Nurse Family Partnership supports more first-time mothers in SC

FLORENCE –Evadney Ward, 26, of Florence was nervous. The home pregnancy test confirmed she was going to be a mother.

With her mother and most of her family living hundreds of miles away in New York, she wasn’t sure who to turn to for pregnancy advice.

That’s when she saw a flier posted at the health department in Florence. It helped her find a second family: the Nurse-Family Partnership program.

The nationally recognized program for low-income, first-time mothers expanded last November to serve mothers in Florence, Darlington, Dillon and Marlboro counties. It pairs nurses with pregnant women before the birth of their child and into the first two years of motherhood.

The program, implemented locally by McLeod Health, has three primary goals: to improve pregnancy outcomes, enhance child health and development and strengthen the economic self-sufficiency of the families it serves.

Ward, who is expecting her baby in August, is one of 15 clients assigned to nurse Denita Davis.

At 26, Ward is one of the older clients in the program, which has clients who range from 14 to 28 years old.

While some of them are single mothers who have no involvement with the father of their child-to-be, that is not always the case.

In Ward’s case, dad-to-be Roy Smith hasn’t missed a home visit.

“I’d just like to know what I’m getting myself into,” Smith said.

Davis welcomes his participation.

A father’s involvement is lacking completely in some cases.

“Especially the teenagers,” Davis said.

Directing the focus

Part of Davis’ job is to direct focus to the child that is coming and help expectant parents prepare to care for a baby.

“You try to steer them in the right direction but in a way that keeps them coming back to you for advice,” Davis said.

On a recent home visit, Davis took Ward’s weight measurements and blood pressure readings as they talked.

Ward spoke with Davis like she was a close friend.

Car trouble and expensive repairs had left Ward with no money in her savings.

“I was stressing bad,” Ward said.

Ward, a manager at a fast-food restaurant, had been saving the money to have over her maternity leave.

“I was crying when I saw all my money was gone,” said Ward.

Later the discussion turned to family situations and how to mend troubled relationships.

Davis carefully listened before the conversation turned to coping with stress and breathing techniques.

Davis then encouraged Ward, who has had problems with high blood pressure, to check her blood pressure regularly. Davis asked about headaches, cramps and other ailments.

“Are you drinking enough water?” she asked.

“I’ve been drinking a lot, and I like Icees,” Ward said. “I have a freezer full of Icees.”

Breastfeeding

Davis moved on to a lesson on how to properly breastfeed, complete with a baby doll for positioning examples. Ward had chosen the topic at a previous home visit from a list of options.

“I want to keep everything as natural as possible,” Ward said. “I see people switching milk all of the time, and their baby is sick. If I’m making it, I might as well use it.”

Davis backed up Ward’s decision with all of the benefits of breastfeeding.

“It decreases stress hormones in your baby and you,” Ward pointed out. “Breast milk contains everything that your baby needs to grow. Your breast milk is tailor made for your baby.”

She talked about the disease-fighting nature of breast milk and how it changes to meet the needs of the growing child.

“That is some smart milk,” Ward said.

Davis and Ward also discussed concerns about not pumping enough milk and transitioning from the nipple and bottle before moving on to proper positions for holding the baby while nursing.

Ward demonstrated with a baby doll a cradle hold and a football hold.

“I’d be scared I’d drop her,” Ward admitted about one of the positions.

“You just have to keep your hand under her here and her head,” Davis said as she demonstrated.

“I just want to make sure I do everything right,” Ward said.

Davis explained that after the baby is born, a lactation consultant at the hospital would probably assist her in nursing the baby for the first time. She described the initial days of nursing as crucial when the milk is still coming in.

‘Liquid gold’

Davis said colostrum was loaded with natural antibiotics for the baby.

“That colostrum is like liquid gold,” Davis said.

But how do you know when the baby is finished nursing or has had enough milk?” Ward asked.

“She will get full eventually and fall asleep or stop nursing,” Davis said.

Davis explained that a newborn’s stomach was about the same size as a golf ball or smaller.

In between home visits, Davis encourages Ward to write her questions down.

