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Fluid Experts
Lactation consultants as postmodern professional specialists
Katherine Carroll
Centre for Clinical Governance Research, University of New South Wales, Australia
Kerreen Reiger
La Trobe University
Abstract
Since their accreditation as a professional specialty in 1985, lactation consultants have grown in number and prominence in maternity care. In North America and Australia, breastfeeding management is now a domain increasingly presided over by certified experts.
This article explores the way in which this speciality has established a distinctive identity that straddles seemingly contradictory maternalist, and medicalised, discourses. Drawing on professional sources and on a small study of Victorian lactation consultants, it explores the shift from the maternalist imagery characteristic of voluntary breastfeeding support groups, to a more complex message about breastfeeding as a contemporary social practice.
We argue that the way in which lactation consultants negotiate complex relationships with peers and clients gives rise to a fluid professional identity. This reflects not only their historical legacy and recent changes in health systems and professional roles, but also a postmodern cultural context, in which women negotiate their embodied identities as mothers, lovers and workers.
Keywords
breastfeeding, lactation consultants, professions, sociology, maternity care
Article Text
The health workforce has recently undergone many changes, most notably those associated with what is euphemistically called health care 'reform'. This has been characterised by the neoliberal restructuring of services to make them more 'economic, efficient and effective' (Hancock 1999). The impact on the traditional professions of medicine and nursing have been widely debated (Walby 1994; Allsop and Saks 2002), but the growth of new occupational groups also deserves analysis. This article considers the emergence of lactation consultants (LCs), an occupational group which fills a specific role not only within maternity care institutions, but in private practice in the community. This development has received little sociological attention, even in Australia which has the highest rate of LCs per baby born in the world (Drew and Escott 1997; Minchin 1998). Since the mid 1980s, in both North America and Australia, LCs have carved out a niche as an emergent professional specialty, and are increasingly influential in the lives of mothers and babies.
The distinct identity developed by LCs, combines (sometimes uneasily), medical science and maternalist wisdom, formal expertise and respect for women's embodied experience. The processes giving rise to this identity, and the form it now takes, suggest an interpretation of the significance of LCs as an emergent specialisation. Without addressing debates on the nature of professions as such, we argue here that the positioning and identity of LCs may signify the 'postmodernisation' of professional practice. Our analysis draws on previous work on changes in maternity care, the role of breastfeeding advocacy groups, and on a small qualitative study of Victorian LCs. Given that LCs work in a context of rapid change (both in health systems and in the cultural expectations of motherhood), we argue that the historical processes shaping lactation consultancy have produced a fluid, multiple identity: one that is constantly being negotiated with peers and adjusted in response to clients.
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