Negotiating Care: The Role of Lactation Consultants and Doulas in the Medical Maternity System.

Abstract

This dissertation provides a comparison of two relatively new occupational groups working in maternity care: International Board Certified Lactation Consultants and DONA International birth doulas. Using 150 hours of ethnographic observation and 72 interviews with lactation consultants, doulas, clients, and health care professionals, I examine their role in the maternity care system, including the impact of medicalization on their approaches to creating change in maternity care practices and the meaning and function of their caring labor, as well as the negotiation of paid caring relationship with their clients. I find that, in order to balance their occupation’s foundational goals of demedicalization with their role as the clinical managers of breastfeeding, lactation consultants engage in medicalization and demedicalization simultaneously, but some aspects of their medicalization (e.g., medical control) are actually used to demedicalize (e.g., depathologize). This adds the new concept of “medicalizing to demedicalize” to the literature. I also find that lactation consultants and doulas represent more than a simple transfer of care from family to market because of the impact of medicalization on childbirth and breastfeeding. They are taking on an entirely new role - the role of advocates and guides to the medical maternity system, a system that is often difficult to navigate for women who wish to avoid medical interventions during childbirth and breastfeeding. However, despite this need for an advocate and guide, lactation consultants and doulas still have difficulty being paid to care, due to the “hostile worlds” perspective that sees true caring and paid services as incompatible. This creates tension for lactation consultants and doulas between their passion for supporting mothers and their need to earn income for themselves and their families.