To See Yourself
Sade Taylor needs no time to consider what she has learned about herself since having her daughter Sayori. Without missing a beat, she is emphatic: “I’m an amazing mom!”
We swap smiles before celebrating. Her confidence is reflexive, made all the more radiant through reflection on months of change. Her sincerity towards becoming a mother is a tribute to the journey it has taken, and continues to take, to speak that truth.
In the background, Sayori plays nurse to her doctor doll and baby patient. The doll drops several times but Evgenia Ogorodova, known as Nurse Genia, is there to assist in recovery. Sayori loves babies and spending time with her cousins who are close in age. On family visits to Pennsylvania, she often asks to hold them even though she is technically the youngest. In this stage of life, she is absorbing everything around her and I wonder if Sayori attempts to practice some of what she has seen Nurse Genia do.
Nurse Genia visits with Sade and Sayori in their DC home every other week. In between weighings, developmental screenings, and impromptu storytimes, the nurse and client talk through life’s many challenges to arrive at its triumphs. Today, nurse Genia focuses on how Sade is doing; the family’s schedule recently changed as the 24-year-old enrolled in cosmetology school full-time. This is the longest she has been away from Sayori since birth and studying a new topic alongside a sea of new faces can be jarring. The transition has taken some getting used to.
There is also the simple fact that raising a child is not easy, particularly when you shoulder most of the daily responsibility. Sade wants a moment that is hers, one where she can slow down on thinking for a bit, and maybe take some time for self-care. Visiting with friends has been difficult too. “Sometimes I say, you know, just gimme a break.”
Amid the shifts, Sade expresses joy in motherhood and misses her daughter when they are apart. Their relationship has shaped her outlook on life. “[Sayori has] taught me patience and I’ve become more positive. I’ve turned down a lot of situations that I normally would have reacted on before,” she offers. The change is evident to others as well, like Sayori’s father. “Her dad is like, ‘You’re different.’ I’m like, I know. I’m more quiet now.”
Sade laughs at herself easily, especially when she shares her approach to caring for Sayori as a newborn. “I’m very big on you change that baby, you wipe that baby,” she says, ”put some clothes on that baby.” Wanting to make sure Sayori did not get too cold, she layered undershirts, sweaters, and jackets to the point of sweating. The overdressing is well-meaning attentiveness—how she learned to navigate motherhood for herself.
“Sade has just really come into her own [sense of] knowing,” says Nurse Genia. It is an intuitiveness that Nurse Genia has observed over the past 18 months. She pauses with a look of pride, her voice trailing as if seeing the signs for the first time. “I can see this confidence and self-assurance. She knows she's a good mom. She knows she is doing the best she can, and she knows she's moving forward and has a plan she feels really good about. There’s a lot of overall growth that’s amazing to be a witness to.”
Their partnership is a launching pad as Sade makes real the life she envisions for her family. The birth of her daughter was the catalyst. “She teaches me a lot,” reflects Sade. “My daughter’s the best. If it wasn’t for her, I don’t know where I would be right now. She calmed me down.” Turning to meet her gaze, Sade says, “Thank you, Sayori.”
Right Where You Are
As Sayori approaches her second birthday, Nurse Genia will continue visiting the family until she is 24 months old. Their connection came through Nurse-Family Partnership: a nationwide program built on an evidence-backed model which pairs first-time mothers with a registered nurse for home visits at no cost to the family. Their bi-weekly meetings are standard practice, though they are flexible and fit the mother’s schedule or desire for more visits.
Eligibility for the program is income-based and is open up to 28 weeks of pregnancy in a mother’s first live birth. This means that one nurse can spend around two and a half years getting to know a family outside of an office setting, immersed in their daily routines. Nurses serve as another set of eyes to observe children’s development, a listening ear for mothers to vent, and a sounding board for any questions that may arise. Often, they are a welcome presence to new mothers who are still finding their way.
“I’m not gonna lie, parenting for the first time, you just don’t know what you’re doing,” Sade shares. “You're going off…what people say. But [nurse Genia], it’s more so like she’s there. I know if I need to tell her something, she’s like, ‘We’re gonna help you get through this together.’”
