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By Rose Hoban
New mothers have a lot to think about – breastfeeding is new, they’re still healing from giving birth, they’re trying to get their babies to sleep and eat and there’s a lot to learn about this little person.
On top of it all, they’re tired, they often have family members visiting and there’s a new member of the household to integrate into the routine.
It’s enough to overwhelm even the most organized of women.For the past few years, new mothers in Durham County have gotten a little bit of help in the form of a nurse who stops by once, or a few times, to every woman in the county who gives birth – every one.
Now research published through the project, called Durham Connects, is showing that the simple act of a nurse visiting new mothers and their babies cuts subsequent visits to the emergency department by half, even a year down the road.
“The focus of our visit is to help the parents feel not only connected to their baby but also to their community,” said Paula Wright, one of the nurses who make the home visits.
She said one of the strengths of the program is helping new parents plug into the resources around them, from child care to pediatricians and clinics.
Wright said all families receive an initial visit, when mothers and babies are assessed on a few main areas: the baby’s overall health, whether the family has a regular source of health care, whether there are safety concerns either in the household or from other family members and what support system the mother and family have.
“If the nurse assesses that a further visit is needed, she can go back one or two times,” she said. “Not every family needs that. If they have a good support system and have had questions answered, you can close the case.”
“But sometimes it takes time to get them hooked up to services if they need them, and the nurse might go back a couple of times,” she said. “Every case is different.”
The program began in 2009, and in that first year about 4,800 women in Durham County gave birth. During that year, leaders of the program randomly assigned women to either get the visits or not, depending on the baby’s birth date. That created a control group, and the project leaders were able to study the effects of the program by comparing women who got the visits to those who didn’t.
Six months after babies were born, study authors called all the families again to see how they were doing. The result that jumped out was that families who received the visits had half as many visits to the emergency department as families who didn’t.
“We make sure the parents are hooked into pediatric care for their child that they feel good about, and that they have a good relationship with the pediatrician,” Wright said. “That should be their first line, rather than rushing to the emergency department.”
The cost to visit one family is about $700 – paid for by grants, the Durham Health Department and programs at Duke University – while an emergency department visit can cost thousands of dollars just to walk through the door. And with an 18 percent rate of uninsured patients in Durham, many of those ED visits end up being unpaid.
According to the study, which was published in the journal Pediatrics, “The program’s modest $700 cost per family is more than offset by savings in hospital medical care costs before the infant’s first birthday, thus making this program a worthy economic investment for a community.”
The researchers found fewer emergency department visits for babies with medical issues, in particular in the first six months; fewer hospital days for babies in the program; and a reduction in emergency visits in families without insurance and those who had Medicaid as their main source of health insurance.
Since the end of the study period in 2010, all mothers in Durham County get visits.
Every baby is different
“Community or public health nurses are in a perfect position to go into someone’s home to do an assessment of the infant and the mother/infant dyad,” said Duke University nursing professor Michelle Hartman, who studies community health interventions. Hartman has no connection to the program.
We talk about utilizing nurses and nurse practitioners to the full extent of their education; this is a great example of that,” she said.
Hartman said the nurses provide the education and support that mothers are unable to get during their short time in the hospital after delivery.
“New mothers have lots of questions, even with their second child, because this one eats differently and looks different from the first,” Hartman said. “Or mothers will say, ‘I don’t remember this happening to the first one. Why?’”
Wright confirmed that one of the program’s primary effects is that the nurses are able to reassure mothers. She talked about one case in which the nurse went into the home, “and the mom was really in a lot of distress emotionally. She was overwhelmed, anxious and needing a lot of support.
The nurse was able to contact [a counseling service] who was able to send a counselor out to the home the next day for that mother to get some help.”
Wright said another benefit of the program has been better coordination between nurses in the community and the Durham County Health Department. Most mothers come home with a six-week postpartum visit appointment; but for those who don’t have regular care, the nurses have been reaching out.
“By our nurses calling in and working with the public health department, we were able to resolve that problem,” Wright said. “Now most moms come home from the hospital with that appointment scheduled.”