Economic consequences of IBCLC profession. Ethical considerations of IBCLC marketing in La Leche League
NB. This is a re-write of the original post from July 4, 2014.
A little-known reality about private practice lactation consultants, especially those who are authors and speakers, is that most of us are able to do this work only because we have supportive partners with good jobs that pay the household bills and provide health insurance. Diana West, IBCLC (from Facebook )
One of the least spoken and most cruel aspect of the medicalization of breastfeeding – the economic punishment of women who invested a lot of time and money into obtaining a certificate that asserts that they know something about breastfeeding to warrant a casual consideration from doctors.
From the birth of the profession from the ranks of White Christian and Jewish middle to upper-middle class women in La Leche League and with the seed money from La Leche League International (LLLI), there was no goal to affirm the knowledge and experience of La Leche League leaders and give them an opportunity to make a living. The plans for the profession were two-fold: give an opportunity to some older leaders to make some pin money once their children were grown and educate existing healthcare workers about breastfeeding. From the very beginning LLLI advertised the IBCLC certificate within LLL and pushed leaders to get certified before the profession eventually closed to experienced breastfeeding volunteer-mothers in La Leche League. Long before profession closure to the experienced women existing licensed medical providers overtook La Leche League leaders sitting for the exam.
Over the course of the last three decades requirements of IBCLC certificate gradually increased, requiring more and more courses thus more time and most importantly money to get the piece of paper. At the same time, nurses and especially medical doctors already satisfy most of the requirements to sit for the exam. They are also primed for quick memorization of large volumes of information and have experience taking tests that are fashioned on the RN licensure exam. All of this in combination makes IBCLC certification exceptionally easy for existing medical providers and exceptionally difficult for La Leche League Leaders.
Even when you have your certificate, it does not guarantee you a job within the field. Most hospitals and doctor’s offices hire people with established medical or allied health profession credentials. Hospitals do not pay for your certificate title job but for the existing doctor, nurse, dietitian, or speech therapist license job. Further, lactation consulting is non-acute optional care. In any economic crisis, your job will be the first to go. In the times of stable economy, it is not the highest paid occupation either. If you are a healthcare provider with a degree and a license AND you have to feed a family, it makes no financial or economic sense to go to the lowest paid occupation within your field. You may have to get two jobs and work seven days a week to make ends meet if you are determined to work with breastfeeding mothers.
Why does this all matter when we talk about IBCLC marketing for LLL Leaders? La Leche League leaders historically stayed at home out of paid workforce. This means no wages, no retirements savings, no health insurance of your own as well as loss of accumulated future income and loss of paid work experience that can be sold on the market. Luring women who are already at a financial disadvantage into a knowingly low prospect low wage occupation raises questions about the ethics of the whole enterprise. Being a mother is a risk factor for poverty in old age. Being a mother who is lured into the low paying occupation is a financial suicide.
I participated in a round table problem solving discussion at the Breastfeeding and Feminism Conference with Mary Rose Tully right before her death. We were supposed to pick any issue within breastfeeding and come up with solutions. The only issue on Ms.Tully’s mind was financial compensation for IBCLCs. It struck me as odd for a person of such prominence to not be appropriately compensated for her work. Yet looking around every IBCLC I knew relied on their husbands to provide and IBCLC work was a supplementary (if at all) hobby income that may cover the expenses of being an IBCLC.
Heavy marketing of IBCLC in La Leche League continued as long as I knew it for one and only reason – money to sustain the IBLCE (the board of lactation examiners) and provide income in a pyramid scheme where people at the top relied on the income brought in by training seminars. When the profession is so new, any and every dollar they can get from any woman participating in the scheme helps propel the profession forward. Nobody cares that the road to IBCLC days of glory is littered by destitute women who unknowingly sacrificed their well-being for the “greater cause” of medicalized breastfeeding. How ethical and moral is it to establish an occupation that poached freely shared women’s knowledge and experience, turned it medical, and monetized it all while throwing experienced breastfeeding women under the bus?
It is hard to establish a new medical womanly profession. International Board Certified Lactation Consultant (IBCLC) had to carve our a territory from the established medical/nursing specialties coming from a soft core La Leche League background of counseling nursing mothers.
Having witnessed the waxing and waning of various issues in La Leche League during the course of two decades, I witnessed a struggle of a new profession to gain power within the medical establishment. Vitamin D, GERD, post-partum depression… Then a biggie hit – breastfeeding after breast reduction surgery… Diana West became a La Leche League super star with an extremely niche subject. She was a traveling circus magician. You can breastfeed with your breasts cut off! This message was supposed to instill confidence in the rest of us with intact breasts.
