Warning signs not enough to prevent infant's death

By By MELISSA FLETCHER STOELTJE

SAN ANTONIO (AP) — Before and after Nidia Yolibeth Alvarado gave birth at University Hospital on Dec. 20, she displayed many of the warning signs of a mother who might commit infanticide.

Some of the red flags about Alvarado — hiding the pregnancy from relatives, for example — weren't relayed to the hospital, which has policies aimed at identifying and helping moms at risk of hurting their babies or themselves.

Police say Alvarado told them that a day after she was discharged, she strangled her son, known as "Baby Boy Mendoza."

His body was found two days before Christmas in a hospital duffel bag on a conveyor belt at a recycling plant.

Alvarado, 25, the mother of two other young children, is charged with capital murder and remains in jail.

In the wake of his death, the hospital is taking another look at its safety practices, which are in compliance with state and federal laws, UHS spokeswoman Leni Kirkman said.

"We update policies as needed to follow evidence-based and best-practice guidelines," she told the San Antonio Express-News (http://bit.ly/1dvN7k8). Before being discharged, all mothers are evaluated by a nurse about their well-being and other possible concerns, she said. If their answers or behavior raise red flags, like the lack of prenatal care, the mothers are assessed in greater depth by a social worker.

Because of confidentiality laws, Kirkland could not say whether Alvarado's initial evaluation triggered a visit by a social worker or provide other details about her demeanor during her stay.

Given that she hid her pregnancy, it's likely Alvarado received no prenatal care, which can put the baby and mother at risk.

Alvarado, an undocumented immigrant from Honduras who was deported once in 2006, checked in at the hospital using what turned out to be a false name, Karen Mendoza, and birthday. There was no record of prior contact with a woman by that name, Kirkman said.

UHS asks patients for identification, but "when they come to the hospital without any ... we are required by law to provide emergency medical care," adding that she couldn't disclose whether Alvarado had furnished any type of ID.

Though visitors to the hospital are not monitored, Kirkman said, the staff noted that no one visited Alvarado during her two-day stay and told police that after the baby's body was discovered, an arrest warrant affidavit states.

The prevalence of neonaticide — the killing of a baby in its first few hours or days of life — is unknown, but one study suggests it could be as high as 2.1 births per 100,000.

Women who kill their babies tend to be poor, relatively young, emotionally immature and single. Many lack prenatal care, feel socially isolated and, like Alvarado, hid their pregnancies.

The screening of mothers before discharge from University Hospital includes a check for postnatal depression and questions to determine how things are going in the mother's life — her relationships, other children, employment, support, finances and living arrangements, Kirkman said. It also gauges her coping ability and stress tolerance.

A social worker might become involved when mothers self-disclose a prior history with Child Protective Services. Teen mothers also receive added attention, Kirkman said.

Other red flags include a mother who doesn't appear to be bonding with her baby or one who appears to be untruthful on the screening test, she added.

If a UHS social worker determines a mother may be at risk of harming her baby, CPS may be contacted for a further assessment, Kirkman said.

CPS might institute a "safety plan," such as placing the child with a relative until the parent receives services to reduce risk, or take other steps to ensure the child's safety.

Other area hospitals have similar assessment protocols, officials said.

All women who deliver babies at hospitals in the Christus Santa Rosa Health System receive an initial assessment that includes a screening for history of depression or mental illness, spokeswoman Rachel Roberts said.

"Based on the results, (she) may be referred to social services," she said. "Likewise, anytime throughout the patient's stay, a nursing associate or physician may refer a patient to social services. Reasons for a referral vary as each referral is unique to the patient being referred."

There is no indication in police documents that Alvarado's relatives notified authorities of other warning signs about her before the baby died.

They could not be located for comment, but they told police they didn't know she was pregnant until she asked to be driven to the hospital.

In November, Alvarado had asked a friend if she knew how she could administer an abortion on herself, the friend told police later.

After being picked up at the hospital, Alvarado told relatives her son was ill and she wouldn't let them see him. The relatives told police Alvarado said the hospital staff "gave her more medication to kill the baby within two hours."

She requested they take her to an apartment where the baby's father lived so he could help her "take the baby to the morgue when he dies," they told police.

Prior to her arrest, Alvarado had no history with CPS, agency spokeswoman Mary Walker said.

Her two other children — a son, 5, and daughter, 2 — were placed with CPS at the time of Alvarado's arrest, although they bore no immediate signs of abuse or neglect.

One way to prevent infanticide is safe-haven, or so called "Baby Moses," laws, which allow parents to safely leave their babies at specific safe locations, such as hospitals and fire stations.

Other strategies are improved sex education and better access to contraception, experts said.

A program at UHS called the Nurse-Family Partnership involves nurses visiting at-risk mothers in the home to offer parenting education and support, but it's limited to first-time mothers, along with other requirements.

Social workers do provide information about other support services for older mothers or those who already have children, Kirkman said.

"Like the rest of the community, we're so saddened by this tragedy," Kirkman said. "We will take this opportunity to evaluate our practice again."

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Information from: San Antonio Express-News, http://www.mysanantonio.com

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