Laurie writes:
"The phone follow up is the very least, but I will say that parents quite
often (in my experience) misjudge jaundice, wetness of diapers, infant
lethargy, infant gassiness (hunger), constipation vs low intake, and whether or
not they are experiencing copious milk production. There is simply no
substitute for in person evaluation, guidance, and support. This is the gold
standard."
My hospital's telephone follow-up program of about 23-25 hours per week got
the ax three years ago in the first round of what turned out to be 3 RIFs
in about 2 years. This was a great loss to the mothers in our area.
The very skilled CLC/CCE who did the follow-up is now a per diem IBCLC in
our facility. I am able to make only a few follow-up calls daily, usually
to those mothers who have left with identified risks or problems, or to
those I am calling as follow-up that I thought was necessary after an out-pt
consult.
Many mother and infants in our area still receive an MCH visit from one of
3 home care agencies in our area. It is not quite as automatic as it used
to be, but still provides a level of follow-up that other areas of the
country may not be as fortunate to have. I know from attending conferences and
speaking with other IBCLCs and visiting nurses ( I used to be one) that we
are a rarity in that this is still fairly available in our area.
I am starting to educate mothers on just concentrating on their infant's
stooling pattern after discharge, and not worrying so much about the wet
diapers, and show them exactly the size of a "good BM." I tell them that if
their infant is stooling appropriately as I describe, then they will most
likely be urinating in a sufficient amount. LLLI (LaLecheLeague International)
has a good handout on this that I refer to. We do give out our own feeding
and output sheet that parents can log on, but I wonder how many of them
really use it.
Mary-Jane Sackett, RN, IBCLC
Pittsfield, MA
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