The motivation is personal for nurse Genia. She immigrated to the US from Russia at 16 and had her first child in college at age 20. As a student and single parent whose family was miles away, she had to comprehend an unfamiliar healthcare system on her own. “I just remember feeling like there’s really no one to help you figure it out. Not even the simple things…I didn’t even have insurance.” Coping with the new changes was a disorienting time. “I wish I had an NFP nurse when I was 20. It would have been really helpful and I wouldn’t have been flailing and crying at night.” The connectivity experienced in Nurse-Family Partnership can be a soothing balm in isolation.
Home visits are the super glue that sustains a years-long bond. The program does not replace routine doctor’s visits, rather it supplements standard care with the extra time needed to absorb information shared in those appointments. NFP nurses speak with clients about the questions they may have been unable to ask during these visits or help them parse out any given instructions. It equips mothers to make the most of their medical services, empowered in their ability to care for themselves and their children. The result is better healthcare outcomes for everyone.
Abby Goldstein is the nurse supervisor of Nurse-Family Partnership at Mary’s Center, the DC branch of the organization. She previously worked with the program nearby in New York City and Baltimore and underscored just how important the home visit can be, “It really allows us to be so much more informed about our client’s lives and the things we need to take into account in addressing their health and social needs.”
While home visits are not a new concept, NFP is unique in that they are fully staffed by registered nurses. Their ability to provide first-time mothers with clinical assistance fills the gap felt between scheduled doctors’ appointments. Regular home visits with clients allow nurses to address issues early on, like providing clarity on developmental markers in infancy or monitoring the, often slight, signs of pre-eclampsia—a potentially fatal pregnancy complication characterized by high blood pressure. Nurses share the knowledge and skills clients need to effectively navigate the healthcare system, and connect them with the right resources sooner.
This is client-led care that renews an ancient practice of servicing people right where they are. Prescriptions offered in a 10- to 15-minute pediatrician appointment can be difficult to grasp in the moment, and even more so once you are home in the thick of parenting. There are also language, cultural, and economic barriers to consider. NFP sees each mother as an individual and pursues health plans tailored to their specific needs: multilingual clients may be offered an interpreter to conduct their meetings and observations from the bi-weekly sessions have led to coordinated care between NFP, primary care physicians, and other medical specialists to monitor the health of parent and baby as needed.
NFP’s consistent visits emphasize shared-decision making in healthcare, not siloed from reality. “People are more likely to be themselves during a home visit. We get to see what their experience is like if they’re willing to share,” says nurse Genia. A standard doctor’s appointment may seem simple enough except, “Even if they aren’t sick, babies are really hard.”
“We develop a relationship that allows people to feel really comfortable asking questions and reviewing things [because]...it’s hard to share if you think people are gonna be judgemental,” says Genia.
Dr. David Olds first experimented with NFP’s home visit model after working in an inner-city daycare facility. He saw the way children were impacted by parental struggles and brainstormed an approach to self-efficacy. Having recently graduated from Johns Hopkins University, he thought the best chance at bettering the lives of children and families was to offer support much earlier in their journey. It led him to pair trained nurses with first-time mothers-to-be in Elmira, New York; Denver, Colorado; and Memphis, Tennessee. The results were the same in each place: improved childhood health and parents who steered their own lives in a new direction.
With over 45 years of research, NFP has proved impactful in providing medical services informed by social factors. They surround mothers with the chance to lead a life they have chosen for themselves, rather than one based solely on circumstantial reactions. A 1997 study on the effects of prenatal and infancy home visitation reported 35% fewer hypertensive disorders during pregnancy. In looking at how home visits can improve the life course of mothers, they found an 82% increase in months employed. And long-term effects for children include being 67% less likely to experience behavioral and intellectual problems by age 6.
The numbers are not merely clinical but a window into the hypothesis that strong families, and full lives, are possible when we bear them together.
Nurse-Family Partnership at Mary’s Center
As a national program, NFP is present in 40 states, Washington, DC; the US Virgin Islands, and some Tribal territories. They have served more than 380,000 families since 1996 and work with nearly 55,000 each year. The effectiveness of their method is shown through the diversity of their locations; each area is uniquely addressed through partnerships with like-minded local organizations. Over 270 agencies have joined with NFP to implement the program in their respective counties.
