New York Times article highlights conflicts with doulas, lactation consultants.

Last Sunday's New York Times Style section featured an article painting doulas and lactation consultants in a pretty unflattering light.  I've posted the section about lactation consultants below. 

When 33-year-old Melissa Malka’s twins were in the neonatal intensive-care unit after being delivered at 33 weeks, a lactation consultant urged her to have tubes delivering formula through her babies’ noses removed in favor of an intravenous feed to deliver nutrients, against the advice of her neonatologist. Intravenous feeds carry a high risk of infection for premature babies, but some lactation consultants fear that  babies will develop a taste for formula and then reject breast milk.

“She was so intent on avoiding formula,” said Ms. Malka, from Olney, Md. “I was very upset with her, but that’s their standard — breast is best.”

Pumping around the clock with no milk to show for her efforts, Ms. Malka sought the help of four lactation consultants, but they couldn’t remedy the problem. When she consulted her obstetrician, she finally learned that she was unable to produce prolactin, a hormone vital to milk production. “You would hope that L.C.s would be well versed in this type of thing since they’re focused purely on the breast,” Ms. Malka said, using the shorthand for lactation consultants.

The breast-only mentality can also put off today’s participatory husbands. Kenneth Cain, a 42-year-old writer in New York, said his wife’s lactation consultant was “a nightmare.” In December, after he and his wife decided supplementing with formula for their one-month-old baby might not be such a bad thing, they turned to a lactation consultant for advice. “All we got was this ideological diatribe on the merits of breast-feeding,” he said. “It was like talking to a Marxist about an international trade deal.”

Obviously I'm a little biased because I'm a lactation consultant, but back in 2006 when we polled readers about your best sources of support for breastfeeding, lactation consultants came in second after husbands/partners. 

So I'd like to hear from you about your experience with lactation consultants.  Good, bad, indifferent?

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Comments

[Jill P]

My lactation consultant was amazing! The nurses at the hospital were not helpful at all and the lactation consultant they have didn't work Fridays or weekends. (My son was born on a Thursday night.)

My son didn't nurse for three days after he was born. At first I thought he was just sleepy but we quickly realized he wasn't making enough wet diapers. I talked to the pediatrician and called La Leche League. Though supportive, they didn't have much advice to give that made a difference. The parenting decision I regret most in life is waiting so long to call the lactation consultant. (I thought she'd be expensive, but it was actually very reasonable, even for a home visit.)

She was wonderful. Within ten minutes, she had my son nursing. She diagnosed a muscle deficiency and gave us exercises to do before each feeding. It took a few days of practice (and feeding expressed milk with a dropper after nursing), but he picked it up eventually.

I was even able to call her whenever I had a problem. A few months later I was heading back to work and she helped me figure out how much to have ready in the freezer, when and how to pump at the office, how much to put in each bottle. She made it easy and clear. Another time my son also started demanding twice as much at mealtimes, which had me very worried about our supply. She figured he had heartburn but he didn't know that and thought it meant he was still hungry. We tried her little technique (burping in the middle of feeding the normal amount) and it worked like a charm!

I never tried formula (we used a dropper to feed him expressed breast milk until the lactation consultant could come), so I'm not sure how my experience compares with those in the article, but I was thrilled with her. I was able to successfully nurse my son for fourteen months! I had a daughter a few years later who nursed for a year (with no help from a lactation consultant). I'm pregnant with my third and looking forward to another successful breastfeeding experience.

[Half Pint Pixie]

I haven't personally used an LC, I could really have done with one in the hospital but seems the hospital doesn't think women need help on weekends! That'll teach me to give birth on a Friday! I'm lucky enough to be related to a great LLL leader so she was loads of help. I have heard nothing but good stories from friends who've used LCs though. I think the media loves portraying "Them vs us" scenarios, sells papers I guess.

I'm commenting here also because the article mentioned one of my pet peeves "The breast-only mentality can also put off today’s participatory husbands". I hate this attitude, my hubbie is so close to littlepixie, the very picture of "participatory" and the amount of people who've said to me "would you not let him bond with her, let him give her a bottle", as if all dads are chomping at the bit to give bottles and their boob-obsessed wives are holding them back with a lactivist stick and trying to destroy their bonding, pah!

