Re:home visits. vs. office visits

[Guest guest]

I prefer home visits to OP visits because I can meet the rest of the family, see what the dynamics are, and enlist the help of dad, grandma, auntie or whoever is there. I find it useful to teach mother's support person how to help mom breastfeed better. I also get to see how the thermostat is set, how baby is dressed and where he sleeps, how many other kids there are, etc. Also, as someone else mentioned, I can see where mom sits to breastfeed. I recently saw a mother who used a large rocking chair; she had to push up on tiptoes to get the chair to lean back far enough. If she had been in my office I would have missed that. I've never had a mother take me less seriously just because I came to her home, after all she is paying to hear what I have to tell her.

I don't care to drive long distances, so charge enough to make it worth my while. When cost is an issue, I refer the mother for an OP visit to the hospital where I work (about half the cost).

-

[Guest guest]

Primarily I do home consults in the Atlanta, Georgia metro area, where, due to traffic and/or distance, 40 minutes one way is probably the typical travel time. I have a nice office in my home used mostly to rent pumps and sell pump parts. Occasionally, if a mother prefers, I will do a consult in the office. Or if it would take an hour or more to reach her, I may ask her to come to me. This may depend on how tired I am that particular week (I'm older than most). My preference, in spite of the time involved, is home consults because I see so much more than I could have imagined or thought to ask about, otherwise. For the more difficult situations, I do believe that it is more productive to be able to see how they live, what they deal with, the physical set-up, the firmness of their seating, what pillows they have, how family members support them - physically and verbally. There is no doubt in my mind that a mother who comes to me gets less help, no matter how hard I try. I look all over their homes and do my best to offer suggestions to make life easier for them. A majority of my clients live in large home, have had c-sections, do a lot of stair climbing. I charge by the hour. More for home consults. Final appointment times are scheduled one feed prior to my visit - I try to arrive about 15 min. before mother feels baby will want to feed. They pay me cash or I will leave an envelope for them to mail payment to me, if they need that. No additional charge for follow-up phone calls. I prefer to do one or, at most, two consults daily. They are too intense, time consuming - especially with follow-up phone calls - to do more. I do believe in follow-up phone calls. My belief is that new mothers are fragile and no matter how many times we invite them to phone us, most feel it is hopeless if things don't improve right away or at the pace they had hoped. Many simply don't believe more can be done. I don't agree with some things we hear at conferences like " moms need to want it more than we do"- as an excuse to not follow-up with them. On the occasions when I'm feeling burned out, overwhelmed and delay follow-ups I can predict that a few vulnerable mothers will have quit.

Anne Grider, IBCLC

[Guest guest]

Dear Colleagues:

I am enjoying this thread.

Follow-up telephone calls are a way of honoring the new mother; in the

USA, a new mother get bupkiss, nada, nothing unless she is lucky

enough to have her own village of female relatives able and willing to

help or to have enough money and education (or smart friends) to hire

a doula.

Letting her set the pace with these calls, with questions like " When

should I call you again? " or " If I don't hear from you in a few days,

I'd like to call and check in. " is a mutual way of relating.

Keeping track of her progress for her is so helpful too, as in, " When

you first came to see me, your baby wasn't latching on at all.

Yesterday, you told me that he latched on THREE times! This is

awesome, and you are making progress. "

warmly,

Nikki Lee