Lactation Consultants, Doulas, and the Negotiation of Paid Caring

by Jennifer Torres

Lactation consultants, who provide breastfeeding support, and doulas, who provide labor support, are two relatively new and rapidly growing groups working in maternity care. The work they do builds upon traditional forms of care that have existed for centuries – supporting women through the process of childbirth and the early days of caring for a new baby. However, these two groups perform this work as an occupation, where they are paid to provide these very intimate forms of care.Torres_image1

As a society, we have quite particular views on the combination of money and intimacy, believing that there are “right” and “wrong” ways to combine them. It is especially difficult to combine them appropriately within the context of caring because it is associated with the private sphere of the home and thus believed to be an innate characteristic of women and something that should be provided for free. My research examines how these beliefs about the combination of money and intimacy affect the work of lactation consultants and doulas and how they and their clients understand and negotiate their relationships. I conducted 72 interviews with lactation consultants, birth doulas, clients, and health care professionals (physicians, midwives, and nurses), as well as roughly 150 hours of ethnographic observation over nine months with three lactation consultants.

I find that lactation consultants and doulas provide both physical and emotional care to their clients. For example, lactation consultants help with breastfeeding positions, while doulas help with laboring positions. They both provide their clients with encouragement, such as affirming that their experiences are normal. If their clients’ birth or breastfeeding experience does not go as they planned or expected, lactation consultants and doulas help women and their partners cope and adjust. All of these aspects of their roles illustrate the intimacy of this work.

The fact that this intimacy is provided for pay creates a need for lactation consultants, doulas, and their clients to negotiate their relationships and details of payment in the “right” way, what Viviana Zelizar calls “relational work.” In terms of negotiating relationships, lactation consultants, doulas, and their clients draw boundaries around these forms of work, defining them as expert, as different from familial care, in order to justify paying or being paid for them. Despite this, however, lactation consultants and doulas experience difficulty charging for their services, using sliding payment scales or even working for free. Clients also experience difficulty negotiating payments, expressing discomfort with both paying and not paying for these services. In all, my article illustrates the difficulties for care workers that are created by gendered understandings of care as an innate characteristic of women and how this can devalue caring and perpetuate the low pay of care work.

Jennifer Torres holds a position at Michigan Public Health Institute. Her article, “Expertise and Sliding Scales: Lactation Consultants, Doulas, and the Relational Work of Breastfeeding and Labor Support,” is published in the April 2015 issue of Gender & Society. To read the article, click here.

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