POSSIBLE THEORIES FOR BAA
This is a simple, but crucial element, it is a biggy. A make or break part of being able to breastfeed successfully and sustain it, even when experiencing aversions and agitations, for many mothers. Ever been woken up in the middle of a sleep cycle, and felt a bit disorientated and groggy? Imagine that happening 5-12 times a night, evey night, and then having to get up and continue with your day as normal. Not possible, right? Yet, thousands of mothers do this for years, and somehow it's not expected to severely effect you - or your breastfeeding relationship.
You need sleep, sleep is for repair, sleep is re-charging , sleep is for sanity, sleep is for a break from caring and motherhood. If mothers were so deprived of food, it would probably mean hospitalization, and it should be the same for sleep deprivation as it's just as essential for your body and mind to function.
Sleep is a well researched topic, and it is well known new parents ought to expect little sleep. Yet, what people don't tend to talk about is that it may go on for years for some parents. There are various studies linking lack of sleep to a plethora of problems, including poor development, depression and anxiety. See here for studies on animals, here for long term sleep loss in human, and here for sleep and depression.
It is not unreasonable to presume that incessant sleep interruptions and deprivation could cause symptoms of BAA. Could less sleep effect skin sensitivity? Or increase likelihood of anger like in the case of the 'hangry' phenomenon (anger when hungry). In short, yes.
Anger and the links to sleep will be researched shortly and added to the theories, it is my contention that some people are prone to a short temper when very tired, but we shall see what the research says, and how it links to BAA.
Lack of proper nutrition can have an effect, even long term, on a lactating mother. See here for an article published on this. Although the quality of milk is not effected by a poor diet, producing breastmilk itself increases the need for sufficient nutrient intake, and if this is not met, it is possible that BAA occurs as a warning sign to change that.
In the support community and BAA groups, there are a number of vitamins and minerals that are anecdotally said to help. These include (but are not limited to):
On an individual level, it is best that the mother have a full blood test, for deficiency is any of the above and have this recified to see if it helps with BAA. Your doctor can be approached for this if you are suffering from tiredness, and fatigue.
Either at the startof the journey, at birth or at the start of breastfeeding. This could be due to having a complicated birth, being separated from baby, having a preterm baby, having tongue tie issues, or (very commonly) the pain from incorrect positioning and attachment.
Studies show women going through nipple pain are also experiencing high emotional distress (see here) - no surprise there - but what does this mean for infant feeding, 5, 6, 10, 20 times a day? Severe discomfort and, understandably, an aversion toward that activity.
Even once the pain has subsided the memory is still there, and the dynamic of the relationship may continue on the trajectory upon which is was started, which is not all together healthy and loving in the sense that it is a pleasant and enjoyable and rewarding activity for the mother, or infant. Cells also carry a 'memory of pain', which may explain chronic discomfort or pain at the breast, even after issues are resolved, see here for an article on a study that shows this. With pain at the beginning of any relationship, the stage is set, and it is very difficult to change the story path. Not impossible, but difficult.
It is well known that a women's body undergoes a mass of changes when pregnant. What to expect, how to cope and how to make things easier can be found easily. Nursing, while pregnant, however, presents a whole new array of possible difficulties and complexities. Nipple sensitivity, hormone changes and the need for rest can be the main culprits in causing aversion while breastfeeding. However, some women find it doesn't happen for the whole pregnancy, and so chose to continue, if they wish to tandem feed. Finding the right balance for you will take time and support, to figure out how to best manage feeds, and how to best look after yourself.
It may make sense for some women who are pregnant and breastfeeding that BAA is a kind of physiological message to wean. The body is preparing for a new child, and preparing new milk, and conserving its energy and resources for that child.
Milk production is different for the different sexes (see Katie Hinde's work published here). Whilst the body can produce colostrum for a newborn and have it come out in one breast, and milk for a toddler that appears from the other, it is unknown what effects this has, if any.
Ultimatley, BAA can be a signal to wean to the mother, and she can choose, if she has the will, and determination, to ignore it.
FEEDING ON DEMAND
Extended feeding, into toddlerhood, and beyond, could be one of the reaons for BAA to occur in some women. The time the infant spends at the breast varies for women, but mothers often express the feeling of being 'touched out' and needing some physical space and time away from feeding. This is a complex arena and would need much more research and thought. More information will be added in due course, if you want to contribute please contact me here.
Could BAA be post-natal depression, or a rubric of it? Whether diagnosed or not, it can include anger and/or agitation as its symptoms, as well as anxiety, sleepnessness and irrtability. It is definitley a possibility for some women.
However, there is a screening assessment and a scoring sysyerm with some screening tools to establish the possibiltiy of post-natal depression (take a self-test here). It is only an indication, and a proper assessment would need to be undertaken, but it's a start if you're curious. Also, many women who experience BAA are adamant that they are not depressed, and do not exhibit signs of anger or irritability if the infant is not latched. By this they mean it doesn't necessarily effect all parts of their life, just breastfeeding when the infant/child is latched.
Depression is just that, 'depression'. If you are doing just fine, getting ready for each day, generally coping and happy (outside of the normal difficulties and woes of parenting), then BAA is separate for you. In the strictest sense, BAA seems to revolve around the difficulties and sensations experience 'when the child is latched', but not at other times.
CORTISOL- see here about cortisol
It is a theory of mine (pure conjecture at the moment but hey, most theories start that way), that women who experience BAA have higher levels of 'stress' hormone cortisol than women who do not. This, in turn, is responded to by the infant, (as cortisol can pass through breastmilk), who then increases the frequency of suckling at the breast, which in turn again raises levels of cortisol in the mother due to her having the aversion and agitation while breastfeeding. If you're not flooded with the loving feeling oxytocin gives you, it is also possible that milk ejection is compromised, as oxytocin is linked to the release of milk, see here.
A randomized control study looking at blood cortisol and oxytocin levels, alongside some qualitative data from breastfeeding women, would either confirm or refute this, but there is yet to be any clinical study trials on BAA . We should campaign for it.