Asel stared at the muted gray and white living room carpet as she rocked her 2-week-old baby Safia back and forth. The gray February evening left the North Side apartment dim. In the corner, a bunch of slightly deflated balloons kissed the ceiling. They advertised celebratory messages like “Congratulations!” and “It’s a girl!”
On this night, Asel’s husband Bakyt was working. He works every night driving for Lyft until the early morning hours. These hours are preferable to the ones he kept as a longhaul truck driver, but he earns less money. When Bakyt is home, he sleeps. The two parents only see each other for an hour or two in the evening.
“It’s so hard,” says Asel. “My husband is home, but he’s not really home.” (Due to the personal nature of the details shared in this series, WBEZ agreed to hold the last names of the families.)
Asel comes from the northern part of Kyrgyzstan, a country in Central Asia that was part of the former Soviet Union until its collapse in 1991. She arrived in Chicago a year ago and almost immediately got pregnant. That catapulted her into nine months of doctors appointments and a regimen of consistent medical care. Then the baby arrived.
Two weeks postpartum, Asel found herself in the throes of a transcendent, grueling and profoundly vulnerable time: the first 12 weeks of new parenthood.
And she found herself mostly alone.
But while the first weeks of parenthood can feel like nothing short of a hazing ritual, postpartum health and mental health remains largely unseen and wholly underexamined in the United States. Unlike other wealthy countries such as South Korea, where women can check into postnatal retreats, or Spain, where new mothers get monthly visits from a community midwife, the United States offers no universal postpartum home visits, no guaranteed paid time off and no certainty of child care.
For many new parents, the most important buoys sit closer to home: friends who start a meal train; parents who take a late-night shift; siblings who unload bags of hand-me-down clothes. For Asel, that kind of help requires a visa, a plane ticket and a 7,000-mile journey.
“You want to have support,” says Asel. “You want to have someone who shares this with you. Someone who asks how you are.” Her voice cracks at the thought as she cups her eyes with her hands. “Sometimes I feel really alone.”
Helping new mothers when they need it most
Illinois is one of several states trying to invest more in young families in the hopes of bringing parents out of poverty and improving health and educational outcomes for their children. Asel’s story is one window into the experience of the immigrant, non-native born Illinoisans who become parents in this country.
When Asel brought Safia home from the hospital in February, she tried to keep Kyrgyz traditions. She struggled to keep the customary strict postpartum diet that limits meals to soup, bread and tea — “I could not,” she laughs, “it was too hard” — but she did take one ceremony seriously.
In Kyrgyzstan, says Asel, newborn babies are not presented to the world until they are 40 days old. Those first few weeks are usually spent with family who help take care of the newborns. In America, however, Asel found herself living in near total isolation, exhausted and questioning every decision.
“I have so many thoughts like, ‘What is this rash on my baby’s face? Did I do the massage wrong? How do I properly bathe her?,’ ” says Asel. “I am always blaming myself and wondering if I’m being a very bad mom.”
Even when she wanted to reach her mother and sisters, she rarely could because both women live in Kyrgyzstan, which is 11 hours ahead of Chicago.
“Support is one of the biggest things for new moms,” said Maria Matias, the associate director of maternal and child health supportive services at Erie Family Health Centers, a network of federally qualified health clinics that serve a large immigrant population. (Asel is among them.) “Without someone to talk to, newcomer moms can really feel stuck in the mud. But these moms are also incredibly resilient. Even when things are tough, they keep going.”
One person Asel relies on is a fellow Kyrgyz immigrant and mother of four who lives around the corner.
“She is my sister,” says Asel, who met the woman a few days after returning home from the hospital. “I don’t have anyone here except my husband. So anytime, whatever I need, I go to her.”
In those first few days when Asel felt totally overwhelmed, the experienced friend showed Asel how to wash Safia in the tub and told her which rash ointments to use. She also demonstrated how to massage Safia’s legs and encouraged Asel to put the baby on her stomach to strengthen her neck.
Asel called her friend the night she found herself doubled over from crippling abdominal pain and began to bleed through her pants.
“I was walking and something came out like I was giving birth again,” recalls Asel. “It was like thick, dark blood, like pieces I could hold.”
Asel tried to call the hospital, but when she didn’t reach anyone, she called her neighbor, who told her not to panic. She told Asel it was bad blood and it was good that her body expelled it. Bad blood, or perhaps a large clot.
Asel did not report the incident to her midwife or doctor. Since she did not have a fever and her blood pressure was normal, she figured her body had taken care of itself.
Every visit to the hospital adds a new bill to the stack piled in a cardboard box that sits beneath Asel’s television. There are the monthly $170 bills for Ambetter, the private insurance Asel bought at the advice of a lawyer friend in Florida. Though Asel qualified for Medicaid, she canceled her application. Asel feared using federally funded insurance could jeopardize a future green card, a concern many immigrants share after the Trump administration doubled down on legal repercussions for noncitizens who accept some form of public assistance.
There’s $900 in rent and $1,000 in car payments. A single online English-as-a-second-language course at the Illinois Institute of Fine Art puts her back $1,300 a month. The costs worry Asel. The monthly tally grows increasingly hard to pay.
Asel says she eventually wants to work, but not while she remains on a student visa and not while her daughter is so young.
