I have touched upon PTSD in previous posts, discussing how people can be on that path and some of the ways that they can seek treatment. One way that helps many is therapy. In the military, there can be many barriers to a Soldier seeking assistance with Behavioral Health. These include Chain of Command conflicts, mission needs and availability of services.
Seeking assistance at the Behavioral Health Clinic on post can be as simple as calling to find out when their walk in hours are, and then going. But sometimes it isn’t that simple. The walk in hours are usually after the duty day has already started, and this can cause some Soldiers to avoid going because they must then speak with their First Line Leader about why they need to be gone. Sometimes if you get lucky, you can go on a day after Staff Duty or manage to find a day when there’s nothing going on and just let them know that you’re running an errand or two and you’ll be back in about an hour.
So what happens during the walk in? Well, you’ll most likely fill out a survey on the computer. It asks questions about how you’re feeling, if you drink or smoke, if you have any conflicts with anyone, whether you’re thinking about hurting yourself, and other questions as well. Once you complete the survey, you wait until a therapist comes and brings you back to their office. Once there, you talk with them about why you are there, what else is going on in your life, and some general back ground questions. Based on that, they will talk to you about making a followup appointment to speak with someone on a regular basis.
From there, you go to the front desk of the clinic to make your follow up appointment, and get an appointment slip. Here’s where it gets tricky for some Soldiers. In many units, it is customary for them to require you to bring your appointment slip in and then they write it on a calendar somewhere so they can help to decrease the number of “No Shows” that they have to medical appointments. Here’s the thing, posting information about your appointments in a place that can be seen by anyone is a violation of your rights under the Health Insurance Portability and Accountability Act (HIPAA). Frankly, it really isn’t anyones business if you’re going to BH or not. But in the military, it can certainly be a tricky situation.
Your unit, mainly your Commander and your First Sergeant, are responsible for ensuring the health and welfare of all of their Soldiers. As a part of this responsibility, they should permit you to seek the assistance that you desire and/or require to ensure that you recover both mentally and physically from a traumatic birth experience. However, that doesn’t mean that they won’t want to speak with you regarding the situation as a whole to ensure that you are okay. I personally don’t know all the regulations regarding this, and whether they can even ask questions or not. My advice on this would be to confide in your First Line Leader first, and discuss with them whether you have to talk to the 1SG or Commander. Best case scenario, you’ve kept your FLL in the loop so they know where you are at and you avoid an awkward conversation with anyone else.
If you are uncomfortable going to the BH clinic on post, there are other options that you can explore as well. Calling Military One Source is a great way of finding out if there are counselors in your area to speak with, and sometimes they are able to get you in with them for several sessions for free. It can be very helpful to be able to speak to a therapist regarding birth trauma, and make a plan of action to not only recover from your past but to move forward.
Beginning on 1 August each year, the breastfeeding community comes together to celebrate the beautiful and natural act of feeding our children the way our bodies were designed to do. As a military member, and a mother, this can be more challenging compared to mothers who stay at home with their children and also to mothers who have more traditional jobs in the civilian sector. According to the World Health Organization, breastfeeding not only provides the best nutritional support for your child but it also enhances maternal bonding, stimulates psycho-social development, improves physical growth, reduces susceptibility to common childhood illness, improves immune system function, and also has long term benefits including increased performance and productivity and reduced risk of some non-communicable diseases.
The WHO also recommends exclusive breastfeeding for at least six months, followed by continued breastfeeding while offering complementary foods for up to two years or beyond. These goals may seem very doable for civilian women, but the military, especially the Army, makes it very challenging. In order to exclusively breastfeed for six months the WHO and UNICEF recommend several things:
- Initiation of breastfeeding within the first hour of life;
- Exclusive breastfeeding – that is, the infant only receives breastmilk without any additional food or drink, not even water;
- Breastfeeding on demand – that is, as often as the child wants, day and night;
- No use of bottles, teats or pacifiers.
Three of these recommendations present significant challenges for military mothers.
Exclusive breastfeeding – no formula – is the first. Many military mothers, after returning to work from the extremely limited maternity leave find themselves in a rather awkward position of having to explain to their (usually single male) supervisor why it is important that she be permitted to use her breast pump every 2-3 hours for 20 minutes. The Air Force, Navy, Marines, and Coast Guard do have regulations in place to ensure that mothers are given these opportunities. However, the Army does not. So many mothers in the Army, when faced with resistance or are flat out told that they will not be permitted due to “mission requirements” either give up pumping at work completely, or they pump as often as they can. Usually once after PT in the morning, once at lunch, and then if they manage to get a break at some other time they do it then as well. The result of these spontaneous pumping sessions is inevitably a reduction in milk supply, resulting in the use of formula to supplement. The second challenge, nursing on demand, is closely tied to the first challenge. In that, we aren’t with our child throughout the day and therefore cannot do so. If unable to pump at the same times that the child is eating, a decrease in supply occurs resulting in supplementation with formula. Third, of course, is no use of bottles or pacifiers. This is just not possible to do as a military mom. The child has to use one or they wouldn’t be able to eat after the end of the maternity leave.
I was very fortunate in my breastfeeding journey with my son. When I returned from my maternity leave, I also happened to be the Commander. I had my own office to provide privacy for pumping sessions, which I simply closed my door and ignored the knocks for 15 minutes. When the new commander arrived, and I became the XO again, we shared an office and it was a bit more challenging. I decided to commandeer the break room twice a day by putting a sign on the door to not be disturbed. I also pumped in my car quite often. Over my year of pumping I also pumped in an LMTV, a HUMMWV, a TMP van as well as the corner of an EST 2000 room. All not ideal places, but I kept myself covered and discrete as possible.
One of the biggest reasons I think I was able to make it to a year was that I simply did not care what anyone else said. I know that I was doing the right thing for my family, and I would stick up to anyone who would say otherwise. And as there is no regulation to guide commanders in the Army, my thought was that if they did not have a policy in place that did not allow for my pumping then by exclusion they must approve it. Because what command is going to put down in writing that they wouldn’t allow a mother to pump when it presents medical risks to not do so? I might not have been able to pump every single time that I needed to, as I remember several times having an aching chest as it had been hours and hours since I had pumped but due to what we were doing I just wasn’t able to get away, but I always did when I could. When my son was 10 months old we PCS-ed to a schoolhouse environment for me to attend a competitive course with my peers. It became even more difficult as I didn’t want to be seen as having preferential treatment for pumping (also a common fear among breast feeding mothers in the military) so I would only pump after PT and at lunch. Which, of course, lead to us weaning at a year. But a year of breastfeeding in the military is a huge milestone! I’m proud of what we accomplished, even if it isn’t the two years that the WHO recommends. If we could have gone longer, maybe we would have.
So this week, as you see military mothers passing by with newborns, infants, and even toddlers give them a little word of encouragement in their journey. Because this is a tough road that we are on, and positive words mean a lot. Encouraging breastfeeding is simply the right thing to do
I would also like to thank the Lactation Consultants who helped us on our journey. During the first eight weeks of my sons life, we had a really hard time with breastfeeding. We were battling with thrush, latch issues, oversupply, reflux, and fast letdown. Without the help of Dorothy, my lactation consultant “angel”, we probably wouldn’t have made it even past my six weeks of leave.
And another shout out to Robyn and her amazing book Breastfeeding in Combat Boots who gave tons of information on how to make it all happen while serving! I was able to meet Robyn last year when she came to speak at Madigan Army Medical Center, and she was very encouraging and positive. She gave a wonderful presentation to the medical providers on why it is so important to encourage breastfeeding and how low the numbers are in the military compared to the civilian world.