In a message dated 10/19/00 12:17:43 AM, [log in to unmask] writes:
Betty writes;
<< As I have learned the importance of home visits during the postpartum
period, I was surprised to find out these visits are not done in my
area. I am interested if any of you do them. What are your
qualifications? Do you feel they benefit the breastfeeding woman? Are
these visits through a home health agency or a hospital? Are these
visits covered by health insurance? I would appreciate any information
you could provide on this subject.
>>
Dear Betty,
Thanks so much for asking about this often overlooked field of nursing AND
avenue for postpartum breastfeeding support! I am an RN with almost 20 yrs
of nursing and 6 yrs. IBCLC. I have worked in many different settings;
hospital NICU, PICU, pediatric cardiology, general peds, home care peds, at a
free standing birth center, as a hospital LC and currently private practice
LC and MCH (maternal child health) RN for a VNA in the Boston area. I just
got home, as a matter of fact, from providing 2 home visits to newly pp Moms
this am. The MCH component of our agency provides pediatric home visits (5%)
and EMD (early maternity d/c) visits (95%) of our caseloads. In Massachusetts
there is legislation that requires that if a Mom leaves the hospital w/i
48hrs. of a vaginal delivery, her insurance must cover the option of a home
visit provided within 1-2 days of D/C (or 96hrs after cesarean). There is
also at least one major insurer in this area that provides visits to any new
Mom regardless of discharge timing.
My qualifications and background are not typical, however. Most RNs that I
have met do not have the range of background and most are not IBCLC. In my
mind, the most integral part of my job is providing breastfdng. support. The
population I see is largely middle-uppermiddle class married couples and my
guess would be 80-90% are breastfdng. This is higher then the hospital
averages in my area, but the breastfdng Moms seem to select themselves out as
a group more interested in home followup. They are also, sometimes, selected
out by the hospital as needing home breastfdng. management.
One aspect that i have found very interesting is that the majority, when
asked, will state that the brfdng is going well and it isn't until the
answers to some of my questions raise red flags or my assessment of the baby
AT the breast (which I always do but is definitely not the standard for
practice!) reveals some probs that the Moms see the need for teaching or
assist. Sometimes these areas for improvement are small, taking off blankets,
sl. wider latch etc and sometimes they are huge-the baby isn't transferring
milk atall but it doesn't matter as the small probs, I think, often multiply
into the larger and result in premature weaning, "not enough milk" etc.!The
timing of the visit is ideal as well, as it coincides with the milk becoming
more abundant for most!
To answer what I feel is your most important ??- yes these visits are hugely
beneficial to breastfdng women, much more so then to those bottle fdng! I
believe that every first time nursing Mom should ideally be provided one by
an RN/LC ! As for those bottle fdng Moms... the 2 that I've seen in the last
wk changed to breast by the end of my visit ;) !!! I wish they were all
that easy!!
Any more questions, feel free to contact me!
Lynn Shea Rn,Bsn,Ibclc
Franklin, Massachusetts
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