Visiting Nurses: A House To House Infant Mortality Prevention Army
State health officials are promoting visiting nurse programs as part of a statewide strategy to reduce Ohio’s infant mortality rate.
It’s persistently higher than the national rate, despite recent progress in reducing the number of sleep-related infant deaths.
Visiting nurses are a powerful tool to help more high-risk infants make it to their first birthdays, many Montgomery County public health advocates say.
In Montgomery County, African American infants die more than three times as often as white babies, county data show. The reasons are complicated. But prematurity and low birth weight are the leading causes.
Smoking, racial disparities and chronic stress also play a big role, says nurse Elaine Patrick.
“Families who live underneath that federal poverty guideline, they have a lot of extra stressors –– if I’m not working or if we don’t have enough extra money for food, or if I don’t have transportation, how am I going to get to my doctors appointment? –– just all of those stressors and the disparities of that population, it tends to put them at a higher risk for premature birth or premature labor,” Patrick says.
Patrick is with the Help Me Grow Brighter Futures visiting nurse program. It’s designed to prevent infant mortality by supporting high-risk women during and after pregnancy.
Patrick spends her days criss-crossing the Dayton area in her bright blue car visiting women and their new babies at home.
Today she’s checking in on 31-year-old mother of three Betty Reynolds.
“Hi!” A smiling face appears at the front door. It’s a bubbly four-year-old named Amariah. She tells Patrick today is her birthday. “It’s your birthday? Happy birthday!”
Inside, Reynolds is relaxing with her feet up on a small sofa. Three-month-old Baby Jacqueline, dressed in pink, sleeps peacefully on her mom’s lap.
Patrick has visited Reynolds every week or two since early in her pregnancy. Reynolds says she first learned about the visiting nurse program at a Wesley Community Center baby shower event.
“Betty and I, we’ve known each other for a while. So it’s nice to come in and I can talk to Betty about how her day is going, or she’s frustrated, or if she’s looking cute one day I’m like, ooh, Betty you’re looking cute. So, you build that relationship where, if she was to have concerns she could tell me whatever is on her mind.”
Infant mortality is defined as the death of a baby before their first birthday.
And baby Jacqueline is especially high-risk. She was born early at 37 weeks. Reynolds supports the family on a very low income. She and her other two daughters lived in a homeless shelter for a while during her pregnancy.
“I didn’t like being in that environment myself and I didn’t like having my kids in that environment. It’s stressful being in the shelter,” she says.
Before Reynolds moved her girls into this house, she and Patrick met for regular blood-pressure checks and other tests outside at Carillon Historical Park.
Reynolds had preeclampsia, a dangerous and often deadly pregnancy-related high blood pressure condition. She says she had it during all three of her pregnancies.
Patrick sits on the living room floor in front of Reynolds and unpacks her medical supplies.
She takes out a baby scale. Reynolds hands Patrick the sleepy baby, waking her up with a little cry.
“First things first, let’s weigh baby Jacqueline, okay?”
The scale’s reading shows the baby weighs 11 pounds, seven ounces.
“That’s awesome because she’s growing the way she’s supposed to be growing,” says Patrick.
Patrick typically sees up to 15 Montgomery County women a week. She monitors their health during pregnancy, and after birth, she visits to make sure mothers are recovering, and babies are growing as they should.
The Montgomery County program took effect with Ohio’s expansion of Medicaid under the Affordable Care Act, also known as Obamacare, and officials say, so far, no infants in the program have died.
Patrick asks Reynolds about baby Jacqueline’s appetite.
“So tell me, how’s she doing eating now, how many ounces, how often and how is she tolerating it?”
“Six ounces, about an hour apart,” Reynolds says. The baby seems to be hitting a growth spurt.
Over the last few months, the women have covered an alphabet soup of issues related to pregnancy and child development, including how to create a safe sleep environment to prevent Sudden Infant Death Syndrome or SIDS, another major cause of infant mortality.
During this visit, Patrick talks with Reynolds about nutrition, the importance of establishing a routine with children and the latest research on early literacy.
“Babies love to hear their moms’ voices,” Patrick says.
Reynolds has dedicated one corner of the small living room to a growing library of books she’s started for her daughters.
“Even if you’re not reading –– just talking to them, they catch on and they’ll follow you,” says Reynolds.
Patrick encourages her to continue read and talk to her girls as much as she can. She tells Reynolds the research shows that even just a few minutes a day make a difference.
“It makes the brain connection,” Patrick says. “If she reads to them every day, by the time she’s five, six years old, she’s like, it’s normal, It’s my routine.”
Reynolds is already a believer.
Her oldest daughter, who is eight years old, is an avid reader. Teachers say she’s doing better than most other kids in her class. It’s a trend Reynolds hopes to continue with her two youngest daughters, by bringing home as many books as possible.
After about two hours, the visit winds down. Patrick gathers her supplies and gets ready to go.
She compliments Reynolds on her parenting.
“Despite all these stressors, I think Betty is totally kicking some serious behind in raising these girls, right Betty?”
Reynolds says she knows plenty of women who have lost babies to infant mortality.
“When you have a friend or you lose a child to SIDS, it makes you be more protective of your child,” she says.
Now, she encourages all her girlfriends to learn about the dangers and take advantage of prenatal care during pregnancy. She tells them:
“Educate yourself. When your doctor asks, do you want to be tested, don’t say no, say yes. Do what you have to do and just educate yourself. Period,” she says.
Many research studies suggest visiting nurse programs like this one are highly effective in reducing infant and maternal mortality, especially in “highly disadvantaged” settings, cutting the need for hospital visits and boosting kids’ readiness for school.
Ohio Gov. John Kasich has increased investment in infant mortality prevention programs in the highest-risk zip codes across the state.
“Alright. So you want to do the same time on the fourth?”
Patrick and Reynolds schedule their next appointment and Patrick stands to say her goodbyes. She and four-year-old Amariah exchange a hug. “Bye, birthday girl! Thanks for letting us come, okay? See you later, mama.”
Outside in the driveway, Patrick says the visiting nurse program works to prevent infant mortality because it fills that gap of emotional support that many new moms just don’t have in their lives.
Patrick knows what it’s like to struggle. She had her own daughter at the age of 19. And after her fiance died, she raised her daughter alone.
Now 37, Patrick says her experience being a young single parent influences her work with women in the Montgomery County visiting nurse program.
“We are an extra cheerleader, we are an extra person in their court to rally behind them and make sure they make good choices during pregnancy and they make good choices with their children. We are just that extra boost they need sometimes in their day,” she says.
Patrick heads to her car. It’s time to head across town to her next visit.
But she’ll be back at Reynolds’ house soon. She’ll continue to check up on baby Jacqueline until she celebrates her second birthday.