In the Texas Panhandle, nurses make home visits to new moms in need

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AMARILLO — Brianna Tilson shuffled through the duffel bag in her trunk, taking a mental inventory of what she needed for her next appointment. She paused, then the nurse tossed in a big pack of diapers before slinging the heavy bag over her shoulder and going up the stairs to Sedraya Kemp’s apartment.

Kemp, 21, was frustrated. Her 21-month-old old son was finally napping after a rough night with an ear infection. Without a car, Kemp had to wait all morning for her son’s father to drop off the medicine.

“I could have walked and got it, but it was already too hot,” said Kemp, who is 15 weeks pregnant with her second child. “I need to hurry up and get a car, because I can’t do that.”

“Do you think you’ll have enough money soon?” Tilson asked.

The young mom shrugged and knotted her fingers together. Kemp just started a new job at a plasma center. She must walk nearly an hour one way for her shift. Leftover money from bills is going to savings, she said, but it isn’t adding up fast enough.

The two talked like old friends. Tilson held Kemp’s son when he woke up while Kemp talked about wanting to be a phlebotomist.

[As a Texas city debates an abortion travel ban, maternal care is scarce in nearby rural counties]

Tilson is part of the Nurse-Family Partnership, a national program that sends nurses to meet first-time moms at their homes and is managed in part by the Texas Department of Family and Protective Services Early Intervention division. The Amarillo office is one of 23 local partners in Texas, with most other offices in major metro areas including Houston, Dallas and Austin. The nurses make home visits during their pregnancy and after to see how the mom and baby are doing, and to guide them to healthy lifestyles. Along the course of the program, which can be nearly three years depending on when the mom starts, the nurse and mom often form strong bonds.

Fertility rates are on the rise in Texas, but health care access is not. Amarillo is the most populous city in the Panhandle, and even its residents struggle with the access issues common in Texas, all of which can leave women vulnerable during their pregnancy or after. This includes a dearth of hospitals, tight budgets, and workforce shortages.

In 2023, there were just 55 physicians in the Panhandle with a current license in obstetrics or gynecology and primary practice, according to state data. With maternal health care limited, more and more women in Amarillo are signing up for the Nurse-Family Partnership.

But, like everything else in health care, it has its limits. The Amarillo chapter, which serves the city’s two counties, Potter and Randall, has six nurses for 150 clients — with 50 spots currently open. They can’t serve outside those boundaries, unless they find the money to expand to the region’s rural areas, where access to health care drops significantly.

Kacie Bell, director of the Texas Home Visiting Program overseeing the partnership, hopes to expand it beyond the two counties. Program leaders are in early conversations with local foundations and other outside sources of funding to close the gaps in access.

“We don’t have the funding,” said Bell with the Coalition of Health Services in Amarillo. “We’re having those conversations at the state level.”

When Tilson visits her clients, it’s as if she’s seeing a past version of herself. Tilson grew up in a single-family home. Her mother was the lone provider, and supplemented the family budget with housing and financial assistance. At 20, Tilson was pregnant, not married, and struggling financially. She dreamed of going to college and a better life.

“I think it helps having somebody who grew up this way,” Tilson said, referring to the mothers she helps. “It lets them know there are options and ways to get out of the cycle of poverty, education being one of them.”

Inspired by her mom, Tilson eventually got her nursing degree, then worked in the neonatal intensive care unit at Northwest Texas Healthcare hospital in Amarillo for five years. There, she saw lost, overwhelmed moms. She wanted to do more to help before and after the delivery. That’s when a friend told her about an opening with the partnership, and she jumped at the chance to apply.

In her six years with the program, Tilson has served 87 families. She has 26 moms now, who are either pregnant or graduating from the program in the next few months. Her appointments typically last between an hour and 90 minutes so she tries to keep it to three visits a day. She has to chart notes and drive, and takes that into consideration when planning her schedule.

“Our days can get pretty long,” Tilson said. “It’s a 20-minute drive wherever you go.”

The appointments can take an emotional toll on Tilson. The program has strict rules on what the nurses are allowed to do. And there are some problems the nurses can’t help with, such as fixing a dangerous living situation or giving the women rides. It’s hard for Tilson and other nurses — their natural instinct is to fix things — especially if their clients don’t have family support.

“It’s heartbreaking, but just being there for them and plugging them into resources can lead to good outcomes,” Tilson said.

Tilson has seen women start the program without a home or a car, and they’re driving by the end. Tracking some of those improvements is difficult. However, the partnership has tracked benefits. There has been an 18% decrease in preterm births and 35% less cases of hypertension from pregnancy.

That data is driving the push toward a rural expansion in the Panhandle. Amarillo is surrounded by small towns through the 26-county region. There’s only 15 hospitals to serve the hundreds of thousands of people living between them, not including ones in Amarillo. Only six of those offer labor and delivery services. According to March of Dimes, about 28% of women in rural Texas live more than 30 minutes from a birthing hospital compared to 4% of women in urban areas.

Susan Bailey is the executive director of the Coalition of Health Services, a nonprofit that includes representatives from 14 of the rural hospitals in the Panhandle. She put it this way: An Austin woman could get to a level one trauma center in San Antonio quicker than a woman in the far reaches of the Panhandle can get to Amarillo’s trauma center.

