Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, January 9, 1994 TAG: 9401080019
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: BETH MACY STAFF WRITER
DATELINE: LENGTH: Long
The 16-year-old girl who came Dec. 3 left two days later, but the consequence of her visit remains - a 1 pound, 15-ounce baby, delivered 13 weeks prematurely.
Hooked up to a host of tubes and monitors, a respirator and an IV, the child is so tiny, so fragile, you could hold it in one hand - but you'd be afraid to.
``The mother had absolutely no prenatal care,'' Allen, a neonatologist, says. ``She said she didn't even know she was pregnant. And now she isn't sure if she wants to keep it.''
As is typical with most teens who deliver at Community, the taxpayer will likely end up footing the bill for this teen's delivery and outcome - a six- to eight-week neonatal stay that could cost well over $100,000 by the time the baby leaves.
``For most teens, it's costless,'' Allen says. ``Their food is free, their lodging is free, their education is free, and having babies is free.
``The thing is, you can't even measure the true cost of teen pregnancy. You'll get all kinds of dollar numbers, but you simply can't measure the true costs.''
What Allen sees as the social costs of teen pregnancy:
n Teens leaving the hospital without so much as a baby blanket, car seat or sometimes even a place to call home. ``You ask them where their baby's gonna get pediatric care, and they haven't even thought about it. And for a teen, it's normal not to be thinking about these things.
``What's abnormal is she's sitting there with a baby in her arms.''
What Allen sees as the medical costs of teen pregnancy:
n Greater incidence of prematurity, higher infant mortality, longer hospital stays, more rehospitalizations and increased abuse and neglect. ``Prenatal care saves dollars, and the most notorious offenders are teens,'' he says.
``They're not in touch with what their bodies are telling them; that's why they got pregnant. If a 15-year-old is having cramps and discharge, she may not even know she's in labor.''
Janet Theimer, a nurse at Roanoke Health Department's maternity clinic, says it's not uncommon for some teens to postpone prenatal care until the gestational stage of 28 to 36 weeks.
Some deny they're pregnant. Some refuse care for second pregnancies because they didn't have complications with their first. Some, she says, simply resent having to wait one to two hours to see the clinic doctor.
``It is frustrating when you're on the outside and you don't know anything about their home lives,'' Theimer says. ``But once you see what these girls live with, it's not so easy to criticize them.
``Some are living in homes where the mother is a crack addict. When you see what goes on in their homes, you see why they get pregnant.''
Down the hall from Community's neonatal intensive care unit is the OB/GYN unit, the place where most healthy women spend 36 hours laboring, delivering and recovering from childbirth. If they have insurance - about 60 percent of Community's patients do - their bills total $3,500 to $5,000.
Marsha, 14, lies in room 608 with her 16-year-old boyfriend, Travis, by her side. It is four days before Christmas, and she has been in the hospital for two weeks. She has two fetal monitors strapped to her belly, and her veins have been so overworked by IVs that doctors are considering putting a catheter in her neck.
``I started losing amniotic fluid, and they checked me and found out I was dilated to four centimeters,'' the high school freshman says. ``Now I'm six centimeters and they're trying to hold me off till after Christmas.'' She doesn't know her due date.
``It's hard being in the hospital, especially on Christmas,'' she adds. ``But I'd rather be here than at home.''
Marsha's mother - who requested that their last names not be used - has already been turned over to a collection agency by the hospital for medical bills incurred by her son and her husband, who can't work because of poor health.
She was told she earns too much as an insurance coordinator for a doctor's office - $18,000 a year - for the family of four to qualify for Medicaid. Although Marsha's mother is covered by her employer's Blue Cross/Blue Shield policy, she couldn't afford the $800 a month it would cost to cover her entire family.
``I've already told the hospital I'll have to file bankruptcy,'' the woman, 43, says. Typical pre-delivery hospital stays average $1,000 a day - and that doesn't include special treatments or physician charges.
