Nurse Arzelia Lopez is heading to her next work appointment in East Oakland.
Her client, Jasmine Jurado, is 19 years old. She has a toddler, who’s 14 months old. It’s been Lopez’s job, since Jurado was pregnant, to provide her with parenting support, both emotional and medical.
Lopez says her goal for today’s appointment is to test the baby’s ASQ.
“To see how [the baby is] doing developmentally,” she says.
But before any official examinations take place, Lopez picks up Anais:
“Come here, you little one!” she squeals. The two women compare their babies; Lopez just had a baby herself, only a few months ago. Baby Anais reaches out to touch my microphone. “Quieres tocar?” nurse Lopez asks.
This lightness makes for the kind of atmosphere that lets Jurado feel like she can confide in someone like Lopez about a life beyond just her baby.
“Sometimes we talk about relationships,” Jurado says. “About how to communicate in your relationship. Other little things like that.”
Technically, this relationship between Jurado and Lopez, is a patient-nurse one. It’s part of a non-profit organization that’s trying to reach a particularly vulnerable population: low-income, first time mothers. Nurse Family Partnership, or NFP, found that limited access to good parenting information, or role models, can present an even greater challenge to new mothers. And that’s where the government is stepping in to fill in the gap.
Here in Alameda County, that means serving a community of largely women of color, from West and East Oakland. NFP sets women up with a nurse who accompanies them during their pregnancy and for the first two years of their child’s life.
It’s a unique model that follows a traditional method used in some Latin American countries. And like the name suggests, it really is a partnership -- in more ways than one.
Kiko Malin, who oversees the Nurse Family Partnership program implementation through the Alameda County Public Health Department, says there’s another key component to these relationships between nurse and mother: mutual respect.
“It’s not about telling the family what to do,” she says, “but it’s about talking with that woman -- and her partner and whoever might be involved in her life -- about her choices that she’s making with respect to her health.”
In NFP, a nurse will generally visit the mother every week. She has a curriculum she follows to make sure the baby is developing healthily. She takes measurements, conducts tests, and checks on the mother and child in between doctor visits, often offering advice and suggestions. But the program’s not just a one-way street:
“Rather than the nurse saying, ‘This is what I think you should do,’ the question might be, ‘What do you think you should do and how can I help you to do that?’” says Malin. “‘How can I help you to identify and realize your goals?’”
Early on, when Jurado first started breastfeeding, her baby wouldn’t take to it. While others urged Jurado to use formula, nurse Lopez encouraged Jurado to stick with it through the first several hard months. Saying it would be better for the baby’s health.
Many clients are women who come from low income communities of color -- communities which Malin says are facing challenges the program seeks to address.
“Where it’s not a super great environment, perhaps, to grow up in, where schools are not the best, where you have to worry about violence in the home, on the street.”
Malin says it can be hard to be stable in a stressful environment like that. Many of these mothers live in poverty, some have experienced abuse, others have dropped out of high school.
“And when a woman in that situation gets pregnant, suddenly she has responsibility for someone else in her life besides herself and that can really represent a pivotal time for her, and an opportunity for her to make some changes in her life,” she says.
“There’s really a feeling that pregnancy is a window of opportunity.”
NFP is working. Kids with mothers who go through the program are more prepared for school, and less likely to be involved in the criminal justice system. NFP has conducted decades’ worth of research and has the data to support it. In one study, they followed the families for 15 years.
Malin says that’s not all: “We know that, through participating in NFP, women are more likely to breastfeed longer; they’re less likely to have health problems; less likely to deliver a preterm baby.”
All of that combined saves a ton of money for the government. It only costs approximately $4,800 to work with one family per year. That may sound like a lot, but Malin says NFP believes this is a small investment for the returns it gets. For example, families that participate in NFP have lower enrollment in Medicaid and food stamps.
A recognizable change
But when we talk about change on a larger demographic scale, what is the change we see within individual families? Ask nurse Arzelia Lopez, and she says that over the past two years, her client, Jurado has changed, too.
“She’s more open,” Lopez says. “We’re both more comfortable with each other. We’re able to talk about pretty much anything.”
Jurado says she looks forward to their meetings.
“It’s a time for me to talk about things [with] someone outside of my family,” she says. “I don’t have many people to talk to so when she comes, it’s happy to me because I get to talk to someone else... so I enjoy it.”
While baby Anais nears two years, Jurado's time with nurse Lopez is coming to a close. The two are talking about her future, and her plans for when she's on her own.
Jurado plans to continue with school to get a degree and eventually become a hospital technician. She says she just wants to be a good example for her daughter.