Friday, June 15, 2012

Maternity Homes: Reverse Morbidity with Hope

This is the presentation I gave at the Research Summit of the International Institute for Bioethics and Patient Care Advancement, modified slightly for this venue.

I am currently involved in the preliminary efforts to open a maternity home in my community and I would like to explain that I am taking that particular step because maternity homes are among the best remedies to the profound needs of special pockets of the female patient population—namely, racial minorities, adolescents, and the urban poor. (For the sake of brevity, I will only speak about a smaller group made up of adolescent women who are impoverished and among the country's larger racial minorities: non-Hispanic black and Hispanic.)

First, some numbers from 2009, the most recent year that the CDC provides birth and pregnancy rates. Of every 1000 women between ages 15 and 19 in this country, 39 give birth to a child. This number is not evenly distributed among the various racial groups in the US. Of 1000 Hispanic teens, 70 give birth; of blacks, 59 do; of whites, only 25.

Birth rates are not the same as pregnancy rates, since some pregnancies end in abortion or miscarriage. Pregnancy rates are not available for 2009, but if rates have remained relatively stable since 2005 (the latest year the CDC provides), then we can estimate even more distressing statistics: the differences between racial groups are even more pronounced, and the abortion ratios are probably also skewed, as high as 50% among black adolescents compared to maximums of 43% in whites and 36.5% among Hispanics.

Distressing numbers mirror distressing trends that anyone observes driving through inner cities. I am from a city of population 1.2 million, 23% of which is made up of residents below the poverty level in 2009. Growing up, I associated apartments, 75% of which are rented by individuals below the poverty line, with family problems, low education, crime, street drugs, teen pregnancy, and a cycle of poverty. (Find your city's data here.)

Credit: greenkozi
My casual observations are supported by public health studies, among them a 2008 study tracking families across three generations which found that low socioeconomic status predicts harsh parenting and behavioral problems in children. Moreover, a 2005 paper correlated neighborhood physical disorder (generally characterized by disrepair, low amount of greenery, etc) with crime and teen births in Pittsburgh. Everything in the environment of the urban poor—from the neighborhood to the relationships—points to what this 2005 study calls “a general sense of powerlessness.”

The effects of this personal and social depression touches OB/GYNs and other clinicians in prenatal clinics, emergency rooms, and labor and delivery wards. The morbidity directly tied with poverty and its effects is enormous. I looked at the list of delivery room morbidity from our lecture on the topic and crossed off the items not related to poverty. Some of the ones I was left with are obvious (hypertension, drug and alcohol abuse, history of previous infant with jaundice, respiratory distress, or anemia, poor fetal growth, etc), but I’ll highlight a few because of their prevalence or preventability:
  1. Incompetent cervix, linked with surgical abortions, which (as we have seen) are higher among minority groups.
  2. Abnormal position, often preventable with regular prenatal care.
  3. Infection, which (if not sexually transmitted) may be due to inadequate vaccination of the mother or (if sexually transmitted) an effect of inadequate gynecological care or poor sex education.
  4. Congenital malformations, the neural tube variety being tied directly to poor supplementation, perhaps resulting from poor prenatal care or unplanned or unwanted pregnancy.
  5. Maternal diabetes, causing macrosomia, leading to a large for gestational age infant with glucose imbalance. The baby’s size predisposes him to injury during childbirth, which can be serious; the glucose imbalance predisposes him to infection and jaundice.
So what can be done about this situation? My conclusions, unsurprisingly, echo what the weeklong IBPCA Distinguished Lecture Series has emphasized. Dr. Daniel Daly, referring to Cardinal Bernardin’s A Consistent Ethic of Life, emphasized that our duty to protect life extends to every moment of our fellow man’s time on this earth. Dr. Martha Shuping, Dr. John Bruchalski and Kristan Hawkins have emphasized the important of forming, deepening, and maintaining relationships to work with and for the vulnerable persons we want to protect.

I took this picture. The sky looks so hopeful...
In addition to IBPCA lecturers, independent research highlights the importance of relationships in a young girl's reproductive decisions. In 2011, family communication initiatives were shown to be very effective ways to delay first sexual intercourse; also in 2011, involvement of the fathers of babies carried by teens was found to improve fetal outcomes; and in 2006, home-based mentoring programs were proven effective in delaying second births among adolescent mothers. The relationships a young girl has with her parents, significant other, and mentors can help her flourish when they are marked by significant investment of time and care.

But when a girl finds herself pregnant without strong relationships, she needs help. She often find them in Pregnancy Resource Centers (PRCs), so well detailed in the Family Resource Council’s document A Passion to Serve: How Pregnancy Resource Centers Empower Women, Help Families and Strengthen Communities.

Another source of empowerment is maternity homes, housing establishments that offer help to women facing crisis pregnancy and homelessness. A 2005 report on maternity homes of the Department of Health and Human Services found that maternity homes across the country offer many services; this list makes clear that such homes undo or prevent the morbidities reviewed earlier. Especially note that they offer:
  1. Classes in parenting skills and life skills like banking—to mothers and fathers.
  2. Education: some maternity homes are also charter schools and can help young mothers complete their high school curriculum or earn a GED.
  3. Mental health services and case management, offering individual professional care.
  4. Referrals for substance abuse and prenatal care (and, in my experience of several homes, strict rules about making appointments and staying substance- and alcohol-free).
This important work can break this general, overwhelming powerlessness by investing in women and families, the time befitting their transcendent value.

