Barb Ibrahim, a nurse of more than 30 years, unpacks in Matt and Amber Luman鈥檚 kitchen, in rural 老夫子传媒 County, Ore.
Ibrahim pulls a baby scale from a bottomless, black bag she totes everywhere, like Mary Poppins, and weighs the Lumans鈥� new daughter, Esserley. Sun lights Esserley, naked but for her diaper, as she wriggles on the smooth, white scale.
A tall window in the kitchen reveals a vertiginous view of the Lumans鈥� backyard: a rocky cliff鈥檚 edge dropping into a steep canyon dotted below by wisps of juniper and a smattering of miniature houses and cars.
Ibrahim drove half an hour to check in on Esserley and her parents. She鈥檚 part of a new program, slowly rolling out across Oregon, called Family Connects.
The program offers any family with a new baby a no-cost visit at home with a trained nurse, like Ibrahim. It鈥檚 the state鈥檚 response to a grim, American reality: The U.S. has one of the highest death rates of any wealthy nation for and both.
And no wonder. After birth, the only support many families in the U.S. can count on is the occasional, 15-minute check-in at the pediatrician鈥檚 office. A safety net made of gossamer.
Now, Oregon is trying to change that.
Nurse Barb Ibrahim and her Mary Poppins bag
Esserley is Matt and Amber Luman鈥檚 first child, and they seem genuinely relieved when Ibrahim arrives for her second home visit with them. Amber is taking online classes to earn her undergraduate degree and hopes to become a school counselor. Matt works at a video store in nearby Bend.
Ibrahim measures Esserley and takes her temperature. She even rubs her fingers through the baby鈥檚 hair, strawberry blonde like her mom鈥檚, checking the soft spots where the bones of her skull haven鈥檛 yet fused. All the while, Ibrahim and Esserley coo at each other.
After this quick medical checklist comes the beating heart of any Family Connects visit: the chance for new parents to ask a registered nurse whatever they want.
Some share their confusion or frustration. Others are eager for advice or comfort in those early weeks of a baby鈥檚 life when new parents are most likely to feel exhausted and adrift.
Amber tells Ibrahim that Esserley鈥檚 been doing well, except for a little trouble feeding.
鈥淪he clicks at the breast and the bottle,鈥� Amber says, 鈥渟o it lets a little bit of air in.鈥�
As if to prove her mom鈥檚 point, Esserley unleashes an impressive burp.
On their previous Family Connects visit, Ibrahim had shown Amber different ways to hold the baby during feeding, to try to help with that gas.
鈥淵ou were telling me about the football hold,鈥� Amber says. 鈥淚 tried it, but I couldn鈥檛 get it.鈥�
Ibrahim sits with Amber on the couch that divides their small kitchen from the TV room, and they work on the football hold again. Amber says softly, 鈥淭hank you so much for coming.鈥�
鈥淛ust having Barb here has helped me feel supported emotionally and improved my mental health 鈥� right in the thick of these first few, hard months of parenting,鈥� Amber tells NPR.
鈥淪ince I鈥檓 a first-time mom, I wanted [Ibrahim鈥檚] advice,鈥� says Veronica De Paz, another new mom in 老夫子传媒 County whose son, Adriel, is a few months older than Esserley. 鈥淎nd [Ibrahim] told me, if I have any questions, I can always message her 鈥� And she always gets back to me.鈥�
鈥淏abies are just hard.鈥�
Family Connects offers any family in Oregon one to three home visits from a trained nurse within their baby鈥檚 first few weeks of life 鈥� at no cost to families.
The program was developed in Durham, N.C., and research from its smaller rollout there found it was , including a big drop in the number of trips new parents were making to the emergency room.
鈥淏abies are just hard,鈥� laughs Dr. Elizabeth Steiner. 鈥淎nd so I was very intrigued by this idea.鈥�
Steiner is a family physician in Portland, Ore. She didn鈥檛 create Family Connects, but she may be the biggest reason it鈥檚 come to Oregon. In addition to being a doctor, she鈥檚 also a state senator and a mother. For her, helping young parents wasn鈥檛 just good policy, it was personal.
Two days after her own daughter was born, Steiner says, 鈥淚 developed horrible postpartum anxiety and depression. I didn't sleep for weeks.鈥�
Around 1 in 7 new mothers in the U.S. report postpartum depression. Steiner says she could have used the kind of support a Family Connects nurse can provide.
