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Subject:
From:
Lee & Karen Palmer <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 8 Feb 2006 22:49:12 +1300
Content-Type:
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Jeanette - I feel your frustation.  Not that New Zealand is always a shining
example of maternity care (or so the press states), but every mother is
entitled to 5 - 10 home  visits in the first 4 - 6 weeks postpartum. At
least 3 of these would be in the first week following a 48 hour discharge.
This is a seven day a week service with on-call availability out of hours.
For this I am paid $400.00 by the Health Department.  That is not a lot when
you consider the work that is involved but it does increase breastfeeding
rates and  reduce  hospital admissions.

If I may make an observation of the US system - it appears that a lot of
money is spent in the delivery room and little in the community.  New
Zealand used to be a bit the same until women lobbied to have a more  women
focused materntiy system that was based in the home.  Alright - we have free
maternity care and it is largely midwifery run-but surely it would be more
cost effective for your insurance companies to put the resources where they
are needed.

Please - this is not a criticism.  I do not want to offend anyone.  But
sometimes it is interesting to know what happens in other places.

Karen Palmer
Midwife and IBCLC
New Zealand

--- Original Message ----- 
From: "Jeanette Panchula" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, February 08, 2006 2:11 PM
Subject: Breastfeeding and neonatal weight loss


> 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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