Be kind whenever possible. It is always possible. –Dalai Lama
I was four when I met Coleen and Rachelle, sisters and my childhood backdoor neighbors. The first time I saw them was through my mom’s bedroom window as I watched them glob mud pies in their unfinished yard. Instantly, I was crazy about them. I went on to spend the majority of my young childhood obsessively playing dolls with Coleen, and secretly idolizing Rachelle as a hip, maternal figure even though she’s only a handful of years older than me.
Funny how those memories seem just a trip-to-the-old-neighborhood-away. Coleen, Rachelle and I are all moms now, and it’s almost surreal to watch our children play together. Being a ‘real’ mom is not often like playing dolls, but eerily the same sometimes.
At one of our most recent visits, Coleen pumped during dinner and our conversation turned to lactation care providers (LCPs). Both Coleen and Rachelle told me they had unpleasant experiences initiating breastfeeding; they reported the LCPs were pushy and seemed to have an agenda.
I sympathized having had similar feelings about the “help” I received when my oldest was born. Learning of their experiences made me mournful too, because they’re my friends! And because I’m aware of the imprint health care providers make on women, especially postpartum. Sadly I wasn’t surprised, because it’s not the first time these feelings have been reported. In fact, there’s been damaging backlash as a result of “lactation professionals’ agenda,” which amounts to our implicit belief in opposites as Dr. Karin Cadwell broke down at the 2016 International Breastfeeding Conference. (Think The case against breastfeeding, Lactivism, Bottled Up, Guilt-free bottle feeding, Is breast best? to name a few.)
During our visit, we didn’t dwell on pushy LCPs, but the conversation certainly hasn’t left my mind. When a colleague shared Lions, and Bottles, and Teats, Oh My!—Legal Analysis: International-Code-Supportive Teaching About Bottle and Teat Use by Elizabeth C. Brooks and Kathleen Kendall-Tackett’s PhD, IBCLC, FAPA Clinical Lactation editorial Should Lactation Consultants Be Mean? Let’s Bring Civility, Kindness, and Professionalism Back Into Our Discourse, I thought mostly about Coleen and Rachelle. The material Brooks and Kendall-Tackett cover in their pieces is mostly in regard to behavior between professionals, but I wonder how much of that sentiment percolates from colleague to client.
I’m interested in sharing Coleen and Rachelle’s experiences, not to vilify any one credential of lactation professional or LCPs in general, but to expose the inappropriate, unhelpful and mean behavior of perhaps a select few who have the potential to tarnish the reputation of an entire profession and/or advocacy group.
Kendall-Tackett puts it this way in her editorial: “A couple of years ago, a good friend of mine, who is high up in the doula world, told me that ‘lactation consultants are mean.’ Of course, I argued back. But in the end, I had to agree that at least some lactation consultants do behave quite meanly at times…I realize, as I write this, that I’m only talking about a few people in our field. Unfortunately, these few have created a toxic environment…Do we really want to be the mean profession? Doesn’t this create a serious credibility problem for us?”
More important than reputation though, are the mothers and babies who don’t reach their infant feeding goals and are left feeling deflated and defeated as a result of their interactions with someone who’s supposed to be there to help.
Learning of accounts of unlikeable behavior by LCPs gives us all a chance to reflect on the way we support and advocate for mothers.
As part of our interview, I asked Coleen and Rachelle to describe the ideal lactation professional.
“A woman who has personal experience breastfeeding. Someone who is positive, kind, patient, and helpful with the mom and baby through any breastfeeding challenges,” Coleen said.
Rachelle described someone similar: “The ideal lactation professional would be calming and offer help with whatever the mother is facing regarding breastfeeding. They would be positive and encouraging throughout the process. It would also be helpful to see constructive commentary and an empathetic outlook towards mothers that seem to be struggling with the process.”
Their responses align with the desires of other mothers too.
In The experience of nursing women with breastfeeding support: a qualitative inquiry by Kathleen H. Chaput, PhD, et al, the authors conclude, “Nursing mothers want advice and support from people with the knowledge base to ensure resolution of problems, but it is critical that support be delivered without pressure and with emotional sensitivity to both mother and baby.” Not unreasonable.
Aggressive, condescending interactions
And yet, Coleen and Rachelle’s encounters with LCPs were unpleasant at best.
“My first interaction with a lactation professional was in the hospital the day after I had the baby. She came in briefly to help with feeding, perhaps 20 minutes or so in the beginning then she’d come in randomly to check on us. It may have just been her strong personality, but she came off very aggressive while trying to be overly nice in an exaggerated way. A nurse had helped with the first couple of feedings and had given me a nipple shield to use, however the LP wanted me to stop using it right away which I wasn’t a fan of as my nipples were cracked, bleeding and so sore!
