Preg­nant mom finds her way after home­less­ness

The Telegraph (Macon) - - Front Page - BY SAMAN­THA MAX [email protected]­con.com

Four months ago, Alas Wal­lace knew she needed to make a change. The 22-year-old was preg­nant with her fourth child, and she didn’t want to raise the new­born in her home­town of Jack­sonville, Flor­ida.

The city had too much his­tory – too many mem­o­ries she wanted to leave be­hind.

With a baby on the way and three tod­dlers in tow, Wal­lace packed up her be­long­ings and moved in with a cousin in Ma­con. By De­cem­ber, she’d left her cousin’s place and was stay­ing at a home­less shel­ter.

Wal­lace is one of many young par­ents across the coun­try who has ex­pe­ri­enced home­less­ness.

Young par­ent­hood af­fects home­less women at dis­pro­por­tion­ate rates. More than 40 per­cent of 18- to 25-year-old women who have ex­pe­ri­enced home­less­ness in the past year are ei­ther preg­nant or al­ready a par­ent, ac­cord­ing to a na­tional sur­vey by Voices of Youth Count, an or­ga­ni­za­tion that tracks youth home­less­ness.

The un­sta­ble liv­ing con­di­tions that ac­com­pany home­less­ness can pose health risks for preg­nant women and their chil­dren, es­pe­cially in a state like Ge­or­gia.

Ge­or­gia con­sis­tently falls to the bot­tom of na­tional rank­ings for ma­ter­nal and in­fant health care for its high mor­tal­ity rates and short­age of providers, es­pe­cially out­side of ma­jor metropoli­tan ar­eas. The state has the third-high­est ma­ter­nal mor­tal­ity rate, with 46 deaths for ev­ery 100,000 live births, and fifth-high­est in­fant mor­tal­ity rate, with nearly eight deaths per 100,000 live births, ac­cord­ing to Amer­ica’s Health Rank­ings’ 2018 re­port.

Bar­ri­ers to health care af­fect preg­nant women and in­fants across the state, from ru­ral towns to bustling ur­ban hubs. For preg­nant women ex­pe­ri­enc­ing home­less­ness, ac­cess to pre­na­tal and in­fant care can be par­tic­u­larly dif­fi­cult to reach.

“There’s a lot of room for im­prove­ment for how we pro­vide ser­vice,” said Dr. Keisha Callins, an OB-GYN who works with low-in­come pa­tients in Mid­dle Ge­or­gia.

‘I JUST NEEDED TO DO IT ON MY OWN’

Wal­lace spent most of her child­hood in fos­ter cus­tody, while her mother bat­tled se­vere schizophre­nia. Be­tween ages 8 and 19, Wal­lace passed through more fos­ter homes than she could count. She was still liv­ing in a group home when she be­came preg­nant with her first child.

Stud­ies have found that teens in the fos­ter sys­tem face higher preg­nancy rates than their coun­ter­parts not in state cus­tody.

As Wal­lace’s par­ents cy­cled in and out of her life, she strug­gled to trust them.

“I didn’t know how to cope with ev­ery­thing that I was go­ing through,” Wal­lace said. “It took me un­til I had got­ten older

and re­ceived a bunch of coun­sel­ing for me to un­der­stand ev­ery­thing that I was go­ing through.”

Wal­lace is still close with her par­ents, de­spite their years apart. But after liv­ing with rel­a­tives in Jack­sonville for the past few years, she de­cided she wanted a fresh start.

“I came to Ma­con to get away from ev­ery­thing and ev­ery­body, ’cause I just need to fo­cus,” she said. “I just needed to do it on my own.”

Far from the weight of her past, Wal­lace felt re­lieved. But her cousin’s home was small, and Wal­lace didn’t want to over­stay her wel­come.

Seven months preg­nant, Wal­lace sent her kids back to Flor­ida to stay with fam­ily for the hol­i­days, then moved her­self into the Sal­va­tion Army women’s shel­ter. It wouldn’t be a long stay, she told her­self. Just enough time to find a steady job and a stable home.

With help from the shel­ter’s di­rec­tor of so­cial ser­vices, Naomi Lad­son, Wal­lace set goals for her­self and checked them off one by one.

After a month at the Sal­va­tion Army, Wal­lace se­cured a ware­house job that paid $14.95 an hour and a three-bed­room, two-bath­room mo­bile home in south Ma­con.

