New York Times Examines Conflict Between Doulas, Lactation Consultants; Physicians, Nurses, Parents

Main Category: Nursing / Midwifery
Also Included In: Pregnancy / Obstetrics;  Primary Care / General Practice
Article Date: 05 Mar 2008 - 8:00 PDT

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The New York Times on Sunday examined how the increased popularity of doulas, or birthing coaches, and lactation consultants has led to conflict with some physicians, nurses and new parents.

According to the Times, studies have found that women who have a doula during birth have shorter labors, fewer medical interventions and a more positive experience. Although national statistics regarding physician and nurse attitudes toward doulas are not available, a 2006 study found that 44% of women in Alabama who used doulas described the relationship between their doula and hospital nurses as hostile, resentful and confrontational. Reston Hospital Center in Virginia banned doulas in 2005 after disagreements between physicians and nurses and doulas.

Disagreements among lactation consultants and medical staff also are common, the Times reports. According to the Times, some lactation consultants have upset new parents by urging women to breastfeed in all situations, including when physicians have recommended formula or when women have had difficulty breastfeeding and want to supplement with formula.

The American College of Obstetricians and Gynecologists does not have an official position on doulas. Sarah Kilpatrick, chair of the group's committee on obstetric practice, said doulas can be helpful but added that "occasionally [doulas] attemp[t] to interfere with the medical aspect of delivery."

Mary Sanderlin, a doula who became a labor and delivery nurse, said conflict usually arises when doulas act outside of their scope of practice. "As a doula, I certainly felt there were times when the medical staff weren't being transparent about their wishes," but a good doula "can force the medical staff to come clean about certain interventions," Sanderlin said.

A major source of the conflict is a lack of standardization and oversight for doulas and lactation consultants, Maureen Corry, executive director of Childbirth Connection, said. The number of doulas certified by Doulas of North America increased from 750 in 1994 to 5,842 in 2005; however, doulas do not require certification and anyone can be a doula regardless of training, the Times reports.

The number of lactation consultants certified by the International Board of Lactation Consultant Examiners has increased by 15% since 2003 to nearly 9,000, the Times reports. IBLCE requires 2,500 hours of practice and 45 hours of course work for certification. Requirements to meet certification vary among different groups, and there are at least six different acronyms signifying lactation credentials. As the Times points out, "How can a sleep-addled mother differentiate among a C.L.E., a C.B.E. and a C.L.C.?"

Jessica Sacher, a registered nurse and lactation consultant at UCLA Medical Center, said she does not believe doulas or lactation consultants are "deliberately trying to deceive mothers out of malice," but added that "parents have to do the same amount of due diligence" in choosing a doula or lactation consultant "as they would when seeking a pediatrician" (Paul, New York Times, 3/2).

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