I wrote;
>>encourage Moms to take advantage of VNA home visits.
<snip>Remind them to ask (when the VNA nurse calls to schedule the visit) for
a nurse with IBCLC credential or at the minimum, experience with
breastfeeding issues! <<
Jennifer Tow  replied;
>>This is a loaded suggestion, since it is unlikely the doc is going to
remember or even think it important to tell the mom to ask for a VNA nurse
with bf experience <<
I understand and agree with many of your points but I'm not so sure about
this one. IN THEORY I don't think it is unreasonable to expect the OB to see
the VNA nurse as an important component in the continuum of good mother/ baby
care, of which breastfeeding is a huge part. The early maternity discharge
visits that I described are OFFERED to patients not prescribed thus OBs often
are involved in the lobbying efforts for them ie. touting the benefits etc.
in an effort to encourage patients to opt for them. They do this, largely,
because it makes there job easier. I said IN THEORY because I do understand
that there are limits to the practical aspect of this, not the least of which
is nurses providing visits that aren't skilled in breastfeeding support. I
could work forever trying to educate within VNAs regarding the importance of
skilled breastfeeding support but like you, after years in the medical system
I realize that change occurs (in our lifetime ;) ) only when it is patient or
MD driven. I see my recommendation as killing several birds with one stone
here; by reminding the OB of the importance of postpartum brfdng support and
of the easy availability to it through these visits (thus their emphasis on
it may precipitate change) AND  by stressing to families that it is their
right to demand quality care in this area (when they ask enough someone is
bound to listen!).
Lynn Shea Rn,Bsn,Iblcl
Franklin,Massachusetts

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