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Baby Eating Right? Sex While Pregnant? First-time Moms Get Family Coaching

BY ANA VECIANA-SUAREZ
Published in The Miami Herald

Like most first-time mothers, Gladys Sanchez worries about meeting her 2-year-old's emotional and physical needs. What should she do when he throws a temper tantrum? How much should he be eating? Is he speaking well enough for his age?

''I want to do the best for Andys, but sometimes I'm not quite sure what that might be,'' says the Miami Gardens woman. ``For example, he's very strong willed and I need to make sure to discipline him. But I don't want to scream at him. What can I do?''

For concerns like this, Sanchez, 45, turns to her family coach, Iris Aguila.

''Patience,'' Aguila advises. ''Lots of patience.'' She then details her tips. Her favorite: Don't always say no. Positive reinforcement can go a long way.

Aguila works for HealthConnect in the Early Years, an agency funded by the Children's Trust and run by the Healthy Start Coalition of Miami-Dade. Launched three years ago, the family coach program targets all first-time mothers in Miami-Dade with a simple but effective pitch: Have questions about pregnancy and parenting? We can provide the answers.

The family coach program was part of a larger initiative started by the trust targeting children's health issues. It includes community outreach in neighborhoods and the increased presence of nurses and social workers in schools.

The family coach program is free and open to all county residents, regardless of income. Coaches do pre-natal and post-natal home visits, provide information about breastfeeding, child development, nutrition, immunizations and health screenings and basic baby care. It is these free home visits that distinguish it from other models the Children's Trust studied in the United States, Canada and Europe.

''We know that maternal health has a lot to do with a baby's development, so we wanted to make sure the program was made available for women during pregnancy,'' says Emilio Vento, director for HealthConnect. ``And we also know that the early years are key to a child's development so we want to target that time as well.''

Hence, the program aims to start home visits in early pregnancy and continue with the young family until the child is 3.

A LIFELINE

Sanchez has been with the program for almost two years. A stay-at-home mother, she and her husband Antonio, 50, consider the program a lifeline and Aguila a friend.

''I have learned so much from her,'' Sanchez says. ``She gives me so much information when she visits and I know I can call her at any time. In between visits she even calls me to find out how I'm doing, how the baby is doing. I feel very comfortable asking her any question.''

Aguila, a psychologist who specialized in pediatrics in Cuba, is typical of the program's 24 family coaches. All have at least a bachelor's degree in a medical field. Some are midwives, others are nurses. Most have some kind of experience or expertise in mental health.

''The service the coaches provide depends on the needs of the family,'' Vento says. ``Their needs drive the services.''

LOCAL DIFFERENCES

There are marked geographic differences, he adds. In deep South Dade, the mothers are more transient, and there are more cases of drug abuse and domestic violence. In Central Miami-Dade, the urban core, more families are involved with the justice system in some way. In the north, more mothers tend to be in stable relationships and usually have lived in the area longer.

Of the 2,300 moms visited last year, only 30 percent were middle-class moms in stable environments. This forces family coaches to add other expertise not directly related to parenting -- more case management and referral on employment services, eviction, mental health and substance abuse.

Aguila covers the North Dade area and visits about 50 homes once or twice a month. She provides mothers with videos, pamphlets and her own professional experience to help manage the challenges first of pregnancy, then of a new family.

She answers standard questions -- How long should I breastfeed? When should I start brushing my child's teeth? -- but also fields some personal concerns. Mothers ask if it's OK to have sex while pregnant. Others worry their breasts are too small to breastfeed. Some confide that they feel unattractive, that their husbands are ignoring them, that they feel depressed and lonely.

''It's all new for a first-time parent, no matter how well educated,'' Aguila says. ``So you have to give them a lot of encouragement, a lot of positivity.''

While Aguila would like all the mothers to stay with the program until their children turn 3, some move out of the county or return to work and say they don't have time.

But what truly frustrates her is a medical system that lets too many mothers fall through the cracks. ''What worries me most is these mothers who don't have insurance and don't qualify for Medicaid, so they're not getting the post-partum medical care they should be getting,'' she adds.

FAMILY DISTANCE

Many of her mothers are from other countries, and their families are far away. They need a support system to help them not only with basic baby care, but also in navigating public programs.

Sanchez, for example, is from Colombia. Except for a younger sister, her relatives remain there. But even if new mothers have a strong support system, family coaches are especially trained to provide up-to-date information that an abuela or bubbe doesn't always have access to, says Emily Cardenas, senior communications manager for the Children's Trust.

Almost half the mothers in the program are single. Constanza Salinas, 21, is one.. Eight months pregnant, she lives with her parents in their Hialeah home, but the father's baby is not in the picture. She began the family coach program when she was two months pregnant, and Aguila has talked to her about prenatal vitamins, birthing classes, even where she can buy a car seat at a reduced price.

''I've never gone through this and I'm scared and nervous,'' Salina says. ``I want to get the most help I can get for my baby. A lot of times I just wouldn't know where to go without Iris. She's real good at providing support.''

For more information on the program or to schedule a visit, dial The Children's Trust Helpline at 211.