The bill that weighs most heavily on Asel is the nearly $7,000 she owes for Safia’s birth. Ambetter covered half, but Asel and Bakyt must cover the rest.
In the United States, Medicaid covers nearly half of all births. And for many, that coverage comes with no out-of-pocket costs. Additionally, there are government programs in Illinois that are designed to lower the costs of prenatal care, delivery and postpartum appointments for low-income mothers and their babies.
But many new parents, like Asel, don’t necessarily know how to find such programs, and so they end up navigating a health care billing system that is infuriating, opaque and expensive. According to data from the nonprofit Kaiser Family Foundation, the average health care cost of childbirth in the United States is $18,865 with an average out-of-pocket payment around $3,000.
That’s a huge expense for most American families, said Aditi Sen, a health economist and the director of research and policy and the Health Care Cost Institute, a nonprofit that studies how to lower the cost of health care in America. “That’s higher than most families’ average monthly spending on housing, and it’s three times the average spending on food – and that’s for people with pretty good health care coverage.”
When it comes to the billing process for maternity care, added Sen, it’s not very informative for patients. “It’s not transparent at all and it’s not meant to be.”
Add the stress of language barriers, immigration anxieties, and cultural misunderstandings, managing the onslaught of bills can feel like a Sisyphean task.
Ideally, cost would just not be a concern when it comes to giving birth, said Sen. “There are so many unpredictable parts of introducing a new baby into a family. Ensuring equitable and affordable access to care should just not be one of them.”
A joyous taste of home
An oversized bag of King Arthur flour catches the light on a sunny morning in mid-March as Asel prepares for Safia’s 40-day celebration. She stands in the kitchen over a large pot filled with chunks of beef. As the meat steams, Asel chops potatoes and carrots, which she then slides into the hot broth.
The stew, called dimlama, is a traditional Kyrgyz dish, one Asel will pair with side salads of beets and corn and lettuce with cucumber and a yogurt dressing as part of the day’s feast.
There is a notable lift in Asel’s step as she pivots from her cutting board back to the stove. The first guest arrives around noon and carries a large bowl filled with a heap of dough, which she dumps onto the kitchen table. Asel giggles at the inelegant mound, her eyes bright and smiling. Soon, two more Kyrgyz women arrive and station themselves in an assembly line.
Together, they shape the dough into 40 large, flat discs that they fry in olive oil. The ritual of frying bread, explains Asel, is meant to bring health and protection to the baby.
While two women work the bread, a third tells Asel to gather her gold jewelry and put it in a bowl of water. They will soon bathe Safia in 40 spoons of gold water to ensure the baby’s good fortune in life. When the water is ready, Asel and her friend crowd into the small bathroom and hold Safia over the tub. Rubbing the water across Safia’s back and belly, the two women recite a prayer for strength and good health.
The bread takes nearly two hours to cook and when the last piece is done, the apartment fills with a rich, sweet aroma. Eager to eat food from home, the four women gather around the dining table.Like Asel, her three friends have all recently arrived in Chicago. Two fled Russia when the war in Ukraine began and another came just two months ago with her husband and two children. Today is the first 40-day celebration they’ve organized in America. The first time they’ve made it their own.
Over the next hour, the conversation shifts from horse meat, a common ingredient in Kyrgyz food — “We really miss it,” says Asel — to American schools and marital relationships. They discuss plans for the start of Ramadan and whether they should buy gifts at Target.
“It’s so beneficial for newcomer moms to connect with one another,” said Maria Matias of Erie Health Centers. “It means there is someone they can count on and it means not having that sense of being alone. It gives them a sense of purpose and family.”
Policymakers are realizing, too, that a lot of new mothers get stranded. Reaching them sits at the heart of the Chicago Department of Public Health universal home visiting pilot program to coach and support new parents a few weeks postpartum. Gov. JB Pritzker wants to fund a similar effort statewide.
“Despite the fact that we know this time period is very important, we do not have a universal system of support in this country,” said Candice Robinson, medical director of the bureau of maternal, infant, child and adolescent health at the Chicago Department of Public Health. “Our program really aims to establish that for all Chicagoans.”
Until that kind of comprehensive care becomes more widespread, many new mothers, like Asel, must lean on one another.
Toward the end of the meal, one of the women shifts back in her seat. She’s 36 weeks pregnant and her baby is kicking.
“The next time will be for you,” says Asel, looking at her friend. In just a few weeks, Asel appears wiser and more confident. A few weeks from now, spring will be in full bloom and Asel, enticed by the flowering trees and chirping songbirds, will start walking daily. When she reaches 12 weeks postpartum, she’ll remain tired and flustered by the ever-changing rhythms of a newborn, but she’ll know every phase is exactly that — temporary.
As if on cue, Safia begins to stir. But before Asel can reach her, one of the women takes the baby and holds the tiny body to her chest. Asel watches and relaxes back in her chair, grateful for even a moment of respite. She takes another bite of stew and savors the tastes and sounds of home.
Elly Fishman is a freelance writer and the author of “Refugee High: Coming of Age in America.” Manuel Martinez is a visual journalist at WBEZ.
Additional visual support was provided by WBEZ archivist Justine Tobiasz, Andjela Padejski and Mendy Kong. The project was edited by Cassie Walker Burke and fact-checked by Molly Morrow. Audio files, which were provided by the mothers, were engineered by J. Kyle White-Sullivan.