Executive Summary
Through the Nurse-Family Partnership at Le Bonheur Children’s Hospital, low-income women who are pregnant for the first time are getting support in their home throughout the pregnancy and until the child is two years old.
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Registered nurses meet with the women in their homes at least every two weeks until the baby is born, check for signs of complications, and educate the women on how to have a healthy pregnancy.
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The nurses educate the women on a variety of subjects involving healthy pregnancies and child care and visit them in the hospital after delivery.
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After the mother and infant get home, the nurse teaches the mother how to care for an infant, assists with breastfeeding, and, as the baby grows, educates the mother on topics that are relevant to the child’s age.
First-time mothers who are at risk are getting support through the pregnancy and until their children are two years old through the Nurse-Family Partnership at Le Bonheur Children’s Hospital in Memphis, TN.
The program, which started in 2010, is part of a national program to support low-income women in their homes to help them have healthy pregnancies and give their children a good start in life, says Marilyn Smith, RN, BSN-CLC, supervisor of the Nurse-Family Partnership.
The program is free to participants. It is implemented by Le Bonheur and funded by a grant from the Tennessee Department of Health and a private foundation, she says.
The team at Le Bonheur includes five nurses, an administrative assistant, and Smith. "There is the possibility of increasing to eight nurses," Smith says. Each nurse works with up to 25 clients. The nurses who work with the mothers have bachelor’s degrees and go through a week-long intensive training course at the Nurse-Family Partnership headquarters in Denver.
Many of the participants in the program are teenagers and don’t have a good support system, Smith says.
Women in the program must be first-time mothers who meet poverty guidelines, live in Shelby County, and must enroll before the 29th week of pregnancy. "We like to enroll them as early as possible so we can have the maximum impact," Smith says. Participants are eligible for Medicaid and/or the Special Supplemental Nutrition Program for Women, Infants, and Children.
Participants are referred to the program by past or current participants, community pregnancy testing agencies, health departments, social service agencies, and school guidance counselors. If women don’t meet the guidelines for the Nurse-Family Partnership, they are referred to the Early Success Coalition, a group of local and state, private and public agencies that provide services that promote the healthy development of children.
When a woman is referred to the program, either Smith or the administrative assistant calls her, explains the program, and makes sure the woman wants to participate. "The program is totally voluntary. The client has to agree to participate," Smith says.
Then one of the nurses meets with the woman in person in her home, or occasionally at other locations of the client’s choice. During the visit, which typically lasts an hour and a half, the nurse and the client start to get to know each other, she says. The nurse starts to educate the client on how to have a healthy pregnancy, answers any questions, and works with the client to set goals.
After that, the nurse visits the client for an hour to an hour and a half at least every two weeks until the birth. When the mother and baby get home, the nurse visits every week for six weeks, then every two weeks until the baby is 21 months old, then monthly until the child is 24 months old, she says.
"The client determines who will be in the home when the nurse visits. It may be the baby’s father or it may be the client’s mother, grandmother, aunt, and other family members," Smith says.
At each visit, the nurse monitors the client’s vital signs and conducts an assessment, looking for signs of complications of pregnancy such as pre-term labor and pre-eclampsia, and refers the client to her physician when appropriate.
"We provide some hands-on nursing, but we do not replace obstetrical care. We make sure the clients also see their doctors for recommended prenatal care. We are there to be the eyes and ears of the physician and to alert them when the client’s condition warrants it," Smith says.
At each visit, the nurse educates the woman on a variety of subjects involving healthy pregnancies and child care. Topics may include how to eat right, the effect of alcohol and drugs on the fetus, how to recognize signs of preterm labor, how to get the home ready for the baby, how to involve family members, and how to communicate with your physician, Smith says. They help the clients set short-term and long-term goals for the pregnancy and the birth of the baby.
The nurses conduct depression screenings and refer clients who screen positively for depression management. They support the women with addiction issues, encouraging them to seek treatment, help them line up community resources such as housing assistance, and assist them in lining up schooling or job training. "The nurses are a referral source for whatever issues the clients are dealing with," Smith says.
In the third trimester, the nurses start educating the clients on what to expect during labor and delivery and on the benefits of breastfeeding.
The nurses visit the baby and mother in the hospital. "We’re almost part of the family by then," Smith says.
After the mother and infant get home, the nurse assists with breast-feeding, teaches the mother how to calm a crying baby, educates the mother on postpartum care, and covers other topics based on the mother’s wishes and the child’s age and development.
"The program includes interactive activities during which the nurses work with the mothers as they interact with their babies," Smith says.
The nurses are not home care nurses and if the baby is sick, they advise the mothers to call the pediatrician or take the child to the emergency department, she says.
As the baby grows, the nurse starts promoting safety in the home and outside the home, Smith says. They give tips on how to choose a safe childcare provider, how to provide positive discipline, normal growth and development, and help the clients work toward their goals of getting back in school or getting a job.
When one teenage client said she was struggling with chemistry class, the nurse made tutoring the client on chemistry a part of each visit. As a result, the client got a good grade in chemistry class, Smith says.
"We take an individual approach with each client. Our goal is to support our clients through their pregnancies and help them get what they need to stay healthy and care for their child," Smith adds.
