Freezing for two
December 11, 2016 11:30 AM Subscribe
What happens when pregnant homeless women have their babies? And secondarily, what can I do to help?
I am curious about what procedurally happens starting when pregnant homeless women go into labor. This probably varies by location so I'm interested in both New York City and other areas. Do police or homeless outreach orgs keep tabs on women they know to be pregnant? Do the women go to the ER to deliver there, or are they admitted into Labor and Delivery? Do they keep their babies? What are some services and options available to them postpartum? And what happens if they choose not to avail themselves of those options and want to go back to the streets? What if the baby needs to stay in NICU but mother is discharged... does she get some kind of transitional housing or she goes back out onto streets? Do shelters have to prioritize accepting pregnant women? Do shelters take women with... newborns?!
There is a woman who stays on the blocks near my apartment. I give her money when I see her or I pick up a bag of food and fruit and yogurt and drinks and prenatal vitamins and hand warmers whenever I'm on my way to CVS. I know there are shelters here that admit pregnant homeless specifically but assume she prefers the perceived safety of the streets (and NYC shelters are currently horrifically overcrowded).
What else should I do? It's quite cold here this week and it all sounds very scary. Thanks for shedding some light into something I'm embarrassed I never really thought about before.
I am curious about what procedurally happens starting when pregnant homeless women go into labor. This probably varies by location so I'm interested in both New York City and other areas. Do police or homeless outreach orgs keep tabs on women they know to be pregnant? Do the women go to the ER to deliver there, or are they admitted into Labor and Delivery? Do they keep their babies? What are some services and options available to them postpartum? And what happens if they choose not to avail themselves of those options and want to go back to the streets? What if the baby needs to stay in NICU but mother is discharged... does she get some kind of transitional housing or she goes back out onto streets? Do shelters have to prioritize accepting pregnant women? Do shelters take women with... newborns?!
There is a woman who stays on the blocks near my apartment. I give her money when I see her or I pick up a bag of food and fruit and yogurt and drinks and prenatal vitamins and hand warmers whenever I'm on my way to CVS. I know there are shelters here that admit pregnant homeless specifically but assume she prefers the perceived safety of the streets (and NYC shelters are currently horrifically overcrowded).
What else should I do? It's quite cold here this week and it all sounds very scary. Thanks for shedding some light into something I'm embarrassed I never really thought about before.
Best answer: I am an emergency physician in a large urban "safety net" hospital. Homeless pregnant women come to the ED routinely (one might more cynically say "over and over, constantly") for prenatal issues. The ones who are a little more "together" psychiatrically do follow up appropriately with Ob-gyn for routine prenatal care, not least because pregnancy qualifies them for Medicaid no questions asked and thus removes barriers to care that might previously have prevented them from office followup.
Unfortunately, many homeless women have substance abuse and psychiatric issues which preclude organized behavior including clinic followup appointments. I had one frequent repeat patient recently who ended up delivering precipitously on the street -- I saw her after that and both she and baby were OK.
We have a small population of floridly psychotic and/or psychostimulant-abusing homeless pregnant women whose care as you can imagine is very, very challenging. EMS and PD bring them in over and over for acting crazy out in the community. As often as not they end up restrained in the ED and given antipsychotic meds for their own safety and the safety of providers. Most of these women do end up delivering their babies in an appropriate obstetric setting but the babies tend to have long NICU or even PICU stays for drug withdrawal, prematurity and other severe problems.
I will say that there are many effective social services, including aggressive social work and case management, available to homeless women who get pregnant and have kids. This population is much more likely to get access to services like women's-and-children's shelters and even permanent housing placements which were not available to them before they had children. In a back-handed way, for this reason, even in the Very Red State where I practice, pregnancy ends up being a positive for many of my homeless patients.
posted by killdevil at 12:04 PM on December 11, 2016 [20 favorites]
Unfortunately, many homeless women have substance abuse and psychiatric issues which preclude organized behavior including clinic followup appointments. I had one frequent repeat patient recently who ended up delivering precipitously on the street -- I saw her after that and both she and baby were OK.
