Mary wrote: <<I would think that if this was due to sexual trauma ect it
would last throughout the nursing and not end with ejection. The entire
episode lasts only seconds, but thank you as this is something to think
about. Also this woman has neither exibited nor expressed any revulsion to
her baby, intimacy or breastfeeding.>>

Elishiva wrote: << Mary, I strongly agree with you.   People are in general
too quick to ascribe psychological causes to women's physiological
troubles, and I would hope that the lactation community would avoid buying
into that nasty habit.  I think it's oxytocin, too, and I bet it's not that
rare, either.>>

Kathy Dettwyler wrote: <<I think this research was done to try to help
women with mental illnesses, who may fall between the cracks because the
only health care provider they see is their ob/gyn-doctors who
traditionally have neither the training nor the time or inclination to ask
about other issues women may be having....Given the high rates of depres
sion and eating disorders among women in the US, I think this sounds like
an excellent idea, especially when I think of girls from say 14 to 24 who
may be in excellent physical health, and therefore not going to any other
doctors, but who go to their ob/gyn yearly for their Pap smear and birth
control pills.  Eating disorders among young women in the US are a huge
problem-as someone who spends her days with 18-22 year old women, I see and
hear about it all the time.  If these girls can get some help via their
ob/gyn visits, it would be great.>>

Our lives are extraordinarily complex. The Western separation of the
concepts of mind and body fails to acknowledge the complex interplay of all
aspects of our existence. Western health care and concepts are not
holistic. Health care providers commonly work in only one area: mind
(psychology) or body. It is rare to find someone with equal training and
experience in both areas. There is (generally) little stigma to the
treatment of disorders that has been labeled physical: we don't hesitate to
go to the doctor to fix a broken bone. Disorders that are labeled
psychological do, however, commonly have a stigma. Feminist approaches to
psychology acknowledge the harm done to women (and men) when rationality is
labeled male and is valued and emotionality is labeled female and devalued.
Gender stereotypes and inequality impact the conceptions and practice of
psychology. Women's concerns are commonly unappreciated, misunderstood,
misdiagnosed, and mistreated (see Sheila Kitzinger's "The Crying Baby"). In
such an environment, I understand the frustration and caution expressed by
some regarding considering a potential psychological component to an
emotional reaction with the milk ejection reflex.

In my opinion, however, I believe we do a disservice to women to not
CONSIDER the possibility of a psychological component to various lactation
situations (e.g., emotional reactions to MER). Especially since potential
triggers of traumatic intrusion (a re-living of past trauma, such as
nightmares or flashbacks) for survivors of child sexual abuse who
breastfeed include triggers (a physical, mental or emotional stimulus that
produces a patterned, involuntary response) such as the sensation of
let-down, handling of breasts by self or caregiver, skin-to-skin contact
with self or baby, squirting of milk, physical sensation of milk on hands
or breasts, sucking/licking/biting sensations on breasts, the sounds of
sucking, changing sense of boundaries (breasts now "belong" to baby), the
dependency of the baby (mother can't say "no"), nighttime or darkness,
nursing in bed or lying down, baby playing with breast, the "demands" of an
older baby wanting to nurse, "non-nutritive" sucking by an older baby, and
conflict or anxiety over the nurturing and sexual roles of the breast. The
breastfeeding mother who was sexually abused as a child may have 1) no
apparent memory of the abuse, 2) some memories of abuse but perceives no
present connection, 3) sudden memories of sexual abuse; 4) she may be
beginning to resolve the abuse or 5) may have resolved past abuse.

(The information regarding potential triggers and the five levels of
resolution above were presented by Dierdre Knowles, MA in her session
"Breastfeeding and the Sexual Abuse Survivor" at the LLL of Washington Area
Conference October 7th, 2000. The five levels of resolution are defined by
Kathleen Kendall-Tacket, PhD, Family Research Lab, University of New
Hampshire.)

One out of three women will be raped in her life-time (1). By age eighteen,
1 out of four girls will have experienced sexual abuse, probably by a
family member (2). These women include those who become breastfeeding
mothers. These mothers need competent mental health care. Unless they also
happen to be a mental health professional, LCs do not have the training to
assess and treat such issues. (For example, one should NOT ask a
breastfeeding mother questions like "Were you sexually abused?")
Distressing emotional symptoms during the MER (or any other aspect of
breastfeeding) are worthy of attention: from the mother, from the LC, from
the physician, from the mental health professional. Whether or not sexual
abuse is part of a woman's history, a mental health professional
(knowledgeable and supportive of breastfeeding and associated issues, like
attachment parenting) can provide valuable assistance (e.g., in teaching
relaxation techniques). LCs concerned about the appropriateness of care
that a breastfeeding mother might receive from a mental health professional
can interview care providers, get recommendations from colleagues, and/or
do breastfeeding education in the mental health care community.

(1) & (2) are both included in The New Our Bodies Ourselves by the Boston
Women's Health Book Collective (1984), which list (1) as coming from a
study by the Los Angeles Commission on Assaults Against Women and from p
rojections based on FBI figures. (2) is listed as coming from "Silent
Children--A book for Parents About the Prevention of Child Sexual Abuse.
Linda Tschirhart (1980). These figures are consistent with statistics I
have read elsewhere and whose references I cannot immediately find.

Kendall-Tackett, K. (1998). Breastfeeding and the sexual abuse survivor.
Journal of Human Lactation, 14:2, 125-130.
Kendall-Tackett, K. (1997). Breastfeeding and the sexual abuse survivor.
Leaven, 33:2, 27-29.
(http://www.lalecheleague.org/llleaderweb/LV/LVAprMay97p27.html)

Given the prevalence of sexual abuse and sexual assault against women,
breastfeeding mothers benefit enormously from LCs familiar with this issue
(the work of Kathleen Kendall-Tackett is a good place to start). Holistic
care involves considering, acknowledging, treating and referring for the
many diverse aspects of breastfeeding that exist: from the physical, to the
social, ... to the psychological.

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

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