I was trying to finish high school and take the ACT test and get into college and get a job. I didn't have any money, so there wasn't any money to lose at that point. But I was navigating trying to figure out what social programs I qualified for.

And if I'm going to wax political at all, it's just I recognized that I was able to go from a 17-year-old single mom to college professor because there were programs in place that provided support for me. So I'm really passionate about the importance of that social safety net.

My second fourth trimester was 14 years later, and I was . . .

Kirtly: Brave. I quit at one. I was overwhelmed. So you were brave to do it again, Katie.

Katie: Yeah, 14 years later, and I was a much more traditional situation. I was married. We had a 14-year-old and I had three other stepchildren. My husband and I both worked. And at that time, I knew I was going to have six weeks of paid time off. I had to use up all of my vacation, but I maintained my income for six weeks. But at six weeks, I had to get right back to work because we could not afford to not have that income.

And so it gives me a lot of sympathy for people who are navigating either trying to get social support or having to make a decision about, "Can I not afford to go back to work?" And so I know both of those situations really well.

I think that's where families really start to understand the reality of the fourth trimester from a financial perspective. When you're pregnant, it's all dreaming about nurseries and cribs and decorating and the image, the look. But the reality really sets in when you have to start paying for childcare in order to go back to work.

And in Utah, if you put your baby in childcare, it's about $11,000 a year, so nearly $1,000 a month. And when you consider that the average salary in Utah is around $49,000, that's 22% of someone's gross income going to childcare.

Kirtly: Eleven thousand dollars a year, that's actually for eight hours a day, or nine if you can get it because you have to travel. It's a lot more than that. It's often $15,000, $20,000 a year.

Katie: Yeah, it's substantial. And so I think that becomes a decision people have to make. Is it more expensive to keep your child in daycare and keep working?

And then let's talk about paternity leave. We just don't even have that in the U.S. In European countries, fathers often get six weeks as well. And so one parent can go back to work and then the other parent can take their leave, and so you can do some juggling and have a little bit more time to bond with your baby where one or the other parent can be home.

But in the U.S., mothers are having to do this, essentially, solo parenting. You're recovering yourself from your delivery. You're still trying to figure out breastfeeding and get that rhythm going. And then having to decide if the work that you bring into the house is valuable enough to pay for someone else to replace you. It's a really difficult situation.

So, yeah, if you go back to work early and you're exhausted . . . I see this a lot too. Women are the ones carrying the health insurance. And so it's not just the money they earn, but they're also staying in the workforce because they're the person that has the insurance. And you're exhausted and you're the person trying to feed the baby. I mean, it's just so much.

Kirtly: I do think sometimes going back to work . . . even though I was working 60-plus hours a week and taking night call, sometimes at least I could sit in my office and it was quiet. That sounds terrible. Somebody was watching my newborn while I at least had a quiet minute, which a lot of women, especially if you have more than one kid, they don't have a quiet minute. I know you were there with lots of small kids. You brave people.

Anyway, people who don't know think that the Family and Medical Leave Act, which was a bipartisan act enacted a long time ago, actually pays for family leave at the birth of a new child. But no, it only supposedly keeps your job while you're out, but it doesn't pay.

If you want paid leave, you have to save up vacation or sick leave or what's now called paid time off. And God forbid you ever got pregnant and had to go out early, and so that was using up your paid time off, or you didn't plan your pregnancy and you didn't have that much paid time off.

So people have their time-offs where their job is secure, but they have no money. And this may not be a burden for many women and their partners, but it is for many.

I saw this in the hospital all the time as we discharged new moms who had very little. They wouldn't let the family take the baby home without a car seat at the time. But there were car seats that could be donated. So people got a car seat if they didn't have one.

Women were going home often to unpaid leave, worrying about how to get back to work, to low-paying jobs and struggled to get childcare. And what about the $1,000 strollers and the cribs and clothes and diapers and formula if the mom's going back to work? For other reasons, breastfeeding is impossible.

These goodies are unrealistic for many, but they're on all the websites. "This is what you need for your baby. If you really love your baby, you're going to get this totally wonderful you name it." A snuggly. What you really need is a car seat. So if you're going to take a baby home in a car, you need a car seat.

The baby can sleep on the nest on the floor or sleep with you the first three months in that fourth trimester, which is not recommended by pediatricians, but it's done all over the world.

