child welfare watch vols. 19 & 20

Learning to Be a Mom :
Nurses help new mothers bond with their babies

Rosetta Savana was 17 years old and living in her 19th foster home when she found out she was pregnant. She'd already had two miscarriages, so she was thrilled when her first ultrasound indicated that her baby was doing well. But then she ran into a series of health problems of her own: her lifelong asthma flared up, complicated by gestational diabetes that wouldn't come under control even with three insulin shots a day. Her blood pressure skyrocketed, leading to blackouts and debilitating headaches. By her third trimester, she had been rushed to the hospital by ambulance a number of times, only to be sent home. "Every day or two, I was in the hospital, but I guess they didn't get it that there's really something wrong," she recalls.

That's when Joanne Schmidt entered—and quite possibly saved—Savana's life. Schmidt is a nurse with the Nurse-Family Partnership (NFP), a home-visiting program for low-income, first-time mothers, administered by the city's Department of Health and Mental Hygiene. Nurses in the program have small caseloads and follow clients from pregnancy through their babies' second birthdays, meeting regularly to talk about everything from safe sex to teething to job applications. Three years ago, NFP partnered with the Administration for Children's Services, launching an initiative that has now paired nurses with about 125 young mothers in foster care.

"The Nurse-Family Partnership model has shown a steep reduction in rates of child abuse, increased cognitive function and school readiness among children, fewer unintended subsequent pregnancies and significantly increased workforce participation among mothers."

Schmidt says health care providers underestimated the seriousness of Savana's condition. She insisted that the hospital admit Savana in her seventh month of pregnancy—rather than send her home as it had previously. Doctors induced labor and performed an emergency C-section. Five months later, Savana's son, Tristan, is a healthy, wide-eyed baby with chubby legs and a big, drooling grin. For her part, Savana graduated from high school after Tristan was born and now plans to attend nursing school, paid for by her foster care agency, Children's Village.

The NFP program serves 2,300 New York City families and has an annual budget of $19.5 million from various sources, including Medicaid, Temporary Assistance for Needy Families (TANF) and the Robin Hood Foundation. NFP has yet to generate evaluation data from its services for young moms in foster care, but the program has demonstrated impressive outcomes in its work with other populations of low-income mothers. Over three national studies, the NFP model has shown a steep reduction in rates of child abuse, increased cognitive function and school readiness among children, fewer unintended subsequent pregnancies and significantly increased workforce participation among mothers.

The program helps new mothers develop healthy bonds with their kids. "The nurses encourage moms to anticipate their babies' births and engage in excitement about that," says Lisa Landau, NFP's New York City director. "Once the child is born, it's talking about the importance of interacting, reading, being on the floor with your child. For some women that's very natural; for some it's not something they might know in their own families."

The program is limited to first-time mothers. It usually enrolls young women who seek support early in their pregnancy, so there's time to create a strong relationship with the nurse before the baby is born. These rules, and limited funding, mean only a fraction of young mothers in foster care can take part. But for those who can, advocates say the program provides something foster youth often lack: someone who's paying consistent attention. "Pregnant teens in foster care face a lot of instability," says Mariam Sammons, director of the Mother/Child Program at the foster agency New York Foundling. "Having continuity is so important, not just to focus on the parenting piece but also on the mom and her own needs."

The program is both confidential and voluntary—and that may be why it works. "Adolescents in foster care have a lot of people telling them what to do," says Tonya Pearson, an NFP nurse for the past four years. "Our program is very client directed—anything they don't want to talk about is off-limits." Nurses help clients identify their own goals and how to achieve them. "It's not about what we think is best for the young woman," says Pearson. "It's about what they see for themselves. Then you celebrate each small success."

Veronica Arias was 18 years old and going into her second year in a Supervised Independent Living Program when she found out she was pregnant. Terrified that ACS would take her baby from her, she hid the pregnancy until she started to show, and then she went AWOL from her foster care agency for a month. "I was lost," she says. "I was worried about if I'd be able to do it right—I've been in care all my life. I didn't know how to raise a baby."

Arias' caseworker referred her to NFP, which connected her to Pearson. "I get nervous talking to people about my business," says Arias, "but she had this aura. I trusted her." They talked about what parenting would be like, and Pearson gave her strategies to bond with her baby while she was still pregnant. "I used to sing to her and talk to her," says Arias. "It made no sense to me, but then she was born and she opened her eyes when she heard my voice. She knew who her mommy was."

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