Anyway, back to your question... From what I've heard, and read, I think LC's are by and large a huge help and should be an essential part of all maternity hospitals (and not just during the weekdays!)

[Heidi]

I went through four LC's before I found one that actually wanted to help me breastfeed. I had heard all about these lactation "Nazi's" that "force" you to breastfeed and I thought - sounds great, I really WANT to breastfeed. If I have any trouble these women will be there to truly help me. The first one I honestly think thought she was doing the right thing. My baby wasn't nursing much at birth and she told me to supplement with formula. The pediatrician however, thought my baby was just fine. The second one kept saying things like "Aren't you sick of pumping? Isn't it driving you crazy using the SNS? Why don't you just give him a bottle." The third one actually handed my mother in law a bottle to feed him with immediately after I said I wasn't bottle feeding him. The fourth, was Janet Whalley of "Pregnancy, Childbirth and the Newborn". She was completely supportive, full of ideas and alternatives and confident that I could get my milk supply up and I did. Almost one year and still nursing!

[Yvonne T.]

My lactation counsultant was very helpful! I would call the lactation department at my birthing center all the time, and I still do 10 months later! I had a very bad experience trying to nurse my 1st child and didn't receive any help. I didn't even know about L.C.'s back then. But what a difference now! I think the article is an example of an extream in our society. Every group of people has a few that are just a little over bearing at times. It doesn't mean they are bad people and their actions shouldn't lable the whole group. My L.C. was very compassionate and understanding regarding feeding issues. After all they are their to support and educate, not make our decisions for us.

[Ashley]

I'm going to try and say this as nicely as possible: Of COURSE LC's are of the "breast-only mentality." If you know what is in formula and know that it isn't what babies (especially those in the NICU) need, why wouldn't you be?

[Ewokmama]

My lactation consultant was not the most knowledgable, but she was extremely supportive and encouraging, and I really appreciated her gentle spirit. She was BY FAR more knowledgable than the my doctors and nurses. I think that a lot of people misplace their ill feelings on the lactation consultant, when in reality they are upset with what is happening with their bodies or their babies but having trouble processing the emotions.

[Safire]

I used the LC at my local hospital and I loved the information they had for me. They have weekly meetings open to everyone and free, and also cafe meetings at the local sandwich shop. They were very helpful in showing me exactly what I was doing wrong, and it was only after meeting with them that I finally nursed without pain. I really do believe that they are not just about the breast, but about educating women and creating a network of breastfeeding women to help each other. Even though I stopped nursing my daughter over a year ago, I still keep in touch and learn things from them that I'm excited to apply to my twins.

[Paula]

When my then 9 day old baby was doing nothing but scream, wouldn't latch and couldn't figure out how to nurse, the LC at the hospital I gave birth at suggested that I put cabbage in my bra and just dry up my milk.

It was ignorant comments like that that made this then 20 year old, scared mom to a starving baby give up nursing.

I also had a different LC diagnose me OVER THE PHONE with thrush. I tried gentian violet and grapefruit seed extract to no avail. The LC then had the Dr. prescribe Nystatin and then 14 days of Diflucan when that didn't work. 2 weeks later when the medication didn't work and I wasn't cured she finally consented to see me and diagnosed my problem as eczema. All of that medication for me and my 3 week old baby for no reason!!

I don't trust anyone in a hospital setting. We had a home birth the next time around.

[Jen H.]

I was very much helped by my lactation consultant. After my emergency cesarean I was traumatized and the baby wouldn't latch. It took a lot of work, but we were finally able to nurse successfully and peacefully. Still going strong at 11 months. I get really irritated by articles like this. I am thankful for my LC's great store of knowledge, gentleness, and professionalism.

