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.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation consultants are failing not merely at their chosen metric, exclusive breastfeeding rates, but at their fundamental task, providing breastfeeding support.[/pullquote]

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:


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:


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.