By Jon Wells
March 5, 2011
Amber's life was not about to get off to a promising start. That was clear before she was even born.
There may be cases where a teenage first-time mom with little education or financial resources gives birth to a healthy baby, raises the child with confidence, and everyone grows up happy.
But statistics suggest that is rare — that the risk dramatically increases for both baby and mother of languishing in poverty and poor health.
This was the road that baby Amber was at risk of travelling along with her 18-year old mother-to-be.
In a sense Amber's story began five years ago. A teenager named Caitlin Parker was growing up in Tillsonburg, a small town 60 kilometres southwest of Brantford. She met a guy named Chris Curley on the beach at Turkey Point. They dated and in 2007 moved together to Hamilton, neither having completed high school. Caitlin got jobs at Second Cup and Tim Hortons, Chris worked in asbestos removal.
Soon after that, at 18, Caitlin became pregnant. She cried at the news: it was not what she wanted to hear.
The couple was in crisis. But as it happened, this was in 2008, and they lived in the one city in Canada where special help had just become available, even though they didn't know it.
They visited the Maternity Centre on James Street South to find a doctor. From there, Caitlin's name was referred to a new pilot program run by the city's public health services, called the Nurse-Family Partnership.
The NFP is an intensive home support program, in which public health nurses make regular, focused visits to young first-time moms with low incomes. A designated nurse visits the client 14 times in the weeks leading up to childbirth, and then regularly during the first two years of the baby's life.
The program has been proven to break what health professionals call the "intergenerational cycle of poverty." Studies in the U.S. suggest the nurse visits give babies a healthy start during the most formative period of their lives, influence positive behaviour and health in the mother, and produce a ripple effect for future generations in the family.
In 2008, Hamilton became the lone Canadian test site for the program, one that was already in bloom in the U.S., operating in 32 states. In each of the first two years, 108 clients entered the program in Hamilton. The first 13 "graduates" are now moving on after having completed it.
The program costs about $5,600 a client, a year. Studies in the U.S. show the program has proven to be cost-effective, with a payback of $6 in social costs savings for every $1 invested.
In September 2008, a public health nurse named Melissa Pietrantonio contacted Caitlin Parker. They met at Tim Hortons. At first Caitlin and Chris were skeptical about the whole thing, but it was not difficult for them to warm up to Melissa, who, at 25, wasn't too far off their own age, and who had an engaging and gentle manner about her.
That visit turned into a second visit, and a third. The program entails the nurse visiting weekly with their client for the first four months, then every other week until birth. After birth the visits run weekly, then every other week. Melissa and Caitlin met about 50 times in total, often with Chris there as well.
Prior to the baby's birth, Melissa and Caitlin talked about the future, how to care for the baby, but also for herself, about how Caitlin could eventually get back to work, pursue a career that interested her. The nurse talked with the couple about how to strengthen their relationship as they prepared for childbirth.
The baby, Amber Lee, was born Dec. 19. She already had a head start.
After birth, Melissa helped Caitlin through postpartum blues. Chris and Caitlin phoned her when Amber got sick, asking for advice.
"Melissa is an amazing nurse," Caitlin says. "We built a relationship, a friendship. When we first got in the program I had no goals as to what I wanted to do, but she helped me figure out what I could do with my life."
The frequency of the nurse visits, and the content of the counselling, is all based on curriculum developed by an American physician, Dr. David Olds. All the international test sites — in Australia, Germany, Netherlands, and United Kingdom — use the same curriculum so results can be accurately measured. The Canadian NFP Network is located at the Offord Centre for Child Studies at McMaster University.
Public health services recently received the go-ahead from the board of health to continue receiving referrals to the program in Hamilton using existing resources; the 2011 budget is $639,438. Funding comes from the Healthy Babies, Healthy Children program, which is funded by the provincial Ministry of Children and Youth Services. Currently 76 young women/families in Hamilton are receiving nurse visits.
But local officials want to expand the program to meet demand. Mayor Bob Bratina wrote a letter to the province seeking an increase in funding, otherwise, the program will have to cap the number of new moms each year at 100. (Five local nurses are devoted to the program; each nurse can only take on 20 clients at a time.)
Health officials expect there will be 300 to 400 young women in Hamilton eligible for the program each year. In 2009, 410 first-time mothers under age 21 gave birth in the city.
"(The program) is based on the philosophy that changing lives is not about a handout, it is about helping people become self-sufficient," said a public health report.
Amber turned two years old in December. She has curly brown hair and a passion for her toy bunny and all things Minnie Mouse. On this afternoon, her mom has just arrived home from work.
At nurse Melissa's urging, Caitlin went back to school, at Grand Health Academy on King Street East., where she graduated and was presented an honours award. She is now a personal support worker at a nursing home. She loves her job. Chris has been staying at home with Amber and plans to return to work when she starts preschool.
Melissa's official nurse visits ended on Amber's birthday with a graduation celebration. But today is a special visit, to talk about the journey, have their picture taken. Amber waddles around, holding her bunny, smiling for the camera.
The family lives in a modest apartment. There is a church across the street. Up on the fourth floor, out the living room window, the steeple looks close enough to touch.
At sunset, sometimes you look out and see the steeple framed against a pink sky, the crest of the Mountain rising in the distance. At those moments it looks, Chris says, like a postcard.
Life offers no guarantees. But for Amber and her young parents, the ground feels solid under foot.
"Everything is good," Caitlin says. "I feel very successful in everything I'm doing right now."