NFP found a home in DC at Mary’s Center in 2021. The Fort Totten-based community health complex has administered wellness services to the DC community for 35 years. It is a bustling endeavor as the waiting room fills with patients before 9 AM. Their services are housed in a new facility, just a short distance from the Fort Totten metro stop. As they approach the center, clients are met with a modern structure surrounded by fresh-cut grass. Inside, large swaths of glass windows allow the sun’s light to pour in, illuminating the halls and the toys available in the waiting area. Staff moves quickly as they connect clients to any number of programs: medical care, a dentist’s office, language courses, a senior wellness center, and job training.
Nurse-Family Partnership at Mary’s Center has been an exciting step and a long push. Their staff of four, including Nurse Supervisor Abby and Nurse Genia, is connected to its mission as Mary’s Center operates robust and wide-ranging home visiting programs. Having their home base in the center allows them to continue serving as many families as possible. Local clients can be referred to the program through care at Mary’s Center, interest through online sign-ups, connections from social services, or word of mouth.
Enrollment in the program is voluntary, and some clients come to NFP having battled grave experiences, including mental health challenges, medical diagnoses, lack of support, and abuse. Creating an environment where clients feel embraced in their journey is a deliberate effort as they face a present unknown.
Local support for the program underscores the value of its mission and has been vital to its success. DC councilmember Brianne Nadeau has been an advocate in helping to secure funding. She recently worked with Chairwoman Henderson and members of the Health Committee to allocate $225,000 of the Department of Health Care Finance’s budget to support the First Time Moms Grant, in which NFP participates. She has also introduced legislation for Medicaid reimbursement for evidence-based home visiting services, a push that would ensure the sustainability of NFP in DC.
The Richard E. and Nancy P. Marriot Foundation was also instrumental in the program’s DC launch. The group provides grants to innovative partnerships looking to uplift DC communities, like working to address the city’s maternal healthcare desert. With their help, NFP hopes to expand to serve more families in Wards 7 and 8.
The focus on prenatal and maternal care for DC residents mirrors a nationwide effort. In March, the CDC reported a spike in maternal mortality in 2021. The report noted a 40% increase from the previous year and attributed it to the pandemic. The number of preventable pregnancy deaths was a staggering 84%. And disparities in the type of care and access to facilities largely impact Black women, a group three times more likely to succumb to complications in pregnancy or delivery. Nurse-Family Partnership at Mary’s Center makes care available to those most in need and least likely to receive it, as DC’s infant and maternal mortality rates are considerably higher than the rest of the country’s.
Access to a healthcare professional who can come to mothers on the mother’s schedule can make a drastic difference in her and her baby’s health—the landscape for maternal care in DC is covered with one more support system through NFP. Their home visit model helps detect issues early on and acknowledges the systemic barriers that can keep first-time mothers from receiving the resources needed to thrive.
A Personal Connection
First-time parents walk an unknown path.
Nurses have long been a communal guide to new mothers and fathers. They are a steady voice to anxious hearts as they usher them to the place of being nurturers themselves. Theirs is the role of healer and protector, bringing warm hands and smiling faces to each interaction. Care is a stance best assumed by knowing people, dwelling with and among them. NFP operates in this spirit. They are involved in the lives of first-time mothers with a posture of openness and flexibility.
The NFP office at Mary’s Center remains stocked at all times with donated supplies that families may need: clothing, travel gear, and formula. As we leave Mary’s Center, Nurse Supervisor Abby pushes a stroller down the street to take to the client of one of her nurses. It is not an uncommon sight at NFP, as nurses may pack play sets and bring diapers to drop off during their home visits. They may even build cribs or change lightbulbs and smoke detectors once they are there.
It is not outside of the realm of possibility for nurses to provide tangential support either. No act is too much if it can help mothers pursue the path they seek. In the past, this has looked like helping mothers write new resumes as they return to the workforce or connecting them to behavioral health services as they navigate post-partum. It has even included finding housing options that best support the families’ emotional and health needs.
NFP nurses participate in all aspects of securing a safe and healthy future for families. They recognize that it is not always more advice that is needed to produce successful outcomes. Often, it is a reassuring presence to soothe uncertainty, speak well of a client’s basic instincts, meet tangible needs, and celebrate daily wins that form a solid foundation. These routine moments collectively yield something greater.
