Pale and sweating, the slight teen-ager made it to the waiting room and collapsed in a chair.
On one of the hottest days of August, she had to walk 2 1/2 miles along congested streets to reach the Freetown Health Center, the nearest maternity clinic. Her father's car was in the shop, and she didn't live near a bus route.
Seven months pregnant, she was a little unsteady on her feet. Shearrived at the public health clinic in Pasadena drained and feeling faint.
It was the clinic's second emergency of the morning. Another pregnant woman had called earlier to cancel an appointment, saying she was about to be evicted.
"A lot of our girls have trouble dealing with their pregnancy because they have a million other problems,"said Michelle Goodson, a social worker who counsels many of the nearly 200 women who get prenatal care each year at the Freetown clinic. "They're having financial troubles or they can't find any cheap housing or they just broke up with their boyfriend, and they don't know how to pay the bills."
She and other health care workers at the Freetown, Annapolis and Odenton clinics point to several major stumbling blocks that prevent expectant mothers, especially teen-agers and those from poorer neighborhoods, from getting good prenatal care. Among them are:
* Transportation problems. Many women working at entry-level jobs or in the service industry don't own cars. They either walk to work, get rides from friends and family members or take the bus.
To help women like the teen-ager without a ride, the Freetown clinic has set up an emergency cab account, said Marianne Degnan, the nurse manager. But hiring cabs doesn't cure the problem.
* Harmful habits, from smoking cigarettes to using drugs. Nearly three-quarters ofthe patients at the Freetown clinic smoke, Degnan said. About 25 percent of the smokers quit while they're pregnant, but the rest keep onpuffing.
Drug use often prohibits pregnant women from getting proper care. When a woman is strung out on crack cocaine, she has a hardtime remembering her monthly checkup, let alone to eat more leafy vegetables and fruit, Goodson pointed out.
* A shortage of affordable housing. Most of the women on medical assistance aren't married or have husbands without steadyjobs or who work in the construction industry or similar trades that have frequent layoffs. They live from paycheck to paycheck.
Figures from the county Office of Planning and Zoning show unsubsidized apartment rents in the county have soared inthe last decade, with the average climbing from $292 in 1980 to $574in 1990. The number of apartments renting for less than $400 a monthdropped from 1,745 in 1989 to 605 in 1990.
* A lack of specialized care at the local hospitals. North Arundel Hospital doesn't offer obstetrics, and Anne Arundel Medical Center is equipped to handle onlynormal deliveries. Premature, underweight and sick infants are transferred to Baltimore hospitals.
Harbor Hospital Center, just acrossthe county line, offers the most complete services for pregnant women at risk of having low birth-weight or drug-addicted babies.
The service shortage has prompted the county Health Department to focus more of its efforts on preventing premature babies who are more likelyto die young.
The department set up regional maternity clinics tooffer everything from nutrition counseling to drug-treatment programs. Health officials also want to continue programs such as Healthy Generations, a pilot project in Glen Burnie that hooks at-risk women upwith medical insurance and prenatal care.
With proper prenatal care and home visiting to check on the progress of low birth-weight babies, the county's infant mortality rate could be dramatically reduced, said Dr. Leland Spencer, who is studying the problem for the HealthDepartment.