Diapers. We had cloth diapers for environmental reasons and that was a kind of a pain, but we did it. The cloth diapers are cheaper than disposable. But sometimes there's help to defray the costs of disposable diapers.

Although you may have to look for a secondhand car seat and strollers, I know there are places in larger communities where these things can be donated if clean.

So The Road Home can take donations here in Salt Lake City. You can search online for your town, or you might call United Way's Community Help hotline, 211, to get help finding things in your community. So United Way pulls together all the resources for all families and people who are in need. So calling 211 gets you a knowledgeable volunteer and you say, "I really need a car seat and a stroller. Secondhand or used, where can I find one?"

Of course, baby number two, if you're on your second child, you can use the things baby number one may have grown out of. If you space your babies closer than four years, which most people do, baby number one will still be needing a car seat and the stroller and the crib. So now you need two. And there's so much stuff that's marketed to new families that you don't need.

Katie: Oh my gosh. Yeah.

Kirtly: It's pretty stuff, and I certainly gave some pretty stuff to my grandbaby. So if you're pregnant and need help, think about what you really need and figure out what you can afford. Find out where you can get it used and get friends and family to pitch in if you can.

The most critical time for a new family that is counting on having the mom back at work is juggling work and child care. That's the biggie.

Katie: Yeah, I know. I mean, it was a challenge for me. I remember it wasn't an option. We were just not in a place where we could afford to not have both of our incomes even though we were doing relatively well. I would have loved to have stayed home with my second child. I knew that was going to be my last and I had hoped that that would be where I was.

But when women step out of the workforce, you lose more than just that immediate income. Even if you can afford to take the time off then, you are losing time that you're contributing to social security, which adds up in terms of when you're eligible to retire, how much money you have in social security and how many segments of work you've contributed. Again, the compound effect of what you're contributing to your retirement.

And so when women do step away from the workforce, you're losing wages in the short-term, but also in the long-term. And so now that I'm finding myself thinking more about my retirement years than my fourth trimester, I'm looking at it and thinking, "I guess maybe in the long run it was good that I stayed in the workforce." I'm looking at my retirement nest egg and thinking, "I'm going to be all right."

So, there's a compound effect that I think it's hard to think about at the time.

Kirtly: And your daughter is awesome. Your daughter is so wonderful.

Katie: That's the other thing that I tell new moms. I think she turned out better for having multiple caregivers and learning to trust other people. She absolutely would only take a bottle from her daycare provider. She wouldn't take it from her father and she absolutely wouldn't take it from me. But she figured that out, that this one person was safe and a bottle was going to be fine as long as it was her main daycare provider.

Kirtly: She was a little tyke. She was just a month, two months old when she made that decision. Isn't that amazing to you?

Katie: Yeah. And boy, was she stubborn about it. But I had a great daycare provider who learned things about my daughter that I'm not sure I would have discovered. I'll share one because I know she won't mind.

She did not like the seam on her socks to touch her toes. And so if the socks were on the correct side facing the toe, Jackie was in distress. And her daycare provider figured out that if the socks were turned inside out and the seam was not touching the toes, she was fine. I'm not sure I would have solved that problem, but this experienced daycare provider figured out what was bothering her.

So I think she did end up better off for the multiple caregivers in her life. And I stayed on my career path and that has paid off, and my daughter turned out okay.

But I think for people who are navigating this, there is a whole maze of support that's out there and that's hard to navigate. And sometimes nobody tells you where to find it.

So I think you're right, the United Way is a great resource. There's a program across the country for women, infants, and children that helps with a variety of food, formula, and resources.

And it turns out that only about 35% of eligible families in Utah are accessing their WIC benefits. So even people who are on Medicaid or SNAP don't always automatically know that they qualify for WIC in addition. So that's a food security support that's there that I just want to put a plug in for because it's a great program. It's one that I accessed in my first pregnancy, and it's one that goes unused in Utah.

So I'll put a plug in for WIC. If you think you might be eligible, you can just Google WIC, it's right there, and see if you qualify.

Utah was the 45th state . . . it took us a minute, but we have expanded our postpartum Medicaid coverage to 12 months. So that's traditional Medicaid. Women now get a year of coverage except for a little segment of that called Emergency Medicaid. I do see a fair number of patients on Emergency Medicaid, and those folks lose coverage in the month after they deliver.

