Renae Oxendine answers the nurse’s questions while her daughter, Aireonna Oxendine, plays. | Staff photo by Sara Hottman
Both mother and nurse smile, reveling in the healthy baby’s enthusiastic responses — a success story for the Nurse-Family Partnership program.
Harris, 26, is a nurse with Robeson County’s Nurse-Family Partnership, part of a national program that seeks to improve pregnancy outcomes, child health, and economic self-sufficiency for first-time moms whose income is no more than double the poverty line.
The national Nurse-Family Partnership targets counties like Robeson, which has the second-highest teen pregnancy rate in the state; a high infant mortality rate; a low graduation rate; the highest poverty rate in the state; and a low rate of proper prenatal care — all of which lead to low birth weight, high preterm labor rates, and bad parenting.
The four specially trained nurses in Robeson County’s program and the mothers — up to 100 — they serve are trying to buck the negative trends with two years of education on prenatal, postpartum, and parenting practices.
“With education, they’re better equipped to provide for a child and provide for themselves,” said Cindy Herndon, director of the Robeson County program. “They’re not stuck in a cycle of poverty.”
Nurses visit clients at their homes weekly or biweekly, teaching the curriculum and answering mothers’ questions. When Harris visited Oxendine last week, they went through a checklist to make sure mother and baby were making their doctor appointments and taking care of themselves; practiced age-appropriate games for baby; and went over material about lead poisoning, that visit’s assigned topic.
February marks the Robeson County program’s one-year anniversary for accepting clients. Oxendine, 25, signed up in March 2009; she says the program helped her when she was “trying to manage everything” — schoolwork at The University of North Carolina at Pembroke, a student-teaching job, and being a single mom.
“It’s helped tremendously,” Oxendine said. “It helped educate me in areas I wasn’t familiar with, and Jessica played a huge roll in being there whenever I needed her.”
The Robeson County Nurse-Family Partnership was launched in October 2008; by January 2009 it had four nurses who could assist 25 clients each. By July, the program had 89 mothers.
The program operates out of the Health Department and is funded by the Kate B. Reynolds Foundation and Duke Endowment. In 2008 the organizations provided three years worth of funding — $472,484; future funding is tied to satisfactory reviews. Smart Start contributes a child-care subsidy to the program, so if clients prove they’re going to school or work, the subsidy pays for their child care. Oxendine was one of the first clients to benefit from free child care, Harris said.
Some of the program’s original mothers have since left, so last week nurses had 74 clients — some as young as 13 years old — among them, with referrals rapidly filling the remaining 26 slots. Client referrals come from obstetricians, school nurses, the Health Department, and the Women’s Life Center.
“It’s been fast and furious,” Herndon said with a laugh. “It’s like you blink your eyes and you’re almost a year out.”
Initial indications show the program is working: the retention rate is 81 percent, pre-term births are low at 2 percent, and high percentage of mothers, 70 percent, are breast feeding.
These accomplishments are significant considering the program’s clientele: 36 percent of their mothers are 13 to 18 years old; 60 percent are 19 to 29 years old; and 4 percent are 31 to 33 years old. The demographic they serve is primarily minority: 37 percent American Indian; 37 percent black; 14 percent Hispanic; 9 percent white.
“When they’re teens they’re thinking about themselves, not thinking about the fact they’re going to be responsible for another human being,” Herndon said. “They don’t see what’s ahead of them at all. They’re only living in the moment, so they need a lot of guidance.
“A 13-year-old is in seventh grade. You can imagine a 13-year-old, barely out of playing with Barbie dolls, is having all of these changes with her body.”
Harris said the nurse’s job is to act in a purely supportive role to ensure a healthy pregnancy, a healthy baby, and a healthy future for the mother — particularly if she’s very young.
“Maybe she can’t go to school and talk to her friends about what’s going on,” Harris said. “We lift them up. ... We look at it like, ‘I’m here for you’ and ‘what can we do for you?’