I hope I have helped you to share my perspective on women’s health: I see parts of the female patient population that are vastly underserved. The morbidity that presents in the clinic cannot be treated without addressing the deeper effects of powerlessness—financial poverty, crime and violence, substance abuse, neighborhood safety, poor education, and family struggles. Maternity homes are a powerful tool to address these deep problems. They foster a sense of hope, found and strengthen relationships, and provide material, mental, social, and spiritual aid.


  1. Do the people who run these "maternity homes" help the mother of the child achieve a level such that she will be able to keep her child and let it have the privilege and right of growing up with it's own mother? Every child should have that right, and every woman should have the right to prove she can be a mother to her infant, rather than having someone "assume" she is unfit and take the infant from her before she even has a chance to prove them wrong. There are many of us still alive out here who are mothers from the baby scoop era and our children are still out here as well. Trust me, adoption is not the best for the child or the woman IF the woman wants to mother her own child. Please, I beg you, take that into consideration as you work toward having your "Maternity Home." Give life a chance, and by that I mean a life between the actual physical/biological mother of the unborn child and HER child (not the church's child or the maternity home's child) when he or she is born. Help them, don't tear them apart! No good is served by doing that. Many of us can attest to that, as we've been there and so have our kids. It's a tough road for everyone to walk and in our time it was about the only one our parents would drag us down ... but today it's not that way. So, again I beg you, do not willfully try to remove the child from a mother who wants to keep her own flesh and blood. May God help you do the right thing in each case.

    1. Dear Anonymous,
      Thank you for such an earnest and kind post. Please be assured that the type of organization I want to take part in does not force or coerce women to place their children for adoption. In my limited experience, most of the women choose to parent their child. In honesty, I don't have the depth of experience that you do with the baby scoop era, and so I didn't realize the phrase "maternity home" was associated with it. I am sorry if I caused alarm, and I am so grateful for your concern for women and their children. God bless you.

      (I am sorry this comment was so full of typos before I reposted it!)

  2. First, I commend you on a most compassionate approach to a problem thousands of us moms have experienced, but with sadder outcomes than the one I hope you're proposing. I'm excited about the possibility of adding your facility to my resource list of "good" maternity homes, should your plans materialize.

    You probably were surprised at the moving appeal by Anonymous to steer your proposed maternity home totally away from the 'option' of adoption. I would like to take that plea a step farther. You have an opportunity to provide a refuge for moms who, elsewhere and through countless 'pregnancy services,' are steered subtlety - or blatantly - into the adoption funnel. To understand this, I recommend this article, 'Shotgun Adoption,' by Kathryn Joyce:

    Along with children and the elderly, pregnant women are the most vulnerable people in our society. Often without resources or supportive guidance, they reach out for help anywhere they see an outstretched hand. Unfortunately, those who offer 'help' more than likely have an ulterior motive: obtain their precious babies to feed an insatiable market. Adoption, after all, is a multi-billion-dollar business, and babies are its most-sought product.

    As I write this, efforts are under way to rescue pregnant women who have been victimized by shark agencies or facilitators who offered housing and other services to them in their time of need. These brokers transport the mothers-to-be from their home states to states in which the mothers have the least amount of time after delivery to sign relinquishment papers and literally no revocation period. One mom was rescued just this past weekend.

    The Internet literally swarms with disenfranchised moms who have been 'helped' during problem pregnancies over past decades. The pain is excruciating and everlasting. Without exception these moms would have parented their own children if only there had been genuine, caring, supportive help available to them. Instead, their only 'choice' (which was never actually a choice) was adoptive placement.

    I am encouraged by the emergence of maternity homes that serve mothers and their babies together. I am particularly excited when I find a website for one that makes no mention anywhere of the "A" word. These homes take in and properly care for pregnant clients, help them through their deliveries, and provide extended services to help them and their babies get a good start in the outside world. Enabled to parent their own children, rather than facing life without them, moms have been given the incentive to better themselves through further education and healthier lifestyles. If you would like a list of the maternity homes I've found that feature this kind of care, just give the word!

    1. Dear Adoption Digger,
      Thank you for reading and for expressing your hope in this endeavor! I certainly hope to be among the "good" maternity homes. I can't agree more that pregnant women are very vulnerable, and I have no motive other than to help--to offer all that is good and allow them to make free choices.

      Ugh, I hate the idea of making money off of my fellow women; that is simply abusive. I'm touched by your words about the excruciating pain of forced "help." Please give me that list of good homes (my email is in the page footer).

      I read the article by Kathryn Joyce, and was really saddened that people could be so abusive. Coercion has no place in my plans.

  3. Another great approach would be to coordinate the efforts of people who genuinely do want to help pregnant women and single mothers, such that the mothers can obtain help without having to get it all from the government or a public or private institutional setting. It is pregnancy and motherhood, not schizophrenia or a tendency to serial murder. The only reason these women are seen as pathological is because WE as a society treat them that way--context is everything.

    There are existing resources. I'm not seeing enough effort made to expand them or to point mothers toward them. Please don't tell me that even if you're not going to push adoption, the only reason you're putting together this maternity home is so that you can create more Christians through desperation. Because that's not cool either. Conversion is supposed to be a personal choice and you are not going to get real Christians if you minister to the poor with food in one hand and a Bible in the other.

    Just saying. Most of these women are probably already Christian anyway, lapsed or not. But "charity" as a disguise for evangelical efforts makes me very, very itchy.

    1. Dear Dana,
      Collecting people who genuinely want to help is a great plan. As you said, we should really be treating these women with love and due dignity--they're not criminals or problems, and they shouldn't be treated that way.

      "Charity" as a disguise for evangelism makes me not only itchy, but angry. Rest assured that I understand that conversion is only valid when it is the choice of a completely free will.

      Thanks for reading and for leaving a comment displaying such love for others.