Are lactation consultants helpful or harmful?

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It is an article of faith within the breastfeeding industry that lactation consultants are good at what they do and are caring and considerate in how they do it. Many women beg to differ.

Lactation consultants are failing not merely at their chosen metric, exclusive breastfeeding rates, but at their fundamental task, providing breastfeeding support.

I undertook a survey to determine just how effective lactation consultants are and whether they are indeed as caring as they believe. The results ought to be deeply concerning to lactation consultants.

Over 400 women participated in the survey, which was open to anyone who had initially wanted to breastfeed.

The first question was “Did you find the lactation consultants at your hospital helpful to your efforts to breastfeed?” and these were the results:

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The good news for lactation consultants is that many women found them helpful in their efforts to breastfeeding. The bad news is that the majority did not. Over 46% of respondents rated their hospital based lactation consultants as somewhat helpful or very helpful. That’s far lower than I expected since lactation consultants have one and only one job, to promote breastfeeding. I would have thought that they would at least be effective in doing so.

The reality was that more than half of the respondents found lactation consultants to be ineffective or even harmful. That group was almost evenly divided between those who thought their lactation consultants made no difference, made them feel pressured or even made them feel inadequate. Considering the strenuous effort and millions of dollars expended to promote breastfeeding this is a disturbing finding.

Why are hospital based lactation consultants so ineffective? The survey cannot tell us but several possibilities come to mind.

I doubt that this reflects the competence of lactation consultants themselves. I suspect the overwhelming majority are well educated, well trained and deeply committed.

Is the training itself flawed? That’s certainly a possibility since a lot of what passes for “knowledge” among lactation consultants is actually false. Lactation consultants are taught that breastfeeding is nearly perfect, that insufficient breastmilk is rare, and that with proper “support” nearly any woman can exclusively breastfeed. But breastfeeding, like any other natural process, has a significant failure rate, insufficient breastmilk is common and that women stop breastfeeding for a host of reasons, not typically for lack of support.

The answers to the second question “Did you breastfeed?” bear that out:

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Less than 28% of respondents were able to breastfeed exclusively for as long as they wanted. Slightly more than 16% of respondents found breastfeeding too painful, inconvenient or distressing. Over 26% felt that their babies were not getting enough to eat and more than 24% found that combo feeding (combining breastfeeding and formula) worked best. That amounts to a remarkably dismal failure rate for lactation consultants. Their goal is nearly 100% exclusive breastfeeding and their failure rate exceeds 66%.

This is similar to overall US breastfeeding rates. Over 79% of women try breastfeeding but only 20% are exclusively breastfeeding at 6 months.

Were lactation consultants willing to use a different, more realistic metric, they’d find themselves far more successful. Fully half of women were giving their babies some breastmilk for as long as they wanted. Sadly lactation consultants do not bother to consider women’s desires in their assessments.

That may explain why the majority of women found lactation consultants to be useless or harmful. Lactation consultants are obsessed with rates of exclusive breastfeeding. Women are concerned with happy babies, happy mothers and happy families. Breastfeeding might be a part of that but only to extent that it is satisfying for babies. Therefore, there is a tremendous mismatch between the support women want and the “support” that lactation consultants have been taught to give.

Lactation consultants would do well to keep these informal definitions in mind:

Support: Helping a women achieve HER goal.
Pressure: Helping a woman achieve YOUR goal.
Cruelty: Telling a mother that if she CARES about her baby, she’d replace HER goal with YOUR goal.

Nearly 18% of survey respondents felt pressured by the hospital based lactation consultants and nearly 17% reported that the lactation consultants were cruel enough to make them feel inadequate. In other words, more than 1/3 of respondents found hospital based lactation consultants to be harmful instead of helpful.

Obviously this is not a scientific survey, but it should give lactation consultants pause. Do the majority of women find their services unhelpful at best? Do a third of women experience them as harmful? I’d be interested to see the results of similar surveys undertaken by lactation consultants or the hospitals that employ them but I have been unable to find any such surveys or studies. It’s almost as if lactation consultants don’t wish to know how women experience their “support.”

Any way you want to look at it, lactation consultants are failing not merely at their chosen metric, exclusive breastfeeding rates, but at their fundamental task, providing breastfeeding support. They need to change what they are doing and how they are doing it because at the moment, the only task they are succeeding at is satisfying themselves.

