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  • Writer's pictureAlexandra Duprey

Postnatal Support Advocates, Part 2 | Jennifer Ewald (LCSW) | Postpartum Emotional Support in the 4th Trimester and Beyond | Delaware Perinatal Mental Health

Updated: Apr 12

When we welcome a newborn home, a whirlwind period of transition and adjustment for the whole family ensues. This shift is felt most deeply by mothers and birthing people. Whether you have just given birth to your first baby or this is your fourth-- the need for immediate and tailored emotional support is often overlooked. Typically you won't see your medical provider until at least 6 weeks postpartum, and that's a one-time visit. This is where Postnatal Support Advocates comes in! One of Postnatal Support Advocates founders, Jennifer Ewald, is a dedicated Licensed Clinical Social Worker who stands at the forefront of addressing this gap in postpartum care. She has made it her mission to offer vital support during the crucial 4th trimester. Through in-home, in-office, and tele-health visits, she and the providers of Postnatal Support Advocates provide a nurturing space where individuals can learn to navigate the complexities of early parenthood with confidence and resilience. In the following interview, Jennifer shares her insights into the importance of postnatal support and the transformative impact it can have on the well-being of new parents.

I hope you enjoy!

Can we start by sharing a little about Postnatal Support Advocates and the work that you do?

Postnatal Support Advocates is a 501C3 non-profit organization. We focus on postnatal emotional wealth, mental health, physical health, postpartum care, and family support mostly during that first year after having a baby. As a non-profit we like to remove the financial barriers to care that families often experience. Our status enables us to receive grant funding, and accept donations and it allows us to also bill health insurance-- offsetting costs without pushing them onto our families.

Do you find that finances are the major barrier to getting support during this period?

I think Finances can be, but I also think that a major barrier to getting support is feeling you have to ask for it at one of the most vulnerable stages of your life and maybe not even having the language to ask for it.

One of our missions is that postpartum support becomes standard of care. That after you have a baby we just show up. That is our grand mission and what we are hopeful will truly become standard of care. We don't want women and birthing people to have to wait until they are NOT OK to say that they are NOT OK.

Of course finance is always going to impact people's decisions-- that is just the way society works, right? And often we find moms, or birthing people, aren't putting their needs first, especially after having a baby when all their focus typically is on the baby. We want to remove any obstacle, by just normalizing the fact that people need help after birth. And everyone should have emotional support-- it doesn't matter if you say "I'm not OK". We don't want to wait for that. And maybe you will be OK, but we want to come and intervene right away. You've had a baby? We should be there, period. and you can say "No thanks" and we will head out, or "Well, actually this is nice". We offer connection and community support with a licensed mental health professionals or a graduate-level mental health professional. We are just there to keep an eye out for you and ask, "How are you doing?". We are there to be the professionals in the room who can support you. whether that is in your home, because it is easier for us to come to you in your home, or in the office because it is nice to get out of the house, or we could also offer virtual support to check in.

So we offer all of those options. Again, we are removing barriers because sometimes parents are like, "Let me just get out of this house". You can bring baby, you don't have to bring baby, you can bring all your kids, or don't bring all your kids-- whatever makes the most sense for you.

So I think that finances are certainly a barrier, and I think that asking for help is a barrier-- often we just don't ask for help-- waiting until we are desperate for help is not the time to intervene-- so we try to be proactive with that.

Can you describe what it is like to apart of your program?

Yes, so ideally we are meeting you within your third trimester. We would like to meet you in the third trimester to help you plan for postpartum support, right? We like to know: "What is your plan? What kind of services do you think you would be interested in? What support do you already have in place? Who is coming, whose helping, who is not? Who do you want to make sure does not show up? What is your postpartum plan in the way that people have traditional birth plans? And then we are checking also for any pre-existing mental health stuff that might already be there because in that case there is a higher risk postpartum... but I always wonder is it the higher risk or are we already accustomed to understanding mental health so we can label it and then seek help. Whereas it might be other folks first time feeling NOT OK, so they don't know how to label it or fear some of that label.

