Prenatal care, which regularly checks an expectant mother's pulse, blood pressure, weight and nutrition, costs $800 to $1,200. After birth, a month's stay in a neonatal intensive care unit can cost $300,000. Marjorie Gish, a registered nurse at the Lamb's Church prenatal care clinic, said the plight of the city's homeless, pregnant women reminded her of her Peace Corps days in a Mayan village in Belize, where shoeless women walked through open pigsties and bathed in a stream. There, however, the chief, convinced of the need, ordered pregnant women to get regular checkups _ a power that no authority wields in the largest city in the world's wealthiest nation. ``Care was more readily available in the village. The homeless and pregnant in New York are probably worse off than the women receiving care in Third World countries,'' said Mrs. Gish. The children who survive have dim prospects of a normal life. ``They are the closest things you can find to refugee populations in underdeveloped countries,'' said Dr. Irwin Redlener of New York Hospital, which provides pediatric care for the homeless through donations by singer Paul Simon and New York Yankees slugger Don Mattingly. ``They are disenfranchised, cut off and undernourished. A lot of kids are not going to recover from the psychological trauma they've experienced,'' Redlener said. ``You end up with a lost generation of children,'' said Stephen Banks, a lawyer with the Legal Aid Society. The average homeless, pregnant woman is 27 years old, a high school dropout who has two or three kids already. Sixty-seven percent are black; 27 percent are Hispanic. Like all homeless, they qualify for Medicaid. Patricia Smith, four months pregnant, has an 8-year-old daughter and 6-month-old son. Everyone in her family has asthma. She had just spent three nights in three different hotels. ``I'm a walking zombie,'' said Mrs. Smith, 37, clutching a dog-eared prayer book to her bosom. ``It's like you're falling and there's no bottom and there's nothing to catch on to. ``It makes me feel like I'm a failure. People treat you like you're nothing,'' she said. ``I'm always petrified. I've chased rats as big as alley cats away from my children. But I have no place else to go.'' Frustrated social workers offer prenatal care but expectant mothers don't actively seek it. Some skip sessions to keep their Medicaid appointments, which can take two weeks to reschedule. Others loathe standing in line for hours and filling out forms at hospital clinics. ``We knock on doors in the hotels,'' said Barbara Conanan, director of the homeless project at St. Vincent's Hospital, which has a van to drive patients to clinics or gives them transit tokens to make it easier to get care. ``You have to reach out. Some don't understand the need for prenatal care. Many of them never sought it for their other children. There's a real lack of education,'' Ms. Conanan said. In a pilot program, a team from Bellevue Hospital identifies and registers pregnant women at the Prince George Hotel. The city then pays their way to and from the hospital for checkups. In addition, the city's Department of Health has clinics inside three hotels, which offer convenience but lack such amenities as private exam rooms found in a hospital or doctor's office. The state Bureau of Reproductive Health also has a $100,000 medical van that dispenses prenatal care at five sites. Living in a hotel may sound downright cozy, especially when a room costs taxpayers an average $2,000 a month or $23,725 a year; that's enough to rent a spacious apartment or make a down payment on a house. Half the bill is paid by the federal government; the other half is split by the city and state. In New York, however, the money most commonly rents space in warehouses of despair such as the Martinique, Prince George, Holland and Allerton hotels. Expectant mothers and children are especially vulnerable in these hostile incubators. Drug dealers recruit homeless children as lookouts and couriers, according to city council's Select Committee on the Homeless. Other kids sit in hallways at night while their mothers deal sex for crack, hotel residents said. Some hotels are brothels, the committee said. By day, hookers rent rooms by the hour. When business drops off at night, the homeless move back in. The beds are called hot sheets because nobody stays on them too long. Jacqueline Macklin, 31, a hotel resident since 1984, sent her 11-year-old twin daughters to live in Philadelphia with their grandmother in 1987 after they saw a security guard shot dead by another guard in the Holland Hotel. ``There's nothing a kid doesn't see in here,'' said Mrs. Macklin, herself a recovering crack addict. ``It's a picture of the worst of our civilization,'' said Robert Hayes, founder of the Coalition for the Homeless. ``It's an abandonment of the most fragile people to the most devastating of environments, and then we wonder why these kids are so irreparably harmed,'' Hayes said. ``It's insane as well as cruel to leave a woman in a situation that will result in a sick baby.''
