Maternal nursing program aids parents
A Chautauqua County girl found herself pregnant at the age of 19.
A high school dropout, the girl started using methamphetamine when she was 17, had been diagnosed with bipolar depression and found herself in the position of supporting a child.
Now, that same girl is attending Jamestown Business College, has her driver’s license, is working full-time and, perhaps most importantly, is the mother of a healthy, happy son.
How did all of that happen? Credit the mother’s hard work and the work of the Nurse Family Partnership, a Chautauqua County Department of Health and Human Services program that works with expectant mothers. Nurses in the program helped the girl join the TEAM program for teen mothers and helped her graduate from high school. They stayed in contact throughout pregnancy and early in her child’s life to make sure both mom and baby stayed on the right track.
Cathy Burgess, Chautauqua County Department of Health and Human Services director of maternal and infant health, recently shared with the Chautauqua County Board of Health three of the program’s success stories.
Another mother had been homeless, had mental health and substance abuse issues, limited access to food and complained of mouth pain. That particular mother now lives with her boyfriend, had 15 cavities filled, continues to keep WIC appointments and delivered a healthy daughter who the mother breastfed for three weeks. A third mother emigrated to Jamestown from Puerto Rico when she was 20 weeks pregnant. The woman was living in a hotel with her husband. Neither had a job. The Nurse Family Partnership program helped connect the couple to Social Services and housing. The family now rents a mobile home, the husband is employed, the family is off of temporary assistance and an interpreter is no longer needed when Nurse Family Partnership officials visit the home because the family is speaking better English.
The Nurse Family Partnership program began in 2015 and consists of five nurses who work specifically with first-time mothers from pregnancy until the child is 2 years old. The Maternal, Infant and Child Health Program began in 2012 and is a peer education program where community health workers are trained by the state Health Department. Then, they go into homes and work with high-risk pregnant women to provide education, make referrals and give support. Mothers can be referred to the program by schools, CPS, WIC, obstetricians and other means. Both programs require either Medicaid or WIC eligibility to participate.
“There is a local share component to both of these programs,” said Christine Schuyler, county health commissioner, at a recent Board of Health meeting. “That means they’re on the chopping block possibly as the legislature looks to make cuts. I will fight as hard as I can to make sure that doesn’t happen. This is true public health at its best and we can’t allow these true evidence-based programs to go away.”
According to the county’s 2016-18 Community Health Assessment and Improvement Plan and Community Service Plan, Chautauqua County sees proportionately more births to women aged 15-19 and to out-of-wedlock mothers than New York state as a whole. Fewer births are to babies who have received adequate prenatal care. Chautauqua County also experiences a higher percentage of babies born within 24 months of a previous pregnancy. Among live births, 36.7% are a result of unintended pregnancy in Chautauqua County, compared to 24.5% in New York state.
Teen pregnancy rates among 15-19 year olds have been on the decline in Chautauqua County from 2005 to 2014, though teen pregnancy rates are twice as high among Hispanic girls than white and black or African-American subgroups.
Chautauqua County moms who are white are more likely to receive adequate prenatal care than their African-American or Hispanic counterparts. African-American babies are more likely to be born premature and at a low birth weight. Infants whose mother is part of the WIC program in Chautauqua County (16.2%) were less likely to be breastfeeding at 6 months compared to New York state (39.0%) and New York State excluding New York City (27.5%). Breastfeeding is considered an important measure because breastfeeding supplies all of the nutrients a baby needs in the proper proportion, protects against allergies, sickness and obesity; protects against diseases and infections; is easily digested so the infant doesn’t suffer from constipation, diarrhea or upset stomach; and a breastfed baby tends to have healthier weights as they grow.
Burgess told Board of Health members that the programs screen for anxiety and depression, drug and alcohol and lead in a home while discussing with mothers contraception, safe sleep, the risks of bottle propping, car seat safety, the risks of smoking in a home with an infant, infant CPR and choking. There are also developmental screenings for the babies to make sure infants are meeting developmental milestones and helping provide mothers with activities to help babies meet those milestones.
“If they’re not, we provide mom with activities, provide her support, show her how to do floor time or show her tummy time,” Burgess said. “Sometimes it’s helping them find that clean, safe area on the floor so they can do these things starting with the basics. Caseloads for our workers are between 25 and 30 moms. Maybe that doesn’t seem like a lot, but with some of our high-needs moms that’s a big caseload.”
The county has started a Moms Quit program which offers free diapers to mothers in the program who quit smoking, or who have family members in the household who quit smoking. The programs also operate in the Chautauqua County Jail with mothers who need support. County employees also make ward rounds of hospitals that deliver babies to provide education on breastfeeding and educate mothers about the county’s breastfeeding hotline. All of the nurses in the county program are also certified lactation consultants.
“Some of you might know there’s not a lot of breastfeeding support if you’re not eligible for WIC,” Burgess said. “Once you’re discharged from the hospital, moms run into problems and there’s nobody to call. So we started this hotline and we started a Facebook page, it’s like a closed chatroom for moms, and we’ve been very successful with those. … I just love that program because it’s been so successful.”
From 2005 to 2014, newborn drug-related diagnosis rates have drastically increased in Chautauqua County. From 2012 to 2014, 118 babies born tested positive for drugs in the delivery hospital, resulting in a rate of 305.6 per 10,000 newborn discharges, nearly three times greater than the New York state rate of 103.5 per 10,000.
One way the county is trying to help those children is with a recently received grant through the federal Child Abuse Prevention and Treatment Act. The money pays for a nurse who works closely with Child Protective Services with any mother who tests positive for opioids at the time they deliver a baby.
“Maybe they’re in treatment or maybe they’re also using another substance,” Burgess said. ” It could be marijuana, but it could also be meth or heroin. If she tests positive we’re going to be there. We can make the visit along with CPS or after, but it’s to support mom. Let her know we’re there to get CPS out of the picture. We want to encourage her, support her, make her aware that we’re not here to take this baby away. we want to help you, we want to support you, connect you to resources, make sure you’re getting the necessary help that you need and educate her on breastfeeding. If she’s in treatment and she’s not currently using, we want her to breastfeed. We want her to be successful and give her that chance. We’ve had a lot of success. The moms that have been identified and qualify for those services are so receptive to that education. They want to know more. They want to talk about it. It’s working with them very well.”
IS IT WORKING?
Burgess told Board of Health members that many mothers who take part in the Nurse Family Partnership program, the Maternal, Infant and Child Health program or the program through the Child Abuse Prevention and Treatment Act tend to sometimes spend as many as three years in the programs. Burgess said it is vitally important for county officials to be involved early in a pregnancy and early in a child’s life, though, to make the most impact.
“They’re engaging with the nurse,” Burgess said. It’s great when we can meet them where they’re at, at the hospital, at that time. Once they’re discharged that connection is so hard. But they’re reaching back out to the nurse. It’s working. They’re asking questions. They want her to come back. They want her to come to the home and see them. It’s working very well.”