Natalie made some very important points.   

I would have to agree with her that the vast majority of the problems I see are not medical in nature -- but most of the problems I see have been created by large institutions that have procedures that interfere with normal behaviors.  Nevertheless I find her post offensive in that she confuses professionalism with medicalization, assuming that those who work as professionals are working to transform breastfeeding into a medical act.  And while I agree that breastfeeding is a normal act, when women have problems breastfeeding it may require sometimes medicalized (be it allopathic or homeopathic, traditional or alternative, herbal or pharmaceutical) interventions.

Some of us who have decided to undergo significant amounts of training in order to provide PROFESSIONAL services beyond what VOLUNTEERS can do for the 5% of women who really cannot fully breastfeed and the 95% of women who deliver in baby unfriendly hospitals and develop complex and complicated problems that cannot be solved by peer support alone.  Many of the problems we see as professional lactation consultants are more akin to severed arteries, compound fractures, severe asthma attacks, and heart attacks .  Perhaps if you had a CPR class you might be able to temporarily deal with any one of those events.  Nevertheless, I think most people would want PROFESSIONAL assistance to be able to deal with more than the initial emergency.  They might need a blood transfusion, physical therapy, dietary and environmental changes. 

While many IBCLCs value peer support, she denigrates her sisters who have chosen to dedicate themselves to further study and experience to become professions at a level whereby they can provide more in depth assistance for complex and complicated problems.  While everyone exalts the "Joe the Plumbers" who are (or at least pretend to be) small business owners, everyone loves to denigrate "Lucy the Lactation Consultant" because she is too greedy to "volunteer" her time and if she doesn't "volunteer" her time or "cut her rates" to the point that she and her family can't survive - she would be "causing women to formula feed" and who needs her services anyway since (even though there is a miniscule proportion of lactation consultants who work outside the hospital) and even worse "she is not as experienced if she takes too long to provider her services.  And the false claim that there is no data yet to prove her worth.

Here I must speak up from my PhD and MHS which include minors in Epidemiology and Program Evaluation.  Again and again, I read overly simplified notions of what this entails. Let me make it clear that a single randomized controlled trial is NOT the gold standard for proving causality.  And while the evidence is completely clear that peer support does improve breastfeeding initiation and duration -- peer support is merely a NECESSARY but NOT SUFFICIENT condition for restoring breastfeeding to normal as well as providing ADEQUATE and full support for those who have medical conditions that interfere with breastfeeding as well as unprecedented new problems that have arisen with a) the ability to save lives of very premature infants, b) fertility treatments that allow women with endocrinological problems to conceive and c) the epidemic of morbid obesity not just in developed areas but developing areas as well.  I have seen over 5000 mothers  so far who came to me because neither the hospital services, nor the mother to mother support groups were sufficient to resolve their problems.  Like any normal human activity there is a place for professionals who can assist those who encounter problems to move towards recuperating some form of normal.  

La Leche League to me is the premier model of what mother to mother support and long before anyone used the term "going viral" they did it. La Leche League was not sufficient, however, to return breastfeeding to the normal duration of least two years.   There are limits to mother to mother support that were not conceived of during the time when there was a sufficient proportion of middle class women who had, for the first time in history, the luxury of having some leisure time to devote to volunteer activities and spreading those volunteer activities to other groups.  Before that period of time there was only a tiny proportion of upper class women who had leisure time, everyone else was scraping by trying to survive.  I think of my grandparents who came from the midwest in during the dustbowl years -- there was no leisure time to  "volunteer".  There were sometimes communal activities --- I will help you build your house, raise your barn if you help me do the same. If we now look at modern society -- would you now expect any carpenter to build your house for free?  I seriously doubt that model will work for anything but some small nonprofit endeavors that are carried out by those wealthy enough to donate money or to those who have sufficient leisure time to volunteer.

From the tales of my grandmother men and women were working side by side -- doing perhaps gender specific activities, but nevertheless economically productive activities for the family survival.  The difference between those times and what many families face now is that men and women are still having to scramble to conduct economically productive activities but they are separated from each other and their children while they are doing those activities.  

And again -- there is not always the leisure time available for many women to be able to sit with there neighbor and hold her hand through 2-3 hours of watching her baby feed to be able to solve complex and complicated breastfeeding problems.  And this certainly does not work in urban centers where women are now isolated from family and from the close knit social groups they may have enjoyed in the past.

Some of us ave worked just as hard if not harder to support breastfeeding as professionals but may not have the luxury of  "volunteer" our time in ways that men would never be expected to.

The other reason why there are limits to mother to mother support is the same reason that breastfeeding supporters are sometimes denigrated with a very unfortunate term that I heartily condemn, the Breastfeeding Nazi.  The reason why some women become frustrated and use such a horrible and indefensible term is because they did not FIT into the group.  A group works well when you have similar values.  It can be horrible to be the odd woman out in a group that doesn't understand you.  

As important are the subtle personality differences in groups.  I conducted a survey of 900 mothers in the Andes of Peru.  In every single one of the 30 pueblos I visited mothers that would whisper to me about what a torture the mother to mother groups were for them because the wife of so and so had her own little clique going that didn't include those who were not deemed worthy of their group.  I also found this to be true among women in Niger who went to groups at their community health centers.  

Peer support groups work for many women, but they do not work for all women. What is most concerted is that we have a prime example of how a group can exclude even and ENTHUSIASTIC member of a peer support group.  A man who gave birth to a child and breastfed his child is being denied the ability to become a La Leche League Leader because he is too different for that group to comprehend. 

I never thought my own sisters would bash small women owned businesses.  I never thought my own sisters would bash those who want MORE education and MORE training and MORE supervised experience.  I never thought my own sisters would bash of women who cannot afford to volunteer because they have families to feed.  I never thought my own sisters would be so UNEMPATHETIC to the 5% of women who really do have problems establishing a full milk supply and to the 95% of women who still have to contend with the slow change that it will take to change large institutions into baby friendly places. 

I have long valued my sisters who have the circumstances which enable them to volunteer. I foolishly thought they reciprocated by valuing those of us who have sought out training to provide professional support to those who NEED more than mother to mother support.  At least here in New York City I find that the vast majority of peer counselors and lactation consultants have a deep mutual respect for our respective roles that should work together through multiple avenues to cover a multiplicity of different types of women as well as men.  So while many may condemn the single proprietor lactation consultants and the group lactation practices run by lactation consultants, I know for a fact that many women value our services in addition to other forms of support.

Sincerely, 

Susan E. Burger.

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