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SUPER-NATURAL BREASTFEEDING: HOW LACTATION CONSULTANTS IN HAWAI‘I DEMEDICALIZE AND RESHAPE WOMEN’S EMBODIED EXPERIENCES A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI‘I AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN ANTHROPOLOGY May 2021 By Crystal Renee Cooper Dissertation Committee: Jan Brunson, Chairperson Carmen Linhares Eirik Saethre Ty P. Kāwika Tengan Aya Kimura Acknowledgements This dissertation would not have been possible without the support and advice of my committee members, friends, and family. First, I would like to offer my thanks and appreciation to my committee members for their guidance. As my advisor and committee chair, Dr. Jan Brunson was especially helpful, providing me with exactly the right advice in addition to warm support. She somehow endured reading many bad early chapter drafts without expressing anxiety, and continually encouraged me to share these stories. Thank you, Dr. Brunson, for your kindness, wisdom, and sense of humor. I would also like to thank Dr. Eirik Saethre for teaching me so much over the years and for the best advice ever for how to start writing after you’ve been in the field. Thanks as well to Dr. Tengan, Dr. Kimura, and Dr. Linhares for sharing your knowledge and offering your encouragement. A special acknowledgement is in order for Dr. Andrew Arno, a committee member who passed away before this dissertation was completed. Dr. Arno was always gracious with his time and attention and truly cared about students. He felt that this research was important and was invested in assisting my efforts. It would be hard to find a kinder man, and while his careful thought and interest was appreciated, his absence is missed. My deepest gratitude goes to all the women who agreed to be part of this dissertation research, and especially to the lactation consultants who so generously gave of their time and effort to help me become an IBCLC and allowed me to participate in and observe their work on behalf of mothers and babies. You all offered your time in the spirit of a sisterhood of support and taught me so much about care work and how women can uplift other women. It has been an honor to learn from you. Thank you to all of the other individuals who are too numerous to name but nonetheless were supportive of me along this journey, whether you offered encouragement, practical assistance, or a much-needed break. Finally, I owe an incredible amount of gratitude to my kids for the many years that they tolerated having a single mom who worked, attended school, and struggled to have much energy for them at the end of the day. You are the reason I did all of this, and as I worked with and wrote about mothers and babies I was reminded of all the struggles and joys we have shared that have made my life so rich. I thank you and love you with all of my heart. ii Abstract Women’s difficulties and negative experiences with breastfeeding have prompted a backlash in the U.S. against its promotion, as well as attempts to change the discourse to say it is insignificant and potentially dangerous with benefits that are overstated. My dissertation examines how lactation consultants in Hawai‘i confronted dominant ideologies that affect breastfeeding and helped women having difficulties. Data was collected over 2.5 years through participant observation at La Leche League meetings, with 7 lactation consultants and their clients, IBCLC training with 4 of the lactation consultants, and interviews of 8 lactation consultants and 15 clients. The research uncovers the contrasting concepts of lactation consultants and breastfeeding mothers. It demonstrates that dominant ideologies inform women’s concepts of the lactating body as likely to fail, and this promotes medicalization and ignores structural barriers. It provides insights into how lactation consultants help mothers form new concepts for positive embodied experiences, and demedicalize breastfeeding from within medical environments. It is significant for its contribution to efforts to improve maternal and infant experiences and health outcomes, and its contributions to the anthropological literature on medicalization, embodiment, and science as culture. iii Table of Contents ACKNOWLEDGEMENTS ......................................................................................................................................... ii ABSTRACT ............................................................................................................................................................... iii FORWARD ........................................................................................................................................................ vi -xiii CHAPTER ONE, INTRODUCTION ......................................................................................................................... 1 Introduction ............................................................................................................................................................................... 1 Theoretical framework .............................................................................................................................................................. 9 Research methods and design ......................................................................................................................................... 35 Dissertation outline ............................................................................................................................................................. 43 CHAPTER TWO, THE RISE OF LA LECHE LEAGUE AND THE CREATION OF THE IBCLC ................. 49 Introduction ............................................................................................................................................................................ 49 The Era of the IBCLC ............................................................................................................................................................ 49 The results of breastfeeding activism ................................................................................................................. 65 The Influence of La Leche League on the Creation of the IBCLC ...................................................................... 72 “Natural” Parenting and the Expert .............................................................................................................................. 80 Infant care and evolution............................................................................................................................................ 87 Instincts and social structure .................................................................................................................................... 92 Conclusion………………………………………………………………………………………………………………………………...….97 CHAPTER THREE, BECOMING A LACTATION CONSULTANT ................................................................ 103 Introduction………………………………………………………………………………………………………………………….103 IBCLC Certification Requirements .............................................................................................................................. 103 My Socialization into a Medical Role ......................................................................................................................... 105 My Story ................................................................................................................................................................................. 106 The Lactation Consultants’ Stories About Why They Became IBCLCs ....................................................... 117 Mary .................................................................................................................................................................................. 118 Karen ................................................................................................................................................................................. 121 Tina .................................................................................................................................................................................... 124 Sandra .............................................................................................................................................................................. 125 Yui ...................................................................................................................................................................................... 127 WIC IBCLCs ..................................................................................................................................................................... 131 The Training ......................................................................................................................................................................... 136 Conclusion ............................................................................................................................................................................. 144 CHAPTER FOUR, SUPER-NATURAL WHITE BLOOD: THE CONCEPTS LACTATION CONSULTANTS HAVE ABOUT BREASTFEEDING ..................................................................................................................... 146 Introduction ........................................................................................................................................................................
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