About three months ago, Amber Leduff, gave birth to her daughter, Autumn, at New Orleans’ Touro hospital. The room was hectic after the delivery, with nurses and doctors bustling in and out. In the chaos, Leduff, who is 30, only half registered the representatives from Family Connects New Orleans, taking paperworks from them and moving on.

But when her doctor encouraged her to enroll in the program, which provides up to three in-home visits to parents of newborns up to 12 weeks old, Leduff took it seriously.

Anyone who gives birth at Ochsner Baptist or Touro hospital in New Orleans and is an Orleans Parish resident – regardless of insurance status or income – is eligible for Family Connects New Orleans (FCNO). The best part about the program? The visits are free.

Four weeks after Autumn was born, Leduff scheduled their first visit. The nurse assigned to her arrived with her own weight table – a relief to Leduff who wanted to ensure, between pediatric visits, that Autumn was gaining enough weight.

“She checked on the baby, talked to me and my husband about our specific needs and how I’m actually doing,” Leduff told the Guardian. “I know sometimes the mom kind of just gets tossed to the side when it’s all about the baby, but she was very engaging in conversation with us, making sure that we were OK and had all the necessities that we needed.”

Family Connects is a national program that offers a glimpse into how state and local governments can support families in meaningful ways during the difficult, and potentially dangerous, postpartum period. In 2021, 43.3% of pregnancy-related deaths occurred in the six weeks following delivery – this program, designed to be universal, works to fill in the gap period between birth and the first postnatal appointment through home-based nurse visits.

Initially launched in Durham, North Carolina, in 2008 as Durham Connects, Family Connects is available in some counties or cities in several states, including North and South Carolina, Arkansas, Illinois, New Jersey, Ohio and Texas, amongst others. New Orleans’ iteration of the program started in August of 2023.

Leduff’s nurse also gave resources to additional services provided by the city that she didn’t realize existed. That had a positive cascading effect: Leduff was able to pass the information along to cousins and friends who had also recently had babies.

The visit provided security and reassurance that, as first-time parents, was needed for both Leduff and her husband. “The benefit of it is giving moms, whether you’re first time or not, whether it’s your second or third child – you always get that peace of mind when someone comes and just answers any questions you have,” she said. “Every question I had, she took with ease and answered thoroughly.”

Supporting a new mother’s mental and physical health

While Louisiana has made strides in clinically treating conditions that can kill mothers, such as hypertension and hemorrhage, the highest risk is in the early postpartum period.

“You go, you have your delivery, you’re in the hospital and everything is there. You go home, there’s a bit of a honeymoon period, and then, for many women, you fall off a cliff,” said Jennifer Avegno, deputy mayor of health and human services. “It’s the time in your life when your resources are generally at their lowest. We often don’t know about it until you hit one of our systems later on, whether that’s child protection, whether it’s the ER, whether it’s substance use treatment.”

While programs such as WIC or Healthy Start help with young children and nutrition, there was nothing for the critical period shortly after birth. FCNO fills that void. Avengo noted that most developed countries have multiple postpartum home visits and significantly better birth outcomes.

The nurses not only provide clinical evaluations of the mother and baby – things that can be particularly important for hypertensive moms and low birth weight babies – but also provide comprehensive social service evaluations of the entire home. For some families, such as those without insurance, the visits may be the only health services they receive.

Additionally, the nurses can screen for postpartum depression, provide breastfeeding support, help with other aspects of adjusting to a newborn and also connect families with resources in the community. FCNO is also now offering maternal support groups once a month, during which moms can commiserate and build relationships during a period that can feel isolating.

“If grandma lives in the home, what’s going on with grandma? If there’s a three-year-old in the home, what do they need? It is a very active, warm handoff and confirmation that you’re getting the help you need,” Avegno said. “Up to two follow-up visits make sure those loops are closed. This is not longterm; we’re not going to be with you forever. But it is to get you through that hump.”

Before FCNO, families would attend the prenatal appointments and “they would be good patients”, Meshawn Siddiq, director of family health and wellbeing, said.

“They wouldn’t tell the provider that they couldn’t afford the medications, so you have very sick patients going to their prenatal appointment and not getting the support that they need,” she said. “Or they would go into the hospital, have their baby and go home and not take their medications.”

Nurses are able to encourage patients to still take the medications they have been prescribed even if they are currently feeling fine. But they can also connect families to resources – social workers, counselors, psychiatrists and psychologists – that they don’t realize they need. Many mothers, program evaluations have found, don’t realize they need the support, or that their “postpartum blues” is actually to a level that necessitates treatment.

While the program is not designed to replace critical post-birth appointments, like the six-week checkup for mom and baby, it does offer additional care – often before either child or parent even makes it to the follow-up doctor’s appointment. The first appointment is typically around week three, Melissa Goldin Evans, an assistant professor at Tulane’s School of Public Health who helped interview participating families, told the Guardian.

“We know that maternal mental health is a major risk factor for maternal morbidity and mortality, in the postpartum period, specifically,” Goldin Evans said. “There’s just not a lot of support for that, especially for first time moms or single moms. To have someone come in and even just say, ‘You’re doing okay.’ ‘This is normal.’ ‘Babies cry; this is what this cry could mean.’ Just having someone ease those early days worries just can go a really long way for someone’s mental and behavioural wellbeing.”

FCNO participation has led to reductions in Medicaid spending for mothers and babies, respectively, nine months after delivery. While the city of New Orleans funded the initial pilot, the program has been so successful that it is now in conversations with the state to get commercial insurance and Medicaid coverage.

“We found that what that does is build trust in the healthcare system,” Avegno said. “The healthcare system is really scary and often cold and appears unfeeling, especially if you’ve had a baby. This is a way where we can say: ‘We really just want to know what you need and how we can meet that need.’”