Mothers of Twins, other mother-to-mother support groups, a telephone hot line for breastfeeding women, or the hospital's lactation consultant.

  • Support for and additional information about breastfeeding provided in the woman's home within a few days after discharge.

  • Support for and additional information about breastfeeding at the first neonatal health visit (within 2 weeks after birth)17 and at the routine postpartum visit, with anticipatory guidance to prevent premature cessation of breastfeeding.18

  • Assistance with strategies for continuing to breastfeed upon returning to work or school.

Home Visits and Other Early Follow-up

The home visit deserves special consideration and discussion because it is not a part of routine care in the United States. In Western Europe, home visits (usually by specially trained nurses) are widely used in postnatal care: seven of nine countries always provided at least one postnatal home visit in 1982.19 In the United States, the value of home visits for a variety of purposes is receiving increasing ecognition.2030

Home visits offer unique opportunities for care providers to observe infant feeding and care practices, the mother's coping skills, and the resources available to the mother; they also allow follow-up of many other aspects of maternal and infant health. Such observations enable the home visitor to tailor the assistance and educational strategies to the mother's and infant's special needs. Suitably trained home visitors can quickly identify ways to advise the mother on planning simple but nutritious meals and snacks, avoiding or managing infant feeding problems, and resolving other concerns. This may be especially valuable for mothers of twins, low-income women, adolescents, women with limited education or intelligence, and women with a history of problems with child rearing. The home visit is also an opportunity to provide direct assistance with techniques for the manual expression of milk and, if desired, for the use of a breast pump.

Although too few studies have been conducted to allow an adequate evaluation of the cost-effectiveness of postpartum home visits, the U.S. General Accounting Office concluded that "home visiting is a promising strategy for delivering or improving access to early intervention services that can help at-risk families become healthier and more self-sufficient" (p. 2).29 A telephone contact can serve as only a partial substitute for a home visit because it does not allow for direct observation or intervention, or for the modeling of desirable behaviors.

A home or office visit with a physician, midwife, or nurse-practitioner within approximately 2 weeks of delivery is highly desirable for both



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