We have a small population of floridly psychotic and/or psychostimulant-abusing homeless pregnant women whose care as you can imagine is very, very challenging. EMS and PD bring them in over and over for acting crazy out in the community. As often as not they end up restrained in the ED and given antipsychotic meds for their own safety and the safety of providers. Most of these women do end up delivering their babies in an appropriate obstetric setting but the babies tend to have long NICU or even PICU stays for drug withdrawal, prematurity and other severe problems.
I will say that there are many effective social services, including aggressive social work and case management, available to homeless women who get pregnant and have kids. This population is much more likely to get access to services like women's-and-children's shelters and even permanent housing placements which were not available to them before they had children. In a back-handed way, for this reason, even in the Very Red State where I practice, pregnancy ends up being a positive for many of my homeless patients.
posted by killdevil at 12:04 PM on December 11, 2016 [20 favorites]
I have to admit I hadn't thought about this either. Google searches led me to this question in a parenting forum. One of the comments references the Sisters of Life, a pro-life organization on the East Side which offers support to pregnant women. Some of the pro-life language may be a little uncomfortable. You could call them and explain the situation and see if they can do anything. Maybe they could send someone over to talk to her.
posted by bunderful at 12:05 PM on December 11, 2016 [1 favorite]
posted by bunderful at 12:05 PM on December 11, 2016 [1 favorite]
Pregnant women in NYC and families with children under 18 are entitled to shelter in NYC.
Both the city and private charities have outreach workers who try to persuade homeless into shelters when the temperature drops. You can call 311 to request outreach to a specific person through HOME-STAT. However, they can't force anyone into shelter unless they appear to be mentally ill and in imminent danger.
Other people may have more specific information, but I think it's extremely unlikely that ACS would permit a homeless woman who had just delivered to be discharged to the street with her baby. This obviously sets up a very difficult situation if the mother does not want to go to shelter after giving birth. However, unless this woman is extremely mentally ill, I wouldn't assume that she intends to try to keep the baby on the streets. If the mother is willing to accept shelter and is otherwise competent, she would not presumptively lose her baby just for being homeless beforehand.
You are very kind to worry about this woman. Have you ever tried just to ask her about her plans, in a nonjudgmental way? She may have better ones than you are aware of.
posted by praemunire at 12:11 PM on December 11, 2016 [1 favorite]
Both the city and private charities have outreach workers who try to persuade homeless into shelters when the temperature drops. You can call 311 to request outreach to a specific person through HOME-STAT. However, they can't force anyone into shelter unless they appear to be mentally ill and in imminent danger.
Other people may have more specific information, but I think it's extremely unlikely that ACS would permit a homeless woman who had just delivered to be discharged to the street with her baby. This obviously sets up a very difficult situation if the mother does not want to go to shelter after giving birth. However, unless this woman is extremely mentally ill, I wouldn't assume that she intends to try to keep the baby on the streets. If the mother is willing to accept shelter and is otherwise competent, she would not presumptively lose her baby just for being homeless beforehand.
You are very kind to worry about this woman. Have you ever tried just to ask her about her plans, in a nonjudgmental way? She may have better ones than you are aware of.
posted by praemunire at 12:11 PM on December 11, 2016 [1 favorite]
My mother used to work for a woman who is a foster parent specifically to newborns, generally temporarily. In most cases, she was the person who cared for the baby while mom/other family either got things together to parent, or relinquished parental rights. Usually she was caring for these babies through drug withdrawal, so their mothers presumably were under the influence of drugs as well. Many times they needed extra medical support, so her foster parent responsibilities included making sure those things got taken care of. Just one insight into a small part of the system.
posted by linettasky at 1:44 PM on December 11, 2016
posted by linettasky at 1:44 PM on December 11, 2016
Best answer: I appreciate your compassion for this person and I think the 311 idea is a really good one and if that doesn't work, asking advice from agencies working specifically with homeless women and homeless families in NY.
Because you asked about how all this stuff 'works', I feel kind of compelled to answer more generally, because I think there's a lot of mythology about how homeless people don't want help or don't want to be housed. Not sure if this is directly helpful for you in this moment, but I hope this is a useful perspective:
I am a nurse case manager in a program for homeless patients in our county safety net hospital and clinic system. I live in a region with a severe housing crisis. While I don't especially work with pregnant women (I focus on people with severe, chronic physical illness), I think I have a good enough sense of the homeless services and hospital policies to understand how this works at least here.
