Author Archive: ACE Aware

The lived experience, Episode 10 – This week: Esther, Part 1

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Esther came to me in a roundabout way because there were breastfeeding problems: overproduction, breast infections, a lot of pumping, endless feedings, a tongue tie… she got stuck and had help with that, but now there is another big hurdle: she has realised that the sadness that came over her a few weeks after birth was not just a ‘bad day’ or feeling a bit down, but postpartum depression, as it has been labelled. She lives far away from me, but another appointment nearby makes a combination possible, so that she does not have to make a long, stressful journey.

Once at Esther’s house I notice that she quickly becomes very open: she is ready for this process. She wants to leave the ‘mess’ of the past behind her, to break away from what she calls the toxic dynamics with people who are very close to her: the members of her family of origin. During the introduction, she does not say much at first about the impactful period that puberty was for her, but during our four-hour conversation she bravely and determinedly works towards talking about it. The systemic methodology with which we start immediately makes her tears well up. She feels a lump in her throat, a burning lump that she cannot swallow, almost taking her breath away.

When we evaluate together, she, like me, notices how positively she experiences the relationship with her partner. For quite a long time, he and his family were her refuge. She felt welcome and seen and they were happy with her as the wife of their son, their brother, their brother-in-law.

For a long time she did not want children, but now that her son has arrived, she is deeply moved by the amount of love he unleashes in her. However, he does not only unleash love, as we will see during our conversation – he also unleashes a lot of old sadness and her tears are the meltwater of everything that has become frozen within her and is stuck inside as a cold and inflexible mass.

She realises that she does not really know who she is, besides motherhood. Where does she stand now? How to go forward? How can she take up the space she did not have as a child? How can she powerfully claim her freedom and break loose from what hinders the development of her potential? These are big questions that are unavoidable, but at the same time they also frighten her and make her sad and silent and sometimes anxious. She regularly has the feeling that the walls are closing in on her, that she would like to leave and start a whole new life, in a place where no one knows her.

In her family, she was an afterthought; her two brothers were 11 and 8 when she was born. She would have liked to do something else in terms of work, but her parents would not allow her. To them, working for her brother seemed like the safest place for her. It reminds her of how, as a young girl, she was constantly protected and pampered, as she calls it, although it did not feel that way. It felt suffocating, like a lack of freedom that other children in her class were allowed to experience: walking to school themselves, choosing their own leisure activities, having space to just hang around and do nothing… For her, it was not like that: she was involved in so many extracurricular activities that her entire week was packed. She was brought and fetched everywhere; her parents did not allow her any independence in this regard. School was a particularly difficult situation: it was only a ten-minute walk, but she was taken by car at all times of the year. Her mother’s schedule caused her to be late every day. Esther repeats it a few times: ‘Every day, really every single day!’ Her classmates therefore thought she was strange. Esther felt like an outsider; she did not belong. “I could have walked or cycled that short distance, together with the others! I felt ridiculed. I experienced it as an enormous restriction of freedom.” It is therefore no wonder that she notices so much in her throat, so much that hinders the free flow of inhalation and speech…

After some time as an employee, her father started his own company and spent most of his time there. There was little attention for Esther. His companies flourished and there was always enough money, but Esther lacked attention and recognition for who she was and what she could do and what she dreamed of.

From the age of 55, her father no longer had any financial need to work and was usually at home, just like her mother, and she saw a dynamic between them that also lacked mutual interest, with little overlap between their activities. Her eldest brother lived on his own for a while, but is now in his early forties and lives with his parents again. He has taken up yet another study and started a company in which he collaborates with his younger brother.

Esther has seen all these developments and says: “I consider myself so stupid. I have much more to offer and I did not have to wait until this age to discover myself…” She cries again and we are silent together. I ask what it evokes in her body. She thinks with closed eyes and says: “Sadness… and also anger…” I ask her what that anger would say if it could talk. Now she does not have to think long: “Fuck off! I hate you for what you did!” She now also feels a tingling in her toes, tension in her lower back, and stiffness in her shoulders. We discuss all the sensations and what they might have to tell her.

