>She has major body-image issues and of course has all sorts of stated
confusion about her sexuality and about touch in general.  Would it be
impossible that her aversions could still be so strong in her mind as to
inhibit oxytocin as she holds her baby to breast?<<

Taking Nancy's thoughts a little further....... We've known for a long time
that milk-ejection can be inhibited by fear, nervousness, and other similar
feelings. We also know that the [afferent] neuro-endocrine pathway for
lactation runs through the portion of the brain that processes emotions (the
limbic system), and that oxytocin is produced by the hypothalamus, which
works in tandem with the limbic system. For those who are not familiar with
this information, here are some quotes for thought from my physiology text:

"Through these connections, the limbic system and the hypothalamus appear to
cooperate in the neural basis of emotional states"

"The hypothalamus and the limbic system are involved in the regulation of
the sexual drive and sexual behavior..."

"Fear can be produced by electrical stimulation of the amygdala and
hypothalamus..."

"centers in the hypothalamus contribute to the regulation of sleep,
wakefulness, sexual arousal and *performance*, and emotions such as anger,
fear, pain, and pleasure."

"The coordination of sympathetic and parasympathetic reflexes is thus
integrated with the control of somatic and endocrine responses by the
hypothalamus"

It also details that oxytocin, which is stored in the posterior pituitary,
is secreted in response to hypothalamic stimulation.

The human psyche is both powerful and mysterious. On a physiological level,
it seems feasible that severe emotional issues could affect the production
and/or release of oxytocin, if not prolactin as well. Because emotions can
be closely tied to specific memories, I would think it would even be
possible for oxytocin to flow in some situations and not others. Now that
Nancy has shared more info on our client, I remember asking her if she
experienced orgasms--- she said that she did. That and the fact that she
seemed to have braxton-hicks made me question the idea that she was not
producing any oxytocin at all. It just seems implausible that a *physical*
defect would be causing this hormone alone not to be produced, when the
hypothalamus seems to be successfully producing its other hormones.

Two other cases: before this mother, I worked with two other moms who had
apparent failed let-down. In the first case, the mother was able to let down
for the pump, but not the baby. I asked Nancy for help, and after working
and talking with the mother for a period of time, Nancy finally dug a little
deeper and asked the mother about some of her past history; it turned out
that she had had a previous abortion, and that she was experiencing guilt
for that with her new baby. Soon after sharing this hidden burden with
Nancy, mom began letting down for her baby and was finally able to
breastfeed.

Having seen the first case, I was more clued in with the next mom I saw who
was experiencing apparent let-down problems. I gently inquired about her
past history and found out that she had two previous children who were in
effect "stolen" from her by her former husband, and that she had not seen
since then. The birth of her new baby awakened great fears in her that she
might lose this baby, too, and in fact she was struggling to bond and feel
love because of this fear of another loss. This case didn't end as well--
even though we discussed her fears, she did not let down, and she did not
pursue additional counseling though I encouraged it.

Food for thought........

Lisa Marasco IBCLC

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