Monica Ramos' voice quivers when she talks about her daughter's birth, five weeks premature, two years ago in Dallas. Little Mariela weighed just 2 pounds. Doctors were unable to explain her prematurity.
"It's very difficult to talk about it," said Ramos, 25. "It's very difficult to remember about how the baby was born and my feelings. It was very hard."
Through a friend who also had a premature baby, Ramos heard about a program that could help her daughter grow and provide support for her as a mother.
The Low Birth Weight Development Center in Dallas is a unique program that reaches out to mothers like Ramos when their babies are still in the neonatal intensive care unit at Parkland Memorial Hospital. It follows up with home visits, offering developmental services to both parents and children. While most major cities have low birth weight health clinics, the director of the Dallas center said he knew of none like his that included help for both babies and parents.
Infants and toddlers are cared for six hours a day in a nursery, working toward individual development goals.
"Because each preemie is different, we can't generalize," said Lucy Toye, director of the day care center.
The children also participate in normal childhood activities such as Easter egg hunts and morning snack time. This helps to keep them from feeling isolated, Toye said.
While their children are learning, mothers receive instruction in English, job skills, computer literacy and GED preparation. Evening support groups are also available for fathers, who discuss domestic violence and father-child relationships.
"We're very strong on literacy - family literacy, in particular," said Rick Davis, the center's director. "We read to the children every day, we encourage their parents to read to them every day.
"We realize in order for parents to provide for all of the needs of these vulnerable toddlers and infants, they're going to need to be able to find gainful employment and be able to provide," he said. "Whether it's job skills training or GED preparation, we want to help them optimize their outcomes."
Ramos said that, during her time in the three-year program, she's learned English, as well as basic health and life skills. She said she's also seen a change in her daughter.
"She learns a lot, she's more active, she's more friendly, also. It's very good for her and for me," Ramos said.
Ramos has also formed relationships with other mothers in the program, something program staff members said is not uncommon. The clinic provides transportation to and from mass transit stations, but many of the mothers have organized carpools, Davis said.
A central goal of the program is to prevent mothers from having a second low birth weight child.
"I think we have to educate these young teenagers on exactly what the risk factors are. ... We have to preach abstinence, I think, number one, but if that doesn't work, we've got to be able to educate them in terms of what the risk factors are and make certain that they understand that," Davis said.
Those risk factors, Davis said, include race, socioeconomic level, smoking, abuse of over-the-counter drugs, sexually transmitted diseases, a lack of prenatal vitamins and a failure to visit with the physician during pregnancy.
Davis said he is proud to be involved in the clinic's work and believes it has made a great difference since it was established in 1992. In 14 years, he said, there is no story more compelling than the others.
"We find that a lot of our mothers are depressed, that they have family or domestic violence issues, that they don't have the attachment to their babies that they should, and so we get an opportunity to impact those things," he said.
Toye, the program's day care director, found herself involved in the cause partly for personal reasons. Her 13-year-old son was 6 pounds 11 ounces and was born at 35 weeks. He didn't have the ability to suck - it would take him two hours to nurse 10 minutes worth of milk. He quickly lost weight, and remains small for his age.
Toye herself weighed just 4 pounds when she was born in 1963. The center would have made a vast difference in her son's young life and in her own life as a mother, she said.
"The support would have been wonderful because I felt very isolated," she said.
"He had respiratory issues, and I was doing breathing treatments around the clock every four hours, so I was also very much sleep deprived, between feeding and breathing. I did that for 36 to 48 months."
A critical part of the program's mission, Toye said, is preparing parents to handle the stress of a special needs child.
"We're also teaching the parents how to handle the crisis," she said.
"If it becomes a long-term situation like it is with my son, it's just the way life is and you go on, and you can become - like he is - a regular teenager, with orchestra and choir and doing everything else seventh graders are supposed to be doing," Toye said. "My goal is to see all these kids become regular seventh graders."
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