“We try to get on their level and build a good, trusting relationship.”
Nurses had two weeks of training in Denver when the Robeson County program first launched, and have attended three training sessions since.
Nurse-Family Partnership looks at infant mortality and teen pregnancy rates as indicators of need in a community.
The infant mortality rate in Robeson County is 14 percent; in North Carolina the rate — baby deaths per every 1,000 births — is 8 percent and in the United States 11 percent, according to the State Center for Health Statistics. Among minorities in Robeson County, that rate is 17 percent.
Robeson County has the second-highest teen pregnancy rate in North Carolina, according to the State Center for Health Statistics, with 55.6 pregnancies for every 1,000 girls ages 15 to 17 years. Teen pregnancies are high-risk because girls’ bodies are still growing, so they need ample nutrients for the mother and the fetus, Herndon said.
Nurse-Family Partnership seeks to instill values of healthy prenatal, parenting, personal and environmental practices that it hopes will last through subsequent pregnancies, Herndon said. The program triies to find a mother’s “heart’s desire” — usually education- or career-related.
Herndon gave a high school-aged mother as an example: “She’s interested in pursuing something in the legal field but doesn’t know what she wants to do exactly.” The girl’s nurse encouraged her to stay in high school, and helped her work through issues like frequent absences.
Education is a primary factor in determining how a mother will care for herself and her child, Herndon said. In Robeson County, about 60 percent of high schoolers graduate, and 12 percent of the population has four-year degrees, according to the state Department of Commerce.
One-third of Robeson County lives in poverty, and 30 percent of all pregnant women who deliver babies at Southeastern Regional Medical Center have not had any prenatal care, Herndon said.
But nurses with the program don’t harp on the negative indicators — “our main goal is to educate,” Harris said. “We educate through repetition, revisiting things, because when I walk out that door, I don’t know what’s going on. ... I can only support, advocate, and tell them what the best practices are.”
Herndon said nurses also gently combat cultural beliefs when they teach healthy parenting.
“It’s the culture in Robeson County to discipline children in a harsh manner. We teach them they’re their babies’ first teachers,” Herndon said, adding “We don’t force our ideas on them; we look at a path and lead them to resources to help them on it.”
Practices like co-sleeping, which can cause Sudden Infant Death Syndrome, is a cultural problem because “they feel almost as if they’re bad mothers if their babies don’t sleep with them,” Herndon said.
Harris tries to adjust her clients’ habits by reviewing educational materials with them and by having them practice placing their babies in a bassinet while they’re sleeping.
“Our nurses are respected because they have a certain knowledge base,” Herndon said. “Most of them have experience with labor and delivery in the hospital. They’re seen as a needed resource for people in the community.
“Clients are proud to be in the program. They rave about the nurses’ dedication and support.”
She said clients have a professional relationship with their nurses, but with the dedication of a friendship, giving nurses vegetables from their gardens and photographs of their children.
“My team is strong and that’s a blessing,” Herndon said. “They’re passionate about what they do and they’re compassionate to their clients.”
A cramped office at the Health Department last week was packed with baby clothes, scrapbook kits, and photos of clients’ newborns and families.
“We get really attached to these girls, seeing them on a weekly or biweekly basis,” Harris said. “They care about their children and we care about their children, and we celebrate with them when they have successes. ... Their successes are our successes.”
Oxendine’s graduation from UNCP was among her goals, and a tremendous achievement, Harris said. Now Oxendine is looking forward to her next goal — a master’s degree in Elementary Education — as well as one year, five months more in the Nurse-Family Partnership program.
“I think it’s an awesome program,” Oxendine said. “I think every first-time parent should have the opportunity to be in this type of program, even if it’s not as intense and detailed as it is for us, it should be available.”
But, thanks anyway !!
You now have a "background " in OB/GYN.
Please tell me what that background is ! PLEASE !