I am still no-mail and just visited the Lactnet archives. I read many posts related to the abusive treatment of women, in the context of breastfeeding "support," but also in other contexts. I want to express my gratitude to all who have participated in and/or thoughtfully "listened" to this very important discussion. It's a difficult conversation to have, which means that it isn't often done, which further means that it is truly needed. 

My chapter, "The impact of traumatic childbirth on health through the undermining of breastfeeding," in the edited book, "Integrating Trauma Practice into Primary Care," is in press. In the course of researching the topic, I asked women to share their experiences with me so that I could include their voices in the chapter in the hope of making all the statistics I was citing develop a human face: that of a mother who experienced birth as traumatic. I have received pages and pages of grief-, horror-, and anger-filled descriptions from women. Many people would feel shocked to hear women say that their birth experience was like a rape. When women use such words regarding a traumatic event, they may be directly comparing their experience to a rape that they experienced in the past and/or they are expressing the soul-shattering magnitude of the helplessness and violence that they experienced in the event that they are describing. The same factors that increase the risk of trauma during 
birth are likely to increase the risk of trauma in mother-provider interactions after birth (or at any other time, for that matter). For example, pre-existing maternal characteristics, such as prior trauma, depression, etc. are likely to increase a mother's vulnerability. Health care providers often don't know that that history exists or realize how incredibly common such a history is. However, the nature of the experience itself, including whether the mother experienced a loss of control and was emotionally unsupported during the experience are also likely to increase a mother's risk. This is something that health care providers *can* do something about. Trauma is subjective, however, it doesn't just happen out of nowhere. To qualify for the DSM-IV definition of trauma, a person must experience intense fear, helplessness, and/or horror in response to an actual or perceived threat to one's life, serious injury, or threat to one's physical integrity, or to witnessing this happening 
to another person or to witnessing the death of another person. So, if, for example, a woman felt intense helplessness while experiencing a health care provider's handling of her breasts and the woman experienced this as a threat to her physical integrity, then that handling was traumatic. It could be traumatic because of maternal characteristics (e.g., it triggered flashbacks to earlier abuse or rape); it could be traumatic because of actions that the health care provider did take (e.g., rough handling) or did not take (e.g., asking permission before touching the woman); it could also be traumatic due to both.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 1994.

Good Mojab, C. The impact of traumatic childbirth on health through the undermining of breastfeeding. In V. Banyard, V. Edwards, and K. Kendall-Tackett (Eds.) Integrating Trauma Practice into Primary Care. Binghamton, NY: The Haworth Press (in press). (I don't know if that will be the final citation, but that's my best guess right now.)

In support of all who are trying to provide sensitive, aware, and wise care to women so that they are less likely to be traumatized in the context of health care and of all who have experienced trauma in any manner,

Cynthia

--
Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC, CATSM 
LifeCircle Counseling and Consulting, LLC 
Website: www.lifecirclecc.com 
Phone: 503-615-0845 
Email: [log in to unmask] 
Ammawell 
Website: http://home.comcast.net/~ammawell 
Announcement only email list: [log in to unmask] 

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