Be­fore com­ing to the Sal­va­tion Army, Wal­lace had strug­gled to get by on her own.

Preg­nant women who meet cer­tain in­come re­quire­ments qual­ify for Med­i­caid, but it took Wal­lace al­most three months to get cov­er­age. Med­i­caid can bill retroac­tively for up to three months of care re­ceived be­fore cov­er­age kicks in, but in the mean­time, Wal­lace had to pay for all of her pre­na­tal care out of pocket.

She said she spent be­tween $200 and $350 in co­pays for each doc­tor’s ap­point­ment, and also had to bud­get in the cost of vi­ta­mins and pre­scrip­tions, all on a lim­ited in­come. At the start of her preg­nancy, Wal­lace had ap­point­ments ev­ery week. The bills quickly added up.

“It got frus­trat­ing,” she said.

The young mother was de­ter­mined to get the care her baby needed, though, even if she had to set aside ev­ery last dol­lar from her pay­check.

BAR­RI­ERS TO CARE

Callins, the Ma­con OB-GYN, knows how dif­fi­cult it can be for women ex­pe­ri­enc­ing home­less­ness to ac­cess pre­na­tal and post­na­tal care. The doc­tor prac­tices at Com­mu­nity Health Care Sys­tems, a fed­er­ally qual­i­fied health cen­ter that re­ceives fund­ing from the fed­eral gov­ern­ment to treat low-in­come and un­der­served pa­tients.

Many of Callins’ pa­tients strug­gle to find trans­porta­tion to their ap­point­ments or have rigid work sched­ules that limit their avail­abil­ity.

Home­less­ness adds a new level of bar­ri­ers to women’s health care be­yond what other low­in­come women may face, she said. Pa­tients ex­pe­ri­enc­ing home­less­ness of­ten hes­i­tate to share in­for­ma­tion about their hous­ing sit­u­a­tion with their doc­tor fear­ing judg­ment.

It’s up to the physi­cian to ask the right ques­tions and pick up on sub­tle cues to en­sure the pa­tient can ac­cess the help she needs, Callins said. Oth­er­wise, women can fall through the cracks.

Pre­na­tal care fol­lows a strict sched­ule, with more than a dozen ap­point­ments to track the baby’s process over the course of the preg­nancy. With­out a re­li­able phone num­ber or ad­dress, it can be hard to get in con­tact with pa­tients and re­mind them about up­com­ing ap­point­ments, Callins said.

She once lost touch with a pa­tient for two months.

After fall­ing out with her fam­ily, the pa­tient had nowhere to go and spent her nights in a struc­ture with no run­ning wa­ter or elec­tric­ity. The pa­tient came to see Callins sev­eral months into her preg­nancy, then dis­ap­peared.

Only when she was ar­rested and in­car­cer­ated for a mi­nor steal­ing of­fense could the doc­tor give her pa­tient the con­sis­tent treat­ment she needed.

“I think that is the first time where home­less­ness re­ally slapped me in the face,” Callins said. She felt con­flicted. “I would never wish in­car­cer­a­tion on any­one, but I didn’t have an­other re­li­able way for me to be able to take care of her.”

Once the pa­tient was re­leased, Callins said she dis­ap­peared yet again.

Callins and a team of so­cial work­ers vis­ited shel­ters around Al­bany, where she was work­ing at the time, with no luck. Night­mares about the pa­tient and her baby kept the doc­tor awake at night for three weeks.

When the pa­tient checked into the hos­pi­tal

‘‘

I HAVE PEO­PLE WHO SHOULD HAVE COME IN WHO WERE IN PRETERM LA­BOR AND DIDN’T KNOW THAT IT’S NOT NOR­MAL FOR YOU TO NOT FEEL YOUR BABY MOVE OR NOT NOR­MAL FOR YOU TO HAVE THAT ED­U­CA­TION, WHICH COULD COME FROM REG­U­LAR PRE­NA­TAL CARE, REG­U­LAR IN­TER­AC­TIONS WITH YOUR PROVIDER. WHO COULD SAY, ‘OK, IF THIS HAP­PENS, THEN DO THIS …’

Dr. Keisha Callins, OB-GYN

one day, think­ing she might be in la­bor, Callins was over­come with re­lief.