“Since the day I can remember, I have never had freedom. That feeling is very old, really very old…” We talk about the emotions that must have arisen at the time as a result of her feeling of loneliness and we see if she can imagine a child of that age. If that does not work, we use her own son as an example, even though he is only little over a year old. I ask how he would feel if she and her partner treated him this way and what it would mean to her if he did not talk to her about it. Her tired eyes fill with tears again and she sobs as she says: “That would hurt me very much. It would mean that he thinks that I will not understand him, that I will not hear him or see him.” The fact that she did not talk to anyone about how she felt at school was for exactly the same reason: in the years before, she had already lost confidence that her mother would understand her. That was the child she was: sad, ashamed, alone with her pain.

I explain that she may not have expressed the emotions, but of course that did not make them go away; she was just ‘keeping them down’. I speak slowly, put a pause between ‘keeping’ and ‘down’. I catch her eyes and ask what could be another word for ‘keeping down’. She hesitates and shakes her head. I say: ‘de-pression’. She looks at me and says: “Ooooooh… woooow… Yes, that sounds very logical… but I have never made that connection myself…” We discuss that now she does seem to have space to express her feelings, that her own family offers her the security and listening ear that she used to miss.

That is a wonderful starting point for change. We will read more about that next week.

Secure, sacred silence – blog by Petra Bouma

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We already knew each other, Denise and I. Four years ago I had also visited her for a lactation consultation. Now she phoned me again, because she had given birth a week ago. The childbed nurse had just left; she had pain while breastfeeding and struggled with cracked nipples. We made an appointment and I went to see her. She opened the door, her four-year-old daughter in tow, shyly hiding behind her. Her son was sleeping in the playpen, but once picked up he was eager to feed. After I had done an oral exam, in which I found nothing special, mom put her son to breast. I made some suggestions and with a few adjustments breastfeeding was painless.

During a consultation, the way the mother experienced the birthing process is always discussed. Denise indicated that she had had a great delivery and that she looked back on it with a good feeling. She had gone to the hospital because, just like last time, the dilation was not progressing. She had started in the birth pool at home, according to how she wanted it. When, after a while of working through her contractions, she got stuck at three centimetres dilation, she was asked what she wanted. She could stay home a little longer or go to the hospital for pain relief. She chose the latter, with which her dream birth disappeared from view.

She went to the hospital, was given pain relief via a pump and then an IV with contraction inducers, because the strength of the contractions had subsided after the move from home to hospital. Once she was fully dilated, she pushed for another seven minutes until her son was born. She looked back on it well, she said; it had gone fine. The only problem now was the pain during breastfeeding and a feeling that things were not really going well yet. That was why she had called me: to help resolve what looked like a breastfeeding problem by means of a consultation. I had listened intently and all sorts of things came to my mind. I considered how I should continue the conversation with her.

After she told her story, I asked how she would have preferred her delivery. She was very clear about that: she had wanted to give birth in the birth pool at home, with her daughter there. They had discussed it extensively in advance that she could be there, and if mom had to go to the hospital, grandma would pick her up. When Denise had been in labour for a while at home, her daughter had woken up and come downstairs; she had been pleasantly present. If mom had a contraction, the girl was asked not to disturb mom for a while, but otherwise it felt very nice for Denise to have her daughter there.

When they called the midwife after a while, she was asked if she had any objections to an intern coming along. Denise had not minded. When they arrived, an internal examination had been done and it had been found that she was three centimetres dilated. Because it was a second child, the assumption was that it could go quickly. That is why the maternity care was immediately called as well. In an earlier phase, during the intake, Denise had indicated that a childbed nurse intern was no problem. During the delivery, she was not asked if she still agreed, so two more people joined. The situation thus looked like this. In a not so large house, with a not so large living room, the coffee table had to make way for the birth pool. Two large steps away from the tub was the kitchen table where the midwife, the maternity nurse and the two trainees were talking to each other. The maternity care intern was quite present and talked both a lot and loudly.

