For one long winter, Yvonne Freeman, then a pregnant mother of three, lived on the streets of Olneyville, with her children, ages 3, 6, and 9. Day by day, she worried about how to feed them, how to keep them warm. But she didn't worry about the one growing inside her. That one, she figured, was safe.

Her obstetrician chided her for missing prenatal visits -- but never asked why. So the disapproving doctor never knew that Freeman, then 26, had been evicted from her apartment because her husband didn't pay the rent, and that she needed to stay away from him because he was beating her.

Sometimes Freeman and her children took overnight refuge in a record store in Olneyville, a ragtag Providence neighborhood. Food stamps kept them from starving. But under such circumstances, Freeman's body was not able to provide the shelter she imagined for her coming child. One day in early February 1994, she was feeling terribly ill. Leaving her children with her mother, she went to the hospital. They told her that her water had broken. She was only 24 weeks pregnant.

Today, Yvonne Freeman understands why that happened. She can describe how chronic stress provokes the release of hormones implicated in preterm birth, and how it also weakens resistance to infections that can trigger premature labor. She can tell you that premature births nationwide have been increasing steadily over the past two decades and costing billions of dollars.

Freeman also knows the statistics showing that African-American women have much higher rates of premature birth than any other ethnic group -- 18.1 percent compared with 11.5 percent for whites. The high rates persist among those who grew up in the projects, as she did, but also among those with high education and income. Because so many premature babies die, preterm births are a major reason for the big difference in infant mortality rates between blacks and whites in America.

Journal photo / Kathy Borchers Fifteen years ago, Xavier, standing with his mother, Yvonne, and her husband, Jose Heredia, was born at just 24 weeks’ gestation. Today, he is an eighth grader at Nathanael Greene Middle School, in Providence.

Freeman is well-versed in these facts because -- in a storybook reversal of fortune -- she has become an obstetrical nurse who has a managerial job and wears a suit to work. And who never for a minute forgets where she came from, or that cold February night when her fourth pregnancy ended.

The doctors told her the baby was in danger and had to come out, but Freeman didn't believe he could survive after so little time in the womb. After she finally consented to a cesarean section, her son Xavier was rushed to the neonatal intensive care unit, or NICU, at Women & Infants Hospital. "He was the smallest person I've ever seen in my life," Yvonne recalls. "I was like, ‘Oh my goodness.' … All these tubes and wires and beeping."

When Freeman visited her baby in the NICU, her three other kids waited in the hospital lobby. It was a chance for them to get warm.

Meanwhile, Xavier was getting top-dollar care at Women & Infants, lying in an elaborate bassinet, surrounded by machinery, cared for by highly trained doctors and nurses. At Women & Infants, every baby who needs such care gets it, swiftly and automatically; no one checks to see who's paying. In Freeman's case, taxpayers would foot the bill, likely to exceed six figures. But if Freeman had had somewhere to turn when she was pregnant -- at least a roof over her head -- chances are Xavier would never have needed that costly help.

FREEMAN GREW up in the Chad Brown housing project, one of four daughters of a poverty-stricken mother and absent father. A promising student, she attended Classical High School, a public school for Providence's brightest, where she was often the only black kid in class. When she visited her white friends, she was amazed at what they had: "I saw they ate all these meals -- three times a day! They had clean socks!"

Journal photo / Kathy Borchers Freeman meets informally with young girls to discuss relationships and birth control. "You don't have to be proper about it," she says. "There's nothing I haven’t heard."

Unlike many girls she grew up with, Freeman says she did not become involved with drugs. But she fell into many of the other patterns that plagued her peers. By age 15, she'd been expelled from Classical because she was pregnant. The father, a man nearly 10 years older, beat her viciously, breaking her jaw and her arm. In the emergency room, a nurse pleaded with her, for the sake of her pregnancy, to get away from this man. (Years later, this same nurse would be astonished to meet Freeman again, back at the hospital this time as a nursing student.)

