Long e-mail re: postpartum visits.
I'm still awaiting funding from the Ministry of Health. I can't wait to start practicing!!!
For now I'll just wait out the heat in the library or my friend's house.
I heard from a woman who interned after I did at a birth centre in the south USA. She trained after I did, but is already practicing, thanks to the more relaxed 'red tape' in her state. She was inquiring about including a day 4 or 5 postpartum visit and was wondering my opinion (the birth centre protocol is a 2 day then 2 week, which I don't think is quite enough). Because I am lazy, I have pasted her e-mail and my response below.
>>> "____" <____> 08/02/06 12:11 PM >>>
Hey, [Storkforbabies],
Are you going good and strong yet? It sounds like when you do, you'll be going steady, as far as how many clients you already have...blessings on all that.
I have a question for you. What pp visits do you do? And what exactly do you do on those visits? I'm considering adding a 5 day pp visit, but I really don't know what I'd do on that day. I really think that clients need a little more support than just 2-day and then 2-week. What do you think?
Love you,
____
>>>
Hi ___!!
So good to hear from you!
I am not yet practicing... still awaiting funding from the Ministry of Health. It has come as late as mid-august before, so it looks like it might be that this year too...
Regarding postpartum visits, I find that the 4 or 5 day is VERY valuable. Right now the [provincial] schedule is day 1(within 24 hr), 3, 5, 7 (7th day is usually at the clinic), then 2,4, and 6 weeks (all at clinic). For an experienced mom with no problems on day 1 and 3, sometimes the 5 day is a telephone call instead. The reason I think that the day 4 or 5 is very valuable is that if postpartum depression is going to set in, it is usually around this time. I usually warn moms that sometime on day 3 or 4 they will have a blue day, but if on day five they are still down, and struggling, it is a good time to have a chat with them, perhaps pull out the Edinburgh depression scale and go through it with them, either to rule out PPD (and give them some reasurrance that although they are going through a rough time, there is nothing wrong) or to diagnose it and get them to see their family doc. I actually had a PPD this winter (this mom had a bit of a rough time: breastfeeding difficulties, her husband didn't make it to the birth, etc), although when I asked her how she was doing, she said "better". I could tell by the way she said it, that that was a stretch! After the visit, I called her family doc, and discussed it with her, and they made the decision not to medicate but to do some counseling. After an hour long visit with me and talking out a lot of issues such as re-negotiating roles within the family now that there is a new member, as well as allowing each other to handle the baby the way they are going to do it (being supportive of each other), as well as talking about how they are feeling, she felt much better, and felt like she wouldn't need to see her family doc unless I thought it was necessary. I felt like it would be a good idea considering that on the Edinburgh scale she was considered depressive, and she went ahead and did that. I think also the fact that I took the time to sit down and talk about it in a caring manner made a big difference to her (in fact, her husband said he felt like he was at the therapist's!!!).... Of course, we don't get a lot of moms with PPD due to the kind of care we give.... but I digress...
Back to the topic - day 5 is also a good day to confirm that things are going well with breastfeeding. Sometimes on day 2 they are still struggling a bit, haven't got things quite perfected, etc. and it is good to be sure that babe isn't starving... ! and to give mom encouragement.
Also, if you are going to get endometritis, it usually shows up day 4 or 5. I had one of those too this winter, and I'm sure it was hospital-acquired, but you never know... anyway, with no activity (just laying on the bed or sitting on the couch) this mom was having about 15 quarter-sized clots per day with her flow, and because she was a first-timer had no idea that that was abnormal (even though we go through the whole speel about how much bleeding is too much). After a round of antibiotics she was fine. No temp BTW. Pulse was borderline high.
Another reason I do it is because often about day 4 or 5, some moms feel like they have been in bed for a long time and they can now get up, vacuum the house, do the laundry, and lug around their 2 and 4 year old. It is a good thing to step in and say "just a bit more rest, please".
So to sum up, yes, I think another visit is very appropriate, and my clients sure appreciated it. There are many reasons to do it and I am all for it. I believe that the clients are well served with it.