So, as a provider, I want to know what people's coverage is because if that's their little window of having access to the healthcare system, I'm trying to make sure that we've caught them up on everything, vaccines, Pap testing, abnormal Pap follow-up. You can learn more about that in the 7 Domains of Paps. And that people leave with contraception that's going to serve them for as long as they need or want that.

So for people on emergency Medicaid, talk to your provider, because we are very willing to help make sure that you get all the coverage you need when that emergency Medicaid expires.

Let's talk about another financial stress. This came up for me in my fourth trimester. It was navigating this with my partner. I'm exhausted. I'm up at night with the baby and still trying to recover. And in my case, that was a time where we had some challenges. I, as I mentioned, had wanted to stay home and the reality of we couldn't afford that and having to navigate those conversations when they were really emotionally charged was a lot.

So I think that's a really important thing to think about too, is knowing ahead of time what your insurance is going to cover, what your deductibles and bills are likely to be, and what's your plan for paying those off.

Those conversations in the context of the fourth trimester when you're also tired and maybe there's some postpartum depression, as we've talked about, you're having to navigate these in that emotionally charged setting. Those can all be really difficult times.

Kirtly: Yeah, I think I blacked it all out. I was sleepless and working. So my beloved husband, if he had difficulties with it, he didn't bother me with it.

I did fall apart at two months in my fourth trimester. In my two months, I felt like, "I can't do this," and I just fell apart crying. And he said, "Well, what can I do?" I said, "I need a microwave." So this is a guy who never bought anything, never bought any house appliance, but he went right out and he got a microwave. I was much better maybe because he just stepped away for a minute.

Katie: Yeah. My friend was just like, "I need a swamp cooler." That's often a moment, isn't it, when you just are like, "What is the one thing I need?"

Kirtly: Yeah, that was the one thing I needed. I needed a microwave. This was early when not everybody automatically had one.

So I think planning for childcare . . . because if you're going to need it, there are waiting lists. There are some amazing sliding fee scale childcare providers in this city, in Salt Lake City, and probably in other cities. They have waiting lists. They're hard to get into. But they provide outstanding childcare.

In our city, I think of Neighborhood House as being the most amazing resource for young families with children, and for elders by the way. It was started 130 years ago by a brilliant woman who had no children who realized what happens when people needed help.

Katie: I love the idea of putting babies and the elderly together.

Kirtly: I think so too. Well, that's how they do it in the villages. When you take a village, when you weren't spending a lot of money on your cell phone and your connectivity, and your car, when you were in a village, it was often the elder women or the teenagers. Because this concept of allomother, someone else steps in to help you so that you could go into the fields.

So people struggle with this fourth trimester, whether you're in a very rural economy in Africa or if you're in New York City.

Katie: Yeah, and it's one of the things that's unique about humans. Most other mammals, even most other primates, don't share their babies. They don't let anybody else hold them or touch them. And so the fact that we do that is one of the things that makes us human. We can interact with not only our babies, but other people's babies, and we share that. It's one of the special things about us as a species.

Kirtly: Yeah, I think it's wonderful.

So how do you plan for a baby financially? What happens if the pregnancy is unplanned? What about baby number two and number three? So if you're still struggling with finances and daycare demands of baby number one and now you have baby number two, that often is where the issue about women actually leaving the workplace to take care of two kids, but then they'd lose all the incomes for quite a long time and their healthcare benefits or their social security.

Katie: It's tough. And then besides that, two babies is more than twice one baby. So there's the cost. At that point, you're right, maybe daycare becomes cost-prohibitive and it makes more sense for one parent to stay home. But then there's also just the needs of two kids and balancing the needs of having a car with enough room for two car seats.

Kirtly: Oh, God. It takes up a whole back seat. They're so huge.

Katie: I didn't want to drive a van. I absolutely didn't want to drive a van. And we bought one of these station wagons that had a third seat in the back. It made sense at the time. Now, I realize that that was a terribly not safe thing to do.

Life becomes a lot more complicated. Errands get much more difficult to just get two kids into a shopping cart and get them into the car. So the amount of time required to run an errand increases exponentially.

It's not just two kids. It's exponential, because the conflict between them and keeping them from their own sibling rivalry and things going on.

Kirtly: There's a very famous YouTube video about a black bear in Western Connecticut. It happens to be in my sister-in-law's hometown. It had four cubs. She was trying to get these cubs across the road, and these were young cubs.

