Sharon Rohrbach, RN, witnessed too many babies die in their mothers' arms.

A newborn nursery nurse in St. Louis for 17 years, she was often called to the ED because she had pediatric-sized IVs and blood pressure cuffs. During these visits, she noticed new parents couldn't tell a sick baby from a well baby in the days following delivery - ultimately costing newborns their lives.

"It was very distressing to me to see babies dying of preventable causes," Rohrbach recalled. "Conditions such as sepsis and heart defects were really not recognizable to these parents in the first 24 hours when babies were being sent home from the hospital."

After researching infant mortality and discovering other countries send nurses to the homes of new mothers, Rohrbach decided to develop a nurse home-visitation agency of her own. Founded in 1991, Nurses for Newborns Foundation (NFNF), St. Louis, provides a safety net for at-risk families to help prevent infant mortality, child abuse and neglect through home-based programs.

Serving At-Risk Families
NFNF offers four programs: Bright Futures, Bridge to the Future, Safe Beginnings and Teen Parent. Bright Futures, the foundation's largest program, focuses on pregnant women who are living in poverty without access to healthcare services. Nurses in the program help women access prenatal care, enjoy a healthy pregnancy, care for their infant after birth and build parenting skills.

The Bridge to the Future program is a "NICU baby follow-through," described Rohrbach. The program acts as a bridge between hospital and long-term community services for medically fragile infants. The family and nurse design services based on individual family strengths.

One of the first programs NFNF founded was Safe Beginnings, a fairly intensive 2-year nurse home-visitation program serving pregnant women or new mothers who are mentally retarded/developmentally disabled, mentally ill or physically challenged. Safe Beginnings aims to reduce premature birth, prevent child abuse and neglect, and promote good parenting skills.

"No matter how healthy the baby is, if the baby is going home with a mother who is mentally challenged and she doesn't have any other support, the baby is going to be in trouble pretty quickly," said Rohrbach.

Lastly, NFNF offers Teen Parent, an 18-month program for first-time mothers under age 19. Teen mothers are encouraged to reduce repeat pregnancies, provide infants with all immunizations and learn about infant safety hazards to reduce accidents. Education about the signs of infant physical illness and community health resources is also part of the program.

The foundation serves at-risk families in St. Louis and Springfield, MO, as well as in 29 counties surrounding the two cities. It also assists families that live in Nashville, TN, and 24 counties in middle Tennessee.

Staying Motivated
All of the nurses that work on behalf of NFNF are employed by the foundation and receive special orientation training and monthly inservice training. "We require that the nurses have a minimum of 5 years of newborn nursery or 3 years of NICU experience before hiring," Rohrbach explained.

NFNF nurses need to possess specific characteristics given the circumstances surrounding most families they aid. "Because we work with a population that is primarily living in poverty with many social risk factors, the nurses have to be extremely empathetic and non-judgmental," said Rohrbach. "If the mother is doing nine things wrong, they have to find one thing that she's doing right and build a relationship with her."

The nurses, who are on call 24 hours a day, 7 days a week for their clients, also need to be bighearted, Rohrbach noted. NFNF's average client income is approximately $500 per month, and the foundation's records report they are evicted an average of eight times during the first year of NFNF's involvement.

"Our nurses have to really be able to work alongside these moms and help them solve a lot of problems that interfere with everyday living. They need to be willing to help find community resources," she said. Most families the foundation assists cannot afford diapers, formula, food, stable housing, transportation and telephone service, among other necessities.

"Did I mention that nurses also have to be able to go into very dangerous neighborhoods?" asked Rohrbach. "They do. And we don't send anybody with them; we send them one at a time."

What motivates Rohrbach and other NFNF nurses to dedicate their lives to NFNF and ultimately the families of at-risk children? "Our infant mortality rates are not getting any better, and our disparities between African American babies and Caucasian babies are also not improving," explained Rohrbach.

 "Our problems are not solved and that certainly keeps me motivated."

• Rohrbach has received numerous awards for her efforts in preventing infant mortality, such as the Robert Wood Johnson Community Leadership Award, the Woman's Day Magazine Women Who Inspire Us Award presented by First Lady Laura Bush, the Use Your Life Award from Oprah's Angel Network and more. For more information about NFNF, visit http://www.nfnf.org/.

Beth Puliti is associate editor and Web editor at ADVANCE. She can be reached at epuliti@merion.com.