Q&A with Dr Iris Leviner

As of February 9, 2023, our Pediatrics and Family Medicine team is partnering with Metropolitan OB-GYN, a trusted practice at Mercy Health Services to offer prenatal OB services at our Fallsway clinic. This expansion of services means pregnant clients will have care in a health setting they know and trust.

Interim Senior Director of Medicine at Fallsway Dr. Iris Leviner sheds light on what prenatal care looks like at Health Care for the Homeless and why it’s so important. Take a look!

Why is offering prenatal care on-site important?

First, clients themselves have been asking for it!

Second, improving access to prenatal and perinatal care is an equity issue. The majority of clients we see at Health Care for the Homeless identify as BIPOC (44% Black, 39% Hispanic/Latino) and 42% identify as women. It’s critical to speak to the gaps in care experienced by Black and Latina women in maternal care. Black women are 3-4 times more likely to die from complications surrounding pregnancy and childbirth than White women. The death rates for infants born to Black Americans with advanced degrees are higher than White Americans who didn’t go to high school. At the same time, Latina women are less likely to get prenatal care, and when they do, it’s later in pregnancy compared to White women.

These statistics are astounding, and I don’t think we can engage in a conversation about prenatal or OB care at Health Care for the Homeless without having this background top of mind.

Many clients accessing OB care so far are Latina/x immigrants without access to full health insurance. I’ve personally seen that many of the sites that we refer clients to for routine imaging or other testing during pregnancy do not offer bilingual scheduling.

What obstacles do clients face in getting prenatal care?

People face many barriers to high quality medical care in general. And pregnancy is an extremely vulnerable time because of the high costs associated with pregnancy itself and a new baby, the very high medical system engagement we demand of women, postpartum childcare needs and recovery time, and changes in physical and mental health.

I’ve heard women talk about missing appointments for lack of childcare, for an unreliable work schedule or for lack of transportation. Many have difficulty even entering into care due to registration barriers – uncertainty and unfamiliarity with clinics, distrust of the system, and, perhaps most heartbreaking of all, for the cost of care. For example, a Baltimore-area community health clinic charges a set $1,000 per pregnancy fee ($500 up front and $500 at delivery).

So many clients experience what is labeled as a “high-risk” pregnancy. From our initial look at the internal referrals we have received, we are estimating that > 50% of pregnant clients will fall into that category.

How does providing prenatal care at 421 Fallsway address those barriers?

Pregnant clients won’t need to pay for prenatal care here. We’ll support them with enrolling in health insurance, with WIC applications and other benefits, and with connecting to material needs like food, shelter and “baby gear.” We’re offering case management visits to schedule ultrasounds at the time of prenatal appointments, and Community Health Workers serve as an extra support to navigate care by attending visits off-site with clients or helping with transportation needs.

The team has also been working on a strong care management plan – employing a registry of all clients enrolled in care, trialing pre and post clinic huddles to review patient care needs that fall outside of visits, building an OB-specific Care Team schedule, and thinking about how to optimize a family care structure that addresses the health needs of the parent(s), infant and siblings at the same time and/or place.

Pre-natal, post-partum, and intrapartum care are a critical part of holistic whole person AND whole family care. There is so much opportunity here! No matter how or where clients access our services, they can all get prenatal care here.

What does someone seeking prenatal care need to know about our program?

We are offering onsite prenatal care at our 421 Fallsway clinic. A pregnant person who is experiencing housing instability can access care through an internal referral from a medical provider at any Health Care for the Homeless site, including walk-in services. OB appointments happen in our Pediatric and Family Medicine clinic every Thursday morning with either Dr. Yves Richard Dole or Dr. Tyler Gray.

Clients enrolled in OB care can reach out to us during our normal business hours through our call center (410-837-5533) or by walking in. After-hours consultations are managed by Metro OB.

Our partnership with Mercy offers care from a VERY experienced OB/GYN doctor and access to labor and delivery at Mercy Medical. Pregnant clients experiencing high-risk conditions, such as insulin dependent gestational diabetes, will be referred to a Mercy OB clinic for prenatal care.

How can staff refer clients?

Staff can refer clients through any one of our medical providers or—if unavailable—to medical walk-ins.