BOSTON — SHE was pregnant and afraid.
Somehow she got into a Miami hospital and gave birth to a baby in the restroom. Then she left the baby there and disappeared.
Any baby left behind like this - along with thousands more babies less dramatically left behind - becomes a "boarder baby" in a hospital.
If the mother cannot be found, or is known to be on drugs, and if placement in a foster home is difficult, or adoption is slow, the baby is "boarded" for a few days, weeks, or months.
A recent study of 72 urban hospitals done by the Child Welfare League of America and the National Association of Public Hospitals (NAPH) disclosed that "boarder babies are part of a larger alcohol and substance crisis of enormous proportions, which is sweeping through major metropolitan areas in the United States and having a profound impact on public hospitals ... and the child welfare system."
Larry Gage, president of the NAPH, says: "Most of these babies are in the hospitals because there is no place to put them, not because they require constant medical attention." He says each baby can cost a hospital anywhere from $240 to nearly $1,200 a day.
A Cleveland hospital disclosed that it had been boarding a baby for five months at $600 a day for a cost of $90,000 to the county.
In New York City there were more than 300 new boarder babies for the first three months of 1992, and 88 percent of all boarder babies there were prenatally exposed to drugs or alcohol. The New York Human Resources Administration says this is a 17 percent increase in the number of boarder babies from last year.
Estimates of the number of boarder babies in all US hospitals go as high as 375,000, but no one knows for certain. Caring for them could carry an annual cost of $34 million, the NAPH says.
"Here in Harlem," says Dr. David Bateman, director of newborn services at Harlem Hospital in New York City, "we have between 15 and 30 boarder babies a month. The peak year was 1989. Since then the foster-care agency has become better organized and recruits more foster parents."
Typically, when a hospital determines that a mother has been on drugs and the baby has been affected by the abuse, the city's welfare or social-service agency is contacted. In some states the agencies are mandated to conduct an investigation into the the mother's ability to care for the child.In many cases the mother is encouraged to visit the baby at the hospital while the agency tries to help the mother.
In other states, health officials investigate the case in order to avoid escalating or complicating the issues by involving more professionals and more paper work.
IN a study done by the US House Select Committee on Children, Youth, and Families, the number of boarder babies increased in a Miami hospital by 20 to 30 at any one time after a law was passed requiring child protective services to assess the home environment of newborns.
"We get about five or six [boarder] cases a month," says Dr. Steven Parker, medical director of the newborn nursery at Boston City Hospital, where cases of drug-exposed infants are turned over to the city's Department of Social Services.
"It's hard to say if the problem is on the rise here because there has been a general decrease in births in Boston in the last few months," Dr. Parker says. "But far and away the most common reason we have boarder babies is because the baby is withdrawing from drugs."
The nationwide increase in the number of babies born with drug-related problems has put an enormous strain on the foster-care system and health-care providers. A report from the North American Commission on Chemical Dependency and Child Welfare found that "88 percent of the state, county, city, and voluntary not-for-profit agencies surveyed noted an increase in the number of children entering foster care who were prenatally exposed to alcohol and other drugs, and 48 percent reported difficulties in locat ing foster homes for (such) children."
Even though several congressional bills are pending that would provide modest amounts of money - the Family Preservation Act and the Educators' and Drug-Exposed Children's Assistance Act - professionals point to long-range solutions.
"What needs to happen," Parker says, "is the economy in inner cities needs to improve along with the support systems for families and care given to children to help them out of poverty. To me the drug problem is the symptom of a deeper malaise. Families are in much worse shape than [a few years ago], more abuse, more drugs. To me, this is the result of urban neglect for the last 12 years."
Mr. Gage says the health programs that exist are probably adequate if they are funded adequately.
"But the shortfall," he says, "is in job training, drug- abuse treatment options, and assistance to single mothers and parents who want to keep a family together - that's what is needed."