In fact, a study of Family Connects in Durham found mothers in the program were 30% less likely to experience possible postpartum depression or anxiety.
鈥淣obody should have to go through that,鈥� Steiner says, 鈥渘obody. And having a trained nurse come into my home when my baby was two weeks old and say, 鈥極oooh, OK, let鈥檚 get you some help here,鈥� would have been transformative.鈥�
Steiner uses her personal story to explain why she wants Family Connects to be universally available 鈥� not mandatory, she emphasizes 鈥� for any family, whether it鈥檚 their first baby or fifth. Because every baby can be challenging, even for a trained doctor.
And every family has different needs, hence the 鈥渃onnects鈥� part of Family Connects: Every nurse also acts as a kind of human clearinghouse of local and regional support for caregivers.
If a family is struggling with housing or food insecurity or addiction, the nurse will connect them with local groups and agencies that can help. Mental health counseling, marriage counseling, child care while mom or dad finishes their degree online. They can even help grandma get a hearing aid if she鈥檚 living in the home and helping take care of baby.
Purple crying
Family Connects nurses tend to emphasize a handful of issues with every family they see, including how to make a crib or other sleep space safe for a baby. They also help parents manage a huge potential stressor: colic, or what the program calls 鈥減urple crying.鈥�
Purple crying is a kind of crying that sometimes can鈥檛 be soothed. It鈥檚 normal but can lead some parents, in desperation, to shake their babies, which is incredibly dangerous. Nurse Barb Ibrahim says she spends a lot of time making sure new parents have a plan for purple crying.
鈥淲e talk through that, and I recommend putting the baby in a safe place, like their bassinet, and then stepping outside for a couple deep breaths. It鈥檚 what I usually recommend, mainly because that worked for me,鈥� Ibrahim says.
She thinks this extra preparation is one of the reasons that early study of Family Connects also found a big drop in Child Protective Services investigations into parents for suspected abuse or neglect of their child.
The cost of care vs. the cost of doing nothing
While research from North Carolina, where the program began, suggests a real return on investment, rolling out Family Connects in Oregon has been a costly struggle.
For one, the pandemic got in the way. Also, while the program is free for families, it鈥檚 by no means free. The state鈥檚 plan is to require insurance companies to pay for these nurse visits, but that鈥檚 taken time and remains a work-in-progress.
And then there鈥檚 the cost itself. Steiner says she was expecting these visits to cost between $400 and $500 per family. 鈥淭urns out, it's probably more like $1,300, at least here in Oregon. And that was a problem.鈥�
What happened? Steiner says early cost estimates were informed by the program numbers in Durham, N.C. 鈥� one city. But Oregon is trying to offer nursing visits statewide.
鈥淚n Oregon, we have a lot of places where people live many, many miles apart,鈥� Steiner says.
Places like 老夫子传媒 County, where Barb Ibrahim works. And part of the power of the program is that the nurses travel, not the families.
鈥淚 like that [Ibrahim] comes over to my house instead of me driving over there,鈥� says Veronica De Paz, in 老夫子传媒 County. 鈥淚 can鈥檛 drive. So my husband would have to get out of work and then take me over there. And I like that [the nurse] can come into your house and just, kind of like friends, like vibe, here at the house.鈥�
Steiner says another reason for the higher costs is 鈥渢here's more of a nursing shortage [in Oregon], so we had to pay higher wages to get nurses who were interested in doing this.鈥�
In spite of all this, Steiner believes the lifetime benefits of Family Connects still outweigh the costs.
Making nights a little easier
At the Lumans鈥� house, Ibrahim checks Amber鈥檚 blood pressure and asks how she鈥檚 feeling these days.
鈥淎 little tired sometimes,鈥� Amber admits. 鈥淏ut I think it鈥檚 normal.鈥�
Ibrahim spends about an hour with the Lumans. Before she goes, she pulls one more surprise from that Mary Poppins bag of hers.
鈥淚 brought you guys a gift,鈥� Ibrahim says.
It鈥檚 a sleep sack, to make the nights just a little easier for Esserley. And for her parents.
Audio story produced by: Lauren Migaki
Digital and audio stories edited by: Nicole Cohen
Copyright 2024 NPR
