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Subject:
From:
Cynthia Good Mojab <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 16 Oct 2000 19:06:43 -0700
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Several points have been raised in the discussion of working with
breastfeeding mothers who have experienced sexual abuse. Beth wrote that
"women should be in charge of revealing that information." While Nancy
wrote that "...the fact is that for some women (maybe not all), past
attempts to reveal may have been met with resistance at best, punishment at
worse. Therefore, they have learned that it's not safe to tell.  Secrecy is
a fertile breeding ground for