Hi all:

I am in a frustrating situation (that seems to be common on posts lately)
and any suggestions would be greatly appreciated!  I was told yesterday that
one of the HMO's we deal with at our home health agency would not grant any
further home visits (other than the 1st pre-authorized one I completed 2
days ago) for 35 week bfing twins who are not bfing well at all.  One twin
isn't spending any time at the breast!  Mom wasn't even pumping prior to my
visit and was freely using a breast milk sub.  We really just touched the
tip of the iceberg on the 1st visit.

It was relayed to me from the HMO reviewer that it is "the mother's choice
to bf and we cannot approve instruction for this.  However if mom receives
instruction for supplementing or pumping, that is ok."  They do not feel
actual bfing is *necessary*!!!!  I couldn't see straight or breathe properly
for quite awhile after that contact.

Ulitmately we will get more visits - using the pumping/supp route, but how
do I deal with this infuriating lack of knowledge/understanding?  I need any
and all tactful suggestions - though I don't feel like being tactful!  (I
actually want to throw a good temper tantrum at this point!)  This is a
tough one - they are a big HMO in our area and our agency's dealing with
them is an eggshell situation at best.  TIA, many times over!!

In desparation,
Debbie Shinskie
Private practice/home health/education