Hello All,

The topics of consult length and insurance billing are discussed periodically here and on professional social media sites.  I offer this viewpoint: 

Many consults are to assist the dyad with the baby’s motor learning toward motor control at the breast, and also to support the milk supply until the infant can drive the volume. Of course our profession addresses all that is related to lactation and infant feeding, and so much is about assisting the baby in becoming skilled at the breast.

Consider that occupational therapists work twice daily with adult inpatients in rehabilitation facilities for the reacquisition of patients’ self-feeding skills. These twice-daily OT visits take place once in the morning and once in the afternoon, typically for at least two weeks and longer as needed. Most adult patients who are relearning feeding skills in rehabilitation facilities are receiving further care after a stroke or traumatic brain injury.

Both members of the nursing dyad deserve at least as much time as one adult patient in a rehab facility who routinely receives professional support from OT for the reacquisition of self-feeding skills.

In nursing dyads, there are two patients — not one patient per consult, unless the consult addresses a concern with only one member of the dyad, such as in mastitis. Two patients during one consult often warrant more time spent in the consult.

Imagine the good that our profession could do if outpatient consults took place daily in instances of the baby’s motor learning toward motor control, as well as in other instances that warrant more frequent follow-up. This is not to say that daily consults should occur for weeks or months without end, but in the early days of skill acquisition for feeding skills, the professional time that is allotted to adult rehab patients who are relearning feeding skills should also be granted and tailored to the youngest patients who are just beginning their learning in how to feed. 

A question for IBCLCs and other infant feeding specialists in England:  

At least twenty to 30 years ago, I came across information on midwives working as health visitors for the National Health Service who made daily visits to new dyads for the first two weeks postpartum.  Was this information correct in regard to the frequency and duration of postpartum visits, and does this wonderful practice still exist? 

With kind regards, 

Debbie

Debra Swank, RN BSN IBCLC
Program Director
More Than Reflexes Education
Elkins, West Virginia USA
http://www.MoreThanReflexes.org

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