Where I live, neither pregnant women nor new parents "automatically" get housing.
Firstly, the category of homeless is broad and somewhat ambiguous. There are visible, street dwelling homeless people, like your neighbor, but there are more people who are less obviously homeless - people who live in their cars, double up with relatives temporarily, live with problematic or abusive partners because they have no other option, people who bounce around from motel to motel, people who live in SROs or shelters or transitional housing. All of these people might be considered homeless, depending on what funding agency is doing the defining.
From the point of view of the social worker in the labor and delivery unit of your neighborhood safety net hospital, a woman who has just given birth does need a "safe" place to go, but often that might mean going temporarily to the home of a family member, going back to a motel room, or possibly placement in a shelter or perhaps a transitional program specifically for families with small children. While some communities might have innovative programs to get homeless pregnant women straight into permanent housing, that would not be the standard or norm.
If someone's homelessness is in part connected to chronic substance use or mental illness, it's quite likely that child protective services will get involved, not solely because of homelessness, but because of the related issues that would make parenting a challenge for this person. So a new baby might end up with a relative or in foster care in this scenario.
I agree with the above poster that it is in a sense 'easier' for a pregnant woman or new mother to get at least into temporary housing than it is for a single homeless adult, because rightfully, there are programs earmarked for this population, however, to get housed, people do need a certain level of organization and emotional and intellectual resourcefulness.
There's a lot bureaucracy involved in getting housed, even if you win the jackpot and get subsidized housing of some sort. You must get your current ID, Social Security Card, often a deposit, etc. Many subsidized housing programs require that you have no eviction history. Where I live, most shelters charge rent. For someone living on the street, even if they do not have severe mental illness or a long history of addiction, it is extremely challenging to be "together" enough to get housing. It does happen, but it's not easy or simple.
When you talk about homeless women "choosing" not to avail themselves of medical services, imagine how challenging it is to make it a medical appointment on time, when you have no car, no bus pass, no calendar, no one to go with you, and no where to store your medications. Even though I'm an RN, a lot of what I do in my work revolves around simply getting people to their doctor's appointments, because it is extremely challenging to do that when you are living in literal constant crisis.
Back to this specific woman, I think her getting connected to the appropriate case management/social services agency is most likely to get her the kind of support she'd need to get permanently housed with her child. But here's something you can do right away, the very next time you see her, and I bring this up because you have already made a choice to do more for this woman than most people are doing: You can just talk to her, and ask her what her situation is. You can share what you shared here: that as someone who is also pregnant, you've been thinking and worrying about her. Ask her if she is willing to share a bit of her story. Ask her if she already has a case manager or wants help finding someone. Ask if she'd like help finding out more about the shelters - she may have had bad experiences, but she may have only heard bad rumors. You can be honest that you don't know how this all works either, but if you want to help, you can tell her that. If nothing else, you'll give her the experience of being talked to and valued as a full human being.
I've run into some volunteers in my work, and there is one guy in particular who knew zero about how homeless services worked, but he basically pestered me and every agency he could until he figured out how to help these two separate guys get housed. They both went from living in the park (where he found them) to being permanently housed, in part due to his tenacity. So thanks for caring enough about this person to wonder how to help.
posted by latkes at 7:55 PM on December 11, 2016 [13 favorites]
Because you asked about how all this stuff 'works', I feel kind of compelled to answer more generally, because I think there's a lot of mythology about how homeless people don't want help or don't want to be housed. Not sure if this is directly helpful for you in this moment, but I hope this is a useful perspective:
I am a nurse case manager in a program for homeless patients in our county safety net hospital and clinic system. I live in a region with a severe housing crisis. While I don't especially work with pregnant women (I focus on people with severe, chronic physical illness), I think I have a good enough sense of the homeless services and hospital policies to understand how this works at least here.
Where I live, neither pregnant women nor new parents "automatically" get housing.
Firstly, the category of homeless is broad and somewhat ambiguous. There are visible, street dwelling homeless people, like your neighbor, but there are more people who are less obviously homeless - people who live in their cars, double up with relatives temporarily, live with problematic or abusive partners because they have no other option, people who bounce around from motel to motel, people who live in SROs or shelters or transitional housing. All of these people might be considered homeless, depending on what funding agency is doing the defining.