..... [personal stuff]
Love you,
Stork
For now I'll just wait out the heat in the library or my friend's house.
I heard from a woman who interned after I did at a birth centre in the south USA. She trained after I did, but is already practicing, thanks to the more relaxed 'red tape' in her state. She was inquiring about including a day 4 or 5 postpartum visit and was wondering my opinion (the birth centre protocol is a 2 day then 2 week, which I don't think is quite enough). Because I am lazy, I have pasted her e-mail and my response below.
>>> "____" <____> 08/02/06 12:11 PM >>>
Hey, [Storkforbabies],
Are you going good and strong yet? It sounds like when you do, you'll be going steady, as far as how many clients you already have...blessings on all that.
I have a question for you. What pp visits do you do? And what exactly do you do on those visits? I'm considering adding a 5 day pp visit, but I really don't know what I'd do on that day. I really think that clients need a little more support than just 2-day and then 2-week. What do you think?
Love you,
____
>>>
Hi ___!!
So good to hear from you!
I am not yet practicing... still awaiting funding from the Ministry of Health. It has come as late as mid-august before, so it looks like it might be that this year too...
Regarding postpartum visits, I find that the 4 or 5 day is VERY valuable. Right now the [provincial] schedule is day 1(within 24 hr), 3, 5, 7 (7th day is usually at the clinic), then 2,4, and 6 weeks (all at clinic). For an experienced mom with no problems on day 1 and 3, sometimes the 5 day is a telephone call instead. The reason I think that the day 4 or 5 is very valuable is that if postpartum depression is going to set in, it is usually around this time. I usually warn moms that sometime on day 3 or 4 they will have a blue day, but if on day five they are still down, and struggling, it is a good time to have a chat with them, perhaps pull out the Edinburgh depression scale and go through it with them, either to rule out PPD (and give them some reasurrance that although they are going through a rough time, there is nothing wrong) or to diagnose it and get them to see their family doc. I actually had a PPD this winter (this mom had a bit of a rough time: breastfeeding difficulties, her husband didn't make it to the birth, etc), although when I asked her how she was doing, she said "better". I could tell by the way she said it, that that was a stretch! After the visit, I called her family doc, and discussed it with her, and they made the decision not to medicate but to do some counseling. After an hour long visit with me and talking out a lot of issues such as re-negotiating roles within the family now that there is a new member, as well as allowing each other to handle the baby the way they are going to do it (being supportive of each other), as well as talking about how they are feeling, she felt much better, and felt like she wouldn't need to see her family doc unless I thought it was necessary. I felt like it would be a good idea considering that on the Edinburgh scale she was considered depressive, and she went ahead and did that. I think also the fact that I took the time to sit down and talk about it in a caring manner made a big difference to her (in fact, her husband said he felt like he was at the therapist's!!!).... Of course, we don't get a lot of moms with PPD due to the kind of care we give.... but I digress...
Back to the topic - day 5 is also a good day to confirm that things are going well with breastfeeding. Sometimes on day 2 they are still struggling a bit, haven't got things quite perfected, etc. and it is good to be sure that babe isn't starving... ! and to give mom encouragement.
Also, if you are going to get endometritis, it usually shows up day 4 or 5. I had one of those too this winter, and I'm sure it was hospital-acquired, but you never know... anyway, with no activity (just laying on the bed or sitting on the couch) this mom was having about 15 quarter-sized clots per day with her flow, and because she was a first-timer had no idea that that was abnormal (even though we go through the whole speel about how much bleeding is too much). After a round of antibiotics she was fine. No temp BTW. Pulse was borderline high.
Another reason I do it is because often about day 4 or 5, some moms feel like they have been in bed for a long time and they can now get up, vacuum the house, do the laundry, and lug around their 2 and 4 year old. It is a good thing to step in and say "just a bit more rest, please".
So to sum up, yes, I think another visit is very appropriate, and my clients sure appreciated it. There are many reasons to do it and I am all for it. I believe that the clients are well served with it.
..... [personal stuff]
Love you,
Stork
posted by Stork at 3:07 PM
0 Comments:
Post a Comment
<< Home