Registered nurse Carole Kriessman performs a quick check-up on Ja’Mil’Lion DeLorenzo’s 4-week-old son, Haiyden, at Grandma DeLorenzo’s home in Glenolden, Pa., on June 9.
Rachel Wisniewski for NPR
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Registered nurse Carole Kriessman performs a quick check-up on Ja’Mil’Lion DeLorenzo’s 4-week-old son, Haiyden, at Grandma DeLorenzo’s home in Glenolden, Pa., on June 9.
Rachel Wisniewski for NPR
In 2020, Lauren Brown, of Upper Darby, Pa., had a high-risk pregnancy. She was over 35 years old, had high blood pressure and had a previous blood clot that could have been deadly. Plus, the COVID-19 pandemic is raging.
When her due date came in December of that year, Brown, 40, needed an emergency cesarean section to deliver her daughter Bella.
All of these factors contribute to a deadly trend in America. This country has long been distinguished by high maternal mortality rate between rich nations, a problem of disproportionate influence black americans. The coronavirus pandemic has only pushed the deaths higher.
But Brown, who is black and a first-time mother, has had an experience of showing solutions.
“It’s a bit scary. But because I have a team of nurses, I have my team at the hospital, I really feel like… my pregnancy went very smoothly,” she said.
A long-term program with results
Lauren Brown and her baby Bella Mumin are part of the Nurse-Family Association with nurse Christina Baker, who visits them at their home in Upper Darby, Pa.
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Brown and Bella are just one of 56,000 families served by a national program called the Nurses and Families Partnership. each year.
That model, first studied in a randomized controlled trial more than 40 years ago, pairs low-income first-time parents with a private nurse from pregnancy until their fifth birthday. two of their children.
It has one overarching goal: Help create healthier and more prosperous families. In Brown’s Pennsylvania neighborhood, the program is run through a local community fund called The Delaware County Foundation. It is one of 774 counties across more than 40 states where the program is run.
Part of that work involves improving pregnancy outcomes for birth parents and their babies.
Brown worked with nurse Christina Baker before, during and after her pregnancy. They haven’t been able to see each other in person for more than a year due to the pandemic, but Baker is still monitoring patients’ blood pressure, stress levels and doctor appointments remotely.
“We’ll call, I’ll let her know what happened and when is my next appointment,” said Brown, who attended nursing school after the birth of her daughter.
A bottle lies on the table at Lauren Brown’s home in Upper Darby, Pa.
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A bottle lies on the table at Lauren Brown’s home in Upper Darby, Pa.
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Lauren Brown and daughter Bella Mumin watch a video on YouTube.
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Lauren Brown and daughter Bella Mumin watch a video on YouTube.
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Research shows that Early education about pregnancy complicationsand multidisciplinary care for women with additional risk factors, as key interventions to improve maternal health results. The Nurse-Family Partnership model does both, with a focus on empowering expectant parents to demand better care if they feel medical professionals are not taking their concerns seriously. their.
Baker said Brown feels comfortable asking questions, but many first-time parents have a hard time doing so.
“One thing that I emphasized early on [is] that, ‘you need to advocate for yourself, because this is your baby, this is your pregnancy,'” she said.
This extra attention and support will pay off. The Nurse-Family Collaboration model reduces the incidence of several maternal mortality risk factors such as pregnancy-related high blood pressure, according to study the results of the program.
Joyce Edmonds, a nurse and associate professor at Boston University who is not affiliated with the program, said: “I am a fan of the Nurse Family Partnership project because as a scientist, when I looked at the data, it was extremely fascinating.
The cause of death is bigger than a program can solve
The Nurse-Family Partnership works to support a specific group of new parents. But it is not a way to tackle the larger causes of maternal death in the United States
Experts say those extend beyond the doctor’s office or the delivery room.
Dr Rose Molina, an OB-GYN and professor at Harvard Medical School who focuses on inequality, said: “Some of the things that I’ve heard about being the hardest to get pregnant are accessibility. affordable housing, childcare and mental health support”. in pregnancy outcomes.
Recently review of recent pregnancy-related deaths in the United States found that a mental health condition was the leading cause of death for up to a year after birth, according to the Centers for Disease Control and Prevention (CDC). That same review found that four out of five deaths during or after pregnancy were preventable.
Organized for Delaware County offices in Eddystone, Pa. Among other programs, the Foundation oversees the local chapter of the Nurse-Family Partnership.
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Organized for Delaware County offices in Eddystone, Pa. Among other programs, the Foundation oversees the local chapter of the Nurse-Family Partnership.
Rachel Wisniewski for NPR
Ja’Mil’Lion DeLorenzo reads material she received from the Nurse-Family Association in her bedroom at her grandmother’s home in Glenholden, Pa.
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Ja’Mil’Lion DeLorenzo reads material she received from the Nurse-Family Association in her bedroom at her grandmother’s home in Glenholden, Pa.
Rachel Wisniewski for NPR
Another gap is access to health care in general. In the United States, people without health insurance are eligible for Medicaid, government-subsidized health insurance, while they are pregnant and within 60 days of giving birth. More than two dozen states have joined the Biden Administration program to extend that coverage up to a year after birth. Nationwide, Medicaid pays for 42% of all births.
But beyond that period, thousands lack basic insurance. As of 2019, there are 800,000 women of childbearing age earning too much money to qualify for Medicaid but not enough to buy private insurance, according to analysis by the Center for Policy and Budget Priorities. That puts them in the “coverage gap.”
Expanding Medicaid coverage and closing that gap will help reduce maternal mortality, according to a report from Georgetown University’s Health Policy Institute.
That’s partly because chronic diseases, such as cardiovascular disease, are the leading medical cause of pregnancy-related deaths. These conditions need to be treated well before conception so that parents are “as healthy as possible during pregnancy,” says Molina.
Expanding access to Medicaid will also increase the reach of Nurse-Family Partner programs, according to that organizationbecause Medicaid dollars can be used to help fund them.
Trusted professionals are key
Ja’Mil’Lion DeLorenzo and her son, Haiyden Hackney, are guided by nurse Carole Kriessman at their home in Glenolden, Pa.
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The foundation of the Nurse-Family Collaboration model is building a relationship of trust.
Credible facilitators, whether nurses, birth attendants or midwives, can help reduce rates of birth complications and address racial disparities in birth care, from research.
Ja’Mil’Lion DeLorenzo, a 19-year-old mother named Jayy, once had reason to be suspicious of medical professionals. As a young man, DeLorenzo met with a rotating group of social workers and therapists while treating depression.
“So now, I have to sit here, tell my whole life story, get comfortable with them, do things with them, and then they leave,” she said of the experience.
But since March, DeLorenzo has joined the Family-Nurse Association, working with nurse Carole Kriessman. DeLorenzo’s son, Haiyden, was born in May.
Kriessman and DeLorenzo share Instagram videos with parenting tips in them, and Kriessman reminds DeLorenzo to take time for himself. DeLorenzo said that she liked that Kriessman was stuck around.
On a recent visit, Haiyden was always grinning in her red pajamas. Krissman and DeLorenzo talk about the boy’s latest developmental milestone: sitting up on his own.
“You sit so cute!” Krissman said, as she weighed him.
She will also be here for his next milestone.
Haiyden Hackney sat up while his mother Ja’Mil’Lion DeLorenzo and nurse Carole Kriessman watched.
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Haiyden Hackney sat up while his mother Ja’Mil’Lion DeLorenzo and nurse Carole Kriessman watched.
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