Giving birth is an intimate event, a life event that deserves safe, sacred space. The process has the best chance of a smooth and desired course if the birthing woman is not disturbed too much, if she is surrounded by people with whom she feels comfortable. You can compare it to sex: if you are observed having sex, an orgasm is highly unlikely for most people. If, on the other hand, you can find your own shape with your partner undisturbed and let everything go as it feels appropriate for you at the time, then an orgasm is much more obvious and will usually come easily.

During childbirth, the same basic principles apply in terms of privacy and a sense of security. If you are in an environment that feels safe for you with people you trust and who trust you, your body can relax and birthing your baby will go smoothly. Disruptions, such as people around you conversing loudly, detract from that safe environment and cause the process to stagnate. In this case, it happened the first time, probably because of the turmoil around Denise, which led to the birth not progressing. In the hospital, the process stagnated again because the new environment and the interventions contributed to the fact that the contractions stayed away.

Such a course also affects the self-confidence of the mother. Something lingers in the subconscious: “It has now happened twice, so I keep in mind that it may go the same way next time. Giving birth at home is not for me. I cannot do this; my body is letting me down. I’m not good enough for such a task… and possibly not for other tasks either…” That is very unfortunate and very sad for all kinds of reasons, because how your mother felt during pregnancy and childbirth, the way you came into the world has a major influence on how she begins her motherhood. Her experience has an influence on your mutual bond and therefore on the rest of life. Does your life begin in an atmosphere of peace and trust or does your mother feel a sense of failure because she (again) failed to give birth to you as she would have liked? How much grief does she carry with her?

And a deeper question: how come it was difficult for her and her partner to guard the ‘sacred space’ of the birthing place like lions, regardless of the opinion of the midwife or maternity care about it? What made it difficult for the expectant parents to stand up for their own needs? There are many more questions thinkable that deserve attention. For example, what made the childbed nurse trainee no longer aware of her place in the whole, of the importance of being silent and humble? What prevented both the midwife and the childbed nurse from pointing out to the intern that her loud talking was disrupting the situation? How come the care providers did not know in advance that the living conditions did not lend themselves to the presence of so many people?

With a trauma-sensitive view, it becomes clear that a more coordinated approach would have been possible at all levels. When we as a society have more knowledge about the effects of this kind of action on the beginning of a human life, we can all contribute to ensuring that that start is optimal, so that we do not stimulate ‘adverse’ but ‘awesome childhood experiences’!

Book review ‘I swear allegiance – Being yourself in a uniform world’ by Michiel van der Pols, Part 2

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Earlier this week I discussed the introductory chapters of ‘I swear allegiance – Being yourself in a uniform world’, written by Michiel van der Pols. If you’ve also listened to the podcast episode with him by now, you will have heard that we also discussed the cover of his book towards the end.

I was curious about the contents of the book, but initially sensed some hesitation in myself because of the somewhat nationalistic-looking cover. My husband decided in the early 1980s to refuse military service on grounds of conscientious objection and I wholeheartedly agreed. The whole concept of military aggression was something I did not like and swearing allegiance to an organisation (or uncritically following protocols that are scientifically outdated) has also been a very complicated concept for decades. The title, ‘I swear allegiance’, in red (‘I’), white (‘swear’) and blue (‘loyalty’) on the cover, supplemented on the top one-third with a Dutch flag under which a hand with two raised fingers can be seen against a dark gray background… I was not sure how I was supposed to interpret all those symbols. Strangely enough, due to the design the two raised fingers (ring finger, little finger and thumb folded in half) looked like a raised middle finger at a quick glance. Was I supposed to factor that suggestion into my interpretation and expectations…? I did not know. The subtitle, ‘Being yourself in a uniform world’, already gave a strong nuance to a few things and the description on the back also gave me the feeling that something special had been achieved with this book.

