Great Expectations

Bringing a social work lens to the perinatal experience

STORY BY MEGAN RUBINER ZINN ILLUSTRATION BY ANNA SMOLSKAYA

The perinatal period—pregnancy, birth, early parenting—can be the most joyful of a person’s life. It can also be the most traumatic. Often it involves elements of both. For everyone who experiences pregnancy, it is a time of great vulnerability on a physical, emotional and societal level.

Among care providers, social workers are uniquely trained and positioned to be of service to people in the perinatal period. Who better to guide parents through this period than a social worker who has been trained to understand both the individual physical and emotional experience, but also the social, cultural and institutional systems they have to navigate?

“I think social work speaks to this work, more so than almost any other discipline,” asserted Ruth Paris, M.S.W. ’82, Ph.D., “I think we own this place of being able to recognize the ecological system and how we are embedded.”

Smith College School for Social Work alums JoAn Monplaisir, M.S.W. ’13, LCSW-C, Gretchen Davidson, M.S.W. ’14, LICSW, Ruth Paris and adjunct faculty member Greer Hamilton, M.S.W., are all social workers who specialize in aspects of the perinatal period. The diversity of their roles shows how many points of entry there are in supporting individuals through this complicated, multifaceted period of their lives.

A SSW adjunct faculty member since 2022, Greer Hamilton is also a fourth year doctoral student at Boston University School of Social Work. Additionally, Hamilton is co-chair of the board of directors of the Eastern Massachusetts Abortion Fund (EMA), where she oversees their hotline staff and conducts outreach. Hamilton is also a trained doula, providing emotional and educational support to clients as they navigate the health care system, birth planning and early parenting. Hamilton started her doula training to help improve the perinatal experiences of Black women in light of the racism and increased risks they face.

SSW alum JoAn Monplaisir is also a doula. She works with clients trying to conceive, through pregnancy, during delivery and in the early weeks of parenting, as well as parents coping with pregnancy loss or going through an abortion. Her services include emotional support, education, advocacy, guidance in navigating the health care system, resource coordination, birth preparation and hands-on support. She is also a hospice social worker, serving as an end of life doula. Thanks to her training as a social worker, Monplaisir brings a trauma-informed lens and a social justice and anti-racist approach to her work. “It really helped equip me with the language and the sensitivities of how to navigate discussions with our families compassionately and ethically,” she said. Additionally, with an eye to economic justice, she runs her practice on a sliding fee scale.

Ruth Paris is an associate professor at the Boston University School of Social Work and the associate director for research of the BU Institute for Early Childhood Well-Being. Paris’ research focuses on families, particularly mothers, addressing issues of high adversity. Her current work has involved trials of BRIGHT (Building Resilience through Intervention), an attachment-based intervention for pregnant and parenting individuals with substance use disorder (SUD) and their children. BRIGHT is an enhancement to substance use treatment with the goal of helping parents remain sober and retain custody of their children. The program supports participants as they learn to regulate their emotions and to understand the connection between their emotions and behaviors as they develop a relationship with their fetus and their baby.

Monplaisir offers doula services from conception through childbirth and post-partum as well as services for hospice clients and during end-of-life care.

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It really helped equip me with the language and the sensitivities of how to navigate discussions with our families compassionately and ethically.

-JoAn Monplaisir

Gretchen Davidson has a private practice in Conway, New Hampshire, and works with a group practice in Cambridge, Massachusetts. As a student at SSW, she undertook a qualitative research project on pregnancy and childbirth experiences among people with past sexual trauma. She also taught at a home birth midwifery college. Davidson has become known in her area as someone who specializes in perinatal mental health, and nearby practitioners and hospitals often refer clients to her. She sees clients with postpartum depression and anxiety, those who have had birth trauma, or those with early trauma history or attachment disruptions affecting their pregnancy, delivery or parenting.

Although each of these social workers have expertise in different elements of the perinatal experience, as they speak about their work, they return again and again to the same issue: perinatal care in the United States is not only broken, it often inflicts new trauma.