I was especially peeved by the reference to "today's participatory husbands" as being put off by the breast-is-best message. My husband was my greatest support. I can still picture him those first days in the hospital, when I was a complete wreck, and he was feeding my pumped milk to the baby through an SNS taped to his pinky, which was easier for her to latch onto. He was and is thrilled that our baby is getting mama's milk.

[bits of myself]

our hospital LCs were great, but the biggest help of all was one of our nurses. we spent over a week in the hospital and we were lucky enough to be taken on as patients of the two charge nurses. the pm charge nurse was also a doula and an LC. how lucky can one girl get?! she was an absolute godsend and we had days and days of her undivided attention. priceless!

[tanya@motherwearblog]

Such great comments and stories.

I've been mulling the article over this week, trying to figure out how I feel about the stories in the article.

First, there are always going to be good and bad people in any professional group (good doctor/bad doctor, good mechanic/bad mechanic). The training and clinical experience requirements are pretty rigorous, so most lactation consultants should really know what they're doing. That doesn't mean that they can necessarily communicate it well, or that they will always show the best judgement. And some are up against some ridiculous expectations (like one LC for many, many patients) which make it hard for them to be as effective as we'd all want.

I think that the trouble, when it comes to breastfeeding, is "the agenda."

I think that lactation consultants are seen as having an inflexible posture when it comes to breastfeeding. Did anyone see the Law and Order episode (I've only read about it) in which the death of a baby is blamed, in part, on a lactation counselor?

To me, the "agenda" is health. Breastfeeding is a healthy behavior for babies and mothers, so we should promote and support it in any way we can, give mothers information to make informed choices, and respect the choices that only mothers can make for their own babies. But to other people that position is viewed (fairly or not) as overbearing or dogmatic.

The strange thing is how different breastfeeding seems to be than other public health issues. You'd never hear anyone accuse a health professional who actively promoted smoking cessation or healthy diet of spouting an "ideological diatribe," would you? There's such a backlash when it comes to this issue.

Please continue to tell me what you think!

- Tanya

[Maria]

I gave birth in Germany, where the midwife who delivered the baby was also my LC. She came to the home a total of 10 times or so after my son's birth, and she would check the positioning and answer all of my questions. Without her, I probably wouldn't have made it through the first week. With her help, we are still going at 14 months!

[Amy]

LC never came to see us in the hospital. Apparently after talking to many other women who delivered inthe same hospital, unless you have a "traumatic" birth, or something goes truly wrong, your just a number and even the LC's don't have time for you.

On a much much much brighter note, the nurse who was assigned to me the night I gave birth was the most helpful person we saw the entire time we were there. If it werent for her, and the warm encouragment from my OB I would probably have given up! I was so tired after labor, and I just didnt think I could do it! Sigh...what a great day that was :)

[Kristin]

I've never used or even spoken to a Lactation Consultant. My midwife got me started, and when I encountered problems, I turned to experienced friends or the La Leche League Website for their articles. Maybe it's because I did not deliver in a hospital, but at a birth center (and #2 at home) that the thought of contacting an LC never even entered my mind.

[Jane]

I've exclusively breastfed my 1st and now my second child. Both my hospital experiences with the LCs were not very positive. They have so many patients to see that not much attention is provided to the moms. But on the positive side, my L&D nurses were great- provided support and advice and made sure baby and I were breastfeeding.
On a side note, my college alumnae magazine recently wrote an article on breastfeeding highlighting the struggle many women face breastfeeding and the sort of demonization of formula. We are told as moms to breastfeed, and some do successfully and some not. We get these terrible maternity leaves, go back to work and pump to try to maintain the breastmilk. Thank goodness I am an executive, with access to the private space to pump and some flexibility in my schedule to do so. But unless as a society we can both support new moms to breastfeed, encourage it when moms try to breastfeed in public, and entitle moms with adequate maternity leaves, we will never see more numbers of moms attempting to breastfeed. It is really such a shame.

