In my workplace we have forty minute appointments, four in a row before
lunch, followed by one thirty minute one to make the appointment book
neater, and then two more after lunch.  In between there may be someone who
came in for a bilirubin measurement and needs to do a naked weight on the
scale in our office so we at least have that information when deciding how
to respond to the serum bilirubin value.  Ideally we would want to see these
babies in clinic but the appointment book is often filled and we have to
settle for less.  During so-called lunch, and regularly throughout the rest
of the day, the person working the clinic is interrupted by phone calls
routed from the hospital central switchboard, some correctly and many not,
as well as ward staff coming in to ask if we can just pop in to the mother
in room this or that whose baby is two days old and still hasn't latched, or
give an opinion on a possible tongue-tie, or any number of things that are
more or less breastfeeding related.  As often as not, there is a student or
some other health professional along for the day to observe and learn what a
breastfeeding clinic looks like.
If the mother has twins, she gets a double appointment.  We used to try to
give double appointments any time we anticipated that things could take
longer than average, but the no-show rate on the double appointments was
higher than it is for the regular ones and it wasted a lot of our time, time
we could have used to help someone else who needed it just as much.  We have
a second room available so if a baby is still feeding, or needs a change
before they can go home, we can take in the next mother and baby without
bouncing the previous ones out on their ears.
I can say one thing for this system - you get really good at doing FAST
global assessments of feeding (the alternative is having a nervous
breakdown, which doesn't appeal to me).  You have to learn to talk and move
slowly and calmly while still thinking fast - not to mention how fast you
need to type to be able to chart the visits afterwards!  The bottom line is
that the mothers who use our clinic don't have any real alternatives, and
they seem genuinely grateful for the help they get.  It's downright
embarrassing not to be able to offer them more time, but in some twisted way
I think it also communicates some good things: you are not alone (evidenced
by the thronging to get on our appointment book) and your problem is
solvable with fairly simple means and a minimal cost in staff time.  The
mothers I see are generally very willing to go to great lengths on their
own, to get breastfeeding to work, as long as they can check in with someone
knowledgeable at regular intervals during the process.
Laurie Wheeler's description rang all too familiar with me, and her
suggestions for how to survive in such a work environment, are worth their
weight in gold.  In my perfect world we would have about twice as long for
each consultation and better furniture too, but the tradeoff here would be
that we could only help half as many, and that isn't acceptable.  
Rachel Myr
about to do a shift on the ward, where I and one maternity care aide will
have nine mothers and their babies to look after for eight hours straight,
and we have to do everything else in addition to helping sort out the
breastfeeding - at least in clinic I get to see them one case at a time :p

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