At 17, Freeman earned her general equivalency diploma. At 18, she was pregnant again, this time by a boy who was not abusive, but young and irresponsible. At 21, she married into a second abusive relationship. She had her third child, and then fled the relationship -- to the streets -- while pregnant with her fourth.

Freeman's first three babies had all been born prematurely, at 34 or 35 weeks (a normal pregnancy is 40 weeks). Homelessness deepened the risks for her fourth, Xavier, who was born so early that few expected him to survive. Instead, Xavier spent months in the NICU.

Not until it was nearing time for Xavier to be discharged did the hospital's nurses and social workers realize that the infant had no home to go to. Freeman, terrified of losing her children, had been cagey with them. Every apartment she'd arranged for somehow fell through. So in the end, Xavier, with oxygen and a cardiac monitor, was discharged to the back of a record store.

It was a difficult and unorthodox situation, says Trisha O'Reilly, the social worker who oversaw the discharge. She remembers, though, that Freeman had come to the hospital to visit Xavier every single day, and that despite her chaotic circumstances, "she herself was not chaotic. She was very resourceful."

"Sometimes the concrete stuff gets in the way of people who are good mothers and good caretakers," O'Reilly says. "Not every baby is going home to the perfect home or perfect situation."

AMID ALL THIS, something extraordinary had happened to Freeman. "The NICU nurses, it was their support that really changed my life," she says. "They really gave me the most nonjudgmental care you could ever give anybody. I came in with so many issues and yet they treated me like anybody else. That was just deep for me."

Freeman so admired the nurses and the work they did to save her baby that she decided to become a nurse. And through a stroke of good fortune, while Xavier was in the NICU, she had met "a wonderful, wonderful guy" in Olneyville, Jose Heredia.

He helped her get an apartment in Federal Hill. The year after Xavier came home, Freeman enrolled at Rhode Island College to earn a nursing degree. Xavier, meanwhile, grew slowly. He needed two eye surgeries and to this day has severe asthma. But he met his developmental milestones and did well in school up until sixth grade, when he started having trouble grasping the work. He's now an eighth grader at Nathanael Greene Middle School.

Freeman got her nursing degree in 2000 and worked in several nursing jobs before landing at Neighborhood Health Plan of Rhode Island, a health insurer that serves Medicaid patients. Today, she and Heredia are married, have two children of their own, and own a house in Providence. At Neighborhood, she was recently promoted into a supervisory position.

Fifteen years ago, when she was living on the streets, did Freeman ever think she'd have a job like this? "I didn't think I'd be alive," Freeman says.

Freeman sees herself, and her premature babies, as prime examples of how social conditions -- housing, education, poverty, domestic abuse, lack of opportunity -- can endanger a woman's pregnancy. Women living in impoverished neighborhoods are more likely to have preterm and low-birth-weight babies. Now pursuing a Ph.D., Freeman is studying the biological processes that make that happen.

"To me, if your outside environment is not great, and mentally you're not feeling good, that's got to impact the uterus," Freeman says. Speaking of the pregnant women she has counseled at work, she says, "We really need to look at these women and find out what their situation is. Are they homeless? Are they in a domestic violence situation? These women are not going to volunteer that information. You're going to have to extract it. Because I know. Because I didn't tell anybody."

Journal photo / Kathy Borchers Freeman shows the girls various types of birth control.

Freeman often talks, her voice rising with urgency, about "giving back." She wants to reach inner-city girls who remind her of herself and empower them with information. Like a Biblical prophet, she gathers groups of teenage girls -- friends of her niece, kids from the neighborhood -- and preaches to them about sex, sexually transmitted diseases, birth control and more. These talks occur in public parks and playgrounds, under the auspices of no one but Yvonne Freeman and her need to give back.

"You don't have to be proper about it," she told eight teenage girls at one such session last summer, urging them to ask her anything. "There's nothing I haven't heard."

She assured them she wouldn't stand in judgment, because she's been in their shoes. "I was 15 when I had my first baby. I didn't know anything," she told them. "I didn't know there was birth control."

Freeman hopes she can show these young women a way out. "You can be a victim of your surroundings," she says. "But you don't have to."