I wanted to chime in on the concept of postpartum care from the perspective
of a physician who practices in a rural area.  
There is very limited services available in many rural areas, and even paid
services are almost non-existent. 
Our local health department and WIC provide some services, but they are
limited and are limited to special needs infants for the most part.  There
is no home visiting program of any kind for healthy newborns, and most
physicians in the area do not schedule a visit until 2 weeks of age with the
newborn.
Our small labor and delivery unit does allow moms to bring babies in for
weight checks, but this requires the parent to be able to get there under
their own power.  If you have had a cesarean birth and have no support at
home (which unfortunately happens quite often) you may well not be able to
bring the baby out alone.  Our teen moms are encouraged to go back to school
as soon as possible, but there is no follow up program for them (and hence a
very high drop out rate) and breastfeeding teen moms cannot get any
accomodation from the school to pump.
There are no doula services for many miles, either.  
I just received a memo from our state's Medicaid program, though, that
states that as of Jan 1, 2006, hospital grade pump rental will be covered by
Medicaid, but standard home visiting services are not.
There are so many holes in our safety net that I certainly wouldn't want to
jump around here!  Unfortunately, I don't think where I live is an
exception, but rather the rule for rural areas.

Jennifer Tieman
Family Physician
Mom to 4, including my nursling Caroline Rose (age 32 mos.)

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