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    Nurse visits for new parents

    Nurse visits for new parents: A nurse at the door in a baby's first weeks.

    About 3.6 million babies were born in America in 2025. In a randomized trial, a few nurse visits at home after the birth cut babies' emergency care sharply, for about $500 to $700 a birth.

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    Ryan K. Hertel · heyitskenton

    The problem

    What we're up against.

    • A new start, millions of times a year.

      About 3.6 million babies were born in America in 2025, and Medicaid paid for 40.2% of births.

    • Danger after going home.

      From 2018 to 2022, there were 6,283 pregnancy-related deaths in America, 1,891 of them more than six weeks after the birth, and more than 80% of pregnancy-related deaths were judged preventable.

    • Hard weeks for many mothers.

      About one in eight mothers have symptoms of postpartum depression.

    • Most families get no visit.

      Home visiting reaches only 1.8% of the families who could benefit.

    What works

    Proven, and ready to grow.

    • Fewer emergencies.

      In a randomized trial in Durham, North Carolina, families offered nurse visits used 50% less emergency care for their babies, and 80% of families took part.

    • Benefits that last.

      By age five, families offered visits had 39% fewer child protection investigations, a borderline result, and mothers were less likely to have depression scores in the clinical range.

    • It can pay for itself.

      Health care billing fell by about $3.17 for every dollar the program cost, by its developers' analysis.

    • The original trials.

      In Elmira, New York, mothers visited by nurses through pregnancy and infancy had fewer verified reports of child abuse or neglect fifteen years later: 0.29 each on average, against 0.54.

    • A national trial.

      A national randomized trial of four home visiting models found positive effects on all five measures of mothers' and families' well-being by kindergarten, and an independent analysis finds Nurse-Family Partnership returns about $1.48 for every dollar.

    What a family could fund

    Where the money goes furthest.

    • A few visits, for every family.

      Family Connects sends registered nurses to every family with a new baby, at no cost to the family, for about $500 to $700 a birth.

    • Already in many states.

      It's available in 21 states, and has served 155,047 families, by its own count.

    • The real price, at scale.

      In Oregon's statewide rollout, one of the program's champions expects the cost to be closer to $1,300 a family.

    • Intensive support for first-time mothers.

      Nurse-Family Partnership's longer, more intensive model costs about $14,459 a family, net.

    • Plenty of room to grow.

      The federal home visiting program reached 75,046 families in 2024, up from 69,571 in 2022, a small share of the families who could benefit.

    Honest limits

    What money can't promise.

    • The biggest new trial found nothing.

      In a large randomized trial in South Carolina, intensive nurse visits didn't improve birth outcomes: 26.9% of births had an adverse outcome with visits, against 26.1% without, and by age two, there was still no difference.

    • Results don't always travel.

      England's version of the intensive program added no short-term benefit on its main outcomes.

    • Mostly the developers' own evidence.

      Until recently, no independent study had tested Family Connects, and the one that did found few significant effects.

    • Many families never start, or stop.

      In the national trial, 83% of families offered visits received at least one, and only 35% of Nurse-Family Partnership clients complete the program.

    • Not enough nurses.

      A third of home visiting program managers have home visitor jobs they can't fill.

    Hard questions

    Asked and answered.

    1. You might ask

      The newest, biggest trial found nothing. Why fund this?

      Ryan

      For its main outcomes, that's true. The visits did modestly raise families' use of safety-net programs, and the short, universal model has trials of its own. Whatever a family funds here comes with independent evaluation.

    2. You might ask

      Why visit every family, even ones doing fine?

      Ryan

      Need is hard to predict from demographics, and nurses found something to help with in most homes: they handled minor problems for 52% of families and connected another 42% to help in the community.

    3. You might ask

      Will families open the door?

      Ryan

      Mostly, yes: in four high-poverty rural counties, 78% of eligible families started.

    In the slider

    See what your fortune could do here.

    Nurse visits for new parents

    The slider prices this cause with these numbers:

    • A few nurse visits at home after a birth cost about $500 to $700 a family, and the slider uses the higher figure.
    • The whole need here is every family with a new baby in America, about 3.6 million a year.
    • A statewide rollout may cost more, closer to $1,300 a family in Oregon, and the one independent study of this model found few significant effects.
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    More of the Blueprint

    Keep reading.

    23 more chapters on the way

    Back to Keep 100

    Sources

    Every number in this chapter, and where it came from.

    1. Source 1: Births: Provisional Data for 2025 (opens in a new tab)

      Centers for Disease Control and Prevention, April 2026. Checked 16 October 2026.

    2. Source 2: Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care (Dodge and others) (opens in a new tab)

      Pediatrics, November 2013. Checked 16 October 2026.

    3. Source 3: Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age (Goodman and others) (opens in a new tab)

      JAMA Network Open, July 2021. Checked 16 October 2026.

      A randomized trial in Durham, North Carolina, by the program's developers. The drop in investigations is only borderline significant.