So ideally that is when we are first meeting you-- maybe your doctor or your midwife is referring you to us, maybe you have a doula and they have referred you, or maybe you've just heard about us, maybe (in our dreams) in hospitals this is the standard of care. Maybe your friend went through our program-- because we really think that word of mouth is going to be a powerful way that we reach people. So you come in, ideally in the third trimester, we are meeting you and getting to know you, we are talking about how quickly we would like to be able to see you. Ideally we are also meeting with partners so that they can also let us know after you have had baby and then we talk. You may not know what you want in that moment, you might think "eh, don't come to my house, I will just come to you" but maybe you've changed your mind. And maybe you are someone who needs/wants just one visit and that is that and we won't see you again and then you come back in a few months because you are like "Oh, I just have some feelings and thoughts" and it doesn't have to be dramatic, significant mental health conditions like postpartum psychosis, of course come if that is the case, but it shouldn't have to be that serious when you reach back out.

Maybe you want to have us come once a week, maybe-- where you are at-- twice a week makes sense. And we are just coming to visit and we are having conversations and while it is definitely mental related and therapeutic, it is experienced conversationally so it so it doesn't feel like this stuffy, uncomfortable, formal mental health intervention. It is more what we all deserve, which is conversational support about what is going on.

Because we are all social workers, we have a lot of resources that we have come in contact with over the years from doing different kinds of social work-- through non-profits and agencies, and through our own private practice work. So we are going to do some case management work for you too. We can connect you with a lactation consultant if that is something you would like. We can connect you with a postpartum doula if that is something you would like. We are going to connect you with people who are knowledgeable about pelvic floor therapy, or health and wellness and if you want to go the route of having a personal trainer, we want to provide that for you, again-- at no cost.

That is the idea-- the access is there if you want it. And maybe you don't want it right now, but we have ear-marked this money because you are apart of this program. And again it is just standard of care-- you don't have to ask for it. I ask "Do you want this? Yes, or no? Because this is what comes with the program". And you can opt out and say, "I don't know if I really want that."

"Well, OK, that's fine!" But if we present all of this as a standard, and that this level of support is to be expected, then it should feel like is. You can just choose to say "No thanks". And you never have to be like: "Do you think, maybe, just maybe, I could have a little help, please?" Cause how often do we really ask for help? And how often are we conditioned not to ask for help in general?

What you are describing reminds me a little of an all you can eat buffet. Where you can pick and choose what menu items are appealing based on your appetite that day.

This also reminds me of when we go out to eat at a restaurant when I was a kid: I knew that I must choose between the least expensive items on the menu-- and that there would be an eyebrow raised if I order a $30 steak-- even if that it what I really feel like having. My husband comes from a family where they order appetizers-- everyone gets their own appetizer-- and everybody can order a beverage. There is an unspoken rule in my family that we are only allowed to drink water when we go out to eat. I definitely have that conditioning where would feel burdensome asking for help postpartum.

Exactly. We know that. We know that is a condition that happens, probably to many folks, but I think especially women, and especially birthing people. We know this, because we are this. Right?

So that is what it would be like for the client, but a lot of what we have designed is because we are mothers, we have been through this experience. Our experience is not going to be the same as yours and it never will be, but there are some foundational things that we do understand. And that is why we, I won't say exclusively, bring on providers that are mothers, but we certainly find it very valuable that our providers are also mothers and mothers from a variety of backgrounds, a variety of different family dynamics and all high-level graduate-level trained or licensed mental health professionals that can rally and support you and can understand. And that is also a part of our mission that the folks who work with PSA, not just the clients-- but also the providers-- are treated equitably, and they are not exploited, and they don't have to ask for help, and they are not working hundreds upon hundreds of hours.

We are prioritizing their work-life balance. We understand that they are mothers, so we understand that maybe they have a non-traditional work schedule. Because who created the traditional work schedule? Let me tell you, it wasn't us mothers! We are refining that all the way around-- for clients, and for providers. This is what I think would be perceived as radicalized, but we would say should be a normalized way of doing work in a sustainable way-- for our providers and for our clients.

