One State’s Approach to Maternal Deaths: Free Nurse Visits After Birth

New Jersey is one of the most dangerous states in the country for women to give birth, particularly Black women, who are seven times more likely to die from pregnancy-related complications in the state than white women.

A new bill establishing a universal home nurse visitation program for newborns is designed to help address that. The bill, which Gov. Philip D. Murphy is set to sign on Thursday, is part of a broader plan to reduce the maternal mortality rate in the state, which experts say is the fourth highest in the country.

For every 100,000 live births in New Jersey last year, more than 26 women died because of pregnancy-related complications, according to America’s Health Rankings’ analysis of C.D.C. data. The data showed clear racial disparities.

“For Black women, they have the worst rates in the state, the state has among the worst rates in the country, and the country has among the worst rates in the world, so that’s put us in a place where we need to focus on changing this,” said Dr. Vijaya Hogan, a perinatal epidemiologist at the University of North Carolina Chapel Hill’s Gillings School of Global Public Health and a lead consultant on New Jersey’s plan.

The broader plan, known as Nurture New Jersey and spearheaded by the state’s first lady, Tammy Murphy, aims to decrease the state’s maternal mortality rates by 50 percent in five years.

“I can’t fathom that a mother could die due to maternity-related complications or the baby won’t live past its first birthday and that’s because of the color of somebody’s skin,” Ms. Murphy said. “We signed up to try and move the needle here in New Jersey, and make New Jersey a safer, more equitable and a fairer state for everyone.”

Under the home visitation program, which is voluntary, a registered nurse would come to the home of families with newborns for a free wellness check, regardless of parents’ income or insurance status. Research shows that the more support mothers have after birth, the better the outlook for them and their babies.

“This is a huge step in the right direction for moms, families and infants,” said Mr. Murphy, a Democrat. “Visits like this are proven to strengthen families’ shot at success and economic growth.”

While Oregon has a similar program, New Jersey will be the first state to offer home visits within the first two weeks after a birth. Adoptive parents will be eligible, as well as those who experience stillbirths. Families will be allowed up to three free home visits within three months and services are expected to become available within the year.

Even though she had a network of support when she gave birth to her daughter, State Senator Teresa Ruiz, a sponsor of the bill, said having a lactation specialist come to her home made her feel more secure about her transition into motherhood.

“I had a good structure of support all around,” she said, “and I can tell you that even with all of that, and understanding my rights and advocating for myself as best as I could, nothing gave me that sense of just ease until that nurse came to my house and said to me that what I was doing was right.”

Nurses will be specially trained to go into the home and assess both the mother and baby, checking for physical problems, issues with breastfeeding, postpartum mood disorder, and any social factors affecting the family. Ms. Ruiz said the home visit is also a chance for the nurse to connect families to other important resources they may need.

“I think back to when I was a new mother and had a community nurse come out, it was very helpful,” said Cecilia Zalkind, the president of Advocates for Children of New Jersey, which pushes for polices that advance child welfare in New Jersey. “It really is to see how the family is doing, to offer assistance, and to give the parents some assurance that the baby is doing well.”

Suzanne Spernal, vice president of women’s services at RWJBarnabas Health, a network of health care providers in New Jersey, described the program as a “home run” that would provide key opportunities for early intervention.

“We know that perinatal mood and anxiety disorders are one of the most underdiagnosed and under-treated complications of pregnancy, so this gives us a chance to do that assessment in the week or two following delivery,” Ms. Spernal said.

“We know that oftentimes when moms and families are experiencing some kind of life-threatening complication that they’ve had the symptoms for hours or days before they present to care,” she added. “This is an opportunity to intervene earlier so that we’re able to possibly circumvent some of these catastrophic adverse events for mom and baby.”

Brittany Rice, a birth care coordinator at the Birth Center of New Jersey, said the center already does after-birth follow-ups with its patients, but that new mothers can always benefit from extra help.

“If mom and baby are well-supported, everyone does better,” she said.