News & Events

UMass Memorial replaces skilled RNs with ‘lactation consultants’

Move comes after CDC calls on hospitals to improve breastfeeding services

From the Massachusetts Nurse Newsletter
October/November 2011 Edition

Just weeks after the Centers for Disease Control issued a call for hospitals to improve maternity care practices to better support breast-feeding for mothers and babies, UMass Memorial Medical Center has made a decision to significantly degrade its own breastfeeding program by eliminating patients’ access to certified registered nurse lactation consultants.

In a callous move to cut costs at the expense of quality patient care, UMMMC management has announced plans to lay off all four of its registered nurse lactation consultants, who have an average of 17 years of experience working in the hospital’s once renowned maternity program. The new plan is to outsource the breastfeeding education to non-nurse consultants who work for the company that supplies breastfeeding pumps to the hospital. They plan to implement the change as of Dec. 1.

The hospital has made this decision when it operates one of the state’s busiest maternity programs (with more than 4,000 deliveries per year), which includes a Level 3 neonatal intensive care unit and an infertility program, serving some of the most vulnerable and fragile mothers and babies in the state. No other hospital in Massachusetts of like size employs non-RN lactation consultants, and most community hospitals in the state rely on RNs for this vital service.

“The nurses of this hospital are shocked by this decision and what it will mean for our moms and babies,” said Lynne Starbard, RN, a nurse on the UMMMC maternity unit which is located on the Memorial Hospital campus on Belmont Street in Worcester. Starbard is also a co-chair of the MNA bargaining unit for the Memorial Hospital campus. “I have personally worked with these nurses for years and I can tell you they are all outstanding professionals who provide an invaluable service to this community. There is no way in the world that a non-nurse lactation consultant, no matter how experienced, can ever replace these nurses, particularly in caring for the complex population of patients we serve.”

To understand the ire of nurses on this issue requires a clear understanding of the importance of breastfeeding for new mothers, and the unique needs of the mothers and babies served by the UMass Memorial program.

In addition to the CDC, all of the state, national and world health organizations have issued strong positions and edicts underscoring the importance of breastfeeding for the health and well-being of children, including the state Department of Public Health, the American Academy of Pediatrics, UNICEF and the World Health Organization.

“Denying optimal breastfeeding support is a cruel blow to new mothers and babies,” said Marsha Walker, RN, IBCLC, who serves on the board of directors for the Massachusetts Breastfeeding Coalition, an organization that advocates for appropriate breastfeeding practices for mothers and newborns. “Substituting lactation support personnel with lower cost replacements is not in keeping with national breastfeeding goals and recommendations established by the Centers for Disease Control and the surgeon general.”

Darlene Breed, RN, has more than 25 years experience in maternity care, including 15 years as a certified lactation consultant. She said the nurses regularly care for mothers and babies with a variety of medical and psycho-social issues that must be assessed by a professional nurse. “Based on that assessment, we have the ability to provide the counseling, teaching and nurturing to ensure that mother and baby bond and breastfeed successfully,” said Breed, who is one of the nurses slated to be laid off. “We have years of experience working with these types of patients, we know what to look for, what to say and how to say it in a way a mom can hear us and move past their fears and anxiety.”

“As RNs,we bring more to the table than just the mechanics of breastfeeding, we bring the ability to understand the biology and physiology, and yes, the cultural factors that are involved in this process,” said Susan DiMario, RN, who has more than 42 years experience as a nurse and 25 years as a lactation consultant. “We can spot issues and problems that a non-nurse cannot, and we know how to communicate those concerns with other members of the caregiver team to ensure the overall safety of mom and baby.”

All four nurses point to instances where, in the course of their counseling on breastfeeding, they have spotted something about a newborn that signaled a potential problem and were able to take steps to avert a potential crisis, or improve the outcome of that child’s care.

“As registered nurses we are advocates for the patient, and because we get to spend an extended period of time with these newborns interacting with their mothers, we are able to sometimes spot subtle physiological issues that might be missed by a non-RN lactation consultant,” said Julie Naya, RN, a 20-year veteran in nursing with 12 years as a lactation consultant.

The nurses also report instances when things went wrong, and they were right there to save the child. “I had a child stop breathing and turn blue, right before my eyes,” said Breed “But I knew what to do, and I was able to resuscitate the child right on the spot.”

Behind this “business story” of hospital cost cutting, lies a deeper story about what it means to provide appropriate care by the professionals best equipped to deliver that care. In the parlance of business, what UMass is doing is known as “deskilling,” attempting to deliver the same service with lower paid, lesser qualified workers. The approach is a staple of the “lean” factory model production processes being employed by UMass and other health care employers in recent years. The same processes were tried during the 1990s in response to managed care and were an abject failure, leading to a dramatic deterioration in the quality and safety of patient care in America’s hospitals. The move to deskill care delivery is resurfacing in the wake of the latest round of health care reform.

The MNA, which represents more than 2,000 nurses at UMMMC, has long opposed any efforts to replace qualified nurses with lesser skilled non-nurse technicians, because the scientific research shows that patient care is vastly improved when it is delivered by RNs, and conversely, care is compromised when patients have less access to RN care.

The MNA is particularly concerned about such misguided strategies when the institution that is implementing it is one of the most profitable health care systems in Massachusetts. UMass posted profits of more than $57 million in 2010 and through the first quarter of 2011, had profits of greater than $11 million.