Libby wrote of an Indian woman who expressed fear that she would not be
able to breastfeed because she "cannot touch her breasts." She said that
the woman "lingered behind" after a breastfeeding class to express this
concern. I think it is very positive that the woman "lingered behind." If
she did not want help, I doubt that she would have done so. I agree that
referral to a mental health care provider should be considered. I also
think that the provider needs to be selected carefully. This mother needs
someone who is knowledgeable about both culture and breastfeeding. A
specific referral to one or more providers whom the LC knows meets these
criteria would be far more helpful than a general referral.

I suspect a team approach with an LC and mental health professional will be
important to breastfeeding outcome for this mother. For example, a mental
health professional should be familiar with the development of a phobia
hierarchy. Here's the nutshell: imagine a scale from 1 to 10, with 10 as
the most frightening level and 1 as the perfectly safe level. I envision
one or more sessions in which the mother, mental health provider and LC
work together to identify breast related actions that match each point in
the hierarchy. Questions like the following might help the mother gain an
understanding of what actions might be manageable and suggest first steps
that might lead to second steps. For example, I recall seeing a drawing of
a nursing mother (from at least a few centuries ago in Germany, I think)
kneeling and breastfeeding her baby through the slats of a cradle while the
baby lay in the cradle. The mother was not holding her breast. How would
the mother rate her fear of breastfeeding in this position? How would she
rate her fear if she wore gloves? How would she rate her fear if she held
her breast with a portion of the cup of a nursing bra between her breast
and her hand? With a washcloth between her breast and her hand? How does
she feel about pumping? How does she feel about the touch of her baby's
mouth on her breast? Her baby's hand? How does she feel about using a
sling? (Babies in some cultures have free access to the mother's breast all
day long in a sling. They quickly learn to find and latch on to the breast
in defiance of other cultures' expectations of the capacity of babies.) And
these thoughts are just the first few results of a few minutes of
brainstorming...who knows what you would come up with together in a longer
period of time!

The point I'm trying to make is that there are as many ways to breastfeed
as there are mothers and babies and cultures and circumstances. If she
thinks that the only breastfeeding goal she could possibly have is to do it
the "usual" way (and her concept of the "usual" way needs to be identified)
and that this "usual" way is terrifying (for whatever reason), then, of
course, she will be distressed just thinking about breastfeeding, much less
attempting it. But if she (with the very creative help and respectful
support of an LC and a mental health provider) can identify various ways to
breastfeed that evoke different degrees of fear, she might be able to set a
goal that attains at least some of the benefits of breastfeeding--and that
might even lead to a next step and a next step... There are techniques for
addressing phobias that use the hierarchy described above--and a mental
health professional should know about them.

In the very least, an LC can talk with her about all the different ways to
breastfeed and brainstorm some possible approaches. Just this will convey a
respect and acceptance of where she is--which is always critical. It will
also give her more opportunity to just express her fear--which is a
prerequisite for effective problem solving. It also will help build more
trust of the LC which is important for the referral making process. Many
folks are VERY leery of "psychological" help due to all the stigma
attached. If the LC can frame a referral in terms of creative problem
solving, the mother might be more willing to consider it.

Just a few thoughts. Best wishes to all,

Cynthia Good Mojab, MS Clinical Psychology
(Breastfeeding mother, advocate, independent [cross-cultural] researcher
and author; freelance writer; LLL Leader and Research Associate in the LLLI
Publications Department; and former psychotherapist currently busy
nurturing her own little one.)
Ammawell
Email: [log in to unmask]
Web site: http://msnhomepages.talkcity.com/SupportSt/ammawell

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