Cindy Garrison, Interim Director of the Leader Accreditation Department (LAD)

Cindy and Mariana Petersen, Interim Administrator of Leader Accreditation (ALA) for Latin America, presented several LAD sessions at the Latin American Regional Conference held in Costa Rica on November 2-4, 2014. This article is inspired by one of their presentations.

What is “mixing causes”?

Mixing causes is a term used in La Leche League (LLL) to refer to the ethical importance of keeping the mission and philosophy of the organization clear and distinct from other issues that may be closely related but are not part of the purpose of LLL. Whether leading a meeting or talking to a mother on the phone, it is important that Leaders keep their own personal biases, practices, or business ventures out of the conversation and provide information based on The Womanly Art of Breastfeeding and other LLLI materials. This discussion is especially important during the application to help mothers interested in leadership know the boundaries within which they will work.

Personal biases

Leaders and mothers who seek to be Leaders are passionate about breastfeeding. They might also be passionate about topics that seem to be in line with LLL philosophy and the mission but are not part of them, such as homeschooling, home birth, cloth diapers (nappies), family bed, vaccine or immunization decisions, or vegetarianism. As an LLL Leader, it is important to be careful about what is said and how it is said to help keep personal biases out of the discussion and so avoid alienating mothers.

Example #1 Home birth

Nancy Newmom is seven months pregnant and attending her first meeting. She is quiet but very observant. She notes the LLL publications on display and starts to look through the Group library. She sees many books on home birth. She had never considered this idea and during the meeting she asks for more information. Gina Groupmom is quick to point out that she had all her babies at home and can give Nancy her midwife’s name and contact information so she can set it up.

How can the Leader avoid mixing causes?

Layla Leader can thank Gina for her offer and refer to the The Womanly Art of Breastfeeding. She can explain that The Womanly Art reflects LLL philosophy and encourage Nancy to read the birth section to learn more about birth and ways to prepare for the experience. Layla can ask others to share their favorite tip for preparing for birth. Layla can also remove some of the home birth books and make sure the library offers a range of books on different birth options.

Example #2 Homeschooling

Nora Newmom has been talking to Luisa Leader for several months about her breastfeeding concerns. Luisa has been very helpful and encourages Nora to attend the next meeting. Nora arranges to have her mother watch the older children and attends with the baby. As they do introductions, Maria Mother asks where the other children are. When Nora explains, Maria replies that they make sure the meeting room is childproofed and adds “Most of us are homeschooling so there is always a teenager or two present to help with the toddlers.” Nora’s oldest child is enjoying kindergarten but Nora now wonders if she would be expected to agree to homeschool to continue to attend the meeting.

How can the Leader avoid mixing causes?

Luisa can respond, “LLL believes that every parent makes the best decisions for their situation and their child. Homeschooling is one option for educating children. As a child gets closer to school age, parents are encouraged to look at all the options and choose the one they feel is best for their child.”

Leaders represent LLL

It is also important to discuss the nonverbal ways in which the LLLI mission can seem blurred and other causes can seem related. A Leader Applicant may not think about how the T-shirt she wears promotes her feelings on birth choices. Her tote bag from a vegetarian grocery store or her bumper sticker for her homeschooling group could suggest that these are LLL-related or even sponsored causes. The Leader Applicant may need to be reminded that as a Leader, she will be speaking for the organization, not herself, and therefore needs to be conscientious about how her words and nonverbal cues represent the mission and philosophy of LLL.

In the same way, a Leader Applicant who includes a signature line on her emails will need to be reminded that when she is corresponding with mothers as a Leader, her emails cannot refer to any business she may have, any personal causes she supports, or a personal belief that could cause a mother to presume that this is also supported by LLL. It is recommended that a Leader or Leader Applicant set up a new email address for her LLL correspondence so that there is no confusion. Her phone voice mail should also not refer to any personal job or business she has, or to her personal beliefs or causes she supports.

Example #3 Promoting organic gardening

Muriel Mom has become very involved in her organic home garden, preserving food and herbs by canning, freezing, and drying. She also belongs to a local food cooperative. She makes sure she wears a T-shirt that advertises the food co-op to LLL meetings and always has several co-op and seed catalogues with her to pass out. She loves the meeting on nutrition and dominates the conversation, bringing the discussion back to self-sustaining farming and organic gardening whenever she can. Lydia Leader tries to counter Muriel’s dominance by asking others to share how they have improved their family’s eating. Muriel feels it is her mission to encourage healthy eating and that LLL supports this. This is one reason why she would like to be a Leader.

How can the Leader avoid mixing causes?

If the behavior persists, Lydia can find a time to talk to Muriel privately. She can express her appreciation for Muriel’s participation in the Group and her interest in healthy eating. She can share the LLL concept on nutrition and the ideas for the nutrition meeting described on page 76 of the LLLI Leader’s Handbook (2003)She can also share the discussion of mixing causes found on pages 46-47 of the Leader’s Handbook. Lydia can be clear that the meeting is for discussing general nutrition, not focusing on one particular type of diet. Lydia can also discuss the difference between the Leader’s role and that of being a mother in the Group. Lydia can offer Muriel other options for sharing her information such as at a Group Enrichment Meeting or as a session during an Area Conference.

