Four registered Nurses (RN’s) at the UMass Memorial Medical Center are getting ready to be laid off. In this case the layoffs are not because the hospital deems their services to be non-essential, but because they believe that they can get a better deal elsewhere. Basically, these four nurses are losing their jobs to outsourcing.

I know, on its face, that this situation seems to be a little bit preposterous. After all, how do your outsource physical care? An accountant can send his files over the Internet to a client. A factory can be moved to a new country and ship its goods into the US, but healthcare is seen as one of those stable environments in which peoples jobs cannot really be outsourced because a physical presence is required.

So, how were nurses cut? Well, these nurses fill a position known as a lactation consultant. What is a lactation consultant? According to the Expectant Mothers Guide, “A lactation consultant is a health care professional who is knowledgeable, skilled, and experienced in lactation (breastfeeding). The lactation consultant’s primary focus is to provide education, assistance and support to breastfeeding women.” So yes, a lactation consultant is a breastfeeding expert.

UMass Memorial Medical Center is going to fire its in-house lactation consultants and instead bring in a private service to give patients advice on breastfeeding. These new consultants will be less expensive primarily because they will not be nurses, just individuals trained to give basic counseling on breastfeeding.

The Massachusetts Nurses Association released a statement calling the layoffs a, “callous move to cut costs at the expense of quality patient care.” While this may sound dramatic to people outside of health care, you have to realize that while the act of breastfeeding itself is not overly complicated for a healthy mother, a variety of medical conditions and medications, even ones that are available over the counter, can have a serious impact on the breastfeeding process and the health of the baby. Some medicines once they are in the mother’s body can be passed on to the child.

Depending on the medication the effects of that transfer can be serious, and potentially even life threatening. While a non-nurse consultant may be less expensive they will not have an understanding of the drugs that may have an impact on the baby. Depending on the question these consultants encounter they may become little more than a referral service, sending mothers to their doctor or pharmacist for the critical information they cannot provide.

The hospital is taking a different position. A spokesman for the hospital said that the changes were related to a change in the hospitals overall model of lactation education. In an email to a local journalist he stated that, “Careful study tells us that outsourcing lactation services will not only reduce Medical Center expenses but also allow us to expand and improve the breadth of service to our patients,” he then went on to add that, “In fact, we will be able to continue one-on-one support for new mothers at a comparable level with services currently in place while we are also able to broaden the availability of support groups and breast-feeding classes at times that better accommodate our patient’s busy schedules.”

The layoffs will take place on the 1st of December, just in time for the holidays.