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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html