I run an outpatients breastfeeding clinic for our local hospital and it has just completed a formal evaluation funded by the Ministry of Health, which should be published shortly.

One of the comments of the evaluation was the effectiveness of scheduling the appointments when the baby was likely to be feeding and as you will know, this is often not easy.  On the phone, I say to the mums, "bring the baby ready for a feed, but not starving". This just about always works out.

All my visits take 60 - 90 minutes (mostly 90) - sometimes longer, so I am interested to see this seems to be an international trend. I too, fit the history taking around when the baby is settled so forming an instant trust on arrival is very important. Luckily I take some baseline information on the phone first. I find every visit needs to be summarised at the end to ensure the mother/parents are going away with some understanding of the issues they are experiencing and the solutions for them to work on. This part cannot be rushed, and sometimes this can be very time consuming if the mum is really sleep deprived and stressed.

All my clients have a primary care giver in the form of a home visiting midwife, or if after 6 weeks, a well child nurse. Babies are only seen by doctors if they are sick or it is a scheduled immunisation. Every mother in New Zealand has access to a midwife home visiting for 6 weeks after birth, so the referrals I get are for the clinical issues around breastfeeding, over and above what a primary practitioner can manage.

I run this clinic on my own, so sometimes have a lap over of mothers.  I have set the room (a big room) so this can be reasonably private.  These mums often reach out to each other and open up a communication as they sense they are going through a similiar experience.  

Karen Palmer
Midwife and IBCLC, NZ


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