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Helping homeless pregnant women: A lesson in hope

By: Joellen W. Hawkins, PhD, RNC, FAAN

For several years, I taught a prenatal class in the pregnancy program at a homeless shelter in Boston. To stay in the program, each woman had to be enrolled in prenatal care, keep her appointments, follow the program and shelter rules, and take care of herself—for instance, by staying off drugs and alcohol. Some had jobs or were enrolled in job training or GED programs; some were even attending college.The experience proved to be a lesson in hope and gave me a new appreciation of the strength of the human spirit. Here are some of the women’s stories (with all names changed).

Demaris, age 19, struggles with English, furrowing her brow and concentrating on the question she wants to ask. “When babies are still inside you, when can they first hear?” Putting both hands on her pregnant belly, she looks thoughtful.

Ruth, age 35, wonders if she’s too old to be having a child—but this is her third, so perhaps it’s okay. In soft, hesitant English, she talks of Kenya, where she was born, and having babies there. But hers were born here, at the city hospital. She reads voraciously, pausing to record questions and other information in the notebook she always carries. She says she reads all the time, and she wonders if this will help her baby be a good student.

The women give full attention to the birth video, oohing and aahing as each baby emerges. Tears make their eyes shiny as they exclaim over each newborn and comment on the labor or birth scene. Their favorite film shows several water births in whirlpool baths at home or in a birthing center.

When I offer to take their pictures, they proudly bare their pregnant bellies and pose. Some laugh about how their tattoos are stretching out. Having a pictorial record of the pregnancy helps them feel more like other pregnant women—women who don’t live in homeless shelters.

Occasionally, a program graduate returns to the shelter with her baby on prenatal class day to share her pride and joy. Graduates also talk about their experiences living in family shelters and finding housing with a friend or family member. (The shelter doesn’t allow children; the program coordinator helps the women find housing.) Each woman truly believes this baby will change her life and she will leave homelessness behind.

Leila has two children—both in Department of Social Services custody. She’s optimistic she’ll be able to keep this baby, find an apartment, and get her other children back. She visits them every 2 weeks and promises they’ll be home with her soon. The oldest, age 12, plans to attend the birth of his new sibling.

Laura shares her previous labor and delivery experiences, presenting herself as an expert for women who are pregnant for the first time. She’s streetwise and tough. Her posture sends the message she’s not one to be “messed” with. Several times, she has been thrown out of shelters or programs for starting fights. But pregnancy seems to have made her more serene, and she talks of getting her own place.

Early on Christmas morning, Sarah goes into labor. After walking five blocks from the shelter to the hospital, she delivers a baby girl, her third child. She names her Merry. Excited about the family program she’ll be discharged to, she believes Merry will mark a new beginning for her. Normally shy and withdrawn, Sarah glows in the aftermath of the birth. Will she make it this time?

Caring for pregnant women who are homeless, whether by choice or circumstance, is a privilege few healthcare professionals have. We learn a new lesson in hope almost daily. Hope wears the garments of homelessness and comes in all colors, ages, and backgrounds. To receive these messages of hope, I listen, observe, and learn.

Joellen W. Hawkins, PhD, RNC, FAAN, is a Professor at the William F. Connell School of Nursing at Boston College, and a Women’s Health Nurse Practitioner at the Sidney Borum, Jr. Community Health Center in Boston, Mass.

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