Do you have a success story you could share with us about someone who has been through your program?

Yes, So we have a client who is 21 year old female. When she was pregnant, she was receiving care at The Center for Women's Emotional Wellness at Christiana Care-- she wasn't quite the right fit for them. They knew about us so, we had a provider over there refer her to us-- mostly because our program is fourth trimester, and initially it was very specific to the first three months postpartum (we very quickly evolved into what we are today.) So this client was pregnant and in her third trimester when we met her. She was very proactive, very self-aware-- for any human being let alone a 21 year old young woman-- about her own mental health and very conscious about not wanting to be struggling with postpartum depression after she had the baby. She wanted to make sure that she would have a connection with her baby. It was really great for her to join us. Because she reached out we were able to support her.

Another thing that PSA does that we often do tandem work so there is more than one mental health professional who is working with you, unlike traditional therapy where it is just one-on-one with one person.

That's great that you would get different perspectives, and if you don't necessarily jive with one therapist, you are not stuck with them.

It's kind of like when you when you go to an OB practice and you don't know which one you are going to get when you are giving birth, but through the months of your pregnancy you meet them all and develop a rapport-- but in a much more personal way. We want you to have all the different perspectives and maybe you don't connect with one of us, and you don't have to see them again. But the really cool thing is that we are all there supporting you and it's more of a team approach-- which is radical in our field-- but we are able to collaborate together as a team for the good of a client. We are supporting you in multiple ways.

I like this a lot. It's like having a bunch of Aunties looking out for you when you need it most.

Yes, it is radically different because it is routed in female way of doing things, and I don't want to genderize everything, but it is like this feminine approach. You don't have to be a woman to be that feminine piece, but it is the deliberate opposite of hyper-independence and the the patriarchy's approach to doing things. It centers care.

A lot of businesses are like "If you center human beings then you won't make money". But I have only found the opposite to be true. It is when you center on people and actually meet them where they are and then they tell their friends and they want everyone to be apart of it. I know that we are in mental health so that makes sense but that is just true in general. I say all that to say, that it is this deliberate approach. The client gets the different perspectives, and it means that not one provider has to carry it all. So it is beneficial for the client and it is beneficial for the providers. Us providers are collaborating-- if you can't meet with someone we don't leave the client hanging-- so we have got another therapist that can come in.

That's awesome.

So with this girl, we had one of providers regularly checking in with her via text about her mental health and then we had me and an intern go to check in with her in real life in-person. She got that much care! She had telehealth, and that particular provider was a focused on mindfulness and gave homework and more concrete stuff to work on and then we are able to provide more experiential support getting into her family dynamic, family of origin dynamics and how that weighed in, what some of them were saying to her, helping her with perspective, helping her with finding her voice, helping her understand herself.

I had my first baby at 21 and I just wish I had had something like this because it would have been so nice to not have had to navigate that alone. (I start tearing up) I am not usually a very emotional person, but this is making me tear up. Because being a young mom was really, really hard.

Now I am getting emotional!

I am so sorry!

No, do not apologize. You are in a councilor's office this is what we do! And this is why we do this. So many women say "I wish I had this"... I-- we-- wish we had this. The part that gets a little tricky is that you didn't know yet that you wished you had this when you are 21 and a young mom, but hopefully you are like "I will never" with your second kid and we want to get in there ahead of time, so that isolation doesn't happen.

As someone who has personally soldiered through postpartum depression alone, I would like to stress that you don't have to go through this transition alone-- programs like Postnatal Support Advocates are here to help.

Thanks so much, Jennifer for sharing about your mission. If you or someone you know may be interested in Postpartum Support follow the links below!

Pre and Postnatal Emotional Support:



Interested learning more about Perinatal Mental health? Read an interview with two Postpartum Support Advocates Councilors HERE.

Read Jen's Interview HERE

Would you like to support the Postpartum Support Advocates mission? You can donate HERE.

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