[Jen]

I've had 2 very different experiences with LC's and I'd have to say that the first one was excellent. I had Maeve at an Air Force hospital in Texas and she didn't latch on right away. The hospital didn't have a LC on staff and the Lt. Colonel nurse they sent me when I asked for help nursing didn't do much good. She shoved Maeve onto my breast and that was pretty much it. She learned to nurse via persistence on my part but the day before I was going to take her home I discovered a bump on the inside of her lower lip. We found out later that it was merely an enlarged salivary gland but at the time the doctors all freaked out and thought it could be HPV or something else contagious. The infectious diseases doctor told me I shouldn't nurse until they found out what it was because they didn't want me to get it on my nipples if it was contagious.

We went out and bought a breast pump on the way home. The next day my husband found out that the health clinic had an LC on staff and called her. She came to my house and walked me through pumping but said that she'd done a bit of research after talking to my husband and felt that it was probably okay for me to just put Maeve on the breast. She was wonderful at reassuring me and checked up on me later in the week to see how things were. At that point I'd pretty much given up pumping and was just nursing and things were fine, so I'd say I had a great experience with her.

The second time I saw an LC was when Gwyneth was about 8 or 9 months old. from about 6 months old I'd had to supplement her with formula due to her severe GERD which had caused her to basically stop nursing altogether due to the pain from reflux while nursing. I really didn't want to stop nursing her and had purchased a new double pump and was really trying hard to re-establish a good supply. The LC I saw was also a holistic medicine practitioner and, though I didn't go to her for those services, when she felt that using an SNS wasn't going to work (Gwyn was too distracted by it) she recommended various herbal galactogogues and proposed that I also be more aware of the foods that I ate, test my pH and so on, in order to ease my daughter's GERD. She felt that there wasn't much she could do for me in terms of getting Gwyn back to a normal nursing schedule, and since we had already started solids I should just nurse as much as possible and pump as often as possible when she didn't want to nurse. I sort of felt let down by this news, but I don't think it was the LC's fault. I did feel a little put out about the need for me to do the pH testing and such because I felt like it was really a waste of my time. But I did take her advice about being careful about what I ate.

On the whole I think that LC's are very necessary. Yes, there are some who are probably overzealous in their approach but that happens in all professions. The majority, however, are probably not (as my friend calls them) "boob nazis". It would help, too, if more nurses were trained in breastfeeding and lactation issues. Or perhaps better trained. I gave birth to Gwyn in Germany and the nurses on our OB ward were particularly helpful to my roommate who was having a lot of problems nursing. The doctor helped by keeping her in the hospital until she was able to nurse successfully and consistently. I admired them particularly since the woman didn't speak any language they knew (she was Kosovar Albanian and only spoke Albanian) and the only translator they had was her husband when he was there and not at work. They kept encouraging her to nurse and wouldn't let her give a bottle. I was amazed, since the Germans are big on fennel baby tea for digestion; I specifically heard the nurse say "First breast. THEN tea," despite the young woman's protests that she couldn't do it.

The only case that I've heard like this in the US is from a friend who used to work the LD ward at a hospital in Charlotte, NC. At that hospital they had LC's on call 24/7. The nurses would page the LC on call whenever a woman was close to delivering so that she could be there as soon as mom and baby were all cleaned up and ready. According to my friend, they didn't let the moms formula feed unless the doctor had prescribed it.

As for Paula's experience with being diagnosed over the phone, I think that this is unethical. And, unless the LC is also a nurse, doctor or PA, she has no right to tell a doctor what to prescribe. A doctor who prescribes for a patient whose problem is previously undocumented and whom he hasn't seen is also acting unethically and potentially putting both mom and baby at risk. Sorry to be on a soapbox about this but my husband (a PA and MD student) says that this situation goes against what you're taught and that it's something that a lazy doctor does.

[Rhynn]

I gave birth four months ago to my little boy and the hospital nurses and LC were very, very helpful and supportive with breastfeeding. Once I said that I intended to bf, no one every suggested formula or bottles during our hospital stay. I kept my finger on the call button every time I nursed my baby, but the nurses never tired of coming to help us get him latched on. The LC did not work the weekend but I did see her when the baby was born, and then again on Monday. She has also answered questions via email and phone over the past few months. This hospital is practicing patient-family centered care on their maternity floor, and I think that makes a big difference. They really want to help the mothers and babies bond to each other, and the staff knows that bfing is a big part of that.