  • Shawna Mathieu

    When my son was born, the hospital LC was awesome. The home visit LC? Awful.
    -chastised me for “giving in” when I gave him a bottle of milk after he’d wailed for ONE HOUR trying to latch and failing.
    -she really chewed me out when she heard that if we didn’t have breast milk in the fridge, I’d make a bottle of formula.
    -she implied that pumping was also “giving up.”
    “He’ll figure it out if he’s hungry enough.”
    -when I requested a second visit when he still couldn’t latch, she said I was doing everything right, and I just needed my confidence built up – left about a minute later.
    -ignored the signs of post-partum depression, even though a large component of the PPD was feeling like a failure because I couldn’t get him to breastfeed – I’d said this outright several times.
    -lied on the paperwork for the home visit program, saying BFing was going great – when I still couldn’t get him to latch.
    -When I asked for more help, she decided she’d visited me “too many” times, even though she’d never mentioned a limit before.

    I think she dumped me from her roster because I wasn’t following the narrative that all I needed was support and it’d magically work.

  • Gæst

    My hospital LCs were helpful in showing me how the hospital pump worked, but with babies in the NICU that was about all they did. I had one actual breastfeeding attempt before they went home where nothing happened, and the LC said she was probably just too small. I later saw a private LC who was much more helpful. First, her primary goal was to get the baby fed. The first thing she did was advise me to get bottle nipples that were easier for my daughter to use. She was the first person not to just cite the breastfeeding pamphlets at me, but instead listened to me when I said I was throwing milk away because my freezer was full. She told me to reduce my pumping sessions – the hospital LCs were all about increasing them, which is how I ended up overproducing. And then because breastfeeding was what I wanted, she also helped me transition my babies from bottles to breastfeeding. (She agreed with the hospital LC that my daughter was just too small at first.) And because I was a single mother of twins, she worked on tandem feeding positions with me so that I could get feeding done efficiently and have more time for sleep – and she never suggested bed sharing. I believe all the stories about that bad ones, but I think a *feeding specialist* has a useful role to play.

  • Rob Cordes

    Any data on the mothers who completed the survey?
    Primip vs multip ?
    Breastfeed prior children and if so successfully or not?
    Family members or close friends who breastfed?

    • Anna

      I can answer for myself – multip, breastfed first two 2.5 and 3 years. Lots of support, access to LCs, money to rent pump etc. Problem was LCs I saw (4 I had an actual appointment with) could not see what the problem was and just told me to keep triple feeding. Finally saw a speechie who diagnosed her weak and disorganised suck in 5mins. She said I could try training her with a dummy but it was unlikely she would suddenly develop the ability to adequately extract milk due to her suck pattern and high palette. Surely the 4 LCs that saw her should have been able to work it out, but they seemed baffled. All they could really offer was domperidone, an SNS and “just pump 10-12 times a day and then power pump twice a day”. If a speechie (and junior at that) could diagnose in 5mins what 4 LCs could not over weeks then what value are they really as HCPs?

  • Manly Seadragon

    I saw several a private LCs in my own home and a couple at a clinic to try to get breastfeeding off to a less nipple-damaging start. I also called the Australian Breastfeeding Association help line a couple of times. While they all did help with the actual mechanics of breastfeeding, they didn’t take ANY thing else apart from my boobs into account in the pursuit of pure and exclusive breastfeeding (which wasn’t even my goal..)
    I was alone, and showing signs of being overwhelmed but was very much discouraged from mixed-feeding (my stated preference) and given lots of ‘advice’ that just one bottle would cause nipple confusion and make my supply plummet. One also drew pictures of my nipples for her notes despite me telling her I had some privacy issues due to a past trauma. Any other wanted to check my nipples for damage in the middle of a clinic waiting room.
    We need baby-feeding and well-mother consultants, not breast milk purists who assume a high level of authority with no holistic medical training.
    I ended up mixed-feeding for 9 months. Baby, dad and me couldn’t be healthier and happier!