Last month, Sade visited a daycare center with Sayori to explore enrollment. Nurse Genia joined. They spoke with the owner of the center to see if it might be a good fit. For Sade, the experience cemented that Nurse Genia “knows my daughter like I know my daughter.” She appreciates this kind of hands-on approach; it’s how she knew that she could trust Nurse Genia in their orbit. Sayori has come to see it this way too, running to the top of the steps to wave Nurse Genia in as she enters for their home visit. Turning towards her, Sade says, “You’re a part of the family. I say that all the time.”
NFP nurses seem to embrace this part of their roles wholeheartedly—to be present for those who have chosen support despite not having experienced that manner of reliability before. The work of parenting is not filled with easy tasks, “and it’s not easier just because we are there,” clarifies Nurse Genia. The nurses in the DC branch are quick to express themselves as supporters and witnesses. Their work centers on the mothers; the ones who, day after day, show up for themselves and budding families.
First-time mothers like Sade show incredible strength in their invitations to the nurses’ extended hands. Parents are opening their lives in an act of vulnerability. They take a chance on themselves, with an audience, all in the hope of building towards their desired futures. Nurses take that seriously, gentle in their commitment to remain true to their word.
They are both brave souls in this regard; facilitating these personal connections may be the most important piece of what NFP does.
Like a Sponge
Right now, Sayori is wide awake to the world. Her developing personality is evidenced in her actions each day. Smiles come quickly with a big “cheese” when prompted by family to take pictures. She is skilled at remembering faces and names, sounding them as best she can. She offers Nurse Genia her toys, showing off her latest interests in Elmo and inviting others to enjoy them too. Sade has also gathered that her favorite color must be blue because everything, no matter its appearance, is tinged with the hue. It is an exciting time as Sayori explores this curious world of home and family.
She is also good at mimicking her mother, whether copying her poses for photos or picking up on the names she hears spoken. Sade notes these changes and tells Nurse Genia that Sayori is a sponge. Her almost two-year-old world is widening and still open to being molded. And like most children, Sayori’s initial response to new emotions or unfamiliar environments can be to push against them. Behavior is how she shares feelings now. Nurse Genia talks through this with Sade, asking her to put herself in Sayori’s shoes to imagine how she might feel. In the same way that she can absorb the light-hearted parts of life, she is a sponge to the stress and energy around her. Sade takes time to reflect on the thought. She is attentive to Sayori’s calls for her, pausing mid-sentence to see about her daughter, but she also seems to tuck their discussion away for further consideration.
It’s a habit that sticks out most to Nurse Genia as she watches Sade grow more and more into the person she wants to be. “As an observer, I think maybe a year ago it was unclear what she wanted her life to look like or who she wanted to be part of it and she’s done so much work in figuring out where she wants to move forward. She’s an amazing facilitator; she is open and wants to participate. It’s a lot of difficult work that for a lot of people takes decades and she’s just done it in a year.”
We all experience inflection points where transitional markers act as soft spots. These periods are our most malleable, and we tend to be more receptive to venturing new paths. New beginnings are clarified, or at least feel more attainable. Similar to Sayori being open to her surroundings, our pivotal moments allow us to consider new possibilities. The first-time mothers that have chosen to participate in the program make that clear. “Nurse-Family Partnership is based on the understanding that welcoming your first child is really sort of a life-changing time that offers so much opportunity to think about what goals you want to set for you and your family and your children, and to have that extra support while you set the foundation for those goals,” says nurse supervisor Abby.
Nurse Genia believes that to be a key aspect: “We’re there to help people feel that they can dream.”
Sade embodies that willingness to partner with momentum, admitting her dreams and the legacy she works each day to create for Sayori. “Since I had her, I had this thing in my head. Like, a five-year plan,” she shares. “Sometimes stuff don’t go as planned, but my five-year plan is for her and myself. Right now, I’m in cosmetology school. That’s gonna take a year. Once this year is up, I’m gonna work towards getting my LLC.”
Having Sayori has ignited Sade’s creative aspirations; styling her daughter’s hair each day has awoken her latent craft. The goals do not stop there. Sade continues to take steps towards opening multiple businesses, including an online clothing boutique named Sayori. “I wanna open [it] for her; I do a lot of stuff for her. Everything is for her. Because I lived my life and did what I wanted to do.”
And while Sade leaves room for Sayori to grow into her own aspirations, “As of right now, mommy got us.”