“She gave me a journal,” Ward said. “If I need her, I text her.”

She has no regrets about signing up for the program.

“It’s a really good program,” Ward said. She said it is a huge benefit to be able to bring questions to “someone who is knowledgeable.”

Ward said it is a plus that Davis is willing to listen.

“It’s another support system,” Ward said.

Not easy

Ward said she knows that being a mom won’t be easy.

“It is hard,” she said. “I already feel like right now I don’t want another one – just this one.”

Ward is thankful for the extra help and advice she gets from the Nurse Family Partnership and wishes her sister had the same opportunity years ago.

As for future home visits, Ward is focused on better preparing herself for the big day.

“I want to watch labor videos,” she said, as Davis took notes.

Davis said she loves her work. Early in her nursing career, she worked in adult health at McLeod, at HopeHealth as an HIV nurse and in family planning at the S.C. Department of Health and Environmental Control.

“Mostly what people need is education,” Davis said. Being a nurse educator affords her the opportunity to “see the change.”

She said it is rewarding to watch young mothers become “more mature and responsible."

‘They listen’

Davis doesn’t take the job lightly. She said her clients often are dealing with many issues and that she is careful about how she responds.

“You have to make sure you are saying the right thing, because they are relying on you,” Davis said. “Sometimes you are the only constant in their life. They listen to what you say, and for some of them I’m their only support.”

Davis said the Nurse Family Partnership program is about the whole person.

“You are dealing with everything,” she said. “It’s not just medical.”

The Nurse Family Partnership is one of the oldest and most evaluated nurse home visiting programs in the nation. Through regular in-home visits, nurses work with enrolled mothers to improve maternal health, promote healthy child development and support mothers with concerns such as continuing school, finding work or establishing adequate housing. The program also encourages participation from other members of the family.

Promising results

In South Carolina, the Nurse-Family Partnership has shown promising results. Nearly three out of every four participants did not have subsequent pregnancies at completion of the 2.5-year program. Ninety percent of babies born to mothers in the program were full term, and 89 percent were born at a healthy weight.

A little less than 50 percent of the people who entered the program lacking a high school diploma or GED end up pursuing one.

The expansion of the partnership to Florence, Darlington, Dillon and Marlboro counties is supported by a public-private partnership that includes the Children’s Trust of South Carolina, the McLeod Health Foundation, Boeing South Carolina and the Marlboro County General Hospital, a private foundation.

"Our program is designed to dramatically improve the lives of at-risk mothers and their young children, which in turn will help these families thrive and our communities prosper," said Kristen Miller, RN, MSN, manager of the Nurse-Family Partnership for McLeod Health.

"Our NFP team is now complete, meaning full to capacity,” Miller said. “We have six nurses, myself as supervisor, and a data entry specialist. We are now serving 60 families – and the number is increasing each week as nurses can only add one to two clients a week per model fidelity. We also now have six babies."

The cost

The cost to fund the program ranges from $3,500 to $6,500 per family annually, according to the National Family Nurse Partnership Program.

The cost varies greatly, based on the area and experience of nurses in the program. Program officials point to various studied that suggest significant cost benefits, such as savings to Medicaid and other federally funded programs.

One such study by the Washington State Institute for Public Policy was conducted in 2012 and updated in 2014. It suggested that the long-term benefits amounted to $23,000 per child.

The partnership is supported statewide by The Duke Endowment, S.C. DHEC, the BlueCross BlueShield of South Carolina Foundation, and South Carolina First Steps to School Readiness, the Children’s Trust of South Carolina and the Nurse Family Partnership National Service Office.

The Nurse Family Partnership program is offered in 26 counties in the state: Abbeville, Anderson, Barnwell, Berkeley, Charleston, Colleton, Darlington, Dillon, Dorchester, Edgefield, Florence, Georgetown, Greenville, Greenwood, Horry, Lexington, Marlboro, McCormick, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Union and Williamsburg.

This story was originally published May 8, 2015 at 10:52 PM with the headline "Nurse Family Partnership supports more first-time mothers in SC."