For years I wondered why Diana West became so popular with an obscure subject and why the most amazing Diane Wiessinger with her unparalleled thinking to help with most common breastfeeding issues like positioning and latch did not match the popularity and demand of Diana West. Even Catherine Watson-Genna’s attempt at claiming medical competence with the ritualistic use of a stethoscope did not propel her into the spotlight the way breastfeeding after breast reduction surgery elevated Diana West. Finally, I figured it out. Stethoscope is 19th century technology that has lost its symbolic power in the age of ultrasound, xrays, CT scans, and MRI. Diane Wiessinger’s skill requires years of study and practice, human intellect, human ability and perseverance of an individual helper/practitioner. Precisely the opposite of what modern medicine is about.
Modern medicine firmly stands on three foundations – drugs, surgery, and the use of technology. The multitude of crippling effects that it produces by the above mentioned means are resolved with more drugs, surgery, and technology. The role of the helper/practitioner is reduced to applying existing protocols (sets of actions pre-determined by healthcare administrators in consultation with risk management and insurance agents) to the unfortunate patients. The intellect and skill of individual practitioners are minimized to reduced the unpredictability of individual practitioners in favor of “objective” measures like drugs, surgery, and technology.
Hence, at first we mitigate the result of scientific nutrition in society by surgically removing breasts that are too large to live or breastfeed. As a result, a woman cannot breastfeed so we now “save” the woman from her disability by giving her drugs to stimulate milk production and sell her expensive equipment to extract milk from her cut breasts as well as a number of gadgets to help with nursing at the breast. In addition to that we also sell formula to supplement whatever meager milk the woman can extract from her breasts. It is a perfect storm! Not surprisingly, Diana West ran out of steam after breastfeeding after breast reduction lost its novelty, yet most recently got revitalized by transgender issues – they ride the same wave of scientific medicine fixing faulty humans. Transgender sells – surgery, drugs, equipment, and healthcare dealer services who sell this equipment.
Yet the most recent crusade of IBCLCs and medically minded La Leche League leaders hungry for power and influence on par with doctors and nurses – tongue tie. Tongue tie opens doors to routine surgery, a very respectable medical occupation with not so respectable beginnings but firmly entrenched in modern medicine. Tongue-tie is a holy grail for IBCLCs because it gives them direct connection to MD or DDS line, giving them almost equal footing in healthcare as solid core medical practitioners. Never mind that beyond the generalities of “tongue-tie may affect breastfeeding”, IBCLCs are not trained or educated to either detect it or diagnose it in relationship to breastfeeding. IBCLCs do not receive anything other than superficial cursory mention of the issue are part of their training. They are not authorized to diagnose it. Most certainly there is no solid prediction scale of who will encounter breastfeeding problems based on anticipatory breastfeeding assessments. All of this confusion and mess opens doors to reigning supreme with a clout of importance in knowing something sacred and complex that nobody else understands. It also makes it worth while to fight claw and tooth to steak it out as an IBCLC issue.
Not surprising, that anybody who raises questions about the legitimacy of current tongue tie crusade and their disabling and damaging effect on women and children, like Nancy Mohrbacher or Alison Hazelbaker, will be shot without warning.
What we witness here is two long-term experienced La Leche League leaders and first IBCLCs with what I suspect a very nuanced understanding of breastfeeding being silenced and pushed out by the horde of mainstream healthcare providers who don’t know breastfeeding from a stick on the ground. There is an undercurrent of providers who are concerned about the idea of breastfeeding and about clinical issues who don’t even vaguely know there are women and children in the picture and that those people come first. People before ideas.
Yet what is infinitely more concerning are the woman and children who suffer pain, anguish, and lost hopes while they are being duped by people with inflated projections of what they could become in the future should they continue their tongue-tie quest. Of concern is La Leche League, a formerly maternal organization that started with an MD, Dr.Gregory White willfully removing himself from the first meetings to allow women to have space to discuss what is of concern and importance to them, taking a stand against all mothers and killing mother-volunteers, one at a time, and siding with the medical establishment to assert the dominant medical agenda. We have witnessed a very fast destruction of La Leche League and IBCLCs becoming a repressive authoritarian figure amidst a crowd of experts disabling and hurting mothers. The medicalized model of breastfeeding has set in. I do not know of any non-medical models of breastfeeding existing in the world today.
