I wish to respond to several issues that were recently highlighted regarding dilemmas that lactation consultants face in hospitals settings. Let me give you some background first. 

About three years ago I was a hospital L.C. in what I believe, must have been the most resistant unit on the face of the earth (some of you, I'm sure feel that same way about your work environment). This was one of the most emotionally exhausting, but also exhilarating and informative experiences of my lactation consulting career. I resigned after 18 months (original contract was for six months hospital, all contract renewals were hospital initiated)  when it was eventually disclosed to me that an artificial baby milk company had paid my salary. I had literally been lied to on an earlier date regarding this issue.  My colleagues and I feel that this information was purposefully made known to me, when I became increasingly aware of and subsequently, vocal about overall unethical practice on the unit. Furthermore, the progressive actions of nurses as client advocates reached a level no longer tolerated by the administration. 

When the information became apparent to me, I wrote a letter of resignation in which I clearly stated my reasons for resignation.  The letter was also sent to several  leading breastfeeding advocates in the city who were noted in the "cc to" section of the original letter to the hospital. 

I was subsequently harassed by the hospital. The harassment included a letter that stated that I was a liar!The nurses' association sent me to a wonderful, socially conscience  lawyer who initiated a legal case as means of showing the public the reality. I agreed to go ahead with the case until the case was eventually dropped due to insufficient funding. 

What did I learn from this experience? A lot (!!!) but in this posting I will focus on issues that are relevant to several of the past postings. The two issues I will focus on are meeting with formula sales people and providing mothers with information or engaging in actions that negate physician instructions.  

A most important task of the lactation consultant in an institutional environmental is to facilitate staff and clients' internalization of breastfeeding friendly concepts. Nursing belongs to all of us not just the breastfeeding specialist!  Hence, the aim is to ensure that staff and clients act in a manner that reflects a view of nursing as a normal and natural succession to inner uterine life.  In order for this to occur, one must take steps that help the staff as well as clients take on personal ownership of issues . 

There are many tools that help to accomplish this task and one of these is to act as a role model.  As a role model, in the resistant environment where I worked as the L.C., I refused to meet or to have anything to do with the marketing tools or sales representatives from artificial baby milk companies. I do not think that it is enough to refrain from using the products that they try to push on us.  In fact, the staff or clients might not be even be aware that we discard these products after they see us interacting with the company sales people.  The only way that we can assist staff and clients in gaining an understanding of the reality of the artificial baby milk company and their product, is by sending clear and consistent messages regarding  this issue.  Hence, my purpose in refusing contact with the sales representatives was to not only demonstrate my disdain for their product and marketing techniques, but more importantly, I intended to convey to the staff that lactation consultants and breastfeeding are not associated or compatible with artificial baby milk. 

I can not express the excitement I felt as an increasing number of staff members began to emulate this behavior and to demonstrate recognition of as well as clear contempt for the marketing attempts of the artificial baby milk company! This understanding was extended to the manner in which the use of artificial baby milk was reduced in their actions. 

As a role model, I also presented clients with up to date and  accurate scientific information, even if that information negated the physician's view. The issue of informed decision making and the ethical obligation of nurses to act as client advocates was discussed at length with both clients and staff.  No, I was not well loved (to say it mildly) by the physicians or some of the staff  in that particular institution.  (Indeed, I am sure that many of the physicians cringed each time the administration initiated a renewal of my contract). However, it is important to remember that health care providers are first and foremost obligated to provide optimal service to clients and not to appease other staff members.

This attitude as well as relevant behaviors were taken on by an increasing number of informed clients and staff members.  Follow up with many clients demonstrated continued confidence and conviction in their interactions regarding nursing. Also, to the best of my knowledge, when  this hospital was closed about two years ago (!!!!),  many of the wonderful and brave staff members took these concepts with them to their new places of employment. 

Hence, I believe that as breastfeeding counsellors, lactation consultants, lay leaders and other most worthy professionals involved in the normal human act of nursing, we should try (to the best of our potential) to act as role models. This often includes acting in a manner that is most uncomfortable (I've been there)!!!  I also realize that for many of you this task is far more difficult than for others and the consequences might be severe. Hopefully, we can support each other to facilitate behaviors that enable others to take on our attitudes, to share in our important work load and to increase family health. 

Keren Epstein-Gilboa MEd, BScN,RN,LCCE,IBCLC, 
PhD (Candidate)

 

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