Alvin Vallejo, a public health nurse in San Francisco, steps inside a dilapidated apartment building in the Tenderloin neighborhood.
He climbs a narrow staircase to visit a client on the third floor recovering from a high-risk pregnancy and a difficult birth. Vallejo turns down the hall, passes a communal bathroom, and knocks on a door.
Dayanis, a 35-year-old mother cradling a newborn dressed in a turquoise onesie, answers the door. (Only her first name is used to protect her medical privacy.)
Last year, she and her husband immigrated from Cuba, determined for a better life. They left two adolescent daughters behind with relatives. Their newest child, Abraham José, was unplanned.
Maternal mortality is at its highest level since 1965. But a new state bill, AB 1057, aims to improve conditions by helping more at-risk families like Dayanis’ receive medical care at home in the early postpartum period to ensure she and the baby thrive.
Dayanis ushers Vallejo inside the orderly but tiny, tightly packed room. A makeshift kitchen lines one wall with a single burner and a tiny fridge. Dayanis sits on a twin bed before covering her baby’s ears as the wails from a nearby police siren fill the space.
Vallejo pulls up a metal chair and opens his clipboard before asking questions about medications, vitamins, unusual symptoms and eating habits. Dayanis says she’s recuperating well.
Vallejo routinely measures her blood pressure. Dayanis’s pulse is a touch high, but he assures her it’s nothing to worry about. He then asks about the baby.
During Vallejo’s visit, Dayanis rocks her son gently as he closes his eyes. She assures Vallejo that her baby, Abraham, is well, but he doesn’t like drinking from a bottle.
So Vallejo offers to order a new one to help. After about an hour and a half, the appointment concludes and Vallejo schedules a time to return the following week.
“Wow. How awesome is it to have a nurse come into your home and just be there to support you?” asks Michelle Gibbons, executive director of the County Health Executives Association of California. “Everybody wants to do what’s best for your kid, and yet, not knowing if you’re actually doing what’s best for your kid. This offers quality care in an intimate setting and engagement with a nurse.”
She says public health nurses provide education on child development, nutrition, housing, and safety and also offer mental health screenings. Research (PDF) suggests that home-visiting programs increase breastfeeding rates and lead to lower cases of child abuse and substance abuse.
“It’s just one strategy to be able to address some of the disparities that we see in getting these kids off to a really good start in life,” Gibbons said.
She added that she would love to see the program address more people, including options for the unhoused and families with more than one child. It’s why, she says, her group is backing AB 1057. The bill would expand the number of evidenced-based, home-visiting models that can be implemented. The legislation was unanimously passed in the state Assembly. Now, the proposal is before the Senate.
Back inside Dayanis’ studio, she says home health visits have improved her mental health and connected her to useful services like housing. Soon, her family plans to move into a city-supported unit nearby with two bedrooms and a private bathroom.
“I have been well taken care of,” Dayanis said in Spanish. “I am very grateful.”
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