So she gets three across, but one doesn't want to go. So she has to go back across the road to get the fourth one who's climbed a tree. And then one of the other ones follows her back across. And then the other one follows her back across. It reminded me of mothers who have many children. It's not just 1 and 1 equals 2, it's 1 and 1 equals 10.

Katie: Yes. There's one other thing I want to talk about. You kind of hinted at this. It's a study I would love to do. If anybody out there is a funder and wants to fund me to do this study, I'm really curious about this.

I'm really grateful that there weren't cell phones when I was sitting there nursing my baby. So I'm aware that my phone knows things about me before I do. And I think there have been some jokes that phones know when you're pregnant before you do. They're collecting so much data on us. And so I wonder how much the phone starts to recognize that you're sitting there and you're scrolling while you're nursing.

So the study I'm kind of curious about is how much do you start getting targeted ads for those things that you don't really need because you settled into a rhythm where your phone knows that you're spending time scrolling while nursing?

Even when I was raising my babies and for time forever before that, mothers spent that time nursing. It was kind of quiet time and you might be singing to your baby or reading to them or just looking at them and gazing into their eyes. But now I think we spend a lot of time, all that quiet time just looking at our phones.

Kirtly: Oh, I hate that. When I see a picture or I'm walking by, I see a mom nursing not looking at her baby who's desperately wanting to look at her eyes, and she's looking at her phone. I think, "Oh, there's important neurologic work that's not being done right now." You can't bond . . . Well, you have bonded with your cell phone, but you shouldn't have. There's a baby that needs to be bonded with.

Katie: And then worse than that, and maybe because of that, maybe it's because of the bonding that you become even more, "I just need this other thing that's going to comfort my baby." The sound machine, the miracle Magic Sleepsuit, or the chair that rocks. You end up in this vicious cycle of buying more stuff to soothe the baby that maybe just needed the time gazing into your eyes in the first place. And so I wonder how much that really snowballs.

Kirtly: Yeah. And sometimes babies just aren't ready to be soothed right now. You know the baby that you walk up and down the hall with in the middle of the night, and you just have to do that.

And at the end of the day, most people have a choice about having a baby. They don't always exert that agency in their children or no children choices, but they have babies by chance instead of planning for them and using contraception until the time is right.

Of course, there just is no right time. If you want children, you find a way. If a child comes to you not planned, most people, men and women and others, find a way.

I remember talking to couples with a big house in a fancy neighborhood with two cars who could not find the money to pay for IVF. Maybe they were hopped up to their eyeballs. And then couples who worked two jobs each and shared an apartment who paid for their IVF, $10,000, in $20 and $50 bills saved up.

And there are cultural changes about not having children as now being a common choice. But for some people in some cultures, children are everything, and people come up with and they find a way because children are everything for a family.

Children should be important, I think, in every community and we should find ways to support families with small children in the fourth trimester and beyond.

How do we as a community and as a greater society help? Find ways to donate your kid's stuff when you're done. Find ways to help out the families of newborns in your close circle. Support community-based nonprofits that support families with children. Be an advocate for maintaining family safety nets like child health insurance and food donations and supports like SNAP. Donate to local childcare agencies that work on a sliding fee scale for families with young children.

If you're listening and in need of financial help, reach out to agencies like United Way. Call 211 to find what's available in your area. If you can be a helper, please do.

Katie: The little things even, really. I remember how much I valued that little neighborhood dinner, that people brought dinner for a number of nights. That was such a relief to just have the time and not have to cook. So that's been something I learned from my own experience and I try to share, is just how much that means.

I think that it matters how . . . Again, I'll go back to my own experience. Maintaining the social safety nets for people. My experience of having a child that I hadn't exactly planned, but it turned out to be a great thing. But as I said before, I wouldn't be where I am now if it weren't for having some support.

So I think as a culture, we need to really think about that thing that makes us human, that we share our resources and we do that regardless of who anybody is and have faith that that's a valuable investment in our community.

Kirtly: Absolutely. Well, thanks for joining us on the Financial Domain of the Fourth Trimester. Check out the other domains and the other topics in our "7 Domains of Women's Health" series at womens7.com, or at the "7 Domains of Women's Health."

Thank you to all the community supporters of people with newborns and all the advocates for social safety nets. And thank you for listening.