Jen Winter did a happy dance when she finally got an alert in the early hours of the morning that the state had opened applications for funding her work with vulnerable mothers and babies. Then she read the fine print.
The request for proposals — issued earlier this summer — only included southern Maine, not Hancock and Washington counties, where Winter has worked as a maternal health nurse for 21 years under the same state grant. It’s not the only region affected by this: Bangor health providers were also shocked last month to learn the state was taking over their public nursing program.
At the end of September, Winter and three other nurses providing care for young families in the two counties will be out of jobs. They have little information about plans to replace them.
The contracts were not sent out to bid in eastern Maine because the state now has sufficient staff of its own, according to the Maine Center for Disease Control and Prevention, which funds the maternal child health nursing program. When Bangor leaders raised concern about the change, Maine CDC Director Puthiery Va told them that it was part of a “programmatic re-envisioning” and would not disrupt existing services.
The agency employs two public health nurses of its own in the region and is recruiting for a third, a Maine Department of Health and Human Services spokesperson said Monday. She did not answer a question about how many of those nurses would be dedicated to maternal and child health, but said all are trained in the necessary skills.
The changes in Bangor have so far gotten more attention, but local nurses farther east are worried about the consequences of ending the relationships they’ve built with families who voluntarily receive their services through in-home visits. They also fear the CDC won’t be able to provide the same level of care in the rural region where resources have already been dwindling and the hospital system shows signs of instability.
“In our communities, there’s going to be a piece missing, and people don’t see it, because it’s prevention,” Winter said.
Maine has had a general public health nursing program for more than a century, providing general health care through visiting providers. It was cut down significantly by the administration of former Gov. Paul LePage, and has slowly been rebuilt under Gov. Janet Mills.
The maternal and child health nurses focus specifically on medical care for mothers and babies, which providers also say can help to prevent broader child welfare issues. In Hancock and Washington counties, they made 148 visits in July, Winter said.
Makenzie Cowles, a single mother in Ellsworth, got early intervention and physical therapy for her infant daughter’s torticollis, a neck muscle condition, because of Winter’s home visits. The program taught her things she didn’t know as a first-time mom, Cowles said, and supported her socially through the visits and a weekly “mommy and me” group the Hancock County nurses run.
“We need these programs to help moms feel supported, be helped with finding resources and to have companionship in one of the hardest transitions in a woman’s life,” Cowles said.
A statewide shortage of nurses in the state is particularly pronounced in these counties, according to a 2024 study by Cypress Research Group that found the region had the lowest number of working registered nurses in the state, as well as the highest average age in Maine.
Valerie Feldkamp, who visits new families in the Mount Desert Island region and helps them learn parenting skills through the organization Maine Families, has worked with the existing nurses for years. She was “shocked” to learn of the change.
Many of her clients are also wary of interacting with DHHS or inviting them into their homes for fear their children will be removed, she said, though child protective services is separate from the CDC.
Even if the department adequately staffs the program, the relationships and trust with current providers will be gone, according to Feldkamp.
Those connections help families facing barriers to getting health care, Winter said. Parents she works with in rural areas are often uncomfortable with doctor’s offices, have challenges navigating the medical system or struggle to coordinate traveling hours to Bangor for appointments, especially if they have unreliable transportation or additional children to care for.
Because they know and trust Winter, they have called her when they need immediate medical attention, experience postpartum psychosis or are threatened by a partner. She’s met them on the side of the road, taken them to appointments and the grocery store.
“It’s the young families that are going to lose out, those moms and babies,” she said. “Things will get missed.”
That’s why Winter moved to the program after working with children in a Bangor hospital. What she saw there was traumatizing, and she wanted to do something to help prevent child abuse, neglect, unsafe sleep practices, domestic violence, drug use and other factors she saw contributing to those hospital cases.
The closures of birthing centers in Calais and on MDI have made it even more challenging to get care, and overbooked hospital systems regularly don’t see mothers for appointments as often as they need them or can’t schedule checkups or immunizations for their children, according to Winter.
Sarah Becker, a mother in Northeast Harbor, had a complicated recovery process from the recent birth of her youngest child. She couldn’t find an in-network provider for treatment she needed, but Winter connected her. Her daughter struggled with bottle-feeding until Winter recommended a new type.
“This program was a lifeline,” Becker said.
The nursing grant was administered by Downeast Community Partners, a social service agency serving the two counties that has cut other services recently due to financial troubles, but the change was not related to those challenges or the agency, according to Winter.
Local nurses haven’t gotten answers from the Maine CDC about its plans. They had also received positive feedback from the state about their services previously, according to Winter.
“They just say their public nurses can handle it, and I really question that,” she said.
In Bangor, elected representatives have pushed back on the decision and are asking the state to find funding. In response to their requests for information, Va apologized for the state’s level of communication around the change.
Correction: An earlier version of this report misstated the titles of the maternal child health nurses.