Since you followed up after the visit, I'd think the ball is back in
the mom's court -- she knows how to reach you for further follow-up.
Not sure if any of this may help if/when she calls back or in the
future...
Considering infant appeared to have achieved a deep latch and there
are no signs of tongue-tie or higher palate, there were no nonverbal
signs of pain, and no nipple trauma was evident immediately after BF
(no flattening, creasing, blanching, tissue breakdown, etc.), I'm
wondering if the mom may have a history of sexual abuse(SA). Did the
mom describe the type of pain felt, e.g. pinching, biting, bruising,
scraping, grated glass, etc. or did you ask her to scale the pain from
1 (low) to 10 (high) to get more of a sense of how she perceives the
discomfort?
What does she say when you something to effect that "Gosh, the latch
looked deep -- picture perfect. And I didn't notice any behaviors in
you that I usually see with moms having sore nipples, plus your
nipples were the same shape, color, etc. when they came out as when
they went in. Usually those are all good signs, but it's not how it
looks to me -- it's how it feels for you. So something is still not
quite right. What do you think could be behind the pain?"
I find moms take questions about SA history in stride if I'm
matter-of-fact about it. If other things have been ruled out and SA's
a possibility, the way I ask is to just say something re: "Sometimes
when there isn't an obvious reason for a mom's nipple pain, a mom asks
if it could be related to having been sexually abused in the past. Is
there any chance something like that is contributing to the pain
you're feeling?" (If this is not a cause or if a mom is not ready to
face it, she'll be clear in her "no" -- verbally and nonverbally.
(Watch to see if verbal and nonverbal match.) If she says "no," accept
it and move on -- even if you think it may be a possibility. By
asking, you're letting her know you're comfortable with anything she
tells you. (Once a mom told me "no," but after she came to trust me
more, she later told me she had been abused.) If she says "yes,"
acknowledge the role abuse may play in her BF issue, and you could ask
her what she thinks you might do to help her move forward with BF (and
beyond). May share other mother's feelings -- both positive and
negative re: BF after abuse. Many mothers find it very healing and a
way to take power back from the perpetrator; others simply can't get
to that place due to flashbacks, etc. -- or at least not yet. LLLI's
web site has a couple of good mother stories and Kathleen Kendall
Tackett has good info via her site.
When a mom hasn't tried any strategy we discussed, I do two things.
First I ask myself if I did a good job of developing a plan of care
with the mother -- or whether I was too into my own agenda. Then, if
feeling OK about the mutuality of care planning and appropriate for
the situation, I "gently" confront the mom, e.g., "I'm feeling
confused. We discussed and you agreed to try A, B and C for three
days, but it has been three days and you say you haven't tried any of
them. What do you think is getting in the way of trying one or more?"
When possible, I confront "yeah...but" moms in a similar way, e.g., "I
hear you say you want to continue breastfeeding, yet you seem to have
some concern with everything I've suggested to help. What do you think
may be getting in the way of even trying A or B?" Or at the end might
ask "Is there a part of one or more of the suggestions that you think
may be workable for you?"
--
Karen G
513-325-2550
www.karengromada.com/
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