HOMELESS AND PREGNANT, WOMEN AFRAID TO SEEK CARE

Think Babies Will Be Seized By Children's Services

EDMONTON - The office of Edmonton's needle-exchange program on some
days looks like a prenatal clinic, with mothers taking naps, putting
up swollen feet or waiting for rides to medical appointments.

For 28-year-old Bridgette Harding, the comfy, worn-out chairs are a
lifesaver. She's homeless, eight months pregnant and a crack cocaine
user staying at the Hope Mission. She would be wandering the streets
from 7 a.m. until 8:30 p.m. without adequate medical care if not for a
pilot project running out of the Streetworks office.

Using $95,000 from the Public Health Agency of Canada, a part-time
nurse and two street-smart outreach workers find homeless, pregnant
women. They help them get medical care and test them for syphilis to
prevent the sexually transmitted disease from making their babies sick.

Since 2005, Alberta has seen 14 cases of congenital syphilis -- babies
who acquired the infection in the womb. Five infants died and nine
require long-term follow-up care. Most of the mothers didn't seek
medical care, partly because they didn't trust the health-care system
and were scared their babies would be seized by Children's Services.

Dr. Ameeta Singh, who was the infectious disease medical consultant
for Alberta Health and Wellness until her contract wasn't renewed
earlier this year, began working with Marliss Taylor, program manager
for Streetworks, to fill that gap in care.

"We're not a prenatal agency," Taylor said, noting her agency has more
expertise in preventing the spread of HIV and hepatitis than it does
syphilis.

"We're the needle-exchange program, but we work with the crowd that
this was affecting, those that are involved in drug use, those who are
involved in the sex trade, so we decided to do a project."

They hired two outreach workers to scour downtown, hop on buses along
118th Avenue and head out to places such as Kindred House and Hope
Mission to find pregnant women who hadn't seen doctors.

They thought they would find 15 women with growing bellies. They've
found 50, including one Taylor almost tripped over outside, crying
after her husband's family kicked her out, saying she had cursed them.

Five or six of the mothers have tested positive for syphilis. Some
were disease-free, but carried antibodies from previous infections.
Others needed vital antibiotic treatments that stop further damage to
the infant by preventing the virus from crossing from the mother into
the baby's bloodstream.

"The tragedy is, it's so preventable," Taylor said.

"It's actually a really sad situation, but I think there's a really
neat way to address it, and I think we've hit on some of that here. If
we could help the women while they're pregnant, and help get them into
a better place with some of the things they need, a lot of women would
not lose their babies."

Most are distrustful. They've had children apprehended, been judged
for being aboriginal, for selling their bodies, for being on drugs and
even for being on methadone after they've kicked their morphine or
heroin habits.

The women are homeless or couch surfing, sleeping on mattresses too
thin to comfort their growing frames and suffering morning sickness
made worse from fatigue. They don't have phones to arrange medical
appointments.

Medical clinics often want permanent addresses on file, an
impossibility for these mothers.

They remain invisible until they arrive in labour at the emergency
department, sometimes infected with a disease for which they've never
been tested.

But when outreach worker Karen Turner says hello, their guards come
down. She offers to check their babies' heartbeats, give them vitamins
and collect a urine sample to test for gonorrhea or chlamydia. Turner
used to be one of them, living a hard life in cheap hotels when she
was pregnant. Sleep wasn't possible until after last call at 2 a.m.
and even then, drug dealers walked the hallways.

"I've known a lot of these girls," Turner said.

"For a lot of them, even if they have family support, they feel too
ashamed or guilty to let their family help them because they don't
want their family to know they're addicted or out on the street."

That was the case for Turner. She won't talk in detail about those
dark days. Her children are now 25, 19 and 17. Turner has three
grandchildren, five puppies and loads of street cred.