The other day an experienced breastfeeding mother was harassed and excluded from Milk Cafe community run by lactation consultants. The reason was most prosaic, the one we have witnessed a million times in history – heresy. Something akin “The Earth is round”. In a way, this is the continuation of the previous post US vs. Them. Chasm between mothers and lactation consultants – concrete evidence of the shift that happens when mothers become lactation consultants.
An experienced breastfeeder stated that there is no need to express milk at night in the hospital if the baby is separated from a mother for just one night. Milk will still come regardless of stimulation. A mother whose colostrum will not be used for feeding and who has difficulty expressing colostrum should sleep the first night after birth and focus on nursing at the breast when she is reunited with her baby.
All hell broke loose. This simple truth sent scores of lactation consultants into convulsive spasms. The suppression of maternal experience and knowledge followed a predictable path that I have witnessed many times.
- Attack, diminish, and eradicate personal experiential knowledge “Oh, but we cannot rely on personal experience”, “the number of children you breastfed is irrelevant to evidence-based medicine”
- Elevate and appeal to “objective” knowledge “Do you have objective data to support your claims?” “Evidence-based medicine tells us otherwise”
- Censorship of women’s experiential knowledge as risky and wrong “personal experience can deviate from what evidence-based medicine tells us. We get our advice from evidence-based medicine, not personal experiences”.
- Instill fear of sharing experiential knowledge “Are you willing to accept the responsibility for potential risk of insufficient lactation?”
- Question maternal ability to evaluate advice and decide for herself “Are you sharing your advice to test mother’s ability to evaluate advice. This is not the best of times for that”
- Elimination of living women from breastfeeding and appeal to mythical “higher order laws” “Physiology based recommendations are fundamental. We simply don’t know everything about this physiology.”
- Denial of your own personal experiential knowledge and professional roots “We just have to follow the laws of lactation without leaning on our own, frequently horribly wrong experience.”
- Deny the experience and intelligence of women throughout history and time “The percentage of exclusive breastfeeding until six months in the world is very low. This comes from ignorance”
- Underscore forward vision and helpfulness of experts vs. short-term thinking of mothers and their lack of good intentions “It’s only logical our approaches are so different. We look two steps forward. It’s important for us to help mothers. You are just insisting upon your opinion for the sake of insistence”.
- Enforce abstract theoretical biomedical knowledge to any and every situation without regard for time, place, and personal circumstances of individual women.
The above methods and their underlying philosophies are not any different from the underpinnings of medicine that has held exactly identical views of women and women’s experiential knowledge. This is concrete proof how both perception of self as “us lactation consultants-not them mothers” and uptake of formal biomedical knowledge to replace collective experiential knowledge are damaging to women’s confidence in their abilities and agency (ability to act in any given environment).
Ultimately, the Wise Woman exited the oppressive, disrespectful, and suffocating community that promotes “tyranny and dictatorship suffocating dissent” (joking quote from the members that is true though the consultants are unaware of it) to preserve her dignity, sanity, and the highly nuanced skill of combining experience with formal knowledge and situating it here and now. As much as the wise woman builds her own house, a mother sifts through a lot of information to find what works for her and figures out how to breastfeed. Oppressive and enslaving system of biomedicine robs women of their shared experiential knowledge. It’s time we exited the system.
The most striking transformation takes place when middle and upper-middle class women professionalize. When successful breastfeeding mothers who share their experiences and support each other turn into professional lactation consultants, a visible and perceptible shift takes place in the perception of self. What used to be “us, breastfeeding mothers” splinters into “us, lactation consultants” and “them, breastfeeding mothers”. This shift is significant because it causes many implications for women who are mothers. Lactation consultants become yet another professional who claims authority and exerts pressure on mothers to conform to certain standards and behaviors.
Medicalization of breastfeeding first and foremost eradicates women and the relational aspects of a nursing relationship between a woman and her child. Medicalization of breastfeeding castrates a nursing relationship between two people to a food transaction between anybody and everybody and a child. This profound lack of understanding of the nature of a nursing relationship between two people leads to disastrous policy that backfires on women and children in a multitude of ways from lack of financial and work protection to blatant exploitation of women’s reproductive abilities (poaching) that results in effective killing of a nursing relationship.
Narrow medical understanding of a nursing relationship as food leads to a reduction of breastfeeding to breastmilk as we see in the name of the World Health Organization resolution of 1981 – International Code of Marketing of Breast-milk substitutes (emphasis mine). This further leads to the goals of the document to be focused around milk and the appropriate swapping of milks while negating the process of breastfeeding as vitally important and not replaceable by bottles.
