In Wake, nurses will aid families

They will advise poor mothers until babies are 2

The young women Suzanne White sees every week are scared.

Pregnant and poor, they cling to White's assurances that they can endure the pain of childbirth, that they can be good parents despite their own often dubious role models, that they have it within themselves to finish high school or even attend college on top of the complication of a baby.

"I feel blessed they trust me and let me come to their homes, and that they want to make good choices," White said. Her job is to meet with the young women on a regular basis, offering both medical advice and ordinary life counseling as part of the Nurse Family Partnership. It is a national nurse-visitation program that has been running in Guilford County since 2000 and will begin in Wake and eight other counties in January with public and private money.

The program's mission is to improve the health of poor children and their mothers by intervening early, while the young women are still pregnant, and sticking with them as their babies grow into toddlers. Established 30 years ago and tested against other interventions to gauge its success, the Nurse Family Partnership has a track record of keeping young mothers off welfare, delaying a second pregnancy and helping women be more attentive and engaged moms.

"The program works in an enormously effective way for first-time mothers," said Robin Britt, executive director of Guilford Child Development and a former secretary of the state Department of Health and Human Services. Britt is also a board member of the national Nurse Family Partnership organization.

He said the Guilford County program has achieved all of what the national program touts as its advantages -- and more. Since it began providing services eight years ago, it has cut the number of expectant mothers experiencing violence, gotten more women to quit smoking during pregnancy, and improved the language scores of toddlers, among other achievements.

He said a major accomplishment is keeping young women from having a second child soon after the first. That can often derail even the most motivated young mother's ability to finish her education or get a job.

Winning the battle

Such proven success sparked interest at the state level, and led to the expansion into Wake and other counties. Each program requires about $500,000 a year to hire nurses and get established. The money was allocated from state and federal taxpayers' dollars, plus grants from the Duke Endowment and the Kate B. Reynolds Charitable Trust, among others.

Wake County's program is expected to begin enrolling women by the end of January, targeting first-time mothers from two poor areas in Raleigh. Four nurses, each eventually carrying a caseload of 25 women, will visit the expectant mothers in their homes weekly before the baby's birth. As the baby grows, visits taper to once a month and then become more frequent before the nurses and mothers part ways when the child turns 2.

Ida Dawson, in the Maternal-Child health program with Wake County Human Services, said she hopes the home visit program will improve one of North Carolina's most stubborn problems -- a high infant death rate. Last year in North Carolina, 1,107 babies died before age 1, an uptick from the 1,033 deaths in 2006.

"We've hit a little bit of a brick wall," Dawson said. "This is something else we can try."

White, who has worked in the Guilford County program as the program director since July, says she has already formed a tight bond with the young women she works with. They met in September, she says, and have grown close as the mothers' babies are due.

"It's very emotional work," she says, noting that she has also worked in an OB/GYN practice and in nurse education. "It takes a very special kind of nurse to do this job. You have to be able to put your client at ease, to the point where they let you into their homes, week after week after week, and still keep professional boundaries while building relationships."

She says she and the other nurses teach women about prenatal care, smoking and substance-abuse cessation, and what to expect during delivery. Once the baby is born, they help make sure vaccination schedules are met, doctor visits are kept and day care arrangements can be made so the young moms can either finish their educations or get a job.

"We've had several clients go on to get college degrees," she says. "Everybody's victory, everybody's success is measured differently. For some, it's getting a driver's license and a job. We celebrate that as much as getting a college degree."