COTEAUX, Haiti – Nathanaelle Bernard was two months short of the due date for her first child when Hurricane Matthew crashed through her town overlooking the Caribbean Sea along Haiti's southwestern coast.
The storm, with its 145 mph winds, destroyed her small home of cinder blocks. Powerful waves carried away most of her belongings, including the clothing and blankets she had managed to collect for her baby. She's now anxiously awaiting the birth amid the ruins of her town, with even food and fresh water scarce.
"I always had this dream my child wouldn't want for anything," the 19-year-old said on a recent morning, her face glowing with sweat as she cradled her swollen belly. After a pause, she added: "It was a nice dream."
She shares a makeshift hut with five members of her extended family and her precarious situation is emblematic of an alarming situation across Haiti's southwestern peninsula in the wake of the storm. The U.N. Population Fund says nearly 14,000 women are due to give birth in the next three months amid widespread shortages of meat, clean water and housing in an area where poor sanitation has created ideal conditions for cholera and other diseases.
Even in the best of times, pregnancy and childbirth is risky in Haiti, which has the highest maternal mortality ratio in the Western Hemisphere. Many rural women give birth at home, often with untrained midwives who administer care using leaves made into tea, smoke or steam.
The Haitian government, with international assistance, has implemented programs that have helped reduce the maternal death rate by nearly half over the past decade. But, with 359 women dying for every 100,000 births due to complications, Haiti is on par with countries such as Ethiopia and Madagascar, according to the U.N.
Many experts fear the advances have been rolled back by Hurricane Matthew, which made landfall on the peninsula Oct. 4. The government says the storm killed 546 people and destroyed the crops and livestock that people like Bernard and her family depend on for survival.
"It is tragic that a single storm can tear up so much of this progress, and that in a single day we can be set back by years," said Marielle Sander, representative for the U.N. Population Fund in Haiti.
Throughout the disaster zone, health clinics and hospitals have been badly damaged and medicine is in short supply, adding what Sander calls a "lethal combination" of factors that threaten pregnant women and newborns, especially those born with complications.
At the general hospital in Les Cayes, the region's largest city, about a dozen pregnant women sought care on a recent morning, some complaining about symptoms of high blood pressure. Expecting women in Haiti are disproportionately threatened by disorders such as eclampsia and pre-eclampsia, which bring high blood pressure and can cause seizures, heart failure and hemorrhaging.
"Before the hurricane we didn't have enough antibiotics and other medication. But now the situation's harder. We need more of a lot of things," said Lucie Naomie Lafortune, the ward's head nurse.
Bernard occasionally gets shooting pains in her stomach, retreating to a bed in the shack her uncle built from scavenged materials after the family's home was destroyed. She curls up with her eyes shut tight, taking acetaminophen she got from a nurse.
She tries her best to push out negative thoughts. But that's tough to do while undernourished and with little protection from any number of diseases stalking people here, including the mosquito-borne Zika virus that can cause serious birth defects if women are infected while pregnant.
Romual Saint-Jean, the 27-year-old father of her unborn child, moved Bernard to her uncle's coastal village from Port-au-Prince after she contracted typhoid in early 2016. They believed Coteaux's salt air and slow-paced life would do her good.
Now, he desperately wants to move the family overseas but has no idea how that might happen. Saint-Jean, who lost his $300-a-month job in July as a Portuguese-Haitian Creole translator for Haiti's U.N. peacekeeping mission, is struggling to find work.
"I don't see a future here," he said after returning from another discouraging job-hunting effort in the capital.
The young couple met last year in the back of a "tap-tap," colorfully painted group taxis that connect Haitians to jobs, markets and each other. Saint-Jean told buddies he thought he had met his future wife.
Pretty soon, Bernard was pregnant. They were happy and excited, even if the baby wasn't planned.
But the pressures are growing and she sometimes has to steel herself to hold back tears.
"I worry most about nutrition," said Bernard, who subsists mainly on rice, corn meal and bean sauce. "How can my baby be strong if I'm not eating well?"
Associated Press journalists accompanied Bernard to the public hospital in the wrecked town of Port Salut, where she got a free checkup. But she couldn't afford an ultrasound to find out the baby's sex before delivery.
Some of the young couple's happiest times are debating names. With a pealing laugh, Nathanaelle said she only knows it won't be Fabienne or Fabiola if it's a girl because she dislikes names that begin with "F." A Pentecostal pastor recently placed his hands on her swollen belly and suggested Jonas if it's a boy.
Grimacing slightly as she hoisted herself from a wooden bench, she prepared for the most relaxing part of her day: Lowering herself into the gently lapping sea and giving her swollen ankles a rest.
Bernard knows her family's immediate prospects are not good. But when she's floating in the shallows she meditates on what remains.
"We lost the things we had. But we're not lost," she said after drying herself on the sandy beach where she and her neighbors bury their waste. "We're alive. Our baby is alive. And that's what's most important."