Medicine as a science is permeated with fear of women and nature. Science has set in to harness nature. Medicine has been waging a war on just about everything under the sun. Indeed a scary and militant attitude. When a woman embarks on the road to get a medicalized certification to help other women breastfeed, she unknowingly subjects herself to subtle and legitimatized brainwashing that will impart women-fearing or women-hating ideas to her.
When I went through nursing and later IBCLC training, I could not help but notice that what I knew as a woman from experience can be hijacked by fear mongering “science”. Science is very number oriented and every human experience is bound to be shoved into a plot, a chart, a number. Except human experiences are so varied that they are best explored through qualitative data that is extremely complex and requires knowledge AND experience well beyond book cramming required to pass multiple choice exams that will grant you a piece of paper certifying you as the expert in this and that.
After I completed IBCLC training I made a decision to distance myself from counseling women as I deemed myself of more danger to women as somebody with a medicalized view of breastfeeding than ordinary women without any training. I knew I was infected with a virus that I could not see, but I knew I had it. You see, I knew women were brave and courageous. Many breastfeeding hurdles are overcome with hope, determination, perseverance, encouragement, and rapid turnover of troubleshooting ideas. Women gain ground in breastfeeding in uncertain situations due to confidence and knowledge that most women can and will breastfeed successfully. Medical knowledge takes this away.
The medicalized IBCLC approach draws upon the standard practice of relying on numbers to reveal “the truth”. Not unlike the labor partographers that maimed many women whose labors did not progress neatly by the graph, IBCLCs are trained to plot women’s breastfeeding progress through number oriented measures and “intervene” when women fail to fit the charts. Interventions that interfere and hijack breastfeeding usually start in the first two days postpartum because women and their newborns fails to meet quotas of feeds, poops, or weight gain. As a result of these aggressive women-fearing and doomsday-expecting actions of medical providers many women never breastfeed. A lot of women today are destined to nurse a breastpump never experiencing the pleasure of their babies nuzzling at mothers breasts. And their babies never know the warmth of mother’s breast in their mouth, just the artificial silicone taste of a bottle nipple.
While medicine is hailed as god sent to people, women should not forget and study the history of medicine’s treatment of women as well as misogynistic philosophy that underpins medical thinking and reasoning. Only then women would be able to safely use some medical knowledge to their advantage in the few situations that do require it.
Robert S.Mendelsohn. Male Practice. How doctors manipulate women
Medicalization of breastfeeding does not have any noble reasons behind it. The plan to launch a new medical professional, an IBCLC, was driven by a desire to make money, not to help women. It is not very different from establishing a monopoly of obstetricians in the birth scene in the early 20th century. The matters get further complicated when support and well-being of women take second place to THE IDEA. No matter how beautiful and wonderful, abstract ideas are harmful to women. “I had one breastfeeding advocate (well known) tell me that she was willing to lie, steal and cheat to get to a breastfeeding society.” (from personal correspondence)”.
Fast forward to 21st century. The idea of breastfeeding crushes the psyche and lives of hundreds of thousands of women, but the machine is turning its gears. Breastfeeding machine has no consideration for women, just for the cause, the idea, “the greater good”. Last night I came across a disturbing discussion dissecting a new mother.
A bored doctor prowls the Internet looking for tongue-tie when asked or not asked to. This is the same MD who tore Nancy Mohrbacher apart for questioning the science of tongue-tie diagnostics. Doctors have a long history of looking down upon women, so the attitude and approach of the doctor is not surprising. What is of interest here – the overwhelming response from women, some of whom are IBCLCs, indoctrinated in the medical attitudes towards women during the course of their training, – the disapproval, the questioning of the woman’s mental faculties, the undermining of a new mother’s judgement, when she openly stated that she had not been looking for any advice and that unsolicited advice was not welcome. One respondent dreamily wished that this mother becomes a “platform for oral restriction awareness”. My estimate is that less than 3% of replies were, in fact, supportive of the mother to draw the line whom she listens to and whom she doesn’t and accepting the fact that women can post online for reasons other than looking for unsolicited advice.
Can we confidently say that the golden age of mother-to-mother support is over and the age of breastfeeding dictatorship has set in? Is this the age when women are all but forgotten and the only thing we remember is THE IDEA of breastfeeding? Do the new professionals who do lip service to their origin by uttering “mother is the expert” continue the undermining of women just like so many professionals have done before them? Just how far do the new breastfeeding professionals are willing to go in their scheme of “lie, steal, and cheat” to get to a breastfeeding society? Most importantly, would you want to live in a society like this? I know I don’t.