Navy veteran Carisma Carter was eight months pregnant when she pulled her red car up in front of the Atlanta VA Clinic. Her seat was pushed far back from the steering wheel, to make room for her big belly.
"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 the latest data show Black women are more than twice as likely as white women to die during or after 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."
The number of women serving in the United States military has been growing.
And women are the fastest-growing group of veterans in the country, according to the Department of Veterans Affairs.
Recently, the VA has been acknowledging it needs to better serve their health needs, including pregnancy and childbirth. Among researchers, there's concern that women veterans may be at heightened risk for pregnancy complications, compared to their civilian counterparts.
Diapers, infant supplies, and cheers all part of VA baby showers
A few years ago, the Atlanta VA Clinic got creative with its outreach to pregnant patients. It began throwing them surprise baby showers for small groups of patients. They helped cement relationships with the clinical staff, and helped ensure pregnant moms had all the supplies they needed as they headed into the final stretches before giving birth.
When the pandemic happened, the VA didn't stop the showers, but instead transformed them into low-contact "drive-through" showers which now happen about every three months.
At a recent shower held on Feb. 10, volunteers set up in front of the main entrance of the Atlanta VA.
The building itself is concrete, beige and bland. But the volunteers managed to create 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 said. " 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 her health, other volunteers rushed forward bearing supplies. Some piled boxes of diapers into the backseat. The final, parting gesture was a $100 gift card.
"To get the last-minute baby needs, because we know there's a lot," explained Kathleen O'Loughlin, who manages the Women Veterans Program at the Atlanta VA.
Cementing relationships between health teams and expectant parents
The quarterly baby showers serve about 20 pregnant veterans at a time.
The goal is to make sure pregnant veterans get all of their prenatal appointments, and also see perinatal specialists if they need to. A trained maternity care coordinator manages each pregnant veteran's care.
O'Loughlin said they can't invite every pregnant veteran to these group baby showers, so they focus on those at highest risk.
These include veterans pregnant with multiples, or 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 says. "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?"
Research shows these kinds of health checks can help prevent pregnancy complications.
The problem is urgent.
The U.S. maternal mortality rate — already worse than most other high-income nations — increased again during the pandemic, according to the U.S. Centers for Disease Control and Prevention.
Physical and psychological injuries linked to military service can increase the risk for poor maternal outcomes, according to Dr. Jamya Pittman, an internist and medical director for the Women 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 says, "We also know that pregnancy in itself can be a stressor on the body."
So, the Atlanta VA designed the baby showers to boost veterans' wellbeing, she explains. Program volunteers are predominantly women veterans themselves.
"This visible showing of support, this community engagement, this celebration," she says, "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."
Rolling out the 'Protecting Moms Who Served Act'
Nationally, the Department of Veterans Affairs is focusing on women's health at all life stages.
For example, the Atlanta Women Veterans Program serves more than 24,000 veterans in the region, and about 9 percent of them are pregnant at any one 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 U.S. Sen. Tammy Duckworth (D-IL), on the day the bill was introduced.
The law, called the Protecting Moms Who Served Act, also provided $15 million dollars to support maternity care coordination programs at VA facilities.
The Atlanta VA is using some 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 appreciates the outreach the VA is doing.
"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."
Not long after speaking with WABE reporter Jess Mador, Carisma Carter gave birth to her twins on Feb. 25. Carter says she and the babies are doing well. The Women Veterans Program will continue to cover her for 12 months after their birth.
This story comes from NPR's health reporting partnership with WABE and KFF Health News (formerly Kaiser Health News).
