Christina Castellano, pictured here with her four daughters, recently earned her PhD from UMSL’s College of Nursing and will join the faculty this fall. Her dissertation examined how empowerment and social support impact the postpartum experience for low-income mothers living in rural areas. (Photo courtesy of Christina Castellano)

As soon as Christina Castellano became a mother, she knew she wanted to help others dealing with the mental health issues many women face during pregnancy and postpartum.

“Once I started having kids, I struggled postpartum with my first and then even more so with my second,” she said. “Knowing that, after I got to a place where I felt kind of back to baseline, I wanted to help others. I have a strong affinity toward those moms and I knew I wanted to help moms in that capacity.”

Castellano – now the mother of four girls between the ages of 18 months and 6 years old – quickly began looking into support groups and other resources for moms. She became a peer mentor and group facilitator for MOMS Line, a free telephone support service for pregnant and new moms in the St. Louis region through SSM Health St. Mary’s Hospital, and also got involved as a peer mentor with Postpartum Support International.

That interest in helping fellow moms eventually led Castellano to the College of Nursing at the University of Missouri–St. Louis, where she recently earned her PhD. For her dissertation, she examined how empowerment and social support impact the postpartum experience for low-income mothers living in rural areas. But Castellano didn’t have the straightest path to UMSL.

A desire to help and educate

In 2010, Castellano graduated with a BA in psychology and theology from Saint Louis University and, knowing she wanted to help others, soon after started pursuing her master’s in social work. Yet about a year into working with young kids in the foster system, she recognized that she had grown too attached and decided to leave the program. After a period of self-described soul-searching, she started an accelerated nursing program through the Goldfarb School of Nursing at Barnes-Jewish College in 2013.

“I knew a lot of nurses at that time, and my aunt was a nurse and my grandmother was a nurse,” Castellano said. “And I think with my background of wanting to help and educate, it provided a good starting off point, knowing that there were a lot of avenues I could lean into.”

After earning her BS in nursing the next year, Castellano began working on the floor as an inpatient nurse in gynecologic oncology, handling cases dealing with ectopic pregnancies, benign hysterectomies and other issues. In 2016, she became the educator for that unit, educating and onboarding new nurses, and later moved to labor and delivery. Working in those environments helped solidify her love of teaching.

“On the GYN oncology floor, we were also, to a lot of our patients, in-patient/hospice,” she said. “So a lot of it is symptom management, and besides the nursing care, I would say about 75% was educating patients and family members on palliative care, hospice and then managing their symptoms at home and in the hospital. We had so many repeat patients, so we got a really good idea of these patients’ trajectories and we got to know them. I took a step back to see what part of the nursing care that I enjoyed the most and it was the psychosocial education aspect of how patients can empower and help themselves.”

Thinking like a researcher

Castellano soon decided to extend her education, starting on the Doctor of Nursing Practice track in UMSL’s College of Nursing in 2018. Yet after about a year, she realized it wasn’t a great fit, as she knew she did not want to practice as an NP. After conversations with faculty member Anne Fish and dean Roxanne Vandermause, she decided to switch over to the PhD program.

“Thinking like an NP is totally different than thinking like a researcher because it’s such a holistic degree,” Castellano said. “By that, I mean that you spend a lot of time analyzing theory, not just research. At that point, I had two daughters and was pregnant with my third, and I had a very passionate background for women’s health. So everything I did was geared towards women’s health, whether it be antepartum, postpartum or perinatal. I really was kind of engulfed in that process, applying everything I was doing in the PhD program to that population.”

Castellano said she narrowed the scope of her dissertation, “The Motherhood Crusade: Rural Low-Income Mothers, Support, and Empowerment”, after noticing a gap in the existing literature.

“Once you start to go into the literature, there’s a lot about low-income countries and how they struggle with maternal mortality and morbidity, but not a whole lot about low-income women specific to the United States,” she said. “Our maternal mortality rates are increasing instead of decreasing – we have some of the worst in the world – but there’s not a lot of research on low-income women or on rural culture. I did not grow up in a rural county, so I knew that was going to be challenging, but I also thought that these voices needed to be heard.”

For her study, Castellano traveled to several rural counties surrounding St. Louis and conducted semi-structured interviews with 18 low-income women living in those communities. Of the 18 moms she spoke with, 16 identified as Black and half were immigrants from other countries.

