- Associated Press - Wednesday, January 22, 2014

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.

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