  • justlurking

    My experience with hospital LCs is just that they are in such a HURRY. With Kid 1, the LC did get baby latched on better, but she left so fast I didn’t feel like I could replicate the process. She also seemed annoyed with me that one of my nipples was slightly blistered. Like that was my fault?! I didn’t know anything but that my baby was hungry and wanted to eat. The night nurse, who actually had some time to chat with me, help me care for my baby, and watch me nurse for awhile, was not just more helpful but far more encouraging.

    When I had my third baby, I had had 4+ years of cumulative nursing experience, but I wanted someone just to check his latch (nursing a newborn is much different from nursing a toddler). The LC came in, heard that I was already experienced, said “Oh, you know what you’re doing, you don’t need meeee!” and disappeared. Thanks?

    • Anna

      Yes this! They are busy and thats not their fault although other staff didnt seem so hurried and scatty. I also got attitude and exasperation for asking for bigger pump parts and needing help despite being experienced.

  • Merrie

    The lactation consultant inpatient with my first was helpful getting her latched, but it wasn’t great that it took her hours to show up (didn’t help that kid was born on a Saturday morning so almost our entire hospital stay was a weekend).

    I also wish that somebody had taken time to explain that our baby was unusually sleepy BECAUSE she was jaundiced and she needed to eat to clear the jaundice, so if we could not get her to wake up to nurse then we should try to get her to take a bottle of formula. Instead, they had me pumping to try to give her a bit of colostrum on a spoon, but I couldn’t really get any out, and they kept trying to get me to get her to wake up to eat but she wouldn’t and they were like, well, if she doesn’t eat after 6 hours she’ll need a blood sugar check, but didn’t say anything about the jaundice. As she was my first baby I assumed this sleepiness was normal and she’d wake to eat when she was ready, and she did eventually wake, eat, and go back to sleep. Also they were stressing out about my milk supply because she wasn’t nursing much. My milk came in with a vengeance anyway and it occurred to me that milk comes in (typically) even for moms who never nurse, and nobody had prepared me for the possibility of having an oversupply.

    (edit: I didn’t realize she had been unusually sleepy until my second baby was born, not jaundiced, and while he slept a lot he also woke every couple hours and wanted to eat. My first slept more like 6 hours at a stretch on her first full day of life.)

    But when I was discharged they recommended me to a breastfeeding support group that met at the hospital and was led by the outpatient IBCLC. I attended that group for quite some time and came back with my second baby. The lady who led that group was great and she was super supportive of everyone having whatever breastfeeding goals they had, and she supported moms who were combo feeding or wanted to wean and stopped anybody from making shamey comments. I wish we could clone her as she’s so much better than some of y’all’s LCs.

    The hospital LCs weren’t much help with my second and third babies but I didn’t need much help anyway. The hospital pediatrician and the hospital LC did talk us into clipping our older son’s tongue tie, which in hindsight was probably unnecessary and ended up costing us $250.

  • Gusst

    Most of the LCs I’ve interacted with – as a patient and as a doctor – know little to nothing about actual infant nutritional needs, breast physiology, or the physiological changes of parturition or lactation. They just assume that the answer to everything is to attempt to breastfeed more, to use devices to breastfeed more, and seem to assume that there is never a case where a new parent is unable to breastfeed.

    The LCs I’ve encountered really don’t seem to actually have a solid basis in any of the biology of the process they assume is perfect. Yet they hold themselves out as experts becaue they are able to parrot guidelines and unscientific articles that they uncritically share amongst each other and hold up as defence of their bullying. It’s quite frustrating to see patients so distressed by so much bad advice, and then when I actually attempt to realistically educate patients, they’re told that doctors don’t know anything about breastfeesing.

    I am sure there are LCs out there who take science and patient autonomy seriously, but I’ve yet to meet one, much as I’d like to.

    • Madtowngirl

      When I was still attempting to nurse my daughter, I developed some weird bump on my nipple. I freaked out and called the LC, who basically told me she couldn’t do anything and to call my provider. Um, what? I thought you were an expert?

      This explains a lot.

    • Anna

      This!

    • Steph858

      So LCs are to real doctors as Nutritionists are to Dietitians.

