Forwarded with permission from Karen Gromada.
-----------------------------

I'm currently nomail for Lactnet due to new job and traveling. This is a
topic I've spoken on at several conferences because I feel passionately
about
it after the practicums I did as a nurse-psychotherapist during my graduate
program in adult mental health nursing.

I AGREE with you wholeheartedly! When mental health history is approached as
simply one other matter-of-fact aspect of a holistic breastfeeding/lactation
health assessment, the client rarely thinks anything of it. Often she is
relieved that someone is finally mentioning it! Even if a client has not yet
built a trusting therapeutic relationship with the LC or perhaps is not yet
even aware of the history herself due to repressed memories, she now knows
she may bring such issues up at a later time as this LC has shown she is
comfortable talking about mental health issues that can have a profound
effect on pregnancy, birth and breastfeeding.

Asking assessment questions about any possible abuse/other mental health
history cannot take control of any revelation from the mother. A women who
chooses not to reveal that info won't reveal it anymore than another woman
may keep some other info to herself, e.g. cigarette use or consumption of
"junk" foods. And no one should be afraid that assessment questions may stir
up repressed memories. In general, the mind protects until it is ready to
begin coping.  Actually, if questions stir up some memories, it may be that
the mind is trying to let its owner know that repressing them has become
maladaptive.

When we don't ask about mental health issues as LC, we should realize that
we
are then contributing to the great conspiracy of silence that surrounds
mental health issues still. And we certainly can't refer a woman to a more
appropriate clinician for treatment of the different but related issue when
we aren't even willing to approach the subject.

I believe you are "right on" with your Lactnet response. Keep it up!!

Karen Gromada

Re: << I may be naive here, but I don't quite understand why LCs should not
ask a
mother about sexual abuse. It's not something that I ask regularly, but
there are times when things aren't adding up, and I am wondering if there
may be another component here. How else to find out if I don't ask? I have
no illusions that I am not a psychological counselor, but perhaps adverse
reactions to breastfeeding are going to be the first clue that mom has
unresolved issues. Of the times that I have felt the need to ask the mother,
I do so gently and in private-- never in front of anyone else, including
dads or grandmas. And if the answer is affirmative, I do a lot of listening
the rest of the consult, and may suggest counseling. >>

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