Harm reduction doulas step in before the point of crisis.
Editor’s note: This photo series was published as part of a project from journalists Celeste Hamilton Dennis and Florence Middleton about harm reduction doulas and the parents they work with. Story subject Livia Perkins contributed handwritten reflections to this series.
Livia Perkins was dressed in a classic red, polka-dotted dress with perfectly curled hair as we climbed over a freeway overpass guardrail. We were looking for the spot where she had lived the year before. We walked down a steep dirt path—her dress catching on brambles—until we reached the edge. The freeway loomed about 20 feet below us as we hunched over to peered into the dark crawl space beneath the overpass. The sound of traffic was deafening. Could this be where she had slept on a wooden pallet while pregnant, navigating substance use and immobilized by a degenerative hip condition? Livia, usually boisterous, was quiet, processing what she experienced in this place.
When I met Perkins, she had emerged from a long journey using substances while unhoused and pregnant. She gave birth to a healthy, rosy-cheeked baby girl and was navigating recovery while living with family. As a photojournalist, I wrestled with how to show the depth of her past experiences through visuals. So I suggested: What if we revisit the most important places in your journey while you write down your memories? Her therapist had recently recommended something similar—that she return to places of hardship to reflect on how far she had come. Perkins agreed.
We traveled together across Puyallup, Fife, and Tacoma, Wash., with my camera and Perkins’ pen. These photos trace Perkins’ experiences of homelessness, substance use, and pregnancy through five portraits of place: the locations that marked pivotal moments in her journey. Each photograph is paired with her handwritten reflections.
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Perkins lived in her car outside this grocery store—where her homelessness began—not far from her family’s home. She would park at the edge of the parking lot facing a field for privacy.
Perkins lived behind a strip mall in a tent with four men and a dog. The tent caught fire while they tried to stay warm. They nearly died.
Perkins’ boyfriend would bring her to this Motel 6 occasionally to get off the streets. For her, it was an escape. This is also where she found out she was pregnant.
This is where Perkins’ life changed. She had been addicted to alcohol and regularly using meth and crack. Her hip was in severe pain from a degenerative condition, and she couldn’t walk. After living under the overpass while pregnant and sleeping on a wooden pallet, she gathered all her strength in life-altering moment to crawl out and seek help.
The grassy spot beside the convenience store where Perkins waited for days in the blazing sun for someone who promised to pick her up and take her to get help. She got second-degree burns while she suffered from a kidney infection. This was her final moment of being unhoused.