“The distance between those trauma centers is less than the distance between our rural counties and area level one trauma centers,” Bailey said.

This puts expectant and new mothers at a greater risk if something goes wrong. According to a March of Dimes report card for Texas, an average of 28 women die from causes related to pregnancy or postpartum per 100,000 births, compared to 23.5 deaths on average in the U.S. From 2016 to 2019, the maternal death rate in Texas is highest among women in rural areas, according to a state report.

The rates and disparities are something all the health care leaders in the coalition are paying attention to, Bailey said. This is why the partnership has support in the region, and has advocates seeking the money to expand to rural areas.

It’s hard for Tilson to think about all the women in the far-flung parts of the state who could benefit from the program. She’s watched moms change their lives in the time she shares with them, and she wants that for all women in the Panhandle.

“You realize how much of a difference you can make,” Tilson said. “So having more nurses in the homes would be amazing.”

This pregnancy has been rough on Kemp. She feels dehydrated no matter how much water she drinks and has suffered fainting spells. This baby is picky, Kemp says. Drinks like Gatorade or Liquid IV taste bad to her. So do her prenatal vitamins.

“I’m sick of it,” Kemp said. “I’ll just drink my water and eat my fruits and vegetables.”

This is Kemp’s third pregnancy. She miscarried once before giving birth to her son, Quaveeon Shaw. While she was pregnant with Quaveeon, and newly enrolled in the program, she had a lot of fears about her pregnancy and didn’t know how to manage them.

“I was always scared he was going to be stillborn or have developmental issues,” Kemp said. “Having the one-on-one lessons told me how to be prepared for if something does happen.”

Tilson brought her blood pressure cuff, and asked if it was OK to check Kemp’s vitals. Kemp agreed, and looked around her living room with her arm across her chest, waiting for the numbers to flash on the screen. It was 109 over 63, which Tilson said was pretty good.

“You want the top number to be under 130 and however low you can tolerate it, that’s what matters,” Tilson said. “Some people would feel faint at 109.”

Tilson has been Kemp’s nurse for most of her time in the program, except for when Tilson went on maternity leave — Tilson gave birth to a girl two years ago, 16 years after having her first son. Since then, Tilson has become a reassuring presence in Kemp’s home. They gab about Kemp’s life while Tilson takes her vitals, weighs her son, and scribbles notes to chart later.

The program is for new moms specifically, regardless of age. One patient was in her late thirties when she joined. The nurses can visit during the pregnancy and until their baby is two years old.

Kemp credits the program for the changes in her life so far. She doesn’t have a car yet, but she said she didn’t have her own place or anything before she had her son. Her son, Quaveeon, turns two in September, which means she’ll technically graduate from the program. But she hopes she can continue to see Tilson since she is pregnant again.

There are two other home-visiting programs other than the partnership that work with families of different age groups. One is Home Instruction for Parents of Preschool Youngsters, or HIPPY. The other is Parents as Teachers, which serves pregnant moms with children up to five years old.

“I can hold on to her a little longer because she is having a hard time in her second pregnancy,” Tilson said after the visit. “Maybe until November.”

The nurses help where they can with supplies, such as the diapers Tilson brought or grocery gift cards that were purchased with money from the American Rescue Plan Act. Those funds end in September though, so won’t be able to provide those cards much longer. This is bad news for their clients, who commonly face financial instability.

Income, or lack thereof, is the most common hardship for moms in the program, according to Liz Favela, nurse supervisor for the program. This pushes women toward worse circumstances, such as unstable housing or no transportation.

Because of these circumstances, many women will skip doctor’s appointments, Favela said.

“A lot of women have to get off work and drive two hours for a 15-minute prenatal appointment,” Favela said. “In their minds, that’s not worth it.”

Favela says those appointments are vital for the moms, as it allows them to track issues with their pregnancy. Conditions like hypertension or preeclampsia may go under the radar.

Favela said the hospitals in Amarillo see high rates of moms who did not have prenatal care. It’s a statewide problem. In 2022, one in 9 babies were born to a woman who received late or no prenatal care. Favela said there’s also not enough providers in Amarillo for how many patients there are seeking prenatal care.

“That’s where our program comes in,” Favela said. “The importance of getting them prenatal care and finding the resources they need.”

Back at Kemp’s apartment, she’s recalling how after she graduated high school, she didn’t have plans for the future. Then she was pregnant with Quaveeon.

“He saved me in a way that nobody would,” Kemp said.

The love for her son is what motivated her to join the partnership. She wanted her own place, a job, to go to school, and she didn’t know how to do that alone.

“I’m looking at how I can make things better for them,” Kemp said. “They didn’t ask to be here, they deserve so much more and I don’t want them to ever feel like a burden.”

Stories like Kemp’s, who is about to successfully finish the program, show health care leaders in the Panhandle that the system works. They had 22 referrals in June, up from 15 the month before, so the program is sought after.

“The nurses can have influence on the mother,” said Bailey, who leads hospital directors in the Panhandle coalition. “Then on an entire family and, subsequently, an entire system.”

While funding is not secure, Bailey said she’s optimistic the program’s leaders will get to expand to the rural areas of the Panhandle one day.

This story was reported with the assistance of the Journalism and Women Symposium (JAWS) Health Journalism Fellowship, supported by The Commonwealth Fund.

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