Return of the House Call: New Orleans Nurses Visit Postpartum Patients and Babies at Home

For a large part of history, healthcare, and especially maternity and postpartum care, primarily took place in the home.

Modern motherhood dictates schlepping out to a pediatrician's visit only a day or two after giving birth, hauling a newborn in a car seat that mothers are technically not supposed to carry, according to their postpartum discharge instructions, and hoping no one picks up a bug at the doctor's office.

Arguably, the traditional U.S. system of maternity and postpartum care is not ideal for recovering mothers and babies, and in New Orleans, nurses have made a dramatic change by bringing back housecalls for postpartum families. 

The housecalls are visits by Registered Nurses through Family Connect New Orleans, a program offered by the New Orleans public health department. And according to parents who have been through it, the program is a game-changer.

House Calls After Birth

According to the program's website, families who have given birth at one of two local hospitals (Ochsner Baptist or Touro Hospital) and live in Orleans Parish are eligible to receive:

• 1-3 homie visits
• The visits are totally free of charge
• The visits will begin around 3 weeks postpartum
• Families with babies 0-12 weeks old are eligible 
• Free visits, regardless of income or insurance coverage

Importantly, the homecare visits do not replace a pediatrician's visit, but are designed to be an additional form of support and adjunct care for families. 

The program is a crucial one because Louisiana has been identified as a state with one of the poorest maternal and newborn/infant health scores (a solid 'F' by the 2025 March of Dimes report) in the entire country. So public health interventions are aimed at identifying risks early with education, active health support, and referrals as necessary. 

"I've never felt so well taken care of and listened to," new mother Lisa Bonfield, who received three free home care visits in the fall with her newborn daughter, told NPR.

Nurse Intervention 

Nurses come equipped to the homecarevisits with all supplies exhausted parents might need, including baby essentials like:

• Diapers
• Diaper cream
• Nipple cream

The house calls address direct parent and baby concerns, such as feeding, breastfeeding, and diapering, but they also delve deeper into potentially identifying health concerns beyond the immediate.

For instance, nurses can ask if the family is safe, has food and adequate housing, offer birth control education and options, and assess for postpartum depression and other mental health conditions.  

"There is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth," New Orleans' health director, Dr. Jennifer Avegno, who helped launch the Family Connect program, explained to NPR. 

Making a Difference

The New Orleans Family Connect program is not the only one in the nation; similar programs have been piloted across the country, and preliminary data says the interventions are working.

For instance analayzed data found that families who received homecare visits:

• Tend to keep recommended babies well-child checkups 
• Tend to keep recommended postpartum visits more
• Had fewer postpartum hospitalizations
• Required less medical care overall, reducing costs
• Reduced ER visits by half in the first year of a baby's life

The program is also designed to more accurately identify mothers with postpartum depression. The program's postpartum screening more effectively led to PPD diagnosis—10% of mothers were eventually diagnosed vs. 6% of mothers not in the program. 

Correctly identifying and treating PPD improves many health factors, including parent-child bonding, physical health outcomes, breastfeeding rates, and severe consequences such as self-harm. 

The program may be especially effective in helping to identify mothers at risk for PPD because, unlike a typical pediatrician's visit, it incorporates both maternal and baby screening in one visit. A nurse is able to ask more thorough questions, assess the mother in a real-world environment, and, importantly, spend time with the mother and child. (One appointment, NPR revealed, took over two hours, a number unheard of at an office setting.)

"I think that I would have felt a lot more alone if I hadn't had this visit, and struggled in other ways without the resources that the nurse provided," one mother who was later diagnosed with PPD after a homecare nurse recommended group counseling said. 

What This Means for Nurses

Not every nurse may be in a position to advocate for or start a postpartum homecare program in their area. However, current or potential future maternal and pediatric nurses should be aware of the benefits of the program, especially in the public health sphere.

The cost-benefit of the programs is overwhelming, with $3.17 in healthcare billing saved for every $1 invested in North Carolina's version of the program. 

"It was overwhelmingly positive experiences," Melissa Evans, an assistant professor at Tulane's School of Public Health, summarized after speaking to families who have been through the homecare visits, adding: 

"This is like a gold standard public health project, in my opinion."

🤔Nurses, what do you think of homecare visits? Share your thoughts in the discussion forum below!