On a recent Monday, Fidelia Ortiz met with the nurse who had helped guide her through pregnancy and early motherhood. But there were no waiting rooms, no sterile exam tables at this visit.
Nurse Lisa Fredrickson simply arrived at Ortiz’s northwest Santa Rosa home with a large bag in her hand, greeted Ortiz and plopped down on the floor with 9-month-old Logan.
“Hola. How are you? You look so big today,” she told the baby, who was busy crawling around the apartment. He settled in on a rubbery ABC floor mat, holding his foot and grinning as Fredrickson and Ortiz discussed everything from Ortiz’s new job to child care and how to get Logan, a very active baby, more interested in reading.
As a county public health nurse, Fredrickson has aimed to support Ortiz physically and emotionally throughout pregnancy and the first two years of Logan’s life. She works for a program called the Nurse-Family Partnership that each year provides home visits to about 140 low-income, first-time mothers who choose the service, with the goal of giving the young family a boost during a particularly formative period for mother and child.
“A big part of (the program) is the relationship that nurses have over time with the client,” said Elisabeth Chicoine, county director of public health nursing.
Developed in the 1970s by University of Colorado pediatrics professor David Olds, the Nurse-Family Partnership has grown into a national, rigorously tested program operating in 43 states. It’s goal is breaking the cycle of poverty by providing low-income, first-time mothers the consistent support they might otherwise lack in the form of a trained nurse who visits her throughout pregnancy and the first years of her child’s life. Local health department officials say it results in women who are healthier during pregnancy, more self-sufficient and better equipped to be mothers, as well as children who go on to be happier and healthier adults.
“Through the trusted support of a nurse, NFP reaches a woman living in poverty at a critical moment in her life, when she is pregnant with her first child,” said Fran Benton, a spokesperson for the national program. “Each nurse builds confidence in each mom and helps her meet her goals to provide for a brighter future for her child and stop harmful cycles of poverty.”
Chicoine added that pregnancy is a time when many women are particularly motivated to make changes. As well, nurses provide support during a key period in the baby’s early life when the child is making important and lasting neural connections.
Fredrickson said she has heard many of her clients say some version of the following: “I don’t want my kid to grow up the way I grew up. I don’t know how to be a mother, but I want to be a good one.”
“There’s a sense of, ‘I want to realize my potential’ that just flows out of them,” she said. “You don’t have to coax it. It’s there. It’s pretty cool.”
Sonoma County just wrapped up its fifth year with the national Nurse-Family Partnership, funded primarily with money from First 5 Sonoma County. Money for that program comes from a cigarette tax approved by voters in 1998 and brings with it a matching grant for additional federal Medicaid funds. Starting this month, the local program also receives federal funding through the California Home Visiting Program.
Since its inception, the local Nurse-Family Partnership has served more than 460 families. But with the current team of seven nurses and one supervisor, they’re reaching only about 11 percent of the women who qualify, Chicoine said.
“Our dream is to grow the capacity in the community to be able to serve at least 25 percent of the eligible population by adding one to two more teams over the next two to three years,” she said. To that end, the county is seeking additional public and private funding.
Nationally, it’s one of the most rigorously tested programs of its kind, county health officials say. Randomized controlled trials have been conducted over the past 35 years and show a range of benefits for mothers and their children. That includes improvements in pregnant mothers’ health as well as increased employment for mothers. Children do better in school, become involved in less crime and suffer less child abuse and neglect, according to the studies.
“A focus of the program is economic self-sufficiency,” Chicoine said.
A public health nurse begins visiting a client early in her pregnancy and continues meeting with her every two weeks or so until the child’s second birthday. During those visits, the nurse educates and counsels the client about health and behavioral issues and how to be self-sufficient.
They do some of the same things a clinical nurse would, like measuring the baby’s growth and weight. From there, Fredrickson takes the client’s lead, providing her with resources on everything from breastfeeding and child literacy to financial matters.
Ortiz, 30, learned about the program through a family adviser at the Vista Family Health Center, where she received care when she was pregnant. Chicoine said most women are referred to the program in this way, through a community clinic. Others find out through a food assistance program or simply by word-of-mouth.
“I decided to apply because they said I could have home visits with a nurse, and I thought I would give it a try,” Ortiz said. She was looking for additional help since most of her family lived far away and her son’s father provided inconsistent support. “Soon enough, I found myself looking forward for the next visit because there was so much about my pregnancy, baby development that I wanted to talk about with her.”
During a recent visit, Fredrickson began by asking Ortiz how her new five-day-a-week restaurant job was going and how she was managing childcare as a result. Before her baby arrived, Ortiz was able to work longer hours and was studying at Santa Rosa Junior College to be a personal trainer. Now, when she isn’t working at the restaurant and when she can find someone to watch the baby, she cleans homes in an effort to make ends meet.
“I’ve been working really long days,” Ortiz acknowledged. A roommate and an aunt help watch her son, even bringing him to the restaurant to nurse.
Fredrickson, who has been working as a public nurse for two years, was clearly proud of Ortiz’ efforts.
“For everyone, finding childcare in Sonoma County is tremendously challenging,” she said. “Fidelia puts Logan first.”
That includes researching the best nutrition, finding ways other than television to entertain her son and including him in her recreational activities.
“He’s so lucky to have this Super Mom,” Fredrickson said.
While some of Fredrickson’s clients are equally successful, others have had “hard blows,” she said. Some are dealing with substance abuse, homelessness or domestic violence, and some have turned their lives around.
Other times, Fredrickson said, “it’s hard to imagine them picking up and carrying on. When it becomes dark or challenged and I don’t know how the story will end, I often will just have to look at the research and the record of the program and know that upstream interventions make a difference downstream.”
At the end of the second year, she said, “I anticipate saying goodbye to my clients not knowing how their story will end, but that however their story continues, it’s their story. I’m honored to be along for the ride.”
Ortiz, who raises Logan mainly as a single mom, said she has often longed for the advice and support of her mother, who lives in Mexico. “There’s been so many times I wished she was here,” she said, but Fredrickson has often filled that gap, encouraging her to seek out more resources and motivating her to be a better parent.
“Talking with her made me feel like I had a mom,” Ortiz said. “She is my guide.”
You can reach Staff Writer Jamie Hansen at 521-5205 or jamie. firstname.lastname@example.org.