CARLISLE, Pa. -- The baby had been wailing inconsolably for three hours, pleading for relief but offering no clue about how to soothe her.
Her mother, Amalia Machin, had tried everything -- feeding her, rocking her, changing her diaper, singing favorite songs, even taking her daughter's temperature to make sure she wasn't sick -- but nothing worked.
It was the kind of night that can make devoted mothers feel like failures, sapping their spirits.
But Machin, a 22-year-old single mother, knew she didn't have to face this parenting crisis alone. Instead, she called someone she knew would understand: registered nurse Cheryl Spicer, who had been visiting her at home since the early stages of her pregnancy.
"I asked her, 'What should I do?' " recalls Machin, swaying as she holds her daughter, 3-month-old De'Aysia Porter, whom she has dressed in a matching pink jacket and shoes. "She said that babies just go through a fussy period sometimes, and there is nothing you can do."
Twenty minutes later, Machin says, the baby went to sleep.
And Spicer, once again, had earned the trust of a vulnerable young mother. Through the Nurse Family Partnership, which serves first-time mothers and their babies in 31 states, Spicer will visit Machin twice a month for the next two years. Many programs receive public money, but Spicer's program is funded by a local foundation.
Programs across the country could soon expand dramatically, thanks to $1.5 billion in funding over five years provided by the health care reform bill.
Spicer and other nurses perform little hands-on medical care, other than taking a mother's blood pressure or measuring a baby's weight. But they give essential advice on prenatal health and parenting, teaching moms everything from taking a temperature to assessing gross motor development.
Most important, nurses help mothers bond with their newborns, she says.
"The attachment that these babies form with their mothers is the foundation for all the relationships they'll have for the rest of their lives," Spicer says. "Oftentimes, people won't make a change for themselves, but they will make that change for their baby, if they are securely attached."
Long-term results
Three decades of research suggest that this kind of help -- given at a crucial time in the lives of both mothers and babies -- has lasting benefits, says researcher David Olds, who has studied home visiting since the 1970s.
In the short term, nurses help women have healthier pregnancies, says Olds, director of the Prevention Research Center for Family and Child Health at the University of Colorado-Denver.
Although nurses help women address their immediate needs -- helping them find food, housing and medical care -- studies show that participating mothers actually spend less time on welfare and food stamps. They're more likely to work and less likely to get pregnant again right away. Their children have fewer injuries, are less likely to be abused and are better prepared to start school. Fifteen years later, their children have fewer sexual partners and are less likely to run away or be arrested, studies show.
Studies also show that home visiting saves up to $5.70 for every dollar invested. That has earned it broad support.
"We're all better off if we make the investment upfront," says Patrick Perez, a member of Fight Crime: Invest in Kids and sheriff of Kane County, Ill. "I would rather see us be involved early and have it be an educational situation, as opposed to no involvement and then become part of the criminal justice system."
Home visitors -- including social workers and other professionals -- now serve 400,000 to 500,000 children each year, or about 2% of children under age 6, according to a 2009 report from the Child and Family Policy Center at New York University. That's only a fraction of the children in need. More than 40% of American children -- or 10.2 million under age 6 -- are from low-income families, the report says.
Machin says she already has learned a lot.
"The more I know, the better I feel," says Machin, who lives with her mother while she looks for work. "When you have a child, you want to do the right thing."
Raising their confidence
Single mom Nicole McCartney, 26, says she hasn't always felt confident as a mother. She was diagnosed with bipolar disorder before becoming pregnant and developed postpartum depression after the birth of her daughter, Jazleen Rodriguez.
"She's so wonderful," says McCartney, helping the 5 1/2-month-old to stand and kissing her arms. "I just don't know if I'm good enough for her."
Spicer, sitting on the rug with them, praises McCartney's attention to her daughter.
"I love how you look in the direction she's looking," Spicer says. "It shows you're interested in being part of her world. You show your baby respect all the time."
Mothers need such encouragement, especially at a time when they're sleep-deprived and exhausted, says Melissa Manning, who supervises the Nurse Family Partnership in the Carlisle area.
"A lot of the people that we work with have never heard anything positive," Manning says.
The key to the program's success, Manning says, is helping women to take small steps forward. Instead of preaching and handing out brochures, she says, her nurses spend much of their time listening.
"People behave a certain way for a reason," Manning says. "We can't go in and say, 'You have to quit smoking.' We ask, 'What is it you like about smoking? What is it you don't like? On a scale of 1 to 10, how much do you want to quit smoking?' "
Manning acknowledges that visiting nurses can't solve every problem. But even small improvements can help children lead healthier lives, she says.
"We've had people who haven't fulfilled the goals we wanted for them, but they still made progress," Manning says. "I saw one of our graduates on the street. The baby was in her stroller without a coat, and there was a cigarette pack on the back of the stroller. But she had made huge progress that someone seeing her on the street wouldn't know about. She had a mental health diagnosis, and she had just kicked out an abusive boyfriend."
Spicer and Manning describe their work as a calling.
"This is definitely a mission for all of us," says Manning, who drives her 17-year-old Acura to home visits. "It's our passion."
Spicer says she feels privileged to get to know these families. Saying goodbye after 2 1/2 years isn't easy, she says.
"I can't imagine doing anything else," says Spicer, a mother of two boys who works part time for the Nurse Family Partnership. "I think I will be an NFP nurse for the rest of my working life."
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