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When you do a home visit do you charge by the hour or a flat rate for the visit? I charge a flat rate, but sometimes, I feel that perhaps that works against me. On one hand, I want there to be a relaxed atmosphere. I want the mom to feel like we are addressing all of her questions and for there to be time for a sleepy baby to come around and to nurse well. I want to make sure she is comfortable in different positions and that she knows how to nurse lying down. In some cases, I want to be sure the baby can be fed supplemental feeds in ways that require some training and modeling. However, I also would like to get out of there in under two hours. Sometimes, I feel like because there is no clock running the time goes on and on. The questions keep coming. The couple I saw tonight, wanted their whole situation resolved and their baby happily breastfeeding, before I left, after three whole weeks of bottle feeding. I don't think so. It was a much too long visit. So which way do you handle this? Thanks, Ann

Ann Conlon-, IBCLCTriangle Lactation Consultantswww.trianglelactation.com"While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby."Amy Spangler

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Home visits:

I try to keep visits under two hours. I do not say this up front. I make sure we all have a game plan as to what to do in the following days to make their situation get better. Find some positive statements to say about the situation even if it does not look good. If the baby is not latching well we discuss the fact that they can call me short follow up visits. Sometimes we go over ideas on the phone for a few days and as the baby grows s/he starts to latch better. My visits are usually at night so the parents are tired anyway. Some visits it is just a matter of adjustment or a new position to get the baby on. It is those visits that do not take much time that I often feel guilty about charging for a visit. The best part about any home visit is when the family sees that they can get help. That life will get better and the baby will eat. I love showing parents ways to hold the baby to calm them down.

I hope you get some other good ideas on this,

Annette Leibovitz, IBCLC

Buffalo Grove, IL

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