Good for you, Pamela! Hear, hear!
Check out a book called The Price of Motherhood: Why the World's Most Important Job is Still the Least Valued, by Ann Crittenden. This author makes the point (well-backed by social research) that all types of "caring" work in the US are under-valued, or not assigned any value at all. I believe that nursing, doula work, and lactation consulting all fall under the rubric of caring work. The message society sends is that we ought to be willing to do this type work for the love of it, and that expecting compensation makes us greedy.
The worst case is parenting. Nearly every economist would agree that well-parented children who will grow up to become motivated and productive workers are the most valuable part of the economy -- they call it 'human capital'. Yet the workers who produce the human capital are penalized rather than compensated in the US. Women give up opportunities for career advancement, have reduced seniority, do not accrue social security while performing unwaged caring work, and are twice as likely to live in poverty as elders. These are just a few tidbits of what the book has to offer. People living in nations where the social safety net is stronger have no idea how women's' work is discounted here in the US.
Martha Johnson RN IBCLC
Eugene OR
-----Original Message-----
From: Pamela Mazzella Di Bosco [mailto:[log in to unmask]]
Sent: Wednesday, October 01, 2003 8:43 AM
Subject: working for pay/long
I think it is easy for those who live in other countries with government
systems and medical care systems to misunderstand the work of LC's in USA settings
working for pay. My path to private practice LC was volunteerism. I had a
very hard time adjusting to being paid for my services. I made the transition
easier than others by working for an agency and letting them pay me, as
opposed to the mothers themselves. But, now I am in the place of charging for my
services and accepting payment. I also attend births as a doula and while I am
doing this work for the love a normal birthing and the joy of being there to
support the mother and her family, I also deposit my payment. I think it is
great that in other countries the medical settings make it possible to make a
living and pay bills without working for pay directly from clients, and maybe
someday the USA will change the way medical care and breastfeeding care are
provided. But, I won't hold my breath or expect it in my lifetime.
Magda, I respect posts and your thoughts have indeed influenced many of my
own choices. However, it is unrealistic to expect those living in the USA's
system to pay bills and function without getting paid. It is also true that in
the USA system breastfeeding products are needed and used. The reasons can be
debated and agreed on or not, but the reality is that the current
breastfeeding climate is hostile and many mothers will need to express milk, use products
to help overcome damage done in a system the has disdain for normal birth and
breastfeeding. This is not the fault of those that provide the services or
the products. The unethical behavior comes with the making of inferior products
or products that interfere with breastfeeding success. The problem is not
the quality products based on research that respects breastfeeding. The anger
and frustration is misplaced. So is the condemnation of those who are
providing the service.
The attitude that no one should profit from the feeding choices or needs of a
baby is interesting. It is not part of the free enterprise capitalist world
I live and work in, but it is interesting. It could be taken even further to
mean that no one should profit from the health care of the same dyad. That no
one should profit from the groceries we buy, from the medicine we take, etc.
That the entire health care system and food systems and drinking water
systems should all be free to the public. Wow. Just thinking how my bills would
drop I did not have to pay to eat, drink, or get medical care. How about free
housing? See, this is not reality in the USA. In fact, everywhere at every
turn someone is making money for something and it is impossible to avoid it or
you end up being the one hungry, or your children do. We do not live in a
money free society and until we do, we need to work to eat. Sometimes that work
includes selling products. Sometimes charging for services or being paid by
hospitals or corporations. We need LCs in the hospitals, we need LC's in private
practice, we need LC's who direct the use of products. Why? Because we
bring the ethics of our practice with us. Our professional ethics will shape and
mold the future of breastfeeding support and information available.
I respect that others feel that the USA is thwarted in its care of mothers
and children. I respect that others think that those of us working and using
products in breastfeeding situations are making a profit unethically off the
needs of others. But, none of that has a bearing on the clinical aspects of
lactation, the emotional support of each other in our work, the goals of learning
more from those who have more experience, and furthering the education of
lactation consultants and those interested in breastfeeding. None of the attacks
of character or ethics are fair to those of us living in our own "real world"
where kids need shoes and the mortgage needs to be paid. We work for a
living. We don't make much sometimes, but what we make helps. Luckily we are
blessed to be able to make our living doing work that brings us satisfaction. Many
work to make ends meet in jobs they hate, and can't get out of, but the work
of lactation is more than work, it is often a passion and it is the passion of
the work that keeps our ethics in check. We are not mostly in it for the
money, we are in it for the love of women and babies and knowing that
breastfeeding matters.
This work is emotionally draining and the financial reward is not
commensurate with the level of stress and hours of work involved.
I have no ties to Medela or Hollister, but I am grateful to the companies
that have chosen to produce products for breastfeeding of quality that help many
mothers and babies find success. I have no ties to any companies that
manufacture and sell products that make a difference in health care from the tubing of
an IV to the highest level of technology, but I am glad someone is making a
profit so they are available. Everywhere someone is making money. This is
true in other countries as well. The difference is only who makes the money and
who pays for it, but I don't see anything anywhere that is truly free with
absolutely no connection to money anywhere down the line. And yes, this includes
breastfeeding because money saved is also money earned. It is wonderful that
there are volunteers who are able to provide their services at no charge. I
still do the same. But just because there are volunteers does not make those
who charge unethical. Making money is not unethical. How you make it can be,
and it may be true that a handful of LC's may not always operate with the
ethics expected. This is not about LC's but humans in general. I liked the
comparison to the mechanic because ethics in the work place is not limited to LCs,
but is an issue in all work where service and/or products are provided.
This discussion of ethics is important. The discussion of who we are and
what we do as professionals is important. We need to understand what is best for
the profession, and we also need to know that the profession has merit has a
career choice or only as further credential for an established career. We
need to be able to openly discuss our attitudes about products, sales, services,
etc. without fear of reprisal for our differences. We need to keep in mind
that the USA is indeed a capitalist society where the only thing that speaks
loud and clear is money and that it is the money that drives the machine. Those
of us working within it try to hang onto our personal values and ethics and
still be able to function. With mutual respect perhaps this discussion can
continue without harming each other.
When I think of the number of women who go to Medela and Hollister websites
for breastfeeding support and information, I am thrilled to know that the women
answering their concerns are Kathleen Bruce and Nancy Mohrbacher. I feel
confident that the information they will receive is correct, current and provided
with the voice of experience and understanding of the value of breastfeeding.
Medela and Hollister are indeed thinking about money. They are thinking of
the value of good representation and information. They are thinking of how
important it is to the corporate bottom line to be sure what they offer is the
best. Lucky for the mothers these companies care about offering the best there
is. Lucky for the mothers that those choices are Kathleen and Nancy.
If you made it this far, I appreciate your time. I know this was a long
post, but it has been bothering me since the discussion began.
Best,
Pam MazzellaDiBosco, IBCLC
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