A new paper shows how lactivists abuse their power as health providers


I wasn’t going to write about corrosive nature of breastfeeding “support” again today, but then I read a new paper that brilliantly explains how the lactation professionals who claim to be providing information and support abuse their position as health providers to shame and blame.

The paper Getting the Green Light: Experiences of Icelandic Mothers Struggling with Breastfeeding, written by Sunna Simmonardottir was published today in Sociology Research Online. Simmonardottir is writing about the experience of Icelandic women and the pressure they feel from midwives who are the main lactation professionals. However, the experience of these women is identical that that of American women and lactation consultants.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation professionals embrace a hierarchical relationship where they can shame women at will.[/pullquote]

Simmonardottir focuses specifically on whether the “support” they receive is remotely supportive and describes a critical principle:

The interaction between women who struggle with breastfeeding and health care professionals can sometimes be problematic and fraught with conflict and many women tend to feel that they did not get the help they needed and even felt that their feelings and experiences were not acknowledged. It is therefore extremely valuable to examine the role of health care professionals working ‘in the field’ as they possess the power to define and promote the dominant scientific discourses that women have to contend with as well as provide them and their infant feeding actions with the professional stamp of approval.

Lactation professionals including LCs and midwives are typically extremely critical of the supposedly tyrannical behavior of physicians, especially as regards the technocratic model of birth and the emphasis on authoritative knowledge. Ironically, they have become the very professionals they detested, advancing a technocratic view of breastfeeding and touting their authorative knowledge.

The technocratic model of breastfeeding postulates extraordinary scientifically determined health benefits for breastfeeding, although:

… when it comes to measuring the impact breastfeeding actually has, the conclusions are at best contradictory and ‘for every study linking it to better health, another finds it to be irrelevant, weakly significant, or inextricably tied to other unmeasured or unmeasurable factors’. Nevertheless, the assumed multitude of benefits and the supposed risk reduction of breastfeeding have become ‘scientific truths’ that have achieved dominance world-wide and are rarely questioned or contested.

So the choice to breastfeed is not really a choice at all:

…[T]he decision to breastfeed in an Icelandic context [and among privileged, white American women] is not really a ‘decision’, per se. Mothers are simply expected to breastfeed and the assumption that all mothers would want to breastfeed (for some length of time at least) is completely taken for granted. Exclusive breastfeeding is constructed as a pillar of successful bonding and attachment and absolutely paramount when it comes to promoting the close primary relationship between mother and child.

Lactation professionals insists that every woman can breastfeed if she wants, so there’s no point in studying why women don’t breastfeed or stop breastfeeding beyond analyzing their “excuses.” Lactation professionals, like the physicians they despise. strikingly ignore what women tell them — breastfeeding can be difficult, painful and provide inadequate milk supply — and substitute their authoritative knowledge that women don’t understand the benefits of breastfeeding and aren’t receiving adequate support to breastfeed.

Breastfeeding is constructed natural and therefore, women aren’t breastfeeding successfully must be “broken.” Therefore, they must endure techlogical efforts to fix them.

This idea that women have a ‘natural ability’ to breastfeed is culturally very strong but at the same time is counteracted with messages about the possible ‘faults’ that the women possess. They are discursively situated as both ‘natural’ and ‘unnatural’ at the same time, and in order to successfully breastfeed they have to rectify those unnatural faults often by going through quite technical processes, involving a range of breastfeeding aids such as breast pumps, artificial breasts and finger- or syringe feeding systems.

Lactation professionals routinely abuse their power as health providers to confer or deny approval to women.

The power dynamics of this particular relationship between mother (patient) and expert are clearly hierarchical, where the latter is in a position to shame and even scold, and the former feels that she has lost her subject status and is even treated like a child …

Many of the women described how the health care professionals had expressed very negative views towards formula and others had a hard time getting information on formula feeding from health care professionals, who wouldn’t comment on practical information, like quantity, the number of feeds and so on… Many of the mothers associate health care professionals with being judged and having to explain and justify their infant feeding practices.

The outcomes can be heartbreaking:

Should a mother exercise her own agency and decide for herself that the best thing for her would be to give up on trying to breastfeed, she runs the risk of being constructed as the villain, the selfish mother who didn’t want to inconvenience herself for the sake of her child. The biggest sin according to this cultural script of good mothering is not trying hard enough and giving up without a fight. The women want an outsider, especially a health care professional to tell them that they have done enough and that they have passed the test, but for some of the women no one ever does.

Lactation professionals insist that they aren’t forcing women to breastfeed or to continue to breastfeed when it isn’t working, but that’s not true.

The notion of freedom and choice does however become debatable when we consider the culture that they inhabit, where almost all women initiate breastfeeding and the notion of ‘giving up’ on breastfeeding means that you have failed your child and your identity as a ‘good mother’ is challenged.

Ironically, lactation professionals have merely replace the despised medical patriarchy with a new matriarchy based on what is “natural.”

The discursive shift from the ‘medical’ to the ‘natural’ has been successfully implemented without any recognition of the fact that the ‘natural’ is also a cultural category, and has no intrinsic meaning. The unequal power relations between patient (female) and physician (male) that were once so strongly criticized have not been discarded, but simply re-imagined and reproduced within current health care systems. By proclaiming that all women have a ‘natural’ ability to breastfeed, for as long as they wish, the experiences of a large number of women are marginalized and pathologized and essentialist understandings of women as a homogenous group are sustained.