Even before Shimiria Bennett gave birth February 7, a nurse came to her home every week or two to help the 18-year-old prepare for motherhood.
Nurse Lawanna Mims talked with Bennett about how to have a healthy pregnancy, what to expect during childbirth and how to care for a screaming newborn.
Today, with that support, Bennett is breast-feeding her 10-week-old daughter, Jahari, and feeling confident in her new role.
It's all part of a new, free Mecklenburg County program that matches visiting nurses with first-time, low-income mothers.
While home visits sound expensive, research has shown that the Nurse-Family Partnership, created 30 years ago in New York, produces stronger, healthier parents and children and saves money by reducing child abuse, substance abuse and crime.
The local program is one of 13 sites in the Carolinas, serving 18 counties, including Mecklenburg, Wake and Cleveland. Nationally, the program serves about 17,000 mothers in 25 states.
All Carolinas sites are supported by grants from a collaboration of private and public groups, including The Duke Endowment, the Kate B. Reynolds Charitable Trust and Blue Cross Blue Shield insurance companies in North Carolina and South Carolina.
Every site has four nurses assigned to make regular home visits to 100 women, starting early in pregnancy and continuing through the children's second birthdays.
"The nurse becomes part of the family," said Rhett Mabry, president of The Duke Endowment. "It helps both the mother and the child. They build trust with the nurse, and it helps them achieve their potential."
Breaking Poverty's Cycle
The Nurse-Family Partnership was created by Dr. David Olds in the late 1970s in Elmira, N.Y., a struggling community with high rates of child abuse and neglect.
Olds, now a professor of pediatrics at the University of Colorado, saw the need to intervene early in a woman's first pregnancy and through the first two years of a child's life to break the cycle of poverty and create a stronger family.
Olds studied the program by comparing groups of pregnant women who received nurse visits to those who did not. The results were impressive.
Data from a 15-year follow-up study showed children were less likely to be abused or neglected, and less likely to be involved in a crime by the time they turned 15. Nurse-visited mothers who were smokers smoked fewer cigarettes and had fewer premature deliveries than women in the control group who smoked. The mothers also spent less time on welfare and had fewer children.
The program has been replicated in other cities with similar results. A 2005 Rand Corporation analysis also showed that for every dollar invested in the program, communities can save about $5 in costs associated with Medicaid and other public services.
Each family costs the program about $4,500 a year. Each of the Carolinas sites gets about $500,000 a year, mostly for nurses' salaries. This was the first year for the program locally, and Shimiria Bennett was the first mom to give birth.
The Duke Endowment and others intend to provide $45 million for seven years. "Our plan is to get them firmly established in their respective communities," the Duke Endowment's Mabry said. "Then we'll try to persuade the public sector that this is an effective use of dollars."
Mecklenburg's program is run by the private, nonprofit Community Health Services. Executive Director Jen Algire said: "So many of the kids who go to juvenile court are not there because they are bad kids. It's because something early in life didn't go right. If we just continue to remove kids from their parents or put them in jail, we never get to the root problem."
Visiting nurses not only help with pregnancy and child-rearing questions, they encourage mothers to stay in school or find work.
"They spend time helping mothers think through what kind of lives they want for themselves and their children," Olds said. "If they feel supported ... it puts them on a very different trajectory than if they feel neglected and disenfranchised."
A Lot to Learn
Shimiria Bennett learned about the program from a brochure at her doctor's office in Charlotte. She didn't know what to expect of childbirth until she began meeting weekly with her nurse, 25-year-old Lawanna Mims, in December.
Before the baby was born, Bennett was sleeping on the couch at her sister's home. Soon after the birth, Mims arranged for the mother and child to move to Catherine's House, a temporary housing agency at the Sisters of Mercy complex in Belmont.
Even though Jahari was small at birth—5 pounds, 10 ounces—she has been gaining about 6 ounces each week.
When Mims asked Bennett how she was doing, the young mother described her baby's recent fever and trip to the emergency room. Jahari had been spitting up milk for several days, added Bennett, as she held the sleeping baby.
Mims took notes and told her to watch the child closely. "Usually babies aren't as gassy when you breast-feed," she said. "If she continues to throw up after every feeding, call the doctor about it."
They spent the rest of their visit playing a game Mims created to review questions about child care and development. Taking turns, they advanced game pieces — small rattles — step-by-step on the homemade board. They drew cards and read questions aloud: How can you calm your baby down?
Bennett answered most correctly, but she stayed silent when Mims asked her to finish this sentence: "I will be a good mother because..."
Mims answered for her, reciting all the things this teen mother has done right. "You've got her into a stable environment. You're still breast-feeding. You're reading to her. You're getting her to doctor's appointments. I think you're doing a good job."
Bennett is also completing her high school degree and applying for a government subsidy so she can get her own apartment. Her long-term goal is to complete a degree in culinary arts.
"So, do you think you're doing good?" Mims asked.
"Yeah," Bennett answered softly.
By Karen Garloch, The Charlotte Observer. Originally published Monday, Apr. 20, 2009