After Elena gave birth prematurely in early January, her infant daughter needed to stay in the hospital for care.
But Elena, whose asylum case is still pending, was too fearful to travel to and from the hospital. She worried she might encounter U.S. Immigration and Customs Enforcement (ICE) agents and be detained.
So she stayed in the hospital at her baby’s side for 13 days while she tried to recover from her C-section. Her husband stayed at home with their older daughter. Elena said she got little rest during that time, and worried constantly about her family.
“It was absolutely overwhelming, I just cried all the time,” she said in Spanish through an interpreter. “All I did was cry.”
Sahan Journal is not publishing Elena’s name due to her immigration status.
Health care providers in Minnesota say many patients, like Elena, who have recently given birth or are pregnant, are being impacted by Operation Metro Surge. Providers say many patients are fearful to come in for care for themselves and their babies over worries they might encounter ICE agents. Some aren’t coming in for care at all and prefer to give birth at home.
“Patients … are trying to figure out, how do I keep myself and my baby safe?” said Dr. Erin Stevens, a local ob-gyn.“No one should have to go through that.”
Getting to and from doctors appointments was an ordeal, as Elena coordinated rides from trusted community members. Because her baby was born prematurely, she needed frequent doctor visits to check on her health and weight.
“I was always full of fear,” she said.
Elena moved her own care to telehealth, showing her providers her C-section incision via a video call to make sure it was healing. Her nurse-midwife has also been able to come to her home for some visits.
“I feel very grateful to God for taking care of my family and me at this time,” she said.
Low patient volumes
Stevens works at a local hospital and sees patients when they are going into labor and giving birth. She said the triage area at the hospital has had fewer than usual patients. She said she’s heard from other providers that patients have not been showing up for prenatal care appointments or have asked if they can get care virtually since Operation Metro Surge began.
While some patients may elect to delay or put off care until the ICE presence concludes, Stevens told Sahan Journal that pregnancy has a much stricter timeline.
“It’s not something that you can just say, ‘Well, I’ll do that appointment when all of this is over,’ because you may not have a baby in your belly by the time this is over,” she said.
An ob-gyn based in the Twin Cities, who did not want to be named over fears of disciplinary action from her employer, said she’s seen a significant increase, especially among Spanish-speaking patients, of people not coming in for appointments since late last year.
“Patients tell us they’re afraid to come to the hospital, and when they do come, they say, ‘This is the first time I’ve been out,’” she said.
She said she’s also heard of patients skipping their prenatal visits and then facing complications when they give birth. In one example, her patient’s baby was breech, which required a C-section.
“It’s so inhumane,” she said. “I just feel like our pregnant patients are sort of the unseen collateral damage of all of this.”
She added that some patients are having to decide who should care for their newborn baby in the event they get detained by ICE.
Dr. Chelsea Thibodeau, a family physician who provides obstetric care in Minneapolis, said patient volumes significantly dropped off after Renee Mackin Good was killed by an ICE agent in January. She said when patients do come in for ultrasounds, providers try to screen for complications and do lab work if patients aren’t coming in as frequently for visits.
She said delaying or avoiding care can have severe consequences, in the short and long term, for both mother and baby.
“Not having your health problems identified and addressed while you’re pregnant can affect the health of your baby, and some of those can be potentially irreversible or lead to longer consequences than just the health of the pregnant person in that moment,” she said.
Even though some ICE agents have reportedly left the state, Thibodeau said the anxiety surrounding coming in for care has remained.
A nurse-midwife who works in St. Paul, who did not want to be named to protect her patients, said patients have been dealing with increased stress and anxiety, which can lead to pregnancy complications like high blood pressure, gestational diabetes, preterm births and babies with low birth weight.
Regular prenatal checkups can catch some of those conditions, she said, but many women are forgoing those appointments out of fear.
“The challenge isn’t just, how do we get someone to get their prenatal care? The challenge is, how do we actually care for someone in pregnancy when they’re too afraid to even leave their home or to sleep or eat,” she said.
After giving birth, the fear of encountering ICE agents continues. One patient told the nurse-midwife that when ICE is outside her home, she hides in the bathroom with her infant.
Munira Maalimisaq, a nurse practitioner who leads Inspire Change Clinic in Minneapolis, said more patients are asking if they can have a home birth. She and other providers try to do home care visits when possible and help arrange for prescription medications to be delivered to patients.
Munira said she noticed more patients wanting to come to her smaller community clinic for care versus a large hospital, as there have been reports of ICE agents being present at Twin Cities hospitals.
“They felt more comfortable doing home visits, felt safer to have a baby by themselves, literally, than going in or driving there,” she said.
While home births may work for some, they can be risky, and are often not the best choice for those with serious conditions. Situations can evolve rapidly, and sometimes an emergency C-section is needed.
“You can’t be 100% prepared for everything that can happen at home,” Stevens said.
While some pregnancy care can be treated virtually through telehealth, many appointments cannot, said Rachael McGraw, women’s health consultant with the Minnesota Department of Health. Care such as ultrasounds, checking the baby’s heartbeat and measuring the mother’s uterus to ensure the baby is growing need to be done in person, she said.
“It’s better than no care, right?” McGraw said of telehealth options. “We don’t want someone to be in a position of getting no care, but either a combination, or being able to visit in-person is going to be best.”
Newborn check-ups also affected
Beyond prenatal visits and births, patients’ hesitancy to come in for medical care is also carrying over into pediatric visits.
Dr. Razaan Byrne, a pediatrician at Children’s Minnesota, said some parents have been anxious to bring their child in for care. She said some patients are inquiring about at-home care. Byrne said that is sometimes possible, but for services like vaccinations, it’s not. She said sometimes insurance won’t cover at-home visits.
“Even though equitable care is offered, there are things outside of our clinic’s control about whether or not that is something for each individual family,” she said.
Newborns need frequent visits in their first days, weeks and months of life, Byrne said. Parents of newborns can struggle to spot symptoms that need medical attention.
“There’s a lot of checks and balances in those first few days, working with the pediatrician to make sure that babies are continuing to thrive,” Byrne said.
Munira said her clinic staff is doing what they can to help mothers in need. Once a week, she and others assemble packages for new mothers with products such as diapers, baby formula and thermometers. Supplies are also assembled to help the mothers, such as pads and nipple cream.
“I don’t even know if they are citizens or not citizens or whatever. It’s just us caring for human beings,” she said. “It’s just someone who’s in need of health care, and we’re providing that however we can.”
Living in fear with a newborn
When Elena was able to return home from the hospital with her baby, she and her husband sheltered in their Eagan apartment. Her husband didn’t go to work. Eventually, he went to Wisconsin and stayed there for two weeks working as a rideshare driver so they could pay rent on their apartment and afford groceries. Elena stayed at home with her baby and older daughter.
“I was stuck here in the house, all alone,” she said.
Now her husband is back in Minnesota and going to work. The family still fears being detained by ICE, even after federal authorities claim that Operation Metro Surge is coming to an end. She and her husband are from Venezuela, and have open asylum cases and work authorization, but worry that’s not enough protection from ICE. She said she and her husband know people with their immigration status who have been detained.
Elena said she stays on the phone with her husband when he drives to work, to make sure he gets there safely. She worries constantly about what would happen if he is detained, which would leave her alone with their two daughters.
“If something happens to him, I’d be all alone. I’m afraid to go to the supermarket, to the grocery store. I’m afraid to go anywhere,” she said. “I still feel a lot of fear, and I won’t feel any different until [ICE agents are] all gone.”