    4. Source 4: Births: Final Data for 2024 (opens in a new tab)

      Centers for Disease Control and Prevention, 9 June 2026. Checked 16 October 2026.

    5. Source 5: Pregnancy-Related Deaths in the US, 2018-2022 (Chen and others) (opens in a new tab)

      JAMA Network Open, April 2025. Checked 16 October 2026.

    6. Source 6: Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 38 U.S. States, 2020 (opens in a new tab)

      Centers for Disease Control and Prevention, 28 May 2024. Checked 16 October 2026.

    7. Source 7: Postpartum Depressive Symptoms in the United States (O'Connor and Su) (opens in a new tab)

      Women's Health Reports, 4 December 2023. Checked 16 October 2026.

    8. Source 8: 2026 Home Visiting Yearbook: Highlights (opens in a new tab)

      National Home Visiting Resource Center, August 2026. Checked 16 October 2026.

    9. Source 9: Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting (Dodge and others) (opens in a new tab)

      American Journal of Public Health, February 2014. Checked 16 October 2026.

    10. Source 10: Promoting Long-Term Parent and Caregiver Mental Health Through Universal Postnatal Nurse Home Visiting (Baziyants and others) (opens in a new tab)

      Prevention Science, August 2025. Checked 16 October 2026.

    11. Source 11: Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months (Goodman and others) (opens in a new tab)

      Development and Psychopathology, December 2019. Checked 16 October 2026.

      By the program's developers.

    12. Source 12: Long-term effects of home visitation on maternal life course and child abuse and neglect (Olds and others) (opens in a new tab)

      JAMA, August 1997. Checked 16 October 2026.

      The Elmira, New York, randomized trial, followed for fifteen years.

    13. Source 13: Beyond the Early Years: Long-Term Effects of Home Visiting on Mothers, Families, and Children (opens in a new tab)

      MDRC, September 2025. Checked 16 October 2026.

      For the federal government, on a national randomized trial in twelve states.

    14. Source 14: Nurse Family Partnership: Benefit-Cost (opens in a new tab)

      Washington State Institute for Public Policy, December 2024. Checked 16 October 2026.

      An independent benefit-cost analysis in 2023 dollars. Its review of studies dates from 2018, before the newest trial.

    15. Source 15: Launch a Family Connects Partnership (opens in a new tab)

      Family Connects International. Checked 16 October 2026.

      The program's own account.

    16. Source 16: Family Connects International (opens in a new tab)

      Family Connects International. Checked 16 October 2026.

      The program's own count.

    17. Source 17: Babies don't come with instructions. But in Oregon, they now come with a nurse (opens in a new tab)

      NPR, via KPBS, 23 July 2024. Checked 16 October 2026.

    18. Source 18: MIECHV on Track to Provide 1 Million Home Visits in 2025 (opens in a new tab)

      Child Trends, 23 September 2025. Checked 16 October 2026.

    19. Source 19: Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population (McConnell and others) (opens in a new tab)

      JAMA, July 2022. Checked 16 October 2026.

      A randomized trial with 5,670 first-time mothers in South Carolina.

    20. Source 20: Intensive Nurse Home Visiting and Early Childhood Outcomes (Swanson and others) (opens in a new tab)

      JAMA Pediatrics, August 2025. Checked 16 October 2026.

    21. Source 21: Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial (Robling and others) (opens in a new tab)

      The Lancet, January 2016. Checked 16 October 2026.

    22. Source 22: Quasinatural Experiment of Postnatal Home Visiting: An Independent Impact Study of Family Connects (Mersky and others) (opens in a new tab)

      American Journal of Preventive Medicine, November 2022. Checked 16 October 2026.

    23. Source 23: Impacts on Family Outcomes of Evidence-Based Early Childhood Home Visiting (opens in a new tab)

      US Administration for Children and Families, January 2019. Checked 16 October 2026.

    24. Source 24: Client attrition in the Nurse-Family Partnership (Hernandez and others) (opens in a new tab)

      Health and Social Care in the Community, July 2019. Checked 16 October 2026.

    25. Source 25: Home Visiting Career Trajectories (opens in a new tab)

      US Administration for Children and Families, 29 January 2020. Checked 16 October 2026.

    26. Source 26: Impact of nurse home visiting on take-up of social safety net programs (Rokicki and others) (opens in a new tab)

      Health Affairs Scholar, April 2025. Checked 16 October 2026.

    27. Source 27: Maximizing the return on investment in Early Childhood Home Visiting through enhanced eligibility screening (Dodge and others) (opens in a new tab)

      Child Abuse & Neglect, December 2021. Checked 16 October 2026.

    28. Source 28: Effect of a Community Agency-Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial (Dodge and others) (opens in a new tab)

      JAMA Network Open, November 2019. Checked 16 October 2026.

    29. Source 29: Evaluation of a Family Connects Dissemination to Four High-Poverty Rural Counties (Goodman and others) (opens in a new tab)

      Maternal and Child Health Journal, May 2022. Checked 16 October 2026.