Tessa Shupe is not new to motherhood, so when she left the hospital with Jaxxon about 24 hours after delivering him, she did not feel anxious – she just wanted to be home.
Shupe had support from her husband and knowledge gained from raising two other boys, now 5 and 9 and declined a follow-up home visit from a UCHealth registered nurse as part of the Postpartum Home Visit Program.
“If I would have known then what I know now … but I was just ready to get home,” Shupe said.
The Postpartum Home Visit Program
Through the program, UCHealth nurses, Karen Yost, Michele Mayes, and Julie Knighton make home visits to see Medicaid-covered new moms about four to six days after they have given birth.
After a mother’s delivery, one of the nurses checks in with the new mom to see if she’d like to schedule a visit in the coming days.
“Our purpose is to help provide resources to these mothers and babies and be an advocate for them to meet their needs,” said Yost, who has been with the program since its inception in 1999.
The team connects with mothers who don’t deliver at UCHealth hospitals through referrals from community physicians and non-profit organizations. As part of the partnership with Larimer County Health and Environment, UCHealth covers the cost of the nurses’ salaries, and there are no out-of-pocket expenses for new mothers.
When Mayes met Shupe in the hospital, a lot was happening. Shupe was tired from laboring all night and had just gotten to her recovery room a few hours prior. She had a visit with the hospital’s lactation consultant. She hadn’t nursed her two sons but wanted to breastfeed Jaxxon.
Many moms face nursing issues in the first weeks
Shupe had been home from the hospital for two days when she received a phone call from Mayes, who was checking in to see how Shupe was doing. Mayes let her know that she or another nurse could stop to lend support if it was needed.
“At the time, I thought I was doing fine,” Shupe said. “I was breastfeeding. But unknown to me, Jaxxon wasn’t latching. I thought (the way he was sucking) was normal. The (lactation consultants) showed me tips at the hospital, but you are fresh out from having a baby, and you don’t remember a lot of it.”
Shupe returned from her first doctor’s visit distraught. Jaxxon was losing weight when, by now, he should have been gaining it. She decided to reach out to the nurses and ask for a home visit.
The benefits of an at-home visit from a UCHealth nurse
The nurses like to do a home visit when the baby has been home for four days. By day four, a mother’s milk is usually in, and the baby should be starting to gain weight.
“We like to wait for that turnaround to make sure they’re on the right track,” Yost said. “These mothers know a lot, but we find things and tweak things to make them most comfortable for nursing, and we help them build on their goals.”
Shupe said she was grateful for Yost’s first visit.
“I think it is so awesome they can come into your house. It’s so practical because they can use things from around your house and show you how to use them to position yourself and your baby,” Shupe said. “Offices don’t have those same tools you have at home, and the first couple of weeks, you don’t want to go anywhere with your baby. You’re in your own world.”
Yost showed Shupe how to prop her feet up and use pillows for nursing. Yost watched Shupe breastfeed on both sides and offered advice about technique. Yost also weighed Jaxxon.
Shupe continued to use those techniques, “but the damage was already done,” she said. Now latching correctly and hungry, Jaxxon began doing short feeds every few hours.
“I was so tired at night because of that, and by Saturday night, something didn’t feel right. My milk came in, and I was engorged. I started not feeling well. I had the chills and a fever,” Shupe said.
She didn’t know what to do but thought it might be mastitis, inflammation of the breast tissue that can sometimes involve an infection, so she texted Yost.
“I didn’t know if she’d reply or not,” Shupe said.
But Yost did reply. She talked Shupe through the steps to relieve the pain and resolve the inflammation, and she asked that she let her know how she was feeling in an hour. Shupe’s symptoms had not improved within the hour, and Yost recommended she go to urgent care.
“But I waited until the morning to go, which was horrible,” Shupe said. “And all this in the first week. So by the second week, I had a dose of the baby blues. I was sad and not motivated. What I was doing wasn’t working for Jaxxon. I went to a doctor’s appointment again, and Jaxxon continued to lose weight. I couldn’t figure out what was going on.”
She reached out to Yost again, who returned to Shupe’s home.
“I just broke down and had a crying moment with her,” Shupe said. “I was overwhelmed with everything. But she assured me everything was good and said she was impressed with my determination.
“She remained such a good resource for me. I’d let her know what was going on and could get in touch if I needed her. She was super supportive and told me how resourceful I was and how impressed she was that I could figure out what works for me.”
Shupe prevailed with breastfeeding, and at one month old, Jaxxon had gained three pounds from his birth weight.
“You can go online and Google as much as you want, but it’s nice to have that person — that team — to bounce things off of,” Shupe said. “If I didn’t have them, I would have given up. I know how easy it is to do formula. I know it worked for our other two. But I didn’t want to give up, and they made it so I didn’t have to.”
Shupe is grateful for the way it turned out.
“Jaxxon is thriving, and it’s all from me,” she said. “There is no right or wrong way, but to see him grow, there is this satisfaction. I’m proud, and you do feel super connected.”
At-home nurse visits offer more than just breastfeeding support
Although Yost and her team deal with many breastfeeding struggles, the program is about more than that, Yost said.
“Everything we do is harm reduction,” she said. “It is not a perfect world because that is not how we live. We see toddlers and preschoolers not developing appropriately and help them with resources. Or, Dad needs a vasectomy: How can they get that done when they might not have insurance?”
The nurses see many new moms with post-partum depression, and even more with PTSD post-partum, she said.
“A woman perceives how the birth process will go, and when something a whole lot different happens, that can be a trigger for people,” Yost said.
The team addresses mothers’ mental health but is sensitive to the cultural barriers when dealing with those issues. Nurses also educate parents about birth control and future pregnancy plans and provide help in navigating the ins and outs of Medicaid.
“We know we make a difference every time we visit with a mother,” Yost said. “Their shoulders lower, the cobwebs clear, and they have a focus. They’re encouraged. Though we are there to see mom and baby, we see what’s going on with the whole family.’’
The relationships built and the resources provided help the whole community become healthier.
“We go out and plant a seed,’’ Yost said. “If we see these women again, we may water the seed or pull weeds others have planted. … We teach people what is as safe as possible. And that’s why I keep doing this because I’ve seen so many seeds grow.”