When Desha Thomas lost her baby at 22 weeks, she felt alone and overcome by grief. Once-supportive friends and family, who had cooed over her growing belly, stopped asking about her pregnancy.
Then a stranger called — and became her lifeline. The woman, a Baltimore Health Department worker who had also lost a child, intuited what Thomas was going through, that Thomas had formed a deep bond with the baby she had already named Ava Morgan.
"I felt like I could talk to somebody that understood the hurt, she understood the love and she understood that it was real and I will feel this way for a while," she said.
The city Health Department, with the nonprofit Family League of Baltimore, is seeking to emulate that intervention with a new program that also includes home visitations. The program aims to reach grief-stricken mothers trying to cope on their own, without counseling from a physician or support group.
Only a handful of such programs exist across the country, and according to the Family League, Baltimore's would be the only one to use as counselors mothers who have grieved the loss of a child, rather than nurses and social workers. A previous home visitation program that relied on professional counselors wasn't widely used.
Officials felt more had to be done to help the mothers cope. Their data on fetal and infant deaths showed mothers were skipping postpartum doctor's visits and some got pregnant shortly after losing a child, before they were emotionally ready.
Baltimore had 104 fetal deaths and 91 infant deaths in 2013, the latest figures available. Fetal deaths are stillbirths that occur after 20 weeks of pregnancy and are not the same as miscarriages.
After the death of a baby, whether in the womb or shortly after birth, mothers may be too depressed to leave the house and some even become suicidal, said Laura Latta, senior program director of early childhood initiatives with the Family League.
She and other health experts believe it's best to reach out to mothers at home, where they may be more willing to open up.
"You can meet moms in a private, safe, comfortable place rather than a clinical setting," Latta said.
Similar home visitation programs have helped to curb the infant mortality rate in the city. In those cases, coordinators visit expectant mothers at home and make follow-up visits after babies are born. They ensure mothers make doctor's appointments, get nutritional advice and are connected to parenting classes.
City health officials say the home visitations have helped to reduce the infant mortality rate 24 percent since 2009. The Pew Charitable Trusts recently lauded those efforts as a model for other states to implement.
Helping mothers deal with the loss of a baby can prevent longer-term emotional problems, officials said. When mothers don't deal with grief, they can internalize those emotions, which can have negative side effects. Or they may be so distracted by those emotions, they pay less attention to their other children.
Some may quickly attempt to get pregnant again, but their bodies may not be physically ready. Or the women may not be emotionally ready, especially if they haven't processed their loss.
"It puts that pregnancy at really high risk and sets the mom up again for possibly another poor outcome," said Cathy Costa,Infant Mortality and Child Fatality Review Director Maternal and Child Health at the Baltimore City Health Department.
Such a loss also can strain relationships and lead to breakups, experts say.
The Family League and the city Health Department have accepted proposals from nonprofits, faith-based groups, government agencies and others to help run the new home visitation program. They expect to begin offering services in the fall.
Officials hope to serve at least 30 families in the first year, with a focus on African-Americans, who have a disproportionately high number of infant and baby deaths because of lack of prenatal care, poverty, and higher incidence of heart disease, diabetes and other ailments that may complicate a pregnancy.
Coordinators visiting the homes under the city program would have experienced the loss of a child, so officials believe they can better relate to the mourning mothers.
"I think women who have not been through this don't know what to say," Latta said. "So they might say it wasn't meant to be. God didn't want you to have this baby. But that doesn't help the mom."
Mothers grieving fetal or infant deaths often confront the idea that they didn't really know their babies; they may feel out of place at group counseling sessions with mothers who lost older children, experts say.
"Families sometimes push the moms and say, 'You didn't really know this baby so you really just need to move on,'" Costa said. "But women can't just move on. It is really a hard thing to go through. You become just as attached to this baby as you would an older child."
Doctors told Thomas, whose baby died in November, that little Ava wasn't growing because blood was not flowing properly to her brain. Doctors told her there was a slight chance she would be born alive.
"We were just praying and hoping that she would come out living so that we could have at least a few moments with her," Thomas said. "Unfortunately, she did not."
Thomas spent a few hours with her daughter, holding her and taking pictures before having her cremated.
"I still bonded with her," she said. "I saw her dad's features in her face. She had fingers and toes and she was real."
Thomas, 33, said she was in shock at first. Then she just felt devastated.
The call from the Health Department helped, and the worker directed her to a support group for other mothers like her.
Thomas still feels sad some days — Mother's Day was especially hard — and the relationship with her fiance didn't survive their daughter's death. But Thomas is grateful she had somebody to help her grieve and explain that it was OK to be down. She says a home visitation program could help even more moms.
"The hardest thing is getting over it; it breaks you apart," Thomas said. "It makes it better to have someone help you with that."
An earlier version gave the incorrect place of employment for Cathy L. Costa. She works for the Baltimore City Health Department. The Sun regrets the error.