When Lisa Bonfield gave birth to daughter Adele in late November, she was thrust into the new world of parenting, and faced an onslaught of challenges and skills to learn: breastfeeding, diapering, sleep routines, colic, crying, and all the little warning signs that something could be wrong with the baby.
But unlike parents in most of the U.S., she had extra help that was once much more common: house calls.
Adele was only a few weeks old when a registered nurse showed up at Bonfield’s door on Dec. 10 to check on them and offer hands-on help and advice.
As a city resident who had recently given 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 packing everything up for a car trip to the pediatrician or a clinic. It was a relief; Bonfield was exhausted and was still trying to figure out how to use the infant car seat.
“Everything is so abstract before you have a baby,” Bonfield said. “You are going to have questions you never even thought about.”
Louisiana is among the worst-performing states in maternal and infant health outcomes. So New Orleans is trying to catch health issues early — and get families off to an easier start — by adding health visits during the crucial first months of life.
The hope is that health outcomes can be improved by returning to the old-fashioned medical practice of house calls.
The Family Connects model has been tried in communities across 20 states. It began in Durham, North Carolina, in 2008, as a partnership with Duke University. In 2023, New Orleans’ health director, Jennifer Avegno, helped launch a local version of the program.
Avegno was concerned by Louisiana’s particularly grim statistics for maternal and infant health.
The state has some of the highest rates of preterm births, unnecessary cesarean sections, and maternal and infant deaths, according to the March of Dimes. A recent analysis from the United Health Foundation found that Louisiana was the “least healthy” state for women and children.
“We got to do some real things real differently, unless you like being No. 50 all the time,” Avegno said.
The home visits are free and available to anyone who has just given birth in a New Orleans hospital, no matter their insurance status or income level.
Avegno describes the home visits as going “back to the future,” replicating a practice that was far more common a hundred years ago.
“There is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth,” Avegno said.
The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city.
They ask if the family has enough food, and whether there are guns in the house and how they’re stored, Avegno said.
In Bonfield’s case, the nurse stayed for over two hours. Bonfield especially liked their conversation about how to safely store breastmilk.
“I’ve never felt so well taken care of and listened to,” she said.
Broad Support
Louisiana has struggled a long time with poor maternal and infant health outcomes, but the problem has been complicated by the state’s strict abortion ban.
The 2022 law led to risky medical delays and unnecessary surgeries in obstetrical care, and confusion among doctors about what’s allowed in ending dangerous pregnancies or treating miscarriages.
Avegno opposes the state’s abortion policies, believing they are harmful to women’s health. But she says that Family Connects offers other ways to preserve and expand care for women. For example, the visiting nurse can check in with the mother about whether she needs help with birth control.
“We can’t give them abortion access,” she said. “That’s not the goal of this program, and that 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, the postpartum home visits seem to have bipartisan support in Louisiana, and state lawmakers want to expand their availability.
Last year, the Republican-dominated legislature passed a law requiring private insurance plans to cover the visits.
The new law is another way that Louisiana officials can be “pro-life,” said state Rep. Mike Bayham, who, as a Republican and an abortion opponent, sponsored the legislation.
“One of the slings used against advocates against abortion is that we’re pro-birth, and not truly pro-life,” Bayham said. “And this bill is proof that we care about the overall well-being of our mothers and our newborns.”
Improving Health and Help for Postpartum Depression
Two years in, there are already promising signs that the program is improving health.
Early data analyzed by researchers at Tulane University showed that families who got the visits were more likely to stick to the recommended schedule of pediatric and postpartum checkups. Moms and babies were also less likely to need hospitalization, and overall health care spending was down among families insured by Medicaid.
Research on 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% in the year before a baby turned 1.
But the statistic that most excited Avegno related to the program’s role in screening mothers for postpartum depression.
The visiting nurses are helping spot more cases of postpartum depression — earlier — so that new moms can get treatment. About 10% of moms participating in the New Orleans program were eventually diagnosed with postpartum depression, compared with 6% of moms who did not get the visits.
Timely diagnosis is important to prevent depression symptoms from worsening, or leading to more severe outcomes, such as suicidal thoughts, thoughts of harming the baby, or problems bonding with their 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 all the childbirth and newborn classes they could. They hired a doula to help with the birth. But Frederick still wasn’t prepared for the stresses of the postpartum period, she said.
“I don’t think there are enough classes out there to prepare you for all the different scenarios,” Frederick said.
When her son, James, was born in May, he had trouble breastfeeding. He was sleeping for only 90-minute stretches at 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 am here to support you and take care of you,” Frederick recalled the nurse saying.
The nurse weighed James, and Frederick was relieved to learn he was gaining weight. But for most of the visit, the nurse focused on Frederick’s needs. She was exhausted, anxious, and had started hearing what she called phantom cries.
The nurse walked her through a mental health questionnaire. Then she recommended that Frederick see a counselor and consider attending group therapy sessions for perinatal women.
Frederick followed up on these suggestions and was eventually diagnosed with postpartum depression.
“I think that I would have felt a lot more alone if I hadn’t had this visit, and struggled in other ways without the resources that the nurse provided,” Frederick said.
Home Visits Save Money
Melissa Goldin Evans, an assistant professor at Tulane’s School of Public Health, helped interview over 90 families participating in the Family Connects New Orleans program.
“It was overwhelmingly positive experiences,” she said. “This is 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 North Carolina’s program found that every $1 invested in the program saved $3.17 in health care billing before the child turned 2.
That’s another reason to require the visits statewide, according to state Rep. Bayham.
“The nurses and medical practitioners will be able to monitor potential problems on the front end, so that they could be handled without a trip to the emergency room or something even more drastic,” he said.
Avegno is advocating that the program be included in Louisiana’s Medicaid program, since more than 60% of births in the state are covered by Medicaid. A recent legislative report made the same recommendation.
This article is from a partnership that includes WWNO, NPR, and KFF Health News.