From the point of view of the social worker in the labor and delivery unit of your neighborhood safety net hospital, a woman who has just given birth does need a "safe" place to go, but often that might mean going temporarily to the home of a family member, going back to a motel room, or possibly placement in a shelter or perhaps a transitional program specifically for families with small children. While some communities might have innovative programs to get homeless pregnant women straight into permanent housing, that would not be the standard or norm.
If someone's homelessness is in part connected to chronic substance use or mental illness, it's quite likely that child protective services will get involved, not solely because of homelessness, but because of the related issues that would make parenting a challenge for this person. So a new baby might end up with a relative or in foster care in this scenario.
I agree with the above poster that it is in a sense 'easier' for a pregnant woman or new mother to get at least into temporary housing than it is for a single homeless adult, because rightfully, there are programs earmarked for this population, however, to get housed, people do need a certain level of organization and emotional and intellectual resourcefulness.
There's a lot bureaucracy involved in getting housed, even if you win the jackpot and get subsidized housing of some sort. You must get your current ID, Social Security Card, often a deposit, etc. Many subsidized housing programs require that you have no eviction history. Where I live, most shelters charge rent. For someone living on the street, even if they do not have severe mental illness or a long history of addiction, it is extremely challenging to be "together" enough to get housing. It does happen, but it's not easy or simple.
When you talk about homeless women "choosing" not to avail themselves of medical services, imagine how challenging it is to make it a medical appointment on time, when you have no car, no bus pass, no calendar, no one to go with you, and no where to store your medications. Even though I'm an RN, a lot of what I do in my work revolves around simply getting people to their doctor's appointments, because it is extremely challenging to do that when you are living in literal constant crisis.
Back to this specific woman, I think her getting connected to the appropriate case management/social services agency is most likely to get her the kind of support she'd need to get permanently housed with her child. But here's something you can do right away, the very next time you see her, and I bring this up because you have already made a choice to do more for this woman than most people are doing: You can just talk to her, and ask her what her situation is. You can share what you shared here: that as someone who is also pregnant, you've been thinking and worrying about her. Ask her if she is willing to share a bit of her story. Ask her if she already has a case manager or wants help finding someone. Ask if she'd like help finding out more about the shelters - she may have had bad experiences, but she may have only heard bad rumors. You can be honest that you don't know how this all works either, but if you want to help, you can tell her that. If nothing else, you'll give her the experience of being talked to and valued as a full human being.
I've run into some volunteers in my work, and there is one guy in particular who knew zero about how homeless services worked, but he basically pestered me and every agency he could until he figured out how to help these two separate guys get housed. They both went from living in the park (where he found them) to being permanently housed, in part due to his tenacity. So thanks for caring enough about this person to wonder how to help.
posted by latkes at 7:55 PM on December 11, 2016 [13 favorites]
Best answer: I'm not near your area - but I run an emergency shelter for homeless women (west coast, Canada).
The main reasons I see pregnant women not utilizing shelters/services are fear of judgment of their mental health and/or addiction issues and/or fear of apprehension of the baby. She has likely had other babies taken away from her - a very traumatizing experience for many homeless women.
I'm sure it is the same there, as it is here, in that shelters really vary in their perspectives and treatment of women. Some shelters may want I.D. or may immediately report a pregnant woman to child services, whereas others may not have such conditions. I would bet the woman you are speaking of is quite familiar with local shelters (the good and the not so good). In my experience, once chronically homeless women find a shelter that feels safe to them - it's frequently the only place they want to go to. Ask her where she has stayed before (and I bet it is full!). We refer to shelters that don't have a lot of rigid conditions as 'low barrier' or 'harm reduction' ( the type of shelter I run).
Here, there are more and more shelters/residential programs opening up for pregnant women or women with infants, but unfortunately, all require abstinence.
A big barrier that can exist here, for homeless pregnant women, is the medical system. I currently have two pregnant women in our shelter, who are terrified of the medical system. It's a LOT of work to build a trusting relationship with a homeless pregnant client - and it requires a LOT of advocacy to rebuild that trust in the medical system. Both women previously have had babies apprehended at birth.
