Lactation experts to be replaced with non-nurses
UMass Memorial hiring non-nurse consultants
Registered nurse lactation consultants at UMass Memorial Medical Center — Memorial Campus, from left, Darlene Breed, Julie Naya, Susan J. DiMario and Diana Provencher. They are to be replaced by non-nurse lactation consultants from a private company. (T&G Staff/CHRIS CHRISTO)
By Karen Nugent TELEGRAM & GAZETTE STAFF
WORCESTER — Susan J. DiMario suspected things were not going as well as described in medical notes the minute she walked into the new mother’s hospital room.
Although everything looked fine — the baby was cradled in its mother’s arms with its mouth at her breast — and the mother told Ms. DiMario, a registered nurse and board-certified lactation consultant since 1986, that the baby had been feeding for about an hour, it turned out the baby had not had a proper feeding for about 12 hours.
They were scheduled to be released from UMass Memorial Medical Center that day, approximately 48 hours after she gave birth, supposedly with the mother all set to breast feed on her own.
“The hairs on the back of my neck went up,” Ms. DiMario said. “That baby was literally asleep. He was just hanging out at the breast. All the charts said he had been feeding fine and that the mother understood everything, but that was not adding up with the way they looked. I don’t think we could say this was going to be fine once they went home. It needed a different approach.”
Ms. DiMario is one of four registered nurse lactation consultants at UMass Memorial Medical Center — Memorial Campus, about to be replaced by non-nurse lactation consultants from a private company in a money-saving move that has prompted opposition from other nurses, their union and the Massachusetts Breastfeeding Coalition. The change will leave the hospital without a single registered nurse lactation consultant.
Ms. DiMario, along with Darlene A. Breed, a registered nurse and certified lactation consultant who has been working in the field for 35 years, and colleagues Julie Naya and Diana Provencher, contend that replacing nurse lactation consultants will prove detrimental to new mothers, babies and obstetrical nurses who are too busy to handle breast feeding instruction.
More than 180 nurses, about 85 percent of the nursing staff at UMass Memorial Medical Center’s maternity and neonatal intensive care unit, have presented a petition to hospital administrators protesting the layoffs, which will take effect Thursday.
The nurses, along with the Massachusetts Breastfeeding Coalition, a nonprofit organization, dispute that the outsourced consultants can handle medical issues with mothers and babies, especially in the recently renovated 49-bed level 3 neonatal unit, a designation meaning it is able to handle the most fragile preterm infants.
According to the petition, UMass Memorial has one of the state’s busiest maternity programs, and no other hospital of its size in the state employs non-nurse lactation consultants. They also contend the outsourced consultants will not be certified by the International Board of Certified Lactation Consultants, which has stringent requirements, and that certification of the outsourced consultants only requires a five-day course.But according to an email to the coalition from Debbie Tishler, the interim consultant who will handle the transition to services provided by Walpole-based Lactation Services LLC, there is a contract in place stipulating that lactation services will be provided by a board certified lactation consultant — IBCLC — for eight hours a day, seven days a week. Four hours each day will be dedicated exclusively to the neonatal unit. Also, the board certified consultant will work some evening hours, which, she contends, UMass Memorial has not provided in the past.
In addition, Ms. Tishler said in the email that non-board certified lactation consultants — CLCs — will be provided to the maternity unit to help breastfeeding mothers and run support groups.
“They will be working to further develop and improve on the current breast feeding support groups that have been in place for a year with virtually no attendance,” she said in the email.
Ms. Tishler said there is no government or other mandate requiring hospitals to employ nurse lactation consultants.
Providing lactation consultants for new mothers is a service that became popular in the 1980s for a generation whose mothers were told formula feeding was preferred and could not offer a lot of help with breastfeeding, according to Ms. Breed. The first IBCLC exam was given in 1986.
Hospital Spokesman Rob Brogna acknowledged that the change was also made for financial reasons.
In response to a contention by the nurses’ union that Lactation Services LLC is the same company that provides breast pumps to the hospital, Ms. Tishler said pumps are provided by Invacare Rentals and Services, formerly Centralized Medical Equipment. She has managed those breast pump programs for three years. She said Invacare Rentals is not the staffing company, but women employed by Invacare have been offered jobs with Lactation Services LLC, formed in October, and that Invacare will continue to maintain a consignment closet of breast pumps at the hospital.
Lynne Starbard, a UMass Memorial maternity nurse, said she is shocked by the layoffs.
“There is no way in the world that a non-nurse lactation consultant, no matter how experienced, can ever replace these nurses, particularly in the caring for the complex population of patients we serve,” she said.
Ms. Breed said while maternity nurses are perfectly capable of handling breast feeding mothers who don’t have complications, lactation consultants are called in for a variety of medical problems, especially in premature and micro-premature babies.
“Babies born at 24 and 25 weeks are surviving, and those babies need breast milk even more, and the mothers need more assistance. They have to pump, and maybe hold the baby near the breast to get a few drops of milk on its mouth. But it may take that baby until 33 to 34 weeks until it can actually suckle,” she said.
Also, Ms. Breed said, non-nurse lactation consultants working in the neonatal unit means that nurses cannot leave their assigned babies if something goes wrong.
Sometimes, babies, even those born a bit premature, start to turn blue around the mouth while nursing, she said. A new mother probably wouldn’t notice until the baby stops breathing.
“I can pick up that baby, put it back in the incubator, start giving it oxygen right away, and call for help. And I can do it calmly, because I am well trained,” Ms. Breed said.
Ms. DiMario said besides premature babies, and those born with cleft palates, neurological and anatomical defects, and other medical issues, there are a host of possible problems with mothers. There are approximately 4,000 births at the hospital each year, many to teen-age or drug-addicted mothers. Other complications include multiple births, mainly due to infertility treatments at UMass Memorial resulting in twins, triplets and quadruplets; gestational diabetes; and the increasing number of C-sections, which can weaken a mother.
Marsha Walker, a registered nurse and lactation consultant who is a member of the board of directors of the Massachusetts Breastfeeding Coalition, said while the coalition does not dispute that non-nurse lactation consultants who are certified by the International Board of Certified Lactation Consultants are capable of working in settings such as a pediatrician’s offices, health clinics or in private practice, they usually lack the medical experience needed for hospital work, especially a large one such as UMass Memorial with a neonatal intensive care unit.
“None of the replacements have hospital experience,” she said. “They are replacing the experienced people with people who have lesser credentials.”
Leominster Hospital employs two nurse lactation consultants, according to spokeswoman Mary Lourdes Burke. One works 32 hours a week, and the other 16 hours a week. They are available Monday through Saturday, and are on-call on Sundays, she said.
Ms. Lourdes Burke said the hospital, which is part of the UMass Memorial system, does not plan to outsource lactation consulting.
South Shore Hospital in South Weymouth, a 318-bed hospital which averages 3,700 to 3,800 births a year, has five nurse lactation consultants who are all IBCLC certified, according to spokeswoman Sarah E. Darcy.
Emerson Hospital in Concord, which delivers approximately 1,160 babies a year, employs several International Board Certified lactation consultants, including at least one nurse lactation consultant.
Contact Karen Nugent at knugent@telegram.com .
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