Marsha delivered a 5-pound, 10-ounce baby boy three days after Christmas. Although the baby was breathing without a respirator, he was admitted to the neonatal intensive care unit for its first few days.
Her mother says she has no idea what the bill will total, though she hopes the baby can be covered by Medicaid.
Two weeks before she delivered, Marsha said she and the baby would live with Travis and his family. The following week, Marsha's mother insisted they were coming home to her house.
``She has fantasized herself being in love; she wanted this baby,'' her mother says. ``We will raise the child as best we can, but I feel for them. Travis is a little slow. I don't know what's gonna happen to them ...
``She's gonna have to live the rest of her life with this.''
``It ain't pretty,'' Allen, the neonatologist, says. ``The anguish and suffering these teens go through - right up to the point of leaving the hospital and not having a car seat to put the baby in, or anywhere to go.''
What can be even less pretty is a look at some of these teen-agers - and their children - five or 10 years after they leave the hospital.
``I see children parenting parents,'' social worker Chrystal Johnson says. ``I see kids who aren't nurtured properly. They have low self-esteem, they act out, do poorly in school.
``Bethany Hall called me this morning,'' she says of the drug rehabilitation program for women. ``They have an 11-year-old girl who tried to commit suicide three times. She's the child of a teen parent - who is also an alcoholic. While the mother was in treatment, the kids were being sexually abused by the stepfather. We see that a lot.''
Johnson is a resource counselor for Project Link, a small, state-funded program for women who have used drugs during pregnancy. The program serves 125 Roanoke women, seeing them through drug-treatment programs, brushes with child-protective services, court hearings and social-services paperwork.
Though most clients are in their mid-20s, the majority were teen-age mothers who now have three or four kids. Eighty percent of them were sexually abused themselves as children.
``Substance abuse and teen motherhood go hand in hand,'' Johnson says. ``One doesn't necessarily cause the other. They're both symptoms of poverty.''
Link counselors feel strongly that Roanoke's teen-pregnancy rate is an issue of economics more than race. Although most of their clients are black, ``what really separates them is they're all poor. If you're middle class and living in the county, you've got that $250 to get an abortion,'' Johnson says.
``These teens, they have no good clothes, their parents don't have money for cheerleading outfits or music lessons. But it's like, `S---, I can have a baby.'''
Once they get on AFDC and trapped into the poverty cycle, other addictions aren't far behind: crack, alcohol, bad relationships, more children.
A surprisingly low number of babies born to Link clients have major medical problems. Although crack is the drug of choice among Johnson's pregnant clients, only two babies have been born with crack in their systems, causing nervousness and developmental delays. One of the mothers, tired of being pregnant, smoked the crack to induce labor; the other was already hooked.
Five babies have been referred to Easter Seals for developmental and motor-skills deficiencies because their mothers were on drugs while pregnant. Two babies have been born to HIV-positive mothers, but are too young to be tested for the virus themselves.
Lily, one of the crack-addicted mothers, has refused to get her baby tested for neurological damage. ``I think she knew something was wrong,'' Johnson says. ``She didn't wanna face it.''
Both Lily and her underweight baby barely survived childbirth. She was past due, in her 10th month of pregnancy, when she delivered the child, her fifth. She's 28.
``Most people don't understand the problems because they don't know this world; they lead very insulated lives,'' Johnson says. At a recent cultural-diversity workshop Johnson attended for social workers, 80 percent of the mostly white professionals there had never been in a black person's home, except for work-related visits.
Complex, interconnected social issues like teen pregnancy, poverty and substance abuse require long-term prevention strategies. ``Programs like ours are hard to sell because they're long-term investments, and the public wants a quick fix,'' Johnson says. ``We'll not see the fruits of our labor till 15 years down the line.''
``The big thing is convincing people to invest in people,'' Link Director Phebe Cress says. ``We have created a society that has no place in it for people; they're throwaways.
``They're bastard children of bastard children of bastard children.''
COMING JAN. 23-The results of our reader write-in: Roanokers share their ideas for ways to curb the city's teen-pregnancy rate.
by CNB