Cynthia,
I'm posting to you privately, but if you think this is pertinent to the
Lactnet community would gladly copy to them also.

Let me preface my comments by stating that I am not currently working in the
counseling field but prior to becoming a stay at home mom worked
professionally as an LCDC (Licensed Chemical Dependency Counselor) the
credential now required in TX.  Originally in TX, and still in most other
states, it's a CADAC (Certified Alcohol and Drug Abuse Counselor).  As such
I almost always worked in an agency and never as an LC, so I can't address
billing issues.  In fact, I'm not sure I can answer any of your questions
except this -- I think there is a need.  I would venture to say there is a
high level of need for the IBCLC/MHP combo.  When I say a high need, I don't
know if there would be enough clients to sustain a practice devoted solely
to IBCLC/Therapy, but that it is certainly an arena that would make a huge
difference in the lives of some nursing dyads.  No one that I know of is
doing this in our area (Austin, TX).  I have not yet referred any clients to
MH professionals as an LC, but have as a LLL Leader.  There are only two or
three therapists in the area I would even consider referring a breastfeeding
mother to.  Not that there are plenty of good professionals, but there is a
dearth of professionals who take breastfeeding and it's importance
seriously.  There are none I know of who are also IBCLCs (there is one who
attended LLL for years when her daughter was younger, they co-slept,
practiced loving guidance and breastfed for 5 1/2 years!).  Depending on the
specifics of the situation I would attempt close follow-up, but I know all
three of the therapists personally so that part would be easy arranged.

Over the years my "special niche" became women's programming.  For a period
of several years I developed and facilitated a special program that focused
on mothers with alcohol/drug problems.  In this capacity I discovered many
things.  One was that even moms with huge substance abuse issues yearned to
be "good" parents and to provide a "better life" for their own children.
Frequently their children were the reason they even considered treatment.
Another was that an overwhelming number of these women had been sexually
abused at some point in their lives, seems like upwards of 70% could
identify sexual abuse.  Some therapists in this field believe the incidence
is much higher.  These women have seldom had appropriate role models and
depression is practically a given.  They suffer from eating disorders and
distorted body image at a higher percentage than the rest of the population.

It was (and is) my belief that nurturing the mother/infant bond would be
highly beneficial for these women.  Such bonding would promote sustained
sobriety as well as lessen the incidence of abuse, neglect and abandonment
in this population.  It was an uphill battle.  Unfortunately, as far as I
know, all residential programs (in TX anyway) that except women with infants
don't allow co-sleeping and consider breastfeeding as any other type of
eating and require it be done in specific areas of the facility (notably NOT
in bedrooms) making nighttime feeding a nightmare.  Further the mothers are
expected to place babies in child care beginning at or before 3 months for
most of the day so they can attend treatment classes or look for work.
Pumping is allowed, but no special accommodations to the daily schedule are
provided.

My personal opinion is that this is an area that NEEDS to be covered (i.e.
mental health issues as they effect the nursing relationship).  My very
first private practice LC visit was to a mom I am now convinced suffered
from OCD or something similar, maybe her anxiety about parenting was just so
high that it looked like OCD.  Either way I would have LOVED to have had you
along for that one!  She couldn't trust that her baby was getting enough
breastmilk from her smallish size breasts.  It didn't matter to her that the
baby looked fine, had plenty of wet and poopy diapers, was happy & alert,
gained great and her HCP told her not to worry.   She pumped and kept
meticulous records about length of each pumping session (to the 1/4 minute)
amount of milk from each breast, what time it was fed to the baby, how much
the baby consumed.  Date, time and composition of each diaper, notes on the
duration of baby's sleep, etc....  The baby was 7 months old when I saw her
and she'd left the house 3 times since the birth!

As you well know, sexual abuse can have a huge impact on a woman's ability
to breastfeed.  While it can be very healing for a woman who has been abused
in this way to be able to breastfeed her children (or to have a natural
birth) it can also prevent her being able to breastfeed.  This can occur as
a direct result (i.e. can't stand to have breasts touched) or as the result
of an over "medicalized" birth experience brought about by her previous
abuse (i.e. sensations of labor are overwhelming, woman tenses and resists
the natural process, ends up with a c-section, baby not put to breast until
hours later, etc.....).  I don't think most women who have been sexually
abused really get to enjoy pregnancy, birth or breastfeeding unless they've
substantially worked through their abuse issues.  I would guess that would
best happen prior to conception, but since we don't live in a perfect world,
wouldn't it be great if it could happen in concert!  The book Birthing From
Within touches on this to some degree, confronting your demons and fears
prior to the birth to keep them from interfering.  My guess is that many,
many women in the US who have "supply problems" that can't be attributed to
true glandular insufficiency are suffering from distrust of their own
bodies, a belief bolstered by our media and culture.  In itself a form of
sexual abuse.

Besides the women I saw as a substance abuse counselor there are those
thousands of women who come from "dysfunctional" homes and need to find
their own way as parents.  They learned at an early age to ignore their own
instincts and to silence their inner voice.  With no blueprint from
childhood of what that may look like and no trust in their own innate wisdom
they will benefit immensely from having a professional who understands the
value of & what it is like to find ones own path as a parent.

Well, a very long response to rather succinct questions.  If you've read
this far -- thanks for hanging in there.  Obviously this is an area about
which I feel passionately.  Please keep us posted as to what comes of this.
It almost makes me want to go back and finish my graduate degree and do the
same thing!

Warmly,
Dawn Martin, IBCLC, RLC
Austin, TX




----- Original Message -----
From: "Cynthia Good Mojab" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, January 02, 2003 5:33 PM
Subject: Mental health and breastfeeding


> Dear colleagues:
>
> We periodically discuss here the relationship between mind/emotion and
> breastfeeding. Many breastfeeding problems are rooted in or related to
> psychological issues (e.g.,  developmental, cognitive, emotional,
> behavioral...). We've all seen how breastfeeding can be affected by
> attitudes, beliefs, behavior patterns, difficulty taking on the mothering
> role, grief and loss, interpersonal conflicts, difficulty coping with past
> experiences involving one's body and belief in its purpose, worth,
> capacity, etc. And while IBCLCs have some training in offering emotional
> support in the context of lactation consulting, some mothers simply need
> more than an IBCLC usually has been trained to provide. I am pondering
> additional ways that I might combine my training and experience in the
> field of mental health (I have an MS in clinical psychology) with my
> training and experience in the field of lactation and breastfeeding. I
> would appreciate input (on and/or off the list as appropriate) regarding
> such a combination. Some of my questions are:
>
> 1. Do any of you provide mental health services (i.e., counseling,
> psychotherapy) in some combination with lactation consulting? If so, how
do
> you combine them? How do you handle insurance filing for the two services
> that might occur in one session?
> 2. How often do you refer breastfeeding mothers to a mental health
> professional? Are there any in your area who are also IBCLCs or at least
> whom you consider to be knowledgeable about and supportive of
breastfeeding
> (including such practices as sleep sharing, attachment parenting...)?
> 3. What kind of mental health needs do you feel unable to meet in the
> context of lactation consulting and so refer on to a mental health
> professional?
> 4. How closely do you work with mental health professionals when you have
> referred a mother to them?
> 5. In your area, is the need for a mental health professional/IBCLC
> combination large or small? Met or unmet?
> 6. Any other thoughts on this topic?
>
> Grateful for any input anyone has time to provide,
>
> Cynthia
>
> Cynthia Good Mojab, MS, IBCLC, RLC
> Ammawell
> Email: [log in to unmask]
> Web site: http://home.attbi.com/~ammawell
>

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