“I think she had some really great methods,” said Castellano’s dissertation chair, Assistant Professor Julie Bertram. “She actually went to rural communities and described what she saw and also interviewed people individually. I think we could probably learn other ways of gathering information. I know she has ideas for advancing the work by linking immigrant women from the city with immigrant women in the rural areas to see how they might be able to help each other. And that was a new idea that only came out of actually getting into the field and kind of learning from these women what was needed. She was able to develop a substantive theory from her dissertation. I don’t think she was expecting that she was going to be able to do that, but she has a willingness and an openness that I think allowed for her to make that happen.”

Castellano’s study was grounded in empowerment theory, and her interviews with the participating moms examined how resourcefulness in the forms of agency and peer support can lead to notions of contented mothering.

“The hot-button word that goes with empowerment is agency,” Castellano said. “Moms have to feel like they have control over their life circumstances and what they can do and have the ability to do. What moms talked about was not just agency but safe cultural context, which lays the foundation for how moms experience agency.

“The other big thing that moms talked about was empowerment. When do you reach empowerment? Moms talked about it never really being a point in time because just when you think you have it, the child grows or your body shifts or you get pregnant again. So there’s this constant cycle of moms just wanting to achieve a way of contented mothering. Moms also really want peer bonds that would follow them on their journey. These were low-income moms, so they put their peer relationships as their number-one priority above monetary resources or above health, and that was surprising to me.”

As part of her study, Castellano connected the moms participating in the project with resources for peer support through groups such as Postpartum Support International and Strength Through Story, which focuses on healing through writing and creative community. Through her own volunteer work, she’s witnessed the transformative power of peer support in helping moms navigate through different issues.

“A lot of moms want to be told, ‘Yes, this is normal’ or ‘No, this isn’t normal,’” Castellano said. “And I think other moms can do that. What I have found in my work as a peer mentor and peer group facilitator is that moms want to hear from other moms more than anything. If we have two moms in a group, they’ll figure it out together. They don’t need me to say anything; they just talk it through together.”

Bertram said Castellano’s own experience volunteering with MOMS Line and PSI put her in a unique position to explore these issues through an analytical lens.

“She has done a lot of volunteer work and committee work as a PhD student, where she kind of uses her passion for helping other women to gain support and empowerment around mental health issues that might come up as a result of childbearing,” Bertram said. “She was really looking to grow scholarship around that issue. She was very service-oriented throughout her time as a PhD student, looking for ways that she could help. And she was kind of merging her research interests with a commitment to service. She seemed like she was looking for opportunities to grow but then also help other PhD students – or really students at any level – to reach their goals. And I think, by getting involved, she was helping herself too.”

Going forward, Castellano plans to continue her research and further connect the moms participating in the study with resources such as MOMS Line and PSI. She also hopes to help foster connections between moms, particularly urban immigrant mothers and rural immigrant mothers, through Facebook and Whatsapp groups and Zoom meetings. She’s already put a few calls out to gauge the interest moms would have in these resources. She’d also like to connect with The Matrescence, a Kansas City-based members-only digital community that offers science-backed resources, guides and wellness support for those navigating the motherhood journey, to see what they can learn from each other.

In June, she’ll be presenting this research for both PSI and the National Alliance on Mental Illness. And starting in August, Castellano – who previously served as an adjunct instructor in UMSL’s College of Nursing – will join the faculty as an assistant teaching professor, teaching a few undergraduate courses on mental health, communication for healthcare professionals and care for dying patients.

Bertram believes Castellano’s research focus, and particularly, what she’s come to learn about the importance of peer support, will make her particularly effective as an educator in the College of Nursing.

“I think she’s going to be able to help students develop peer support networks, because she was finding that is a mechanism for postpartum women, but it’s probably also a mechanism for a variety of life challenges,” Bertram said. “If you can find peer support – not necessarily pay for professional help, but if you can find allyship by finding people that are on an equal status who are looking to grow – that’s a way to move forward towards your goal.

“I’m excited to see how she brings that into the job. I think that she’ll bring some new energy and life into it because she’s at a different stage in her career, and that’s exactly what we want is for students to take ownership of these research projects and then influence a new generation through what they’ve discovered.”