That is indeed my conclusion after reading: this book deserves wide attention, which is why I asked Michiel to be a guest in the ACE Aware NL podcast ‘Raising Resilience’. His vision is a passionate plea for a different social view of dealing with emotions. When leaders are aware of the impact of early childhood trauma and truly integrate the knowledge about the impact of suppressing emotions, their leadership style will change. Of course it is important that trauma sensitivity becomes part of the society-wide DNA and that children grow up without ACEs. However, when the insights become embedded in the culture of large, important organisations, there is at least more room for people to heal, especially when they were unable to develop the desired resilience in childhood. Particularly in the high-risk sector, where people do important and regularly also dangerous work to guarantee the peace, freedom and safety of others, it is important that the mental and emotional well-being of employees receives the care it deserves. This calls for attention to the culture in the organisations concerned, so that all kinds of dynamics take on a healthier character and resilience is supported.

However, organisations such as the military and the police have very old social roots, from which the hierarchical structures can be explained. That makes it quite an endeavour to bring about a paradigm shift. In Chapter 7 Michiel gives an overview of the history of the armed forces from the 15th century. The strict, hierarchical climate is often a barrier to empathy. The fear of making mistakes and being punished for them feeds a very toxic culture within this (and every other) organisation. Michiel experienced this firsthand: “It felt like things were always serious within the barracks. As if it was always war and that was why we had to treat each other this way. (…) Good behaviour is rewarded, bad behaviour is punished” (p.215), possibly with a reprimand, fine, service or curfew as a result and, if more serious, with disciplinary measures from the Military Criminal Law. Deviating from the uniformity in behaviour is quickly seen as difficult and threatening and often makes someone unreliable in the eyes of those ranked higher (p. 216). That clashes with how Michiel now looks at it, namely: “The more authentic and self-confident, the more reliable, as far as I am concerned” (p.326). According to Michiel, being in touch with your own emotions greatly improves your professionalism. This vision is revolutionary for organisations where the following of orders is often still prominently anchored in the system.

Michiel’s vision is based on insights he has acquired as a breakthrough coach. These are closely linked to insights from the trauma field, in which emotions and feelings are seen as the inner, guiding compass. They are signals from the body that tell you what to do. Michiel has summarised his insights in five red threads:

  1. Motivations (about the motivation for career choice: from the head, not from the heart)
  2. Identity (on the degree of identification with the professional role)
  3. Feelings and emotions (about the difficulty in showing them and acknowledging your own needs)
  4. PTSD (about PTSD as a drop in a bucket already almost overflowing due to childhood trauma)
  5. Lack of sense of safety (about difficulty being completely yourself, both in childhood and now)

Chapters 3, 4, 5, and 6 are devoted to these aspects; a large number of stories from people in his coaching practice show how these themes played a role for them in their professional and private lives. The difficult sides of it meant that people got stuck on all kinds of fronts and ended up in a personal crisis. That those people were willing to appear in Michiel’s book by name and rank and share the story of their recovery process demonstrates the need and willingness to show vulnerability. In this way, others can also find courage to change the way they deal with emotions in their work. In the book and also in the podcast, Michiel says he sees himself as an interpreter of their message, which has many similarities with his own story.

It is nice to see that Michiel makes a link between leadership and parenting: “Raising children is almost the same as leadership. You role model life for your children and with your behaviour you are their mirror. To what extent are you able to see yourself as a parent and can you also see your child for who they really are? (…) The extent to which the parents are true to themselves is the mirror for the child to be true to themselves” (p.201). Mirrors… a beautiful and concise image! After all… the cultures in certain organisations and in societies as a whole (medium and large systems) are a reflection of the small systems in which we grow up in our family of origin. When we feel seen there and feel free and safe, we can contribute in a constructive, resilient way to any organisation or system.

