Managing connection and disconnection : relationships as the centre of lactation consultant care for breastfeeding women and their babies

Abstract

Background: Breastfeeding is known to confer lifelong health benefits to mothers and their babies, but many women stop breastfeeding as a result of difficulties. Getting appropriate and timely support may help women to overcome problems and continue to breastfeed according to their own goals. Lactation consultants are a relatively new professional group that offer breastfeeding support. Today there are over 30,000 International Board-Certified Lactation Consultants practising globally, 2000 of whom are in Australia. While there has been extensive research into breastfeeding support, little is known about the role and practice of lactation consultants and whether, or how, their work makes a difference to breastfeeding outcomes. Aim: This research aimed to examine the role and practice of lactation consultants in Melbourne, Australia. Methods: A focused ethnography was conducted. Data consisted of 176 hours of participant observation of lactation consultant practice and in-depth interviews with 14 lactation consultants practising in Melbourne, Australia across a range of settings. Data were analysed using thematic analysis. Merleau-Ponty's theory of embodiment and feminist theories of care and relational care informed the analysis. Findings: Three major findings emerged from the analysis. 1. Lactation consultants prioritised the relationships they developed with women which enabled them to provide holistic care. 2. Lactation consultant care was focused on and through the mother- baby relationship. 3. Lactation consultants negotiated structural constraints in the service system that affected the way women initially learned to breastfeed and how they received ongoing breastfeeding support. To enact their role, the lactation consultants prioritised building a relationship with mothers by warmly welcoming them to the space where care was provided, listening attentively to the woman, demonstrating empathy and being gentle, kind and calm in their interactions. The lactation consultants were also observed using their own bodies in particular ways when engaging with mothers by positioning themselves at the woman's level, and often in very close proximity to mother and baby. They used their body to create private spaces in busy practice environments that were not under their control. Lactation consultants were conscious that others perceived their role as one of primarily 'fixing' problems, but they resisted this view of their practice. Rather, the lactation consultants used various strategies when supporting women, including 'doing nothing', letting time pass, pacing interventions and, at times, letting go of breastfeeding. Even in situations with highly complex medical issues for mother or infant, lactation consultants maintained a focus on the mother- baby dyad and a relational approach to supporting them. The work of participants occurred in the context of the healthcare system and in interaction with other health professionals, especially midwives and maternal and child health nurses. The lactation consultants identified numerous barriers to breastfeeding and breastfeeding support in the healthcare system in which care was provided. These barriers included time-pressured environments, task- focused and prescriptive practices as well as problematic fragmentation between hospital-based and community services that often led to delays in accessing breastfeeding support. Models of care and modifications to practice that enabled lactation consultants and other health professionals to effectively support women to breastfeed were also identified. Discussion: Relational care was at the centre of lactation consultant practice. The lactation consultants prioritised their relationships with mothers and their infants to create an environment of care in which trust and genuine support was provided. In part, the lactation consultant's role was facilitated through a focused and defined role within the healthcare system, but their practice was also constrained by issues in this system. Lactation consultants need to advocate for structures and service models that value these relational care values, which are highly effective in breastfeeding. This could help lactation consultants bring health facilities and other health professionals into a sustainable and highly effective model of relational breastfeeding support for women who wish to breastfeed their babies.

Date of Award	2020
Original language	English