http://www.medscape.com/viewarticle/450641?mpid=10985
Home Visits by Nurse-Midwives Help Teen Mothers and Their Infants

Laurie Barclay, MD

March 13, 2003 - Home visits of teenage mothers by nurse-midwives reduced
adverse neonatal events and improved contraceptive knowledge, according to
the results of a randomized trial reported in the March 15 issue of The
Lancet, but did not improve breast-feeding or childhood vaccination rates.

"Teenage mothers are prepared to accept considerable changes in their
lifestyles to facilitate a positive outcome for their child," lead author
Julie A. Quinlivan, from the University of Melbourne in Australia, says in a
news release. "Opportunities to intervene in the postnatal period exist and
should be used. Home visiting programs that target mothers younger than age
18 years might be able to reduce adverse neonatal outcomes."

After completing an antenatal questionnaire assessing their knowledge of
contraception, infant vaccinations, and breast-feeding, 139 teenage girls
attending a pregnancy clinic were randomized to receive either five
postnatal home visits by nurse-midwives or no intervention. Average age of
the subjects was 16 years.

Based on a six-month follow-up survey of 124 subjects, mothers who received
home visits did better than the nonintervention group in terms of adverse
health outcomes of children (2 vs. 9); infant deaths (1 vs. 2); and
placement in foster care (1 vs. 6). Although home visits substantially
increased mothers' contraceptive use at six-month follow-up, they did not
improve mothers' knowledge of breast-feeding or infant vaccination
schedules.

"Improving knowledge and effective use of contraception could enable the
teenage mother to plan her reproductive life," Quinlivan says. "Further work
needs to be done to investigate the long-term effects of home visiting
programs, and to devise strategies to increase the number of infants
breast-fed and the number who receive all their childhood vaccinations."

Lancet. 2003;361:893-900

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