New Orleans Brings Back the House Call, Sending Nurses To Visit Newborns and Moms

When Lisa Bonfield gave birth to her daughter Adele in late November, she was thrust into the new world of parenthood and faced with a multitude of challenges and skills to learn: breastfeeding, changing diapers, sleeping habits, colic, crying, and all the little warning signs that something might be wrong with the baby.

But unlike parents in most of the United States, she had extra help that was once much more common: home visits.

Adele was just a few weeks old when a registered nurse showed up at Bonfield’s door on December 10 to check on them and offer practical help and advice.

As a city resident who recently gave birth, she was eligible for up to three home visits from Family Connects New Orleans, a program of the city health department.

She didn’t need to feed and change the baby before getting everything ready for a car trip to the pediatrician or clinic. It was a relief; Bonfield was exhausted and still trying to figure out how to use the infant car seat.

“Everything is so abstract before you have a baby,” Bonfield said. “You’re going to ask yourself questions you’ve never even thought about.”

Louisiana is among the worst performing states in maternal and child health. So New Orleans is trying to catch health problems early — and make it easier for families to get started — by adding well visits during the crucial first months of life.

The hope is that health outcomes can be improved by returning to the outmoded medical practice of house calls.

The Family Connects model has been tested in communities in 20 states. The project began in Durham, North Carolina, in 2008, in partnership with Duke University. In 2023, New Orleans Health Director Jennifer Avegno helped launch a local version of the program.

Avegno was concerned about Louisiana’s particularly dismal maternal and child health statistics.

The state has some of the highest rates of premature births, unnecessary C-sections and maternal and infant deaths, according to the March of Dimes. A recent United Health Foundation analysis found that Louisiana was the “unhealthiest” state for women and children.

“We have to do some things a lot differently, unless you like being No. 50 all the time,” Avegno said.

Home visits are free and available to anyone who has just given birth in a New Orleans hospital, regardless of insurance status or income level.

Avegno describes home visits as a “back to the future,” replicating a practice much more common a hundred years ago.

“There is no more critical time and vulnerable time than right from birth and in the few weeks or months after birth,” Avegno said.

Nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure and examine babies and check in with mothers about their health and well-being. They offer referrals to other programs across the city.

They ask if the family has enough food, if there are weapons in the house and how they are stored, Avegno said.

In Bonfield’s case, the nurse stayed more than two hours. Bonfield especially enjoyed their conversation about how to store breast milk safely.

“I have never felt so cared for and listened to,” she says.

Wide support

Louisiana has long struggled with poor maternal and infant health outcomes, but the problem has been complicated by the state’s strict ban on abortion.

The 2022 law has led to risky medical delays and unnecessary surgeries in obstetric care, as well as confusion among doctors about what is allowed to end dangerous pregnancies or treat miscarriages.

Avegno opposes the state’s abortion policies, believing they harm women’s health. But she says Family Connects offers other ways to preserve and expand care for women. For example, the visiting nurse may ask the mother if she needs help with birth control.

“We can’t give them access to abortion,” she said. “That’s not the goal of this program, and it wouldn’t be possible anyway. But we can make sure they’re healthy and understand what their options are for reproductive health care.”

Abortion politics aside, postpartum home visits appear to have bipartisan support in Louisiana, and state lawmakers want to expand their availability.

Last year, the Republican-majority Legislature passed a law requiring private insurance plans to cover visitation.

The new law is another way Louisiana officials are being “pro-life,” said state Rep. Mike Bayham, who, as a Republican and opponent of abortion, sponsored the legislation.

“One of the insults used against abortion supporters is that we are pro-birth and not really pro-life,” Bayham said. “And this bill is proof that we care about the overall well-being of our mothers and newborns. »

Improve health and help with postpartum depression

Two years later, there are promising signs that the program is improving health.

Early data analyzed by Tulane University researchers showed that families who received visits were more likely to adhere to the recommended schedule of pediatric and postpartum checkups. Moms and babies were also less likely to need hospitalization, and overall health care costs were down among Medicaid-insured families.

Research into Family Connects programs elsewhere has found similar results. In North Carolina, one study showed that three to seven home visits reduced trips to the emergency room by 50 percent in the year before a baby turned one.

But the statistic that most excited Avegno concerned the program’s role in screening mothers for postpartum depression.

Travel nurses help detect more cases of postpartum depression – sooner – so new moms can receive treatment. About 10 percent of moms in the New Orleans program were ultimately diagnosed with postpartum depression, compared to 6 percent of moms who didn’t receive visits.

Prompt diagnosis is important to prevent symptoms of depression from getting worse or leading to more serious consequences, such as suicidal thoughts, thoughts of harming the baby, or problems bonding with the 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 every childbirth and newborn class they could. They hired a doula to help with the birth. But Frederick still wasn’t prepared for the stress of the postpartum period, she said.

“I don’t think there are enough classes to prepare you for all the different scenarios,” Frederick said.

When her son, James, was born in May, he struggled to breastfeed. He only slept 90 minutes a 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.

“I’m here to support you and take care of you,” Frederick remembers the nurse saying.

The nurse weighed James and Frederick was relieved to learn that he was gaining weight. But for most of the visit, the nurse focused on Frederick’s needs. She was exhausted, anxious and starting to hear what she called phantom screams.

The nurse had him answer a mental health questionnaire. She then recommended that Frederick see a counselor and consider attending group therapy sessions for perinatal women.

Frederick acted on these suggestions and was eventually diagnosed with postpartum depression.

“I think I would have felt a lot more alone if I hadn’t had that visit and would have struggled in other ways without the resources the nurse provided,” Frederick said.

Home visits save money

Melissa Goldin Evans, an assistant professor at the Tulane School of Public Health, helped interview more than 90 families participating in the Family Connects New Orleans program.

“They were extremely positive experiences,” she said. “It’s like a gold standard public health project, in my opinion.”

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 the North Carolina program found that every dollar invested in the program saved $3.17 in health care bills before the child turns 2 years old.

That’s another reason to require statewide visitation, according to State Rep. Bayham.

“Nurses and doctors will be able to watch for potential problems early on, so they can be treated without a trip to the emergency room or something even more drastic,” he said.

Avegno advocates that the program be included in Louisiana’s Medicaid program, since more than 60 percent of births in the state are covered by Medicaid. A recent legislative report made the same recommendation.

This article is part of a partnership that includes WWNO, NPR and KFF Health News.