  • Allie

    I gave birth just after noon on Saturday, December 22, and there wasn’t a single LC on the ward for the entire 2 nights and 2 days we spent at the hospital. Apparently, their dedication to breastfeeding did not take precedence over their Christmas holidays : )

  • crazy mama, PhD

    Here’s my LC story to add to the anecdotes: When my first kid was born, the nurses were very helpful with BFing, giving me guidance on positioning without being overly pushy. Kid1 took a while to latch—it took upwards of 10 minutes each session to get him on right—but once he was on, he’d happily suck for another 10+ minutes. I wasn’t experiencing any pain, and he was doing great.

    Next morning, along comes our LC. I’d go through the extended process of convincing Kid1 to latch and then once he started sucking, she’d declare that he wasn’t on there correctly and move him around! Kid1 got so annoyed that he refused to nurse for several hours and I had to hand-express colostrum and spoon-feed him.

    Now, a lot of this was just this particular LC’s personality; I’ve met other LCs in non-BFing contexts and they don’t all seem like obnoxious people. But I don’t think I’d ever encourage a BFing mother to see one, and I cringe a little whenever someone gives “see an LC!” as advice.

    P.S. When Kid1 did start nursing again after that, he latched on almost immediately and nursed like a champ for the rest of his babyhood. I joke that he didn’t want any more LCs messing him up either.

  • MaineJen

    The ones I saw after I had my son were…somewhat helpful, I’d say. Kind of pushy in the delivery room (I just delivered a baby, back off!!!), but helped a bit during the next 2 days. I was lucky to have good supply and a baby who was eager to latch, so I maybe didn’t get to see the ugly side of LCs as much as some who had more trouble. Breastfeeding takes practice and is frustrating even when it’s destined to be ‘successful.’ (Or what they consider successful…even I would have been a “failure” officially since my bottomless-stomach son was combo feeding by about 4 months old. I couldn’t keep up with him. He still eats large quantities, come to think of it.)

    • Sue

      It’s a bit like promoters of “natural” child birth – when all goes well, you don’t need them. It’s the difficult situations where you need professional help.

  • FormerPhysicist

    I recall that commentators here have before suggested replacing LCs with infant feeding consultants. That would be awesome.

    A friend found her LC helpful in feeding preemie twins only in that, after seeing the LC, she was confident that breastfeeding was NOT worth as much work as the LC prescribed (pump every 3 hours minimum, latch first every time, SNS, …). The twins are tweens now, and just fine.

  • Christine O’Hare

    I was lucky, I would call my LC somewhat helpful (tips on latch and positions to work w/ my C-section incision), but I was also really cautious about even letting her in my room after learning how pushy they could be. I had already decided to combo feed initially and didn’t want crap about it.
    I’m wondering if as many people would rate the LC’s as helpful if they knew the realities of breastfeeding as we do. I also think the, “did you breastfeed?” question doesn’t fully show the range of experience. None of those options, fully tell my BF story. I combo fed the first week in the hospital until my milk came in, EBF from 1 week to 5 months and have been combo feeding since 5 months as baby’s appetite outpaced my supply. Would I have liked to EBF the entire time, sure, I’m a huge fan of the lack of prep required and portability that goes with EBF, but that wasn’t reality for me or my baby.

  • Jessica

    Mine were a mix. Some were helpful, some less so. To this day, with both my kids, my newborns just did not latch the “right” way — they both figured it out about two weeks old and prior to that they chomped with a death grip. So there was a lot of them telling me I was doing it wrong.

    One consultant wrote in my file that I had an attitude and “seems to want to do everything her way.” Like that was a bad thing. Overall, I was grateful when I had my second and only saw one consultant (they stopped coming after I said I intended to combo feed) instead of one every shift.

    • rox123

      You rebel 😛

  • taking a break from name lists

    Probably should have included an option for “unhelpful”, which would have had the highest percentage. Also why no option for answering “no, not at all” to the breastfeeding question?

    • AirPlant

      I would interpret “Made No Difference” as equal to “unhelpful”. Also I assumed that the population surveyed was trimmed to only include women who wanted to breastfeed since they were studying lactation consulting.
      Not to be pedantic 🙂

  • demodocus

    Can’t say I’m surprised. I did bf as long as i liked, but it wasn’t the LCs who were helpful. It was my son’s doc and the practice’s nurse practitioner. The others weren’t listening as well as they thought they were or were just plain patronizing.