Across Alabama, there are at least 55,000 babies born each year.

But a safe and healthy birth – which not everyone gets – is just the start of raising a child. Many Alabama moms say that difficulties that can come after birth – from breastfeeding, to depression, to figuring out child care – make it tough to support their families.

“I can tell you every single moment of my wedding day,” said Krista Paul, a mom from Madison, Alabama. “I can’t remember how I felt the first three or four months of having a baby. I was exhausted.”

Paul had a smooth birth experience, but struggled when she went back to work and wanted to breastfeed her son.

Paul needed to pump at work since she wasn’t at home with him during the day. She was able to pump for 15 minutes in the morning and afternoon, as well as during her 30-minute lunch break.

“I had to be so freaking efficient,” Paul said, noting that it was virtually impossible to eat during her lunch break because she needed the time to pump.

Paul said her employer made accommodations – they cleared out a room that wasn’t in use for her to pump in without interruption and allowed her to store milk in the fridge. But by the time she set the pump up, Paul said she didn’t have enough time and, despite showing up to work early and trying a wearable pump, she couldn’t get enough milk to feed her son.

To supplement, Paul started using different types of formula, including soy and dairy-free options, but all of them hurt her son’s stomach.

“He was having horrible stomach issues, just hours and hours of screaming,” Paul said. “He was on reflux medications. He was having to take a probiotic every day.”

Paul said getting everything in her life done was impossible with a full-time job. She said she was so tired, she can hardly remember what feelings she was having when she looks back on that time.

Eventually, Paul quit her job. While she said it wasn’t something she necessarily wanted to do, she said she was excited to stay home with her son. Still, she said that, although she cherishes time with him, there are times she wonders if things might have been different if she’d had 20 more minutes at a time to pump.

“Maybe I still would have had to quit my job, but maybe I wouldn’t have. Maybe I would have had just enough milk for him to be okay,” Paul said.

Anjanette Robinson, a licensed professional counselor supervisor and certified doula in Birmingham, said challenges and barriers look different to every mom in the state.

“If you ask 10 different people, you’ll get 10 different answers – but all of them are correct,” Robinson said of challenges moms in Alabama might face.

Robinson has been working to expand support options for new moms and birthing folks for years. She’s led support groups, worked on grant-funded pop-up clinics in low-resource areas and advocated for doula training to be included as a continuing education unit for counselors who are seeking licensure.

“Good maternal health care exists in Alabama,” she said. “You have to find it, and hopefully one day we won’t have to go searching for it – it’ll just be right there.”

Robinson had her daughter 21 years ago, and said she struggled with postpartum depression and anxiety, but wasn’t aware of helpful resources.

After working at a mental health agency for more than 20 years, Robinson moved to a private practice. Six years ago, she picked up a doula brochure.

“As a therapist, when you’re looking for services and there’s nothing, the first thing you think is ‘Maybe I should create that,’” she said.

When she read the doula brochure, Robinson said she thought of all the things that would have been impactful and helpful when she was dealing with postpartum depression and anxiety.

She said doula training “fed her spirit” and motivated her.

Now, she works with many clients who come to her for help with their own postpartum depression and anxiety. She’s also the only therapist at her practice who both has experience in maternal mental health and accepts Medicaid.

Robinson said three of the improvements Alabama can make to help support moms in the state are making trauma-informed care training available to all OB-GYNs in the state, offering specialized support groups for various struggles new parents may face and promoting doulas and midwifery care at the state level.

As a doula, Robinson said it’s important to her to help empower patients to advocate for themselves.

Sometimes, that means reminding a mom about preferences she’s expressed when a nurse or doctor is asking her to do something different.

Robinson said that she may also pick up on certain atmospheres in hospitals because of her own experiences as a Black woman who has given birth in Alabama.

Nationally, Black women are far more likely to die during or after a pregnancy than white women. In 2021, Black women died at a rate of 69.9 deaths per 100,000 live births, while the rate for white women was 26.6. In Alabama, Black babies also die at twice the rate white babies do.

“I understand the complexity that comes with the fear that a lot of Black women have, because they’re more aware now of the maternal and infant mortality rate. They want to make sure they survive a birth, where maybe someone who’s not Black may just want to have a good birth, have good memories,” Robinson said. “As a doula, while I can advocate for them in that space, I try to teach or help develop a sense of empowerment for any client that I’ve ever served, so that they can advocate for themselves.”

Many moms say that after the birth of their child, challenges like access to quality health insurance and guaranteed paid time off can make it difficult to support their family.

Allison Anderson, a mom from Huntsville, said she had a wonderful birth experience.

Then, two months after her son was born, her husband’s employer switched insurance providers. Suddenly, Anderson and her husband were paying $800 each month for their insurance, which she said covers nothing.

“I feel like we’re getting bills in the mail left and right from just every doctor appointment, and insurance is not covering anything anymore,” she said.

She tried to apply for Medicaid for herself and her son, but said she was rejected because her husband made too much money.

She said she’d like to have a second baby, but her preferred OB-GYN does not accept their new insurance.

Before finding the doctor that delivered her baby, Anderson said she remembers speaking to an OB-GYN that she’d picked out based on certain health needs. When she told him she wanted to have a natural, unmedicated birth, Anderson said he laughed in her face.

“He was like, ‘Good luck with that. We’ll see how that goes.’ And I looked at my husband, and he could see tears coming down my face,” she said. “We walked out of that doctor’s office, and I was like, ‘I need a new doctor.’”

Anderson got pregnant two months into starting a new job. She didn’t have the tenure to take full maternity leave, so she pieced together short-term disability and FMLA leave.

But when it came time for her to return to work, her son wouldn’t take a bottle.

Anderson spoke to her doctor and ended up taking two months of unpaid leave. She said she spoke with her leadership and thought she had everything in place, but when she prepared to return to work, she was told her position had been filled. Because she had used up all of her federally-protected leave, her job did not have to take her back.

Since then, Anderson said she’s been looking for a job, but called it a “waiting game.”

She said she’s learned to be frugal, and she and her husband cook at home in place of date nights because they can’t afford to go out.

“We’ve talked about this so many times – all of our money goes to groceries and insurance. That’s where all of our money goes,” Anderson said.

Sarah Swetlik is a gender and politics reporter at AL.com. She is supported through a partnership with Report for America. Contribute to support the team here.