I share Pierrette's experience, which is why I was/am curious to hear what
happens elsewhere.
I had my children in San Diego. My first three were born in the hospital.
At the time, the county policy was that if you were discharged within 24
hours, a public health nurse visited you within 24 or 48 hours (can't
remember which). Even with my third child, a public health nurse came to my
house and checked us out. Given that I was an "experienced" mother, my
pediatrician gave me the option of either coming at 4 days or 2 weeks,
whichever my preference. With my second, after the public health nurse
visit, I was referred to the lactation group back at the hospital for the
breastfeeding difficulties I was having. Honestly, I don't know if my
postpartum brain was working well enough at that point to think, "You need
to get some help and here's where to get it and, hey, you can go tomorrow."
My son was born at home and my midwife or one of her assistants came daily
for the first week.
When I moved to Roseville, I wrongly thought the public health nurse visit
was a standard of care and stuck my foot in my mouth with the department
head, asking her why so many women I knew weren't getting that visit. Makes
sense to me, for many, many reasons. While there are advantages to having a
public health nurse do the visit, it could be someone else. I do think
actually visiting the mother is important.
Mary Wagner-Davis
Date: Sun, 29 Oct 2006 22:56:37 -0800
From: PERETTE PERETTE <[log in to unmask]>
Subject: The 2 week visit and discharge planning
Hi,
A member posted that because of the AAP's recommended guidelines about
followup of newborns that babies are being seen earlier postpartum.
I wish it was so. In my community in the Central Valley- with the
exception of a few providers babies were still being seen 2 weeks postpartum
for the FIRST visit. If the baby had Medi-Cal (the California state name
for Medicaid for low income patients) that first visit could happen as late
as 6 weeks post-partum. Babies did not go out the door with followup
appointments-- moms were expected to call to make appointments- in some
practices that was a daunting task just to get through the phone system.
When I had my private practice-- I did my best to see babies 2-3 days post
discharge from the nursery ( I saw about 50% Medi-Cal in my private
practice).
Up here in Sonoma County- docs see the babies anywhere from 1-2 weeks
postpartum. Most babies do however get a visit from the homecare nurse
(many of whom are also IBCLC's as well).
So perhaps in bigger US cities with higher income patients, babies are
seen within the 2-3 day window by a doc. If one is lucky, the hospital may
have a home visiting nurse do a visit in the first week.
These days, I am spending most of my time (75%) working in public health
doing administrative work, my only clinical work is on the weekends in a
pediatric urgent care. I miss the patient care aspect of general
pediatrics. However in the United States (especially in California) it has
become increasingly difficult to practice general pediatrics and actually
make money (especially if one chooses to care for indigent patients).
Perhaps in the future I will find some happy medium. A way to still do
breastfeeding support and be able to cover all my costs.
Best,
Pierrette Mimi Poinsett MD
Petaluma CA
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