I have observed with interest the responses to Susan's post about 
'nipple rape". .I think it is too easy for those of us who provide 
health care services to forget that the mother may be one of millions 
of women who will be "helped" every year to breastfeed, but that her 
experience is unique to her and her baby and to the course of her life. 
I think it is natural for us to view the experiences of our clients 
 from within our own paradigms. I seriously doubt that women who 
experience assault within the health care system are any more likely to 
confront those who assault them than women in any other situation in 
which they feel violated. In fact, I think they would be less likely to 
speak up, b/c the assault occurs within the context of a "helping" 
situation, in which the mother is extremely vulnerable and will be 
convinced by others that no harm was intended, so she should let it go.

I think we have vastly underestimated or even outright discounted the 
effect that brutality and assault, as well as disrespect and lack of 
regard for basic human rights plays out every day in breastfeeding 
difficulties. Conversely, there is the impact that respect and 
compassion can play in overcoming them. This past week, I had a mother 
wean her baby at only one week due to extreme nipple trauma caused by a 
clenching baby. When the mom called me, I felt the trepidation of 
telling me in her voice and told her that there was no way any mother 
could continue to tolerate the pain she had endured (she had chosen to 
continue to feed at the breast during this time) and that should she 
wish to protect her milk supply, I was confident that with continued 
CST, her baby would relax within a couple of weeks. I do not know if 
she will do this, but what she said was that she was so relieved that 
I, unlike her midwife, had acknowledged her pain and had not criticized 
her. She felt betrayed by her midwife and did not use kind words to 
describe her. As I saw it, this mom was in a dilemna not of her own 
making and to criticize her only added to her pain. We cannot always 
avoid causing another person pain--for example, the truth about the 
risks of AF can do that, but we can sure try to avoid doing it 
intentionally or to use it as a weapon. This mother may never 
breastfeed this child again and that matters very much to me, but she 
isn't going to breastfeed b/c someone dismissed her pain or humiliated 
her.

i had another mom who broke my heart--I do not know if I will ever 
forget her words regarding her birth--she said that she was doing just 
fine with her contractions, handling them up to 5cm and knew she could 
birth as she wanted without drugs. Then an u/s suddenly showed that the 
baby was breech. The baby was not in distress. She said, "they gutted 
me and took my baby out". What they did was completely disempower her. 
The baby was very low down and had to be "unwedged",  leaving him 
requiring a lot of CST. So, b/c this mom chose care providers who have 
decided against all scientific evidence that breech birth requires 
medical intervention, this mother lost more than any of us can ever 
know. Her milk supply was severely delayed and may never fully come in, 
More importantly, she has no one who validates that her experience was 
truly brutal--not "life-saving" and heroic in any way. She had 
absolutely no say in what happened to her. Now, she is exerting power 
in the only way left to her--she is dismissing the "advice" of every 
single person--nurses, midwife, LC, chiropractor and trying to regain 
some sense of control. And since she could have well pushed our that 
baby just fine, she may also find her own path to nursing this baby, 
given half a chance.

I think we can sit and mince words and argue over terminology all we 
want, but the reality is that we have allowed a health care system to 
evolve in the US (and I would venture to say, much of the world) that 
makes our jobs very, very difficult. I do not know what the rest of you 
on this board hear every day, but I hear descriptions of brutality all 
of the time, many of them directed toward the infant. The problem is we 
are so used to routine behaviours that, when evaluated from a whole 
other paradigm cannot be justified and should not be tolerated. We are 
so used to the man-handling of infants at birth, for baths, at the 
breast, in warmers, so used to the separation from their mothers (which 
in and of itself is brutal for the infant, who has no wiring to 
understand and process this terrifying loss), so used to the distrust 
of the infant's ablity to mount an adrenal cortex level that initiates 
labor "on time", so used to the lack of trust in women's bodies to 
allow their babies to be born, so used to ignoring or even denying the 
infant's experience of birth, so used to trying to "teach" babies to 
breastfeed (!!!!), so used to seeing everything from the paradigm of 
the "evaluation tool" that we have forgotten what it means to be a 
complex human becoming a mother or coming into the world--to be a 
mammal and still to be a social, spiritual HUMAN BEING and how that 
being-ness is informed by our most tender life experiences--like that 
of entering the world,  of surrendering to falling in love 
unconditionally or learning a trust that comes from nowhere we have 
ever known before and of learning how to know who we really are.

  How has all of this become so unimportant? How will it change if we do 
not dialogue about the experiences of the women and babies and families 
we work with? I do not believe that most HCPs want to participate in 
this behaviour and I think given a chance, they would choose a whole 
other way as well. Someone has to begin the dialogue. My fear for this 
profession has always been how medicalized we have become and how much 
more we seem to become every day. Our ability to care about and protect 
the physiologic norm may be all that separates us from that path.

Jennifer Tow, IBCLC, CT, USA


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