Babies don’t come with instructions. But in Oregon, they now come with a nurse

Barb Ibrahim, a nurse of more than 30 years, unpacks in Matt and Amber Luman’s kitchen, in rural Jefferson County, Ore.

Ibrahim pulls a baby scale from a bottomless, black bag she totes everywhere, like Mary Poppins, and weighs the Lumans’ 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’ backyard: a rocky cliff’s 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’s 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’s the state’s response to a grim, American reality: The U.S. has one of the highest death rates of any wealthy nation for infants and new mothers 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’s 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’s 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’s hair, strawberry blonde like her mom’s, checking the soft spots where the bones of her skull haven’t 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’s life when new parents are most likely to feel exhausted and adrift.

Amber tells Ibrahim that Esserley’s been doing well, except for a little trouble feeding.

“She clicks at the breast and the bottle,” Amber says, “so it lets a little bit of air in.”

As if to prove her mom’s 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.

“You were telling me about the football hold,” Amber says. “I tried it, but I couldn’t get it.”

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, “Thank you so much for coming.”

“Just having Barb here has helped me feel supported emotionally and improved my mental health — right in the thick of these first few, hard months of parenting,” Amber tells NPR.

“Since I’m a first-time mom, I wanted [Ibrahim’s] advice,” says Veronica De Paz, another new mom in Jefferson County whose son, Adriel, is a few months older than Esserley. “And [Ibrahim] told me, if I have any questions, I can always message her … And she always gets back to me.”

“Babies are just hard.”

Family Connects offers any family in Oregon one to three home visits from a trained nurse within their baby’s first few weeks of life — at no cost to families.

The program was developed in Durham, N.C., and research from its smaller rollout there found it was associated with a handful of significant benefits, including a big drop in the number of trips new parents were making to the emergency room.

“Babies are just hard,” laughs Dr. Elizabeth Steiner. “And so I was very intrigued by this idea.”

Steiner is a family physician in Portland, Ore. She didn’t create Family Connects, but she may be the biggest reason it’s come to Oregon. In addition to being a doctor, she’s also a state senator and a mother. For her, helping young parents wasn’t just good policy, it was personal.

Two days after her own daughter was born, Steiner says, “I developed horrible postpartum anxiety and depression. I didn't sleep for weeks.”

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.

“Nobody should have to go through that,” Steiner says, “nobody. And having a trained nurse come into my home when my baby was two weeks old and say, ‘Ooooh, OK, let’s get you some help here,’ would have been transformative.”

Steiner uses her personal story to explain why she wants Family Connects to be universally available – not mandatory, she emphasizes — for any family, whether it’s their first baby or fifth. Because every baby can be challenging, even for a trained doctor.

And every family has different needs, hence the “connects” 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’s 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 “purple crying.”

Purple crying is a kind of crying that sometimes can’t be soothed. It’s 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.

“We 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’s what I usually recommend, mainly because that worked for me,” 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’s by no means free. The state’s plan is to require insurance companies to pay for these nurse visits, but that’s taken time and remains a work-in-progress.

And then there’s the cost itself. Steiner says she was expecting these visits to cost between $400 and $500 per family. “Turns out, it's probably more like $1,300, at least here in Oregon. And that was a problem.”

What happened? Steiner says early cost estimates were informed by the program numbers in Durham, N.C. – one city. But Oregon is trying to offer nursing visits statewide.

“In Oregon, we have a lot of places where people live many, many miles apart,” Steiner says.

Places like Jefferson County, where Barb Ibrahim works. And part of the power of the program is that the nurses travel, not the families.

“I like that [Ibrahim] comes over to my house instead of me driving over there,” says Veronica De Paz, in Jefferson County. “I can’t 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.”

Steiner says another reason for the higher costs is “there's more of a nursing shortage [in Oregon], so we had to pay higher wages to get nurses who were interested in doing this.”

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’ house, Ibrahim checks Amber’s blood pressure and asks how she’s feeling these days.

“A little tired sometimes,” Amber admits. “But I think it’s normal.”

Ibrahim spends about an hour with the Lumans. Before she goes, she pulls one more surprise from that Mary Poppins bag of hers.

“I brought you guys a gift,” Ibrahim says.

It’s 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