Hi Sandy:

I was hired & began a lactation program for a home health agency in 6/95.
Due to the nature of their incorporation/affiliation, we have a home
visiting program, rather than a follow up clinic.  I can briefly tell you
what it entails:

1. 10 steps from BFHI in place but revised a bit to suit home health needs.

2. Policies in place that are based on the 10 steps

3. All OB/ped nurses are completing the UNICEF 18 hr course & following me
for pt. visits until we are comfortable.  They refer to me as needed.

4. Lactation visits that are appropriate for each of our OB/ped programs - #
of visits depends on the program & mother's needs & 3rd party payors:

        -early maternal discharge:  follow up in mother's home 24-48 hrs after
        their discharge - all OB/ped nurses are covering these visits - they try
        to schedule me for bfing clients, but it doesn't always work.  A mom
        discharged with bfing problems is given priority for me to see her.

        -Regular prenatal/pp visits as referred by HCP - some specifically
        request LC visit, some don't but schedulers are alert to mom's feeding
        plans and plan appropriately

        -Healthy Beginnings plus - I case manage any bfing moms in this program.
        It involves 4 prenatal visits & pp follow up that is more detailed
        than other programs but varies.  One prenatal visit is entirely
devoted         to bfing in this program.

        -Babies First program - A 2 yr. low income infant follow up program
        alloting 8 visits per baby - state grant.  If mom is bfing, I case
        manage for the duration or until weaning.

I personally like the in-home follow up for many reasons.  I can honestly
see what her "nursing nest" looks like.  I get a real feel for the social
issues around her.  I can better guess what may or may not work and plan my
suggestions appropriately.  I also feel there are moms who really love the
decreased hassle of staying home as opposed to packing up to head out to a
clinic/office.  There are also those moms who are very worried about what
you might see - ranging from she and the house are a *wreck* to something
more scary like she has no heat.  Hence another reason I like the home visit
- getting a mom more help than she may have dreamed possible.  Re: the house
being a wreck (or mom!), I always include as part of my call to schedule
with mom directions to *NOT* make these issues a concern.  I remind her that
dust and pajamas are a part of normal pp!  I tell her that an immaculate
house will scare me - I have 4 kids!  I suggest that I hope I find her just
out of bed when I get there.  Often moms begin the visits offering yummies -
I take that as the golden moment to remind her of her pp roles - rest,
recover, get to know her baby, & bf!  Then we discuss who can provide HER
with yummies over the next few days/weeks.

One thing I have learned in this role - 3rd world conditions exist a might
close to home.  Sometimes we fall into the trap of thinking not in my
backyard but it is!!!  I have woven this into the 18 hr course - bfing &
survival isn't just a 3rd world issue.  Thankfully I found that experienced
home health nurses take this quite seriously - newer ones soon learn too!
This is by far the easiest LC position (save the dealings with 3rd party
payors!) I have ever had from the standpoint of dealing with staff.

I am still learning a great deal but this is where I am for now.  Hope this
is helpful to you.

Debbie Shinskie RN CES IBCLC