Tuesday, April 1, 2008


by Wendy Haldeman, MN, RN, IBCLC, Co-Founder of The Pump Station

Perhaps at that moment, I was just feeling tired and unappreciated as we all do sometimes. It quickly shifted to discouraged and extremely cranky after reading Pamela Paul’s recent piece in the New York Times, “And the Doula Makes Four.”

According to Ms. Paul, laboring women are being made to endure a hellish birth experience, while vulnerable and starving infants are limited to mother's milk or nothing at all. The alleged cause of this appears to be the outrageous and self-serving conduct of the birth doula and lactation consultant. Wow. I had no idea I belonged to such an evil group of professionals!

After consuming several glasses of wine and taking numerous cleansing breaths, I could sympathize and acknowledge that Ms. Paul makes some compelling points during her diatribe. Let me elaborate: as I am both a registered nurse and lactation consultant, I wear two hats. It has been troubling to me for some time that patients have to “go out of network” in order to attain the birth they desire, and to successfully breastfeed their child. Is it too much for a mother to expect that the labor and delivery nurse will also act as the patient’s advocate? And why can't the postpartum and nursery nurses guide and teach the new mother in infant feeding? These two functions are clearly within the role of any nurse who practices maternal child health. And yet, somewhere along the line, nurses became unwilling or unable to carry out these basic tasks.

As a result, the public continues to need the services of birth doulas and lactation consultants. But expectant parents must be made aware that all such individuals are clearly not created equal.

One of my pet peeves is how seemingly every baby nurse and doula now calls herself a lactation consultant, without limitation. The truth is, they can. Currently there are no legal requirements to practice as a doula and/or lactation consultant, and no license or certifications are mandated. It is up to the employer – the stressed if not overwhelmed new parents – to challenge such a claim. As my partner Jessica Sacher stated in the Paul article, “Parents have to do the same amount of due diligence as they would when seeking a pediatrician.”

It concerns me greatly that a few overzealous individuals choose to place their own agenda ahead of the physical, emotional, and psychological well being of their client. I would just urge those colleagues to stop and consider what is most important: that babies and their parents thrive. But I would also remind the public that the great majority of doulas and lactation consultants spend their professional lives doing just that: ensuring the safety and well–being of their clients. Even Ms. Paul admits, bless her, that “doulas and lactation consultants can be godsends for many women”.

For definitions of breastfeeding acronyms and abbreviations click here.