CHARLESTON, W.Va. -- Jeannie Clark has visited the homes of families with newborn children that had a dirt floor and holes in the roof. Another family couldn't pay to heat their home, so their babies slept in cribs 20 degrees below freezing.
Marsha Miller has had a new mother call her in the middle of the night, frantically asking how to help her newborn.
Miller advised another mother that laying her baby against the couch cushion nose-first was not a safe sleeping situation for her child.
Both Clark and Miller have worked as designated-care coordinators throughout West Virginia in the Right from the Start program for years. There are 180 providers who visit homes each month.
Right from the Start is a statewide in-home visitation program that provides prenatal care, counseling and some parent education to pregnant mothers and infants who qualify for Medicaid. The statewide program is contracted with the Office of Maternal, Child and Family Health.
Clark worked as a care coordinator for 13 years until 2001. She is now the director of Perinatal Programs at the state Department of Health and Human Resources.
Clark said some mothers don't want the home visitors to walk into their house for various reasons, but the registered nurse said she isn't there to judge.
She wants to make sure both baby and mother are healthy.
"West Virginia has a culture where they don't really want other people coming into their homes," Clark said. "I'm not coming to see how clean your house is. I'm coming to be your friend, to help you learn and to have a healthy pregnancy. I'm your nurse."
The moms could not hire a designated-care coordinator even if they wanted to, and she knows that, she said.
To be eligible for Right from the Start, a woman must be a pregnant resident of the state and have a current Medicaid card or medical coverage through the Office of Maternal, Child and Family Health.
Clark said all pregnant teenagers are eligible for coverage through OMCFH, regardless of family income. Also, mothers whose babies are 1 year old or younger can be eligible if the child is eligible for Medicaid.
Of the 21,000 births each year in West Virginia, 60 percent of those babies are eligible for Medicaid, Clark said. There are 3,000 women and 3,000 babies enrolled in Right from the Start. That's a number that hasn't changed in the past four years, she said.
Right from the Start gets a list of every woman in the state who is eligible for Medicaid and pregnant and sends her information about the free program in the mail.
Chantelee Scott is one mother who received a brochure in the mail and decided to sign up for the voluntary program. Scott, 21, of Charleston, found out she was pregnant in November 2010. Since it was her first pregnancy, Scott said she knew she needed help.
Scott's Right from the Start designated-care coordinator answered personal questions that she had been too embarrassed to ask others. The licensed social worker reassured Scott that she didn't need to stress about every little thing and reminded her to take her vitamins and eat healthy.
During her once-a-month visits, Scott's care coordinator made sure she was comfortable with having a Caesarean section and showed her DVDs on breastfeeding and basic child care.
"She stressed a lot to make sure I didn't miss my appointments. I was terrified and she relieved some of my fears," Scott said. "She was a friend rather than a professional person talking to me. She actually cared and got excited for me."
When twins Naylynn and Nevaeh Conley were born on July 6 last year, a new care coordinator, Linda, visited the family's home. Linda visited once a week when the girls were newborns, Scott said.
"I was scared. I had twins and I didn't think I could do it," she said. "If it wasn't for her coming, I don't think I would be the mother that I am. I know I would still be a good mother but I wouldn't know exactly what to do without her."