“Myth or fact? Smoking anywhere around the baby can increase the risk of infant death.”
A half dozen pregnant women at the Columbia Public Health Center in South Seattle take turns reading statements about infant care and discussing whether they agree with the claims.
On the smoking prompt, they all agree: Fact.
But there are other details that need discussion. Aliceshae Lett, a statuesque young woman in pink skinny jeans, says she smokes when she’s not pregnant. But she says she’s careful not to do it around her 4-year-old.
“They tell you, you need to have a smoking coat or a smoking sweater,” Lett says. “Take that off, wash around your mouth, wash your hands before you even hold them. So you have to quarantine yourself. But it’s understandable.”
Another woman says her mom will smoke in another room, but won’t take her cigarette outside. It’s hard, she says, because it’s her mom’s house.
These moms and two health care providers meet two Mondays a month here for Centering Pregnancy, a prenatal group for women throughout their pregnancy. About 6 percent of women in Washington state wait until the very end of their pregnancies for prenatal care – or get no care at all.
This lack of care can impact a child’s later success at school. Researchers have found that poverty is the main predictor of a child’s success in school. Poverty, they have found, impacts a baby’s brain before the child has been born. Prenatal care helps to bridge that gap.
Every meeting begins and ends with healthy snacks. Moms take their own blood pressure, and they take turns stepping behind a folding screen with a doctor to get measured, check the baby’s heart rate, and discuss any concerns.
In another corner, a nurse gives a client a flu shot. But most of the hour-and-a-half-long meeting is a group discussion.
It’s an approach that’s becoming popular at low-income clinics around the state.
Another South Seattle clinic also caters to mostly low-income patients and moms like Kara Habib.
On this day, Habib is in for her 10-week prenatal visit with Judy Lazarus, a midwife here at Neighborcare Health Rainier Beach Medical and Dental Clinic.
“The other thing I found out after my last visit is that my iron level was kind of low,” Habib tells Lazarus.
“It’s not good to be anemic,” Lazarus says. “At least it’s a pretty easy fix between diet and taking some extra iron pills. So we can build it back up.”
Lazarus says she’s impressed that Habib has kept her weight gain to a minimum even though she works at a doughnut shop.
They discuss how Habib can boost her nutrition when morning sickness limits her appetite.
Lazarus says this is the kind of prenatal care that keeps mothers and babies healthy and supports babies’ developing brains.
“You can’t make up for that time lost in early pregnancy,” Lazarus says.
But many low-income women don’t get enough prenatal care. Lazarus says about a third of her clients don’t come in until midway through pregnancy – or even later.
She says it’s vital for moms to get the right vitamins and fatty acids for their babies’ brains.
She says that’s especially important among the low-income women she sees who may have trouble keeping food in the cupboards, or who turn to junk food for cheap calories.
Lazarus says it’s also crucial to detect and treat health problems in mothers that can affect babies’ brain development – like depression.
When moms are depressed, it can slow their babies’ brain growth.
So can other common health conditions.
“Thyroid disease has a big impact on future intellectual capacity for babies,” Lazarus says, “so someone who has any kind of thyroid disease, being in control very early in the pregnancy is very important.”
But she says there are a lot of barriers to prenatal care for low-income women.
They might work long hours, not have a car or childcare. Or lack health insurance – even though low-income women are guaranteed insurance coverage during pregnancy.
Even with insurance, Lazarus says a lot of things aren’t covered.
“There are things that I would advise people to take, like iron supplements that are liquid, that are over-the-counter, that I wouldn’t necessarily advise my patients to take. I can ask, but it would be a significant expense for them,” she says.
Insurance also doesn’t cover the infant care and other preparatory classes that have become standard fare for women in higher income brackets.
‘It’s So Worth It’
Back at Columbia Public Health Center in South Seattle, Dr. Jane Huntington says it's the conversations at Centering Pregnancy groups that make it so valuable for her low-income patients.
They can brainstorm solutions to problems that may not exist for wealthier women.
“The value of being in a supported, open, non-judgmental environment with other people who are going through this problem,” she says, “and not with the medical expert who really has no idea what it’s like to actually live with some of the problems that our patients live with – I think that’s how we transform people’s health and really make people healthier.”
Aliceshae Lett says she enjoys these bimonthly group meetings, even if she has to drag herself there.
“When I’m out, I’m tired and I’m irritated, so I’m like, ‘Ah, I don’t want to go,’ but once I get here, it’s so worth it,” she says. “Hearing the stories of everybody else kinda opens you up."
“You realize, OK, you’re not the only one doing it, and that there’s other people going through what you’re going through right now, like the hormones and the being irritated and the headaches.”
Although Centering Pregnancy has been around for decades, it’s only in recent years that this model of care has been taking off locally. Now about one-third of prenatal patients at Columbia Public Health Clinic attend Centering groups.
But Lett may soon need to find a new place for her prenatal care.
This public health clinic for the poor is facing financial problems of its own. King County budget cuts mean the county will stop offering obstetrics services at the clinic, including Centering Pregnancy, at the end of the year.
Correction: An earlier version of this story incorrectly stated that the Columbia Public Health Center will close at the end of the year. The county will close the majority of its departments at the clinic. The nonprofit health care organization Neighborcare will become the main provider for those services at the center.