I recently had a woman who was ten days over her due date (and panicking) and a major hospital refused her services (after a four-hour wait in the emergency, *sigh*) because she admitted to using marijuana. So imagine how a woman using heroin would be treated...
Fortunately, we have a women's hospital (although 1 1/2 hr away from where I am) that primarily does not judge nor refuse services to pregnant women. They also have a section for actively using, pregnant women (they try and stabilize the women on medication, such as methadone). Perhaps there is such a service in NY?.
Check to see if there are street nurses in the area. A local shelter should know if there is. Street nurses tend to be quite sensitive and non-judgmental. We sometimes use the ambulance services - for a primary check-up. Neither service can "force" someone into the hospital, but they tend to be quite sensitive to the homeless situations and maybe they can detect any major concerns.
Other ideas: perhaps McDonald gift cards - or other such fast food places. 'Cause it's a place to warm up and linger for awhile - and also to get some food.
And everything latkes said!
posted by what's her name at 8:41 AM on December 12, 2016 [2 favorites]
The main reasons I see pregnant women not utilizing shelters/services are fear of judgment of their mental health and/or addiction issues and/or fear of apprehension of the baby. She has likely had other babies taken away from her - a very traumatizing experience for many homeless women.
I'm sure it is the same there, as it is here, in that shelters really vary in their perspectives and treatment of women. Some shelters may want I.D. or may immediately report a pregnant woman to child services, whereas others may not have such conditions. I would bet the woman you are speaking of is quite familiar with local shelters (the good and the not so good). In my experience, once chronically homeless women find a shelter that feels safe to them - it's frequently the only place they want to go to. Ask her where she has stayed before (and I bet it is full!). We refer to shelters that don't have a lot of rigid conditions as 'low barrier' or 'harm reduction' ( the type of shelter I run).
Here, there are more and more shelters/residential programs opening up for pregnant women or women with infants, but unfortunately, all require abstinence.
A big barrier that can exist here, for homeless pregnant women, is the medical system. I currently have two pregnant women in our shelter, who are terrified of the medical system. It's a LOT of work to build a trusting relationship with a homeless pregnant client - and it requires a LOT of advocacy to rebuild that trust in the medical system. Both women previously have had babies apprehended at birth.
I recently had a woman who was ten days over her due date (and panicking) and a major hospital refused her services (after a four-hour wait in the emergency, *sigh*) because she admitted to using marijuana. So imagine how a woman using heroin would be treated...
Fortunately, we have a women's hospital (although 1 1/2 hr away from where I am) that primarily does not judge nor refuse services to pregnant women. They also have a section for actively using, pregnant women (they try and stabilize the women on medication, such as methadone). Perhaps there is such a service in NY?.
Check to see if there are street nurses in the area. A local shelter should know if there is. Street nurses tend to be quite sensitive and non-judgmental. We sometimes use the ambulance services - for a primary check-up. Neither service can "force" someone into the hospital, but they tend to be quite sensitive to the homeless situations and maybe they can detect any major concerns.
Other ideas: perhaps McDonald gift cards - or other such fast food places. 'Cause it's a place to warm up and linger for awhile - and also to get some food.
And everything latkes said!
posted by what's her name at 8:41 AM on December 12, 2016 [2 favorites]
Best answer: I'm a social worker at a public hospital in NYC. I'm going to repeat a bit of the comments above because I want to give kind of a step by step process of how these cases are handled here.
If a woman who is pregnant and homeless wants to access prenatal services, all she has to do is show up at a public hospital on an outpatient basis. In NYC, public hospitals are required to treat anyone regardless of ability to pay or whether they are undocumented (and not just in the ER). To clarify comments above, women who are undocumented are eligible for emergency Medicaid which will pay for the hospital stay during which they give birth, though not ongoing Medicaid, but this does not matter much in NYC as the public hospital system will provide routine ongoing care regardless. All patients are also provided with round trip metrocards at every visit regardless of insurance status (and if not automatically offered, can request one).
There are homeless outreach teams that literally walk the streets to find people and inform them about services so even if she isn't aware on her own, it's not completely unlikely she will be identified and offered services. If you would like to make sure she's identified, help is here.
