For instance:
	1.  Where do you generate the contact information with address and
phone numbers?
	2.  Do you follow up at 3 weeks?  3 months?  6 months?  9 months?
12 months?
	3.  Is this follow up by phone or post cards, letter?
	4.  Do you have a designated person to make all these contacts?

***************************************************
Evelyn asked these questions, and though I may not have answers to them all,
I would like to suggest that we DON'T have to have everything taken care of
via the hospitals.

One of the concepts that I try to bring out wherever I go is the need to
"collaborate" with all the other groups in your community whose interest is
having healthy mothers and babies.

For example, in our county, there is the Maternal, Child and Adolescent
Health bureau, the Public Health Nursing department, WIC, the insurance
company that insures many of our low income moms, and others who provide
prenatal and postpartum services.  

One project we developed was funded by the insurance company, manned by
staff (health visitors, translators and health visitors) from the Public
Health Nursing Department in collaboration with the hospital.  Moms were
called on day 3, 7, 14 and 21 - we were making sure that infant and mom
appointments were made (important to the prenatal and pediatric programs'
Quality Assurance), that they had gotten assistance if they had questions
and referrals to local programs (public health nursing and WIC as needed.
We called with "anticipatory guidance" (i.e. day 3 - you may have
engorgement, then breasts will soften, but that's OK and day 10 warning
about fussy periods) as well as questions that helped to identify who needed
help vs. who needed general information.  Linking them to support groups,
(we have one that meets in each of our WIC offices, and moms do NOT have to
be on WIC to attend), Lactation Consultants, La Leche League, etc. is
important.  

Hospitals can be the best resource to avoid the "no man's land" of the early
postpartum period - but we want to make sure moms can link to services that
can keep on helping moms after discharge.  

The "tag team" approach can reduce the stress on any one group - and
demonstrating collaboration and quality assurance makes JCAHO happy - and
hospital administrators look good...  A WIN-WIN for all including moms. 

Some examples of follow-up documentation can be found at the website:
www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/BFP-MdlHospToolki
tPolicy10.aspx

If the various groups can meet and develop a memorandum of understanding,
then information can be shared, moms can be helped, and we can prevent
losing moms in the process.

Jeanette Panchula
California, USA

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