[L]

My lactation consultant was great - I started breastfeeding more or less "by hook or by crook" on my own after my c-section, and called her in when my DS was 1 month and I wanted to get off the shield and also make sure I was doing things in a way that would be best for us to make it to at least 1 year. She was mellow, supportive, kind, and her own mission statement says "take what you can use," which I took to mean that she espouses a total philosophy but it's important for people to take what's relevant for them from it. I have been EBF since my son was a week old, but I know my LC has also helped moms who have to supplement.

That said, the lactation nurse at the hospital where my son was born (whom I assume is also an LC) was a nightmare. I thought her tone was condescending and didactic. When I skipped a dose on my stingily-parsed pain med schedule after a c-section to hobble down to the hospital breastfeeding class (which covered the same material I'd heard before my son's birth) in hopes of getting advice after my son had been given bottles in the NICU, when I asked what I could do to get back on track after a situation where I was separated from my son after birth, I really did not care to hear "why? where were you?!" Even as a bit of sarcasm.

I think LCs are probably a cross-section of personalities, just like any other profession. But they definitely work best, I assume, with people who intend to exclusively breastfeed, or who tried but found they had to supplement for medical reasons. I can't imagine any LC really wants to assist in supplementing for convenience reasons, in lieu of helping the mom increase her supply. But should they assist with this, in light of the view that any breastmilk is better than none, and many people give up readily when faced with problems? Maybe they should. I don't know.

[Becky]

The birth of my son is kind of a blur after almost 8mo but we did have a LC (the very one who taught the bf'ing class I took) come to the room during that weekend and check his diaper counts and asked if we had any questions. All was going fine at that time and she could not do much to help us. Once I was out of the hospital and real life set in, I was grateful for the LC outpatient clinic at the hospital closer to my home. They were great at reassuring me that my son was doing fine. The only thing the LC's could have done better was prepare me for the amazing amout of time it takes to nurse a newborn. The internet and LLL site were my biggest help besides the LC's.

[Nola]

This article seems to have taken a pretty negative slant on the issue. Maybe it's just part of the way the for-profit media has to portray everything as *drama* or else newspapers won't sell. Maybe the author is a Similac rep. Send a letter to the editor and suggest running a story on the millions of people who have had positive experiences with doulas and LC's.

I've had good and great LC's. Each has a different personality, which you have to expect. All were *incredibly* encouraging. That was probably the most important part. And the accessibility in our area was really key for me to continue. There were plenty of times I would have had to have stopped if I didn't have readily accessible help.

If you don't like what you hear you should always get a second opinion (and third and fourth). Sometimes we don't want to hear the reality. More often than not, mommy instinct tells us when we get bad advice, even if we don't know what the right answers are.

[MomOnTheGo]

I had a great LC, Sarah, in the hospital - and awful NICU nurses who pushed formula feeding for my daughter who was full-term and only being observed because she'd passed meconium before birth. When I went home 2 days after my daughter's birth and she had trouble latching, the LC I called arranged for my husband to come by at 7:30 to get a pump for me to use until the LC could come to our house later that day. I saw a couple of other LCs in the hospital's clinic and they were both reassuring and aware of many "tricks" to try.

[Kat]

I am a hospital based doula and work very closely with our lactation consultant. We are kind of a double team with me helping with immediate breastfeeding after birth and her stepping in later on if problems arise.

We frequently work with the doctors on issues who openly admit that we are the professionals when it comes to breastfeeding and take our suggestions seriousely to help families that wish to breastfeed especially when the infant is ill or there is another problem that directly relates to feeding.

I think that lactation consultants and doulas are a great asset to the team as a whole. But then, maybe I'm biased too.

