I have been really interested in the discussion on "time for visit" re:
out-patient consults. As a RN I had a job for several years (in the 1980s)
doing "early discharge" postpartum visits -- usually within 24-48 hours of
hospital discharge, which included mother and baby assessment, often
included BF assessment, sometimes included an infant heel stick for
metabolic screen testing or bili, etc. Then I had a LC PP during 90s and
into the 2000s and did "in office" and couplet home visits, etc.
Occasionally, still do a home visit for a neighbor, relative or friend but
mostly in-hospital LC currently.
At any rate, I noticed when I first started post-discharge visits that it
was rare for such visits to take less than 60 min. Needed at least this much
time to get informed consent signed (a quickie), get history, etc. -- which
are also important aspects of establishing trust, observe a BF,
develop/review an action plan with the mother, etc. Obviously, we worked
around the baby so the order in which I went about a visit could change --
and I generally preferred getting baby vital signs or heel stick during BF,
since baby was calm/blissed on mom's milk endorphins (and bled better so
less "trauma" for baby and all involved)...

OTOH, I also noticed that when a visit went beyond 90 minutes that maternal
nonverbal behaviors (body language, expression, ability to attend to what we
were doing, etc.) began to indicate that the visit was over! Occasionally, I
found I was the one "closing down" when things went much over 90 minutes.
Honestly, exceptions to the 60-90 min "rule" were/are extremely rare. (This
time only includes actual time spent with couplet client -- not
documentation time!)

Those experiences led me to believe there's a built in 90-min max
"wave"/cycle for a consultation of this type. (Also seems to apply to other
types of professional-to-client interactions.) Less than 60 min, except when
"trust" has already been established and/or baby is ready and/or is fairly
simple "tweaking" issue, is usually not enough time to achieve desired
"outcomes" -- yet more than 90 min also becomes ineffective/inefficient use
of time related to client (or consultant) shut down!

The current discussion on Lactnet seems to reinforce my "wave"/cycle
theory. Don't know if of interest to anyone else, but it sure has been for
me!

Karen Gromada

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