When 28-year-old Navy veteran Carisma Carter pulled her car up to the front of the Atlanta VA Clinic, her seat was pushed far back from the steering wheel to make room for her big belly. Carter was eight months pregnant.
"I'm having two boys, twins. It's my first pregnancy," she said.
Carter knows the pregnancy risks she could face as a Black woman, especially in Georgia, where data shows Black women are more than twice as likely as white women to die during or within a year after a pregnancy.
"I take care of my body during the pregnancy, but, yeah, I'm very aware," Carter said. "And I just try to stay positive."
A recent report from Rand Corp. outlines some of the ways the health needs of women differ from men's, including pregnancy and childbirth. And health researchers have said female veterans may be at heightened risk for pregnancy complications, compared with their civilian counterparts.
A few years ago, the Atlanta VA Clinic got creative with its outreach to pregnant women. It began throwing surprise baby showers for small groups of women. The goal is to cement relationships with the clinical staff, make sure pregnant veterans get to all their regular and specialist appointments, and help ensure pregnant women have the supplies they need as they near delivery. A trained maternity care coordinator manages each pregnant veteran's care.
After the COVID-19 pandemic emerged, the VA transformed the showers into low-contact "drive-through" events, which occur about every three months, and serve roughly 20 pregnant veterans each time.
At a shower in February, volunteers set up in front of the main entrance of the Atlanta VA. The building is concrete, beige and bland. But the volunteers created a celebratory atmosphere by decorating a folding table and stacking it high with free diaper bags and other baby supplies.
A car pulled up to the table and a volunteer with a clipboard began hyping up the small crowd, which then burst into applause and cheers.
"Thank you for your service!" they called out. "Congratulations!"
The pregnant veteran behind the wheel looked surprised at first. Then she broke into a big smile. She rolled down her car window.
Volunteers and VA staff members clustered around the car and offered her a tiara of green, white and pink flowers.
"Would you like to wear it?" one asked. "Stunning! Remind us what you're having?"
"I'm having a girl," the woman said.
While they chatted through the open window about her due date and health, other volunteers rushed forward with supplies. Some piled boxes of diapers into the back seat. The final, parting gesture was a $100 gift card.
Kathleen O'Loughlin, who manages the women veterans program at the Atlanta VA, said the events offer "last-minute baby needs."
"Because we know there's a lot," she said.
O'Loughlin said the health center can't invite every pregnant veteran to the group baby showers, so they focus on women with higher-risk pregnancies, including veterans carrying multiples or those who have a disability related to their military service.
"Now, a lot of the women have different musculoskeletal issues because of their service, (or) a lot of service-connected disabilities that civilian women aren't exposed to because they don't have those same job responsibilities," O'Loughlin said. "This is an extra set of eyeballs on them. Are you making sure you're taking your blood pressure medicines? Are you getting all of your appointments, are you meeting with your doctors?"
U.S. maternal mortality rates increased again during the pandemic years of 2020 and 2021, according to the Centers for Disease Control and Prevention.
Physical and psychological injuries linked to military service can increase the risk of poor maternal outcomes, according to Jamya Pittman, an internist and the medical director for the female veterans program in Atlanta.
"A lot of our women veterans have the diagnoses of anxiety, depression. They may also have PTSD, in addition to a myriad of other diagnoses like hypertension and diabetes," Pittman said. "We also know that pregnancy in itself can be a stressor on the body."
The Atlanta VA designed the baby showers to boost veterans' well-being, she explained. Program volunteers are predominantly also female veterans.
"This visible showing of support, this community engagement, this celebration," she said, "is our way of helping to decrease stress and allow the woman veteran to know that she has a partner in her health care and with the arrival of the baby."
Nationally, the Department of Veterans Affairs is focusing on women's health at all life stages.
The Atlanta women veterans program serves more than 24,000 veterans in the region, and about 9% of them are pregnant at any time.
Two years ago, Congress passed bipartisan legislation mandating a national study of pregnancy outcomes among veterans, including any racial disparities.
"There has never been a comprehensive evaluation of how our nation's growing maternal mortality crisis is impacting our women Veterans, even though they may be at higher risk due to their service," wrote co-sponsor Sen. Tammy Duckworth, D-Ill., on the day the bill was introduced.
The law, called the Protecting Moms Who Served Act, also provided $15 million to support maternity care coordination programs at VA facilities.
The Atlanta VA is using some of its share of that money to make sure pregnant veterans receive ongoing medical care for a full year after giving birth.
Carter, the Navy veteran who stopped by the baby shower, said she appreciated the outreach from the VA.
"Just checking on the women, supporting them, making sure that they have everything that they need for the baby," she said, "because a lot of people don't have that support. They don't have family. They're doing this on their own."
Carter gave birth to her twins on Feb. 25. She and the babies are doing well, she said. The female veterans program's maternity care coverage continues for 12 months after the twins' birth.
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