[Amanda]

I had different experiences with LC's at each of my different births. With #1 the LC was gruff and nonsupporting. I stopped bfing within a week. It hurt, and I was cracked/bleeding. Our 2 middle children had improper latch coupled with a whey intolerance and one with severe reflux. A different LC was wonderful, helping me with latch issues after a community breastfeeding support group. I BF'd both of them 14 months each. Our youngest had zero suck reflex at birth, the nurses pushed bottles and formula. Through tears of exhaustion and frustration, I allowed the formula, but no bottles. The most amazing LC I've ever connected with came in, sat with us, watched and listened. She was gentle, supportive, and performed craio-sacrial therapy with our newborn. She was amazing. The baby's jaw was a bit mis-aligned, and it wasn't prompting the suck reflex as it should. She talked to us about finger feeding and the SNS. Something she said I'll never forget, "These are just tricks we use to get from here to there. No one expects you to do this forever. Our goal is successful breastfeeding. Use the tricks for a while to teach her, and you'll see a huge improvement." We finger fed with formula for 4 days while I pumped every 2 hours round the clock trying get my milk in, and to teach her to suck/swallow/breathe with the finger feeding. Then we'd try to latch and bf so she wasn't starved and overly frustrated. Night nursing came easiest first. It was a long process, and sometimes I wanted to just give up, but by 2 weeks, she was doing great. She's now 4 1/2 months old, and it's hard to believe we ever had problems. Without the hospital LC, I'd never have known what to do, and probably given up.

[Stacie (The Twinkies)]

I had a really sh**ty LC. She had never dealt with twins and the only information she really had to offer was "put the baby to the breast and it's so natural everything will just work."

Um. No.

When I called because my son wouldn't latch after his bout with thrush at a few days old she didn't even come watch him try to latch. She just reiterated to put him to the breast and suggested that my technique was the problem. Mind you, I was an exhausted new mother of twins fresh off of a c-section. In retrospect I didn't have any problems that competent help couldn't have straightened out but we couldn't find an SNS on our own.

Gods, I'm going to cry just writing this out.

I ended up having to pump for 2 1/2 months until he learned to latch and by that point my supply was so compromised I had to supplement until we started solids. I am still nursing at 20 months but if my LC had given a shit I might have bypassed a lot of those problems.

I tell everyone to avoid the LCs who work with Birth Partners in CT. The Birth Partner DOULAS are awesome but the LCs were no good at all.

[Dr K]

I am a pediatrician and breast fed three of my own with varying success. From a pediatrician perspective, I greatly value the technical support that lactation consultants have provided me and my patients. As a pediatrician, I feel that my #1 goal in the first few weeks is to teach mom that she is capable of knowing what her baby needs and will be a successful mom. I find that lactation consultants sometimes don't take that same perspective and frequently undermine new moms fledgling self-confidence. LC's freq. paint BF as a Hallmark moment, and for a lucky few it is...but for most mom's it is tough and for some really tough. Birth is a high estrogen situation and high estrogen leads to high emotion and a lot of depression. Not being able to breast feed is a deep cut into a women's core. People talk about how difficult it for men to lose a job because of the blow to his self esteem...providing for a family is his biological function. For women,BF is our equivalant. When I was unable to provide milk for my son after returning to my stressful job as a resident, I felt like a horrible mother. LC's need to be extremely senstive to the negative emotional impact that can ensue from to vigorous of a stance. Millions of babies have been raised on formula with no ill effects. I am one of them.
When you look at the studies, there are MODEST benefits to breatfeeding. An important thing to look at in a study is something called "the number needed to treat". This the number of people who would have to be treated to prevent one adverse outcome. For example, 10 moms would have to breast feed their babies to prevent 1 ear infection. 1,000,000's of moms would have BF to prevent one SID's death.
I prefer to focus on the other positives of BF rather than laying on guilt. BF is cheaper, it is easier at 2 AM when you don't have to get up and make a bottle, you can't leave your boobs at home when you head out to dinner, they are always the right temp, and you don't have to run them through the dishwasher.

It is never ever worth destroying what should be the happiest weeks of a women's life over an extremely modest benefit. Please LC's out there, please think about the big picture and the small role BF plays in the long life of a child. You can help moms more by supporting her in what ever decision that she makes than by guilting her into trying one more day to BF.