I'm going to jump in on this conversation and hope I don't get flamed too 
much!

I have been quite discouraged by what I have observed happening with 
midwives in Ontario. Until about twelve or fifteen years ago (can't remember 
exactly), Ontario had only lay midwives (although some were trained in other 
countries). They could only attend home births, although some went as 
"labour support" if women had to transfer to hospital. It was not a perfect 
system by any means, but the midwives were generally very skilled at making 
the atmosphere at the birth emotionally supportive, providing good 
information while respecting women's choices and decisions and finding 
non-interventionist ways to deal with problems.

Then several schools of midwifery were opened, midwives became qualified to 
deliver at home or in the hospital, and well, a lot changed. Now I see 
midwives who have never had children and who are clearly a little nervous 
about the whole process - their training has focused on "what could go 
wrong" and they are not able to convey that sense of confidence that the lay 
midwives projected. They tend to bustle into the home, spread out all their 
medical equipment (with no recognition that looking at all that stuff is 
stressful for labouring women) and are quick to "risk out" women and insist 
on going to the hospital. I've heard midwives tell women that they are not 
really comfortable with home births and think anyone who doesn't opt for an 
epidural is just being a martyr.

This is not meant as a blanket condemnation of Ontario midwives, as I know 
many excellent ones. I just see that once there was this schooling process 
put in place, the profession changed, and I don't think the changes have all 
been positive. I see women now who are linking up with underground lay 
midwives (who can't legally practise) to get the kind of birth that is 
important to them.

That's what I am afraid of happening in the lactation field. Twenty-five 
years ago in my community, if you wanted to breastfeed your main hope was 
finding a La Leche League leader, because the information given out by 
hospital and public health nurses was terrible. That we have better info 
today is in large part because of the dedicated work of those volunteer lay 
breastfeeding supporters.

Breastfeeding, like birth, is not just a medical event. It is also about 
having confidence in yourself and your body and in an emotional 
understanding of your body and your baby. Helping a mother experiencing 
breastfeeding challenges or learning to breastfeed is not about "apply part 
A to part B and follow steps 1, 2 and 3." It is about listening to the 
mother, understanding how she is feeling, sharing information, respecting 
her decisions, helping her to understand and connect with her baby so she 
can make the best decisions for both of them, providing her with the social 
supports she needs to breastfeed despite other barriers she might be facing. 
La Leche League Leaders, in my experience, are very good at providing those 
things - because they have been where that mother is, they know how it 
feels, and they are passionate about breastfeeding and mothering.

I'm afraid that an education-based entry into breastfeeding support will 
give us Lactation Consultants who can only prescribe and direct, and mothers 
need so much more than that.

Teresa Pitman
Guelph, Ontario 

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