Follow-up of our newborns has become a very sore subject for us in Public Health.  We are seeing a delay in first doctors' visits - and a false reassurance to mothers whose babies ARE seen early that it's "normal" to be losing weight on day 3, 5 or 7.  
   
  They then schedule another visit at 2 months!  With few instructions about coming in if there is problem... between language barriers, the desire not to "bother" the doctor and feeling they are really "exaggerating" their concerns as new moms, situations have deteriorated quickly that could have been prevented by early and frequent contact.
   
  Where I work, our Public Health Nurses are NOT meant to be the safety net for these children!  They cannot make immediate home visits, though they do try, knowing that if they don't, either a baby will be terribly jaundiced, or weak or will be supplemented.
   
  In my "ideal breastfeeding system" - ALL mothers would get a home visit on day 3 - and the decision on when and how often to visit will be dependent on the findings at that time:
   
  If we have a baby that is awake, alert, nursing well and a mother that is showing signs of initiating good milk production, follow-up by phone for the next few days with a home visit again on day 5-7 would be OK.
   
  If the baby is sleepy, ineffective nurser, mother has no signs of milk production, etc., then daily home visits and even possibly a breast pump to get a "jump start" on milk production that has not been initiated is the appropriate plan.
   
  Our problem is...who pays?  If the mother is private insurance - they won't pay for home visitors (at least those I know of here in California).  If the mother is low-income, we usually can have a Public Health Nurse visit her in my county, but this isn't so in every county.  If the PHN finds there's a problem she can't handle, I then make a visit WITH her (so I'm considered a "trainer" not providing "direct services").  
   
  The fact that babies are better served in the home, less risk of catching the "virus of the day" as well as avoiding unnecessary visits to ER and hospitalizations due to jaundice, etc...  
   
  Sorry...my frustration is showing!
   
  Jeanette Panchula BSW, RN, PHN, IBCLC
  California, USA
   

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