Once she shows up to a public hospital she will be referred to a social worker if she mentions she is homeless. The social worker will help her apply for Medicaid and WIC if she isn't already enrolled and is eligible. They will also refer her to a family shelter, which she will be eligible for as she is pregnant, and which are more like dormitories than the men's or single women's shelters. She will also be referred to psychiatric and/or substance abuse treatment if indicated which are also available through the public hospital system (inpatient and outpatient) regardless of ability to pay or legal status.
If she shows up in an ER, she will be scheduled for outpatient follow up treatment.
As mentioned above, it is possible the social worker and outpatient doctors (or ER workers if she shows up there first) will make an ACS report if it appears she is unable or unwilling to follow through with appropriate prenatal, psychiatric, substance abuse, or shelter referrals. ACS, if they become involved, will follow up and require the actions they deem necessary to the safety of the child in order to terminate her case.
If she misses appointments, if she has an ACS case or a psychiatric diagnosis, there are outreach programs that will attempt to find her. (Mobile crisis can be reached at 1-800-LIFENET if you have reason to believe she is going through mental health issues and would like a team to evaluate her.)
She will be able to deliver her baby in a public hospital regardless of ability to pay as well as receive post-natal medical care for herself and the baby. She will not be discharged from the hospital to the street with her baby. A shelter referral will he facilitated.
Once she is in a family shelter, on average she will be moved into permanent housing within 2 years. This can be sooner if she is part of a specific population such as people with mental illnesses, domestic violence which lead to her homelessness, or HIV+.
One more resource you might be interested in: Coalition for the Homeless
posted by Waiting for Pierce Inverarity at 12:20 PM on December 12, 2016 [5 favorites]
If a woman who is pregnant and homeless wants to access prenatal services, all she has to do is show up at a public hospital on an outpatient basis. In NYC, public hospitals are required to treat anyone regardless of ability to pay or whether they are undocumented (and not just in the ER). To clarify comments above, women who are undocumented are eligible for emergency Medicaid which will pay for the hospital stay during which they give birth, though not ongoing Medicaid, but this does not matter much in NYC as the public hospital system will provide routine ongoing care regardless. All patients are also provided with round trip metrocards at every visit regardless of insurance status (and if not automatically offered, can request one).
There are homeless outreach teams that literally walk the streets to find people and inform them about services so even if she isn't aware on her own, it's not completely unlikely she will be identified and offered services. If you would like to make sure she's identified, help is here.
Once she shows up to a public hospital she will be referred to a social worker if she mentions she is homeless. The social worker will help her apply for Medicaid and WIC if she isn't already enrolled and is eligible. They will also refer her to a family shelter, which she will be eligible for as she is pregnant, and which are more like dormitories than the men's or single women's shelters. She will also be referred to psychiatric and/or substance abuse treatment if indicated which are also available through the public hospital system (inpatient and outpatient) regardless of ability to pay or legal status.
If she shows up in an ER, she will be scheduled for outpatient follow up treatment.
As mentioned above, it is possible the social worker and outpatient doctors (or ER workers if she shows up there first) will make an ACS report if it appears she is unable or unwilling to follow through with appropriate prenatal, psychiatric, substance abuse, or shelter referrals. ACS, if they become involved, will follow up and require the actions they deem necessary to the safety of the child in order to terminate her case.
If she misses appointments, if she has an ACS case or a psychiatric diagnosis, there are outreach programs that will attempt to find her. (Mobile crisis can be reached at 1-800-LIFENET if you have reason to believe she is going through mental health issues and would like a team to evaluate her.)
She will be able to deliver her baby in a public hospital regardless of ability to pay as well as receive post-natal medical care for herself and the baby. She will not be discharged from the hospital to the street with her baby. A shelter referral will he facilitated.
Once she is in a family shelter, on average she will be moved into permanent housing within 2 years. This can be sooner if she is part of a specific population such as people with mental illnesses, domestic violence which lead to her homelessness, or HIV+.
One more resource you might be interested in: Coalition for the Homeless
posted by Waiting for Pierce Inverarity at 12:20 PM on December 12, 2016 [5 favorites]
I wish I could mark 'best answer' or at least 'definitive answer' to the above comment
posted by latkes at 2:19 PM on December 12, 2016 [1 favorite]
posted by latkes at 2:19 PM on December 12, 2016 [1 favorite]
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posted by sestaaak at 11:43 AM on December 11, 2016