When a Leader runs a related business

Some Leaders are also lactation consultants, doulas, or childbirth instructors. This can be confusing for a mother who attends the Group meetings and who learns of this additional role of the Leader. The mother may not understand the difference between the help provided as a Leader and the help offered in a Leader’s other role. These Leaders are guided by the Code of Ethics: Leaders with Personal, Professional or Commercial Interests (see references at the end of this article). They cannot mention their additional role during meetings. They are to keep separate phone lines and email addresses to keep their roles distinct. It is also not appropriate for Group members to promote their businesses through LLL.

Example #4 A Group member works as a birth doula

Mandy Mother has a home business as a birth doula. She attends the Smalltown LLL Group. She would like to hand out her brochures to every new mother who comes to the meetings.

How can the Leader avoid mixing causes?

The Leader can explain that even though alert and active participation in birth is one of the basic tenets of LLL, an LLL Group cannot promote or endorse one person’s business over any other business with a similar focus. This is especially important when it could be for the personal profit of a Group member or Leader. 

Example #5 A Leader is also a lactation consultant

Linda Leader works for a hospital or in private practice as a lactation consultant and also leads a La Leche League Group. 

How can the Leader avoid mixing causes?

As a Leader, Linda is careful not to mention her outside employment during the meeting and reminds her co-Leaders and any mothers who are aware of her job not to bring it up in the meeting. Linda also keeps to the guidelines in the sidebar.


Guidelines for the Leader who is also a Lactation Consultant

Linda cannot charge for her services if:

  • a mother first calls Linda as a Leader. Linda is a Leader throughout the relationship and cannot charge for the help she gives. The exception to this would be the mother whose needs became increasingly clinical in nature and beyond the scope of an LLL Leader (see below).

Linda can charge for her services if:

  • the mother’s first contact with Linda is as a lactation consultant with fees payable and then the mother contacts her for follow-up care in the same capacity.
  • the mother’s first contact with Linda is as a lactation consultant in the hospital or privately. Later, the mother goes to the local LLL Group and discovers Linda is one of the Leaders. The mother later calls for help on the hospital or private lactation consultant phone number. Because the mother knowingly contacts Linda in her role as a lactation consultant, Linda can explain the cost and arrange the private consultation.

If a Leader does not have a separate line at home because she does not have a private lactation practice, but is employed by a health care facility or practice, she is encouraged to ask callers who request a private consult a few simple questions to help clarify the role:

  • Where did you get my number?
  • How did you know to call me?

If Linda thinks the mother is calling for a lactation consultant, Linda can verify by asking “Are you calling to speak with a lactation consultant whom you expect to pay for services?” This is especially important because many Leaders are comfortable with doing home visits, but Leaders who also work as lactation consultants usually avoid doing home visits as a Leader because of the confusion that could arise between the two roles.

When a mother needs more…

If Linda takes a call on her Leader number, she is to help that mother to her fullest ability without charge. Linda can proceed with the call as she normally would. However, if she realizes that the mother needs more intervention than Linda is comfortable giving as a Leader (test weights, physician’s reports, or anything clinical in nature), she can provide the mother with the names and contact information for lactation consultants within the local area. Linda should consult her local entity’s guidelines to determine whether she can include her own practice details and costs involved.


Further information

The La Leche League International (LLLI) Board of Directors has developed a “Code of Ethics” which includes several policies to help define and clarify the importance of keeping other causes about which Leaders may be passionate separate from LLL work. The policies which make up the “Code of Ethics” are the “Code of Ethics: Leader,” “Code of Ethics: Leaders with Personal, Professional, or Commercial Interests,” “Code of Ethics: Funding,” and “Cooperative Actions—Guidelines for Leaders,” found in the Policies and Standing Rules Notebook (PSR). Additional information is also available in the Leader’s Handbook on pages 46-47 and 194-195.

Mixing causes distracts from our primary mission and may turn off mothers who need our help. Every breastfeeding mother needs to feel that she belongs in La Leche League, regardless of how she parents in other ways. Remember that mothering through breastfeeding and the ten concepts are the heart of La Leche League—that’s something we can all feel passionate about!


Exploring the new policy: Code of Ethics: Leaders with Personal, Professional or Commercial Interests. Leaven Jan-Feb-Mar 2007; 43(1):22.

Buckley, S. Recognizing our limits: where to go when you don’t knowLeaven 2014; 2:22-25 (lactation consultant sections on pp. 23-24).

Cindy Garrison has been a Leader for nearly 40 years with the same LLL Group she first attended. She and her husband have three grown sons and seven grandchildren. She has held many administrative roles in LLL. Before becoming the Interim Director of the Leader Accreditation Department, she served two terms on the LLLI Board of Directors, including three years as co-Chairman.