As always, I also read Michiel’s book with a pencil in hand, so that I could make notes on beautiful passages and important phrases. There are so many of these underlinings that I cannot discuss all of them, as much as they are worth mentioning. In short: go read that book, dear people! Somewhere Michiel mentions the possibility that he has ‘flattened’ and simplified things too much, but that was certainly not my experience when reading. I read a wonderful story with specific nuances and many relevant case studies. The fact that Michiel is so open about his own deficit in knowledge and awareness at the beginning of his career gives the book a lot of persuasiveness to me. He asks questions that matter and makes statements that matter, such as this one on the last page, when he summarises what he believes is needed for a holistic approach to people’s life story and thus for a cultural change: “It takes courage to let go of old behaviours that no longer fit the times of today. (…) It requires the will to be true to ourselves above all” (p.328). Wow, what beautiful closing words – what a magnificent, almost spiritual inversion of the words on the cover!

Book review ‘I swear allegiance – Being yourself in a uniform world’ by Michiel van der Pols, Part 1

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Through a post on LinkedIN I became aware of the work of Michiel van der Pols, who, as a former marine, focuses on guiding people who get stuck in the high-risk sector. He does this in his role as a ‘breakthrough coach’, in which he works with people to find out where the behavioural patterns that are currently obstructive once originated. Over time he has discovered clear patterns in this and in his book  ‘Ik zweer trouw – Jezelf zijn in een uniforme wereld’ (‘I swear allegiance – Being yourself in a uniform world’), he explains in detail those patterns, which he calls ‘red threads’, in nine solid chapters. After a hesitant start, I was quite fascinated and quickly finished the 300-page book, published in the spring of 2023.

After the foreword by the commander of the Marine Corps, Michiel explains in five introductory pages what led him to write his book. In it he is immediately very open about how he had suppressed all kinds of emotions within himself for years, which eventually came out forcefully: “As a child I felt little room for my own opinion (…) I did not talk about my own problems (…) and in the Marine Corps I just continued this behavior” (p. 17,18). In the sessions he gives, such old family dynamics turn out to have a major influence on current beliefs and behaviour patterns for many people. These are often so deeply ingrained that it proves difficult to get rid of them, but “Growth within a comfort zone is only possible to a very limited extent” (p.21) and so change takes a lot of courage. The rest of the book is essentially about the underlying mechanisms and the steps needed for change. The book is rich in candid stories of people in the high-risk sector who, together with Michiel, have taken on the challenge of change and thus restored the emotional connection to themselves.

From page 27, Michiel explains the core of his ideas in eight pages. Children are born with basic needs and develop ways to get them met; the child “protects itself against what is experienced as unpleasant” (p.27). The closer the child can remain to their authentic core, the healthier and happier they will be. If the child becomes disconnected from itself and becomes alienated from that authenticity, then we speak of trauma. The more adjustments the child makes, the more compromises it makes, however subtle and invisible they may be to the outside world, the more the inner balance will be disturbed, with all possible long-term problems: “If you adapt yourself for a long time and are not true to what you need, the body will react to it. The imbalance will manifest itself in burnout, depression, addiction, PTSD, cheating or entering into unhealthy relationships” (p. 29,30). An adapted identity is created, as it were, which is confused with one’s own identity.

Relationships and work environments are selected in accordance with that adapted identity and the high-risk sector can then be attractive: it provides a strong identity and encourages adapted, (literally and figuratively) uniform behaviour. In other words, the culture in many high-risk organisations is such that people who have learned to adapt can apparently function well for a long time. The suppression of emotions in particular (needed to be able to do the demanding, often dangerous work) ultimately, however, very often leads to the emotional bucket filling up and overflowing.

In Chapter 1 Michiel tells his personal life story. He looks back on how he unconsciously learned to shut down and block his emotions at home, how he got used to doing everything alone and relying only on himself, how his role as a marine gave him something to hold on to and an opportunity to show that he mattered, how individualistic thinking was skilfully converted into collective thinking, and how he realised at one point that by taking the military oath he had promised obedience and submission to a system that could also punish him if he did not (properly) comply ( p.51). Many of his motivations were inauthentic; they were choices made from a sense of emptiness, where he gave up much of his authenticity in the quest for safety.

