Visits by nurses to the homes of economically disadvantaged mothers help reduce premature death of both mothers and their first-born children, a new study finds.
The research with more than 1,000 families over two decades shows the Nurse-Family Partnership (NFP) program can improve survival rates—not only of the children, but also of their mothers.
“Our findings add to the body of evidence that the program produces improvements in the short- and long-term,” says study coauthor Harriet Kitzman, senior associate dean for research at the University of Rochester School of Nursing.
“Mothers have an innate desire to provide the best care for their babies. When nurses empower mothers with the knowledge and skills to better their families’ lives, it transforms life trajectories.”
CALLS, VISITS, LETTERS, AND CARDS
The randomized, controlled study, published in JAMA Pediatrics, found that early intervention through nurse-visits decreased the number of deaths of vulnerable mothers and children, who are at high risk for premature death.
The study of 1,138 young mothers took place in Memphis, Tennessee, and began in 1990. Most participants were African-American, age 18 or younger, unmarried, unemployed, and without a high school diploma.
One group of mothers and babies received standard care. The other participants, in addition to receiving standard care, also were visited in their homes by registered nurses during their pregnancies and for two years after the birth of their first child (averaging 64 planned home visits).
With randomization, groups were similar at entry into the study. Over the next 20 years, University of Rochester School of Nursing researchers conducted 11 in-depth interviews with each study participant at structured intervals. This required maintaining the whereabouts of families through frequent phone calls, visits, letters, and even birthday and holiday cards.
Researchers found the program resulted in a significant reduction in preventable child deaths from birth until age 20. Children in the control group not receiving nurse-home visits had a mortality rate of 1.6 percent for preventable causes, including sudden infant death syndrome, unintentional injuries, and homicide. There were zero preventable deaths among nurse-visited children.
In addition, over the same two-decade period, mothers who received nurse-home visits had significantly lower rates of death from all causes compared to mothers not receiving nurse-home visits. Mothers in the control group who did not receive nurse-home visits were nearly three times more likely to die than were nurse-visited mothers.
The relative reduction in maternal mortality was even greater for deaths due to external causes like unintentional injuries, suicide, drug overdose, and homicide. Mothers not receiving nurse-home visits were eight times more likely to die of these causes than nurse-visited mothers.
NFP nurses begin their visits by focusing on the health and well-being of the mother during pregnancy, the importance of good prenatal care, and the mother’s and family’s plans for life with the baby.
After the child is born, nurses and mothers discuss how to read and respond to babies’ subtle cues, how to look for signs of illness, what to expect at certain ages, the health risks of smoking, drinking, and violence, and plans for sustaining socio-emotional and economic stability.
Building on the bond of trust created while discussing the baby’s welfare, conversations are planned to branch out to other areas such as continuing the mother’s education, housing needs, employment opportunities, the health of other family members, the availability of resources, and the involvement of the women’s partners and other family members in caring for the child.
“Low-income, first-time mothers may have limited access to up-to-date scientific parenting information or role models,” Kitzman says. “By investing in this critical stage of a woman’s life, we not only improve quality of life at a time of stress, uncertainty, and transition, but help first-time mothers develop decision-making capacities and behaviors that will enhance the health of their child and themselves for years to come.”
The researchers’ latest finding of reduced premature deaths for nurse-visited mothers and children lines up with past findings that showed that the program improves prenatal health, results in fewer childhood injuries, fewer subsequent pregnancies, and that it increases maternal employment and improves school readiness. Mothers who went through the program were also less dependent on welfare, food stamps, and Medicaid.
“Having a trusted relationship with a nurse gives mothers confidence to envision a positive future, the desire and willingness to try new activities, and the competencies to overcome obstacles,” Kitzman says.
“The powerful bond created between nurses and first-time mothers can help families break the cycle of poverty and put them on a healthier path.”
Additional researchers from the University of Rochester and the University of Colorado contributed to the study, which received funding from the National Institute of Drug Abuse.
《Effect of Home Visiting by Nurses on Maternal and Child Mortality
》, Published on Journal 《JAMA Network》in July 7, 2014.