She spoke to me in a condescending manner, but would add a smile with a cheery voice which irritated me more. I would have liked her to be more “gentle’ with me being a first time mom and not knowing what I was doing. I didn’t like how she pushed breast-is-best and would make me feel bad because it wasn’t “working’ for us.
The LP had scheduled a follow up appointment for me to come in a week after we went home, but I ended up cancelling the appointment because I didn’t want to meet with her again. I was going to go to a support group with a friend but decided not to after talking with the pediatrician. She said that it was ok if I wanted to pump and bottle feed more than breastfeed. [My husband] and I were already planning on doing that so he could help out with feedings, but it was reassuring hearing it from the pediatrician.” [bold text added]
“I met with the lactations consultants at the hospital after each of the boys’ births. With Jaxon I met with the specialist the next morning after he was born. Jax was born at 4pm but he went straight to the NICU so I didn’t get to try to feed him until about 9pm that night. The nurse originally was the one that tried to help me feed him. They were very positive and encouraging. They had me try different positions and offered advice that had helped them in the past when they breastfed. The consultant came to my room the next morning and she was also pretty helpful. She gave me a nipple shield because she didn’t think my nipples protruded enough. She also provided me with gel pads and lanolin samples to help with the soreness I was feeling. She told me about breastfeeding classes/support groups that were offered through the hospital. I was also checked up on by another consultant while I was there to see if I was becoming any more comfortable with breastfeeding…I found her to be a little frustrating. When I expressed my concerns about the pain and discomfort I was feeling she basically blew me off and said that it wasn’t going to be easy and I needed to push through it. She also told me that I didn’t need to feed Jax for the half hour to forty minutes that I was trying to feed him. I didn’t really know what I was doing so it was a little deflating and she kind of made me feel stupid when she said that was way too long.
When Landon was born I again met with a lactation consultant. She tried to help me with the positioning and discomfort. I told her about my previous breastfeeding history with Jaxon and she said every kid/experience could be different. With Landon a nipple shield made the pain worse so they tried to offer alternative suggestions to make the process easier.
The lactation consultants in my opinion were minimally helpful. Of the three that I saw, the first one offered me the most help and comfort. The other ones just made me feel like I wasn’t really trying hard enough and they were kind of aggressive in how they tried to get the boys to latch on. Beyond the births I never sought any other professional help from any lactation consultants.”
The origin of mean behavior
Most LCPs with evidence-based training could point out at least ten inappropriate suggestions or behaviors by the LCPs in Coleen and Rachelle’s accounts. Technicalities aside, and without making excuses for poor professionalism or devaluing Coleen’s, Rachelle’s, and other mothers’ experiences, I wonder why some LCPs’ behavior is graceless. Do some lactation specialists act mean because they’re stretched thin and burnt out? Does unlikeable behavior stem from lack of interpersonal skills?
Brooks offers an explanation to part of the bullying problem between lactation specialists, which some might argue also affects their interactions with clients.
Brooks writes describing the Code, “There is no ultimate international legal authority empowered to enforce the model document as passed in 1981. In the absence of legislation or regulation within a country, and precedent-setting interpretation of such legal authority, Code supporters are left to interpret the Code’s language and intent on their own, with no sanction for failure to do so accurately.”
“The noble motives for the Code are undermined when skilled clinicians, who aim to respect a family’s need or desire to use a bottle-and-teat to offer a supplement (of any kind), fear (or are) being vilified in the name of the Code,” she continues in Lions, and Bottles, and Teats, Oh My!.
In response to Brooks’s and Kendall-Tackett’s pieces on bullying, Cindy Turner-Maffei, MA, ALC, IBCLC ponders, “I wonder how much of this is just a sidetrack created by our very human resistance to the hard work ahead of us in leveling the structural racism behind disparities in infant and maternal experiences, tackling parental leave legislation and the other very real ‘Booby Traps’.”
Woman-centered, not breastfeeding-centered
If breastfeeding self-efficacy and the avoidance of breastmilk substitutes are public health imperatives, we cannot afford any behavior that might compel women to give up on breastfeeding.
At last year’s International Breastfeeding Conference, Dr. Cadwell asked a roomful of breastfeeding advocates, Are we acting as sales reps or customer service reps?
She suggested we leave sales up to the formula companies and focus on individualized maternal care. Forget about being breastfeeding-centered; the support we offer must be woman-centered, she said.
In The impact of attitudes on infant feeding decisions, Mary E. Losch, et al point out that, in the profiles of women who decided not to breastfeed, one of the most consistent findings was that “women who decide to formula feed are not so much embracing this method of infant feeding as rejecting breastfeeding.”