Due to various events, he became aware that he could show more of himself, because in doing so he also got to see more of the other person and could build much deeper connections with others (p.64). The meeting with his current wife, whom he recognised before he knew her, opened his heart completely and made it clear to him how much he had hidden himself for years. His attention shifted from focus on the judgment of the outside world to loving attention to his own inner world. He embarked on an intensive personal healing journey and this also gave rise to the courage to choose a different course professionally. That is how he became a breakthrough coach: his experiential expertise became the basis for guiding others who are looking to reconnect with their authentic selves.

Michiel felt a deep urge to shape his new profession as a coach in such a way that he remained true to himself: “In a no-nonsense and impactful way, I wanted to help others to break through their blocks on their emotional world and to face their fears of ‘just’ being themselves. (…) If I don’t do that myself, how can I help someone else?” (p.70).
The breakthrough he grants his interlocutors is that through the timelines he works with, they find their way back from thinking with the head, from analysing, rationalising, complicating and minimising what lives inside of them, to feeling with the heart, to tolerating, validating, accepting and integrating – the way we start our lives as babies. As a result, space can arise to grow towards true knowing from the source, towards realising and manifesting, towards sensitivity that, as humans, connects us with the divine.

The second part of this book review will follow later this week, in which I will discuss the ‘red threads’ that Michiel has found, in addition to a number of theoretical points that are discussed in the book. I also had a wonderful podcast conversation with him, which will be online in between these two blog parts. Keep an eye on the socials!

Trauma-sensitive lactation care – I am ready for it!

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It was the summer of 1994 and after a beautiful home birth our third daughter was born. She’s getting married in a few weeks; her white baby clothes from the first days, contrasting so beautifully with her pitch black hair and deep dark brown eyes, are in the attic. In August, they will be replaced by a truly beautiful white wedding dress. Again her eyes and hair, slightly lighter in colour but still beautifully dark, will contrast with her clothes, both with what she will wear during the pre-wedding drinks and with what she will wear during the festive day (that wedding dress) and in the evening, when we are all expected in gala outfit.

On the day of her birth, I could not have imagined that almost thirty years later I would be working as a lactation consultant and medical anthropologist/sociologist. Especially the lactation science is directly connected to her birth. I was literally deathly ill in childbed due to puerperal fever and when we were together in the hospital because of my recovery, I saw that the support for breastfeeding often left a lot to be desired. That is why I became a volunteer at the Dutch breastfeeding association VBN, later a lactation consultant in my own practice, and eventually the trauma-sensitive anthropologist I am today. Some people thought that I was suddenly doing something completely different with that anthropology studies, but I always only saw a straight line from micro to macro to meta level. What happens between mother and child in early life is a template for what follows. What we experience on a small scale in our family of origin becomes on a large scale our frame of reference for how we view the world. And how we all are in the world is the basis of our societies and their associated cultures. Thus, in my experience a direct connection from small to large, from inner to outer environment, from healthy, secure attachment in the parent-child relationship (or lack thereof) to peaceful, empathetic resilience in the world (or lack thereof).

When I was reminded last year that I had to renew my lactation consultant certification this summer (every five years, if we want to keep our ‘IBCLC’ credentials), I did not hesitate: of course I want to remain a lactation consultant! My trauma work as an anthropologist/sociologist within ACE Aware NL and my lactation consultant work for Breastfeeding Center Panta Rhei form such a relevant combination – I want to continue that. In fact… I want to expand it!

So there was no escape: I had to go through the recertification procedure. Since the obligation to take the re-examination has been abolished for re-certifiers (allowed, not required), you must demonstrate in a different way every five years that you have received sufficient training and are also otherwise competent to practice the profession. I consider that justified in itself: mothers and babies are entitled to high-quality care. The only follow-up question then is: how do you demonstrate that you deliver such care? You can provide credits, but have you integrated the knowledge? If, on top of your many years of lactation consultant experience, you have done and learned things other than what the requirements prescribe, does that mean that by definition you cannot provide good care?