Davidson spoke of the lack of access to good prenatal care, postpartum care and to paid leave. “There’s going to be things they encounter just in the process of receiving care that are likely to be harmful,” she added. Being in a rural area, Davidson feels acutely the lack of resources: few mental health providers, let alone providers knowledgeable about pregnancy and parenting, and few support services.

Paris experiences enormous deficits in the health care infrastructure when it comes to pregnancy and parenting among those overcoming SUD, especially because of a lack of coordination of different spheres. “People have been turned away, left and right, from substance use treatment, because they’re pregnant, and they get turned away from pregnancy services because people don’t know how to work with somebody who has a substance use disorder,” she explained.

One of the primary issues is the lack of racial equity in perinatal health care, which was a key factor in drawing both Monplaisir and Hamilton to the work. According to the CDC, the total maternal mortality rate in the United States went from 17.4 deaths per 100,000 live births in 2018 to 23.8 in 2020. Among Hispanic women, it went from 11.8 to 18.2, and among non-Hispanic Black women, it went from an already staggering 37.3 to 55.3. With those in recovery from SUD, Paris noted, the disparities are only compounded, with fewer women of color accessing treatment and fewer people of color providing treatment.

Adjunct faculty member Greer Hamilton began her work as a doula to improve the perinatal experiences of Black women.

Paris, Monplaisir, Hamilton and Davidson all agree that with the end of Roe v. Wade and the sharp gutting of reproductive rights, the harmful outcomes are only going to get worse. Paris, in particular, anticipates more people with SUD being forced to carry pregnancies to term, whether they are in recovery or not, and therefore more children at emotional and physical risk.

Even in areas where reproductive rights will likely remain strong, the overturn of Roe v. Wade is already having an effect. According to Hamilton, EMA is already seeing more people coming to Boston from outside the area for abortion services and they anticipate the numbers will grow. Monplaisir has seen an uptick in clients requesting abortion support and greater feelings of anxiety and discrimination around the issue because the national rhetoric around abortion is so charged. Davidson concurred: “I think it affects all people who have uteruses—the attack on autonomy and the impact of living in a hostile environment.”

The solution to the crisis of perinatal care in this country, they all emphasized, is training far more providers, especially social workers, to better serve this population. This has been a key aspect of Paris’ advocacy. In a 2021 article in Social Work (“Locating Infant and Early Childhood Mental Health at the Heart of Social Work”), she and colleagues asserted that while “social workers are central to the work of assessment and intervention with young children and their caregivers in many settings, few schools of social work ofer training in IECMH (infant and early childhood mental health) and few social workers are familiar with its core principles, scholarship and intervention approaches.”

Gretchen Davidson specializes in perinatal mental health.

I think it affects all people who have uteruses — the attack on autonomy and the impact of living in a hostile environment.

-Gretchen Davidson

On a broad level, improving prenatal and postnatal care requires that we bring a wide social lens to the process and understand that the individual experience is affected by a web of intersecting needs and pressures: societal, physical, emotional, cultural and economic. “Helping people to de-internalize their experiences is really essential for people in this vulnerable time period,” Davidson explained. “To say, ‘part of what you’re going through is not you, it’s the context you’re living in, or the way you’ve been treated.’ There’s just so much self-blame.”

Further, we need professionals working in perinatal health who understand that individual experiences during this period have extensive implications for broader society. “Even though these experiences around abortion and around pregnancy can feel really individual, there are actually great implications for communities and at the society level for not caring for people when they’re either pregnant, when they’re having an abortion, or when they decide to raise a child,” Hamilton affirmed.

The stakes for good perinatal care couldn’t be higher. The more clinicians we have who understand the impact of these intersections and the better we become at supporting parents through this time, the better outcomes we’ll have for parents, and equally importantly, for children. It’s what brings Davidson, Hamilton, Monplaisir and Paris to this work and what keeps them so passionate. “I feel motivated to create a world where people can choose when they want to have a child, how they want to have a child, and how they want to raise a child,” said Hamilton. “If we as a profession believe in social justice and human rights, we should truly consider pregnancy, birth and childrearing as part of that.” ◆

Ruth Paris has focused on the experiences of people with substance use disorder as they navigate pregnancy and birth, with a goal of helping parents retain custody.