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98 Aimee R. Eden Chapter 8 Professional breastfeeding knowledge in the United States today is embodied by the lactation consultant.1 Lactation consulting emerged on the global scene in 1985 as a new and highly gendered health care profession specializing in the clinical management of breastfeeding. Twenty-five years later, at the 2010 International Lactation Consultant Association (ILCA) conference, the more than fifty booths in the exhibit hall were a clear indication of how much the profession had matured. On display were breast pumps of different levels of complexity, plastic nipple shields, silicone breast pads, creams, milk storage systems, bras, clothing, pillows, herbal teas, and supplements—all designed to assist parents in feeding their babies human milk under varying personal, medical, and structural conditions. The amount and variety of equipment, technologies, and accessories available to breastfeeding women, and to the health professionals who work with them, point to the growing business of breastfeeding. Though nowhere near the $8 billion global infant formula market, the market for breastfeeding-related products is growing.2 Most of these items, whether based on scientific evidence or invented out of breastfeeding experiences, are marketed directly to mothers, but manufacturers understand the benefit of marketing to lactation consultants (LCs) as well, in the same way that infant formula manufacturers recognize the advantages of marketing to physicians. The investigation of an almost exclusively female profession whose expert knowledge is built on a women’s health issue deserves a feminist analysis, and this chapter applies a feminist perspective to examining the relationship between professionalized breastfeeding support (in the form of lactation New Professions and Old Practices Lactation Consulting and the Medicalization of Breastfeeding New Professions and Old Practices 99 consultants) and the medicalization of breastfeeding.3 Feminist attention to the control and transfer of knowledge, and resulting social constructions, provides the basis for an interpretation of the emergence of lactation consulting, its place in the existing biomedical system, and its role in reestablishing womanto -woman knowledge transfer. In particular, this chapter focuses on constructions of natural processes (like lactation), and on professionals whose expert knowledge addresses those processes. This chapter also modifies feminist critiques of the medicalization of women’s reproductive health that expose issues of gender and power to analyze how LCs simultaneously empower women and contribute to the medicalization of breastfeeding. The Emergence of Lactation Consulting Shifts in infant feeding knowledge and power ownership can be traced in two waves. First was the initial transfer from mothers to (primarily male) physicians , well documented in the literature.4 La Leche League (LLL) had some success restoring woman-to-woman breastfeeding knowledge among certain groups, but infant feeding remained primarily in the medical realm. The subsequent shift from physicians, as well as from mothers, to (primarily female) lactation consultants has been rarely explored to date. This second shift served to remove, at least slightly, the breastfeeding mother/infant dyad from the authoritative biomedical gaze of physicians. However, instead of returning control to mothers, breastfeeding fell under the gaze of a newly constructed breastfeeding expert, the International Board Certified Lactation Consultant (IBCLC). The profession’s emergence in 1985 and its development over the last twenty-five years illuminates the ways in which the profession has been shaped by the medicalization of infant feeding through active appropriation as well as resistance. On one hand, the actions of the leaders in the professionalization of lactation consulting created a space for the new health profession within the existing biomedical system. On the other hand, the existing medical structures influenced their decisions, constrained the process, and affected the outcomes of their actions. While physicians have been significantly involved in infant feeding since the late nineteenth century, breastfeeding expertise has never been fully claimed by obstetrics or by pediatrics.5 Although nurses within many specialties (prenatal, labor and delivery, postpartum, nursery, and pediatric) often provide breastfeeding support, many do not have the time to provide adequate support, nor do they have the appropriate training to do so.6 In fact, studies have shown that obstetrician-gynecologists, pediatricians, nurses, and even midwives often have minimal formal breastfeeding training and knowledge.7 The professional LC addresses this gap in care, focusing on the breastfeeding mother/infant dyad. In the 1980s increasing attention to breastfeeding as a national and global public health issue created a welcoming environment for a profession that would specialize in breastfeeding management. But the emergence of the lactation consulting profession represents more than just good timing; it...


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