With the abolition of the re-examination, the requirements have been adjusted somewhat and thus I had to make the corresponding ‘self-assessment’ for the first time this summer, so that it would become clear in which areas of knowledge I scored sufficiently and where I had fallen behind and should catch up. Nowadays you must also successfully complete a resuscitation course; you must still be able to demonstrate 75 training points (minimum 50 L (‘lactation’) and 5 E (‘ethics’) and a maximum of 20 R (‘related’)), and if necessary, you must be able to provide convincing timesheets. Colleagues said reassuringly that although you have to have everything in order, you will only be asked for ‘evidence’ if chosen for a random survey. I did all the calculations, submitted my recertification application on July 13th and paid off a few hundred euros. A few hours waiting and then the website would report that I can continue for another five years.

The latter was delayed… not a few hours, but days and days. In the meantime I had been away for a week for a retreat in a place associated with my childhood. I needed it and it did me good. However, I kept checking my e-mail and half way through my week I had a message: “Thank you for submitting your application. You have been selected for an audit; we look forward to receiving your documents! Remember: late submission means the end of your certification.”

Ai, ai, ai… the lack of a quick confirmation had already made me suspect this… and also made me fear this to some extent. Now I had to collect a lot of attachments and prove that I really am still worthy of that credential.
Self-assessment: check. CPR course: check. Training points: check, big check – more training than I thought! But that one part, that time registration… I dreaded that. My rough estimate beforehand now needed more detail. A very busy master year for my studies, a year of board work with limited time for consultations, for all kinds of reasons re-energising after that board year, focus shifted to more biopsychosocial aspects of early childhood… would I get the required number of lactation hours?

In my mind, I went back to all my activities in the preceding five years. I realised that, in addition to the consultations, I had worked hard on the thorough revision of the professional profile. I had also made a solidly substantiated version of it, translated into English, for the European lactation consultant organisation. In addition, I had written an evidence-based essay in response to a draft guideline on the parent-child relationship and the role of breastfeeding and secure attachment therein. I had made the Dutch translation of James McKenna’s second, thick book and had gotten it published by a major Dutch publisher. I had followed all kinds of trainings and courses for ACE Aware NL and read endless books and articles that gave me more and more insight into why it is often so difficult for mothers during the early postpartum period, why their births do not always go smoothly, and how they then struggle with breastfeeding problems. However, none of these things had earned me CERPs, the educational points accredited by the international lactation consultants certifying body. Now that I had to demonstrate both my hours and my CERPs, I became aware that the frame of reference is actually rather narrow. That R category… I was only allowed to record 20 points in that category, while much of what makes me a much better lactation consultant now than before falls exactly in that category or in none at all.

Working out my hours and my CERPs, placing them in exactly the right row… it made me a bit rebellious, but mostly sad. Once again I realised how far we are from a trauma-sensitive approach, from a holistic rather than a fragmented, reductionist approach to health problems. A mother and a baby who together cannot get the breastfeeding relationship going smoothly… there is almost always much more going on than ‘just’ a lactation-related, ‘technical’ bottleneck. Of course, latch should be observed and corrected if need be; of course, anatomical or neurological problems in the baby must be ruled out. And naturally you have to look at how pre-existing medical problems have a place within the breastfeeding relationship, but… from a trauma-sensitive approach you know that even all these things may (and very often probably do) have much deeper roots.

There is still a lot of hesitancy to include these trauma aspects. And there is often a lot of fear to talk about them with clients: can they handle it, do they want to talk about it, is it not rude to discuss them? In such cases, it is good to remember that when such questions come up, they are often a mirror for your own pain, for your own triggers and your own survival strategies. When you develop the competencies that are necessary to enter into that vulnerable, intensely personal conversation with the client in a safe, constructive, compassionate way, a wonderfully beautiful depth arises in the consultations. Then a moving connection arises, because the client feels the safety to restore the connection with their deepest Self. What an honour to be allowed to be present and to contribute to it… talking about high-quality care!

Elsewhere in Europe it took them a few days to study all my attachments, but it all worked out: last Monday I received the message that I am recertified until December 2028 – hurray!
Free rein, therefore, to further the development of trauma-sensitive lactation consultations!