She and colleague Laurie McDermott, who went to school at the Boyle
Street Co-op where her family has worked for three generations,
reassure the street women that nurse Amber Krasowski and Dr. Rubeena
Ahmad can be trusted. The two medical professionals give pap smears or
take blood tests in a small back room at Streetworks. It is outfitted
with an examining table donated from the Royal Alexandra Hospital and
an inexpensive privacy curtain from Zellers.

"Karen and Laurie are so vital to this project because they know the
history," Krasowski said.

She, in turn, speaks frankly to the pregnant moms about drug use,
reassuring them that taking morphine is, while not welcome, better for
the baby than abusing alcohol. She lets moms who have hepatitis C know
that's it's safe to breastfeed as long as they make sure their nipples
don't crack and bleed.

"Here at Streetworks, it's about supporting women where they're at,"
Krasowski said. "We need to set up places so that they encompass a
very welcoming atmosphere, regardless what you look like, how you
smell, what you've consumed, whatever."

Bridgette Harding, who has fetal alcohol syndrome as a result of her
own mother's addiction problems, learned that she shouldn't stop
smoking crack cold turkey because her baby would go through dangerous
withdrawal inside the womb. Harding said she's cut back on her drug
habit, but believes her daughter will still be taken away.

Another woman told the nurse she didn't want to call an ambulance or
deliver at hospital because of an old, Canada-wide warrant for her
arrest. For two days, she laboured by herself at home, then called
Krasowski for help.

They went to hospital and after an emergency C-section, the mother
turned down strong painkillers, so eager was she to visit her baby in
the neonatal intensive care unit and prove to nurses she truly cared.
But then she edged away from breastfeeding.

"She didn't want to have that intimate contact and breastfeed her
little man because she was worried they were going to take him away
anyway," Krasowski said. " 'Why bother?' It broke my heart." Seizing
babies immediately from troubled moms isn't the answer, both Taylor
and Ahmad said.

"We all know our foster-care system is not working," Ahmad said,
adding a child's parents are the best people to provide care if able.

No one wants to put the children at risk, Ahmad said, but if the
mothers can get the necessary support "through the treatments of their
addictions, treatment for their mental illness, making sure they got
food in their bellies, making sure they didn't have to work the
streets to get food and a fix, and a roof over their head, then they
have a chance of keeping their kids."

Taylor said the current health system doesn't support
women.

A different approach has been taken in a Vancouver hospital, Taylor
said, where one ward is reserved for addicted street mothers. The
women are allowed to stay in the hospital for up to 30 days after
giving birth. They receive counselling, help with their addictions and
housing support. Children's Services is not allowed in until after
each woman has a chance to sort out her life.

Nothing like that is available in Alberta, Taylor said. Moms give
birth, have their babies seized by the government, then leave the
hospital ashamed and suffering from post-partum depression. Without
help, they spiral into darkness.

"I think that's one of the misconceptions that the mainstream has:
That these women are bad women, they don't really want their babies
and they don't care," Taylor said.

"They are women who care very deeply, but are ashamed and feel a huge
amount of guilt the way things have gone for them."

[sidebar]

If the Money Runs Out

The Streetworks program for pregnant women lasts until March 2009,
when the $95,000 in funding from the Public Health Agency of Canada
runs out. Program manager Marliss Taylor hopes to find more money, but
if it doesn't come, there are already plans to share what has been
learned.

- - Streetworks has already started a program to train health
professionals on how to be more culturally sensitive when working with
street people. Nurse Amber Krasowski has been invited to speak with
nurse practitioners and hopes to do hospital rounds with new
physicians at the Royal Alexandra Hospital.

- - Streetworks is developing a pregnancy booklet with advice on how
women can be healthier on the streets. What should they know about
prostitution while they're pregnant? What should they know about drug
use during pregnancy? Where can homeless women find help?

- - Taylor wants to create three 20-minute DVDs that street women can
watch on portable DVD players. One would give advice to pregnant
women. One would give information about what it's like to be in labour
and to give birth. The third would give post-natal advice.