“I was like, ‘Even if she’s not in la­bor, I’m keep­ing her un­til we de­liver this baby,’ ” she said.

The doc­tor knew her pa­tient had mis­car­ried be­fore, and she didn’t want her to lose an­other baby.

“I did feel like I had to show ex­tra care and con­cern, and, you know, try to get her to re­al­ize that de­spite her sit­u­a­tion, we were gonna get through this,” she said.

After months of lost sleep, Callins de­liv­ered a healthy baby for the pa­tient.

The story had a happy end­ing, but it opened the OB-GYN’s eyes to the many gaps in preg­nancy care for home­less pa­tients. And those gaps can have dire con­se­quences.

If pa­tients can’t come in for reg­u­lar ap­point­ments, Callins said, doc­tors miss im­por­tant mile­stones that war­rant screen­ings and tests. It also can be dif­fi­cult to pro­vide fol­low-up care if prob­lems in the preg­nancy arise.

“Not hav­ing a stable place does re­ally im­pact the care that they re­ceive, the care they can ac­cess,” she said.

An up­dated ap­proach to pre­na­tal care could bet­ter serve such a vul­ner­a­ble pa­tient pop­ula- tion, she said.

The key is in­creased ed­u­ca­tion, she said.

“I have peo­ple who should have come in who were in preterm la­bor and didn’t know that it’s not nor­mal for you to not feel your baby move or not nor­mal for you to have that ed­u­ca­tion, which could come from reg­u­lar pre­na­tal care, reg­u­lar in­ter­ac­tions with your provider who could say, ‘OK, if this hap­pens, then do this. If this hap­pens, call me. If this hap­pens, go to the hos­pi­tal,’ ” the doc­tor said.

Women aren’t al­ways aware of the free and af­ford­able re­sources read­ily avail­able in the com­mu­nity. Most pre­na­tal and post­na­tal health care needs can be met at the lo­cal health depart­ment, said Judy McChar­gue, dis­trict im­mu­niza­tion co­or­di­na­tor and in­terim county nurse man­ager for the North Cen­tral Health Dis­trict.

The Ma­con-Bibb County Health Depart­ment has its own pre­na­tal clinic, which of­fers preg­nancy test­ing, pre­na­tal ed­u­ca­tion, well-checks and other sup­port ser­vices for ex­pect­ing moth­ers. The health depart­ment also pro­vides pre­na­tal vi­ta­mins and pre­scrip­tions, which can im­prove health out­comes for moth­ers and ba­bies.

But if women don’t know those ser­vices ex­ist, Callins said, they risk worse out­comes.

“We have the re­sources, but we have to help peo­ple uti­lize the avail­able re­sources,” she said. “And we are lack­ing in how we en­cour­age uti­liza­tion.”

A FIRST STEP

After more than a decade in fos­ter care and three years bounc­ing be­tween rel­a­tives’ homes and the Sal­va­tion Army, Wal­lace is ready to start a new chap­ter. The young mother just moved into her first home, in a small mo­bile home park off Hawkinsville Road.

It’s not a for­ever home, but it’s a first step, she said.

Wal­lace moved in just after New Year’s, and she’s hop­ing to get ev­ery­thing set up be­fore the baby is born in Fe­bru­ary. Her three other young ones have al­ready filled their be­d­rooms with col­or­ful pic­ture books and fuzzy stuffed an­i­mals.

Wal­lace said she loves how quiet the area is, and she’s happy to have a bit of ex­tra space to her­self. She also is re­lieved she no longer has to wait out­side in the cold all day, like she did when she was stay­ing at the shel­ter.

“This new home is the start of ba­si­cally a new be­gin­ning for all of us – for me and my kids,” she said. “And I know it’s not go­ing to be the most fan­ci­est home, be­cause it’s our start-off home for the time be­ing. And then, from there, I’m just go­ing to keep work­ing my way up.”

BEAU CA­BELL bca­[email protected]­con.com

Alas Wal­lace, who moved to Ma­con from Jack­sonville, Fla., stands on the doorstep of her Bibb County home with her three chil­dren.

Alas Wal­lace moved to Ma­con for a fresh start, and says she's happy in her south Bibb County home with her three tod­dlers. She is ex­pect­ing her fourth child soon.

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