When Lisa Bonfield gave birth to daughter Adele in late November, she was thrust into the new world of parenting, and faced an onslaught of challenges and skills to learn: breastfeeding, diapering, sleep routines, colic, crying, and all the little warning signs that something could be wrong with the baby.
But unlike parents in most of the U.S., she had extra help that was once much more common: house calls.
Adele was only a few weeks old when a registered nurse showed up at Bonfield鈥檚 door on Dec. 10 to check on them and offer hands-on help and advice.
As a city resident who had recently given birth, she was eligible for up to three home visits from , a program of the city health department.
She didn鈥檛 need to feed and change the baby before packing everything up for a car trip to the pediatrician or a clinic. It was a relief; Bonfield was exhausted and was still trying to figure out how to use the infant car seat.
鈥淓verything is so abstract before you have a baby,鈥 Bonfield said. 鈥淵ou are going to have questions you never even thought about.鈥
Louisiana is among the worst-performing states in maternal and infant health outcomes. So New Orleans is trying to catch health issues early 鈥 and get families off to an easier start 鈥 by adding health visits during the crucial first months of life.
The hope is that health outcomes can be improved by returning to the old-fashioned medical practice of house calls.
The Family Connects model has been tried in communities . It began in Durham, North Carolina, in 2008, as a partnership with Duke University. In 2023, New Orleans鈥 health director, , helped launch a local version of the program.
Avegno was concerned by Louisiana鈥檚 particularly grim statistics for maternal and infant health.
The state has some of the highest rates of preterm births, unnecessary cesarean sections, and maternal and infant deaths, according to the . A from the United Health Foundation found that Louisiana was the 鈥渓east healthy鈥 state for women and children.
鈥淲e got to do some real things real differently, unless you like being No. 50 all the time,” Avegno said.
The home visits are free and available to anyone who has just given birth in a New Orleans hospital, no matter their insurance status or income level.
Avegno describes the home visits as going 鈥渂ack to the future,鈥 replicating a practice that was far more common a hundred years ago.
鈥淭here is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth,鈥 Avegno said.
The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city.
They ask if the family has enough food, and whether there are guns in the house and how they鈥檙e stored, Avegno said.
In Bonfield鈥檚 case, the nurse stayed for over two hours. Bonfield especially liked their conversation about how to safely store breastmilk.
鈥淚鈥檝e never felt so well taken care of and listened to,鈥 she said.
Broad Support
Louisiana has struggled a long time with poor maternal and infant health outcomes, but the problem has been complicated by the .
The 2022 law led to risky medical delays and in obstetrical care, and confusion among doctors about what鈥檚 allowed in ending dangerous pregnancies or .
Avegno opposes the state鈥檚 abortion policies, believing they are harmful to women鈥檚 health. But she says that Family Connects offers other ways to preserve and expand care for women. For example, the visiting nurse can check in with the mother about whether she needs help with birth control.
鈥淲e can鈥檛 give them abortion access,鈥 she said. 鈥淭hat鈥檚 not the goal of this program, and that wouldn鈥檛 be possible anyway. But we can make sure they鈥檙e healthy and understand what their options are for reproductive health care.鈥
Abortion politics aside, the postpartum home visits seem to have bipartisan support in Louisiana, and state lawmakers want to expand their availability.
Last year, the Republican-dominated legislature requiring private insurance plans to cover the visits.
The new law is another way that Louisiana officials can be 鈥減ro-life,鈥 said state , who, as a Republican and an abortion opponent, sponsored the legislation.
鈥淥ne of the slings used against advocates against abortion is that we鈥檙e pro-birth, and not truly pro-life,鈥 Bayham said. 鈥淎nd this bill is proof that we care about the overall well-being of our mothers and our newborns.鈥
Improving Health and Help for Postpartum Depression
Two years in, there are already promising signs that the program is improving health.
Early data analyzed by researchers at Tulane University showed that families who got the visits were more likely to stick to the recommended schedule of pediatric and postpartum checkups. Moms and babies were also less likely to need hospitalization, and overall health care spending was down among families insured by Medicaid.
Research on Family Connects programs elsewhere has found similar results. In North Carolina, one study showed that three to seven home visits in the year before a baby turned 1.
But the statistic that most excited Avegno related to the program鈥檚 role in screening mothers for postpartum depression.
The visiting nurses are helping spot more cases of postpartum depression 鈥 earlier 鈥 so that new moms can get treatment. About 10% of moms participating in the New Orleans program were eventually diagnosed with postpartum depression, compared with 6% of moms who did not get the visits.
Timely diagnosis is important to prevent depression symptoms from worsening, or leading to more , such as suicidal thoughts, thoughts of harming the baby, or problems bonding with their newborn.
Lizzie Frederick was one of the New Orleans mothers whose postpartum symptoms were caught early by a visiting nurse.
When she was pregnant, she and her husband took all the childbirth and newborn classes they could. They hired a doula to help with the birth. But Frederick still wasn鈥檛 prepared for the stresses of the postpartum period, she said.
鈥淚 don鈥檛 think there are enough classes out there to prepare you for all the different scenarios,鈥 Frederick said.
When her son, James, was born in May, he had trouble breastfeeding. He was sleeping for only 90-minute stretches at night.
When the nurse arrived for the first visit a few weeks later, Frederick was busy trying to feed James. But the nurse reassured her that there was no rush. She could wait.
鈥淚 am here to support you and take care of you,鈥 Frederick recalled the nurse saying.
The nurse weighed James, and Frederick was relieved to learn he was gaining weight. But for most of the visit, the nurse focused on Frederick鈥檚 needs. She was exhausted, anxious, and had started hearing what she called phantom cries.
The nurse walked her through a mental health questionnaire. Then she recommended that Frederick see a counselor and consider attending group therapy sessions for perinatal women.
Frederick followed up on these suggestions and was eventually diagnosed with postpartum depression.
鈥淚 think that I would have felt a lot more alone if I hadn鈥檛 had this visit, and struggled in other ways without the resources that the nurse provided,鈥 Frederick said.
Home Visits Save Money
, an assistant professor at Tulane鈥檚 School of Public Health, helped interview over 90 families participating in the Family Connects New Orleans program.
鈥淚t was overwhelmingly positive experiences,鈥 she said. 鈥淭his is like a gold-standard public health project, in my opinion.鈥
To operate, Family Connects costs the city about $1.5 million a year, or $700 per birth, according to Avegno. But the program also has the potential to save money: Research on North Carolina鈥檚 program in the program saved $3.17 in health care billing before the child turned 2.
That鈥檚 another reason to require the visits statewide, according to state Rep. Bayham.
鈥淭he nurses and medical practitioners will be able to monitor potential problems on the front end, so that they could be handled without a trip to the emergency room or something even more drastic,鈥 he said.
Avegno is advocating that the program be included in Louisiana鈥檚 Medicaid program, since more than in the state are covered by Medicaid. A recent made the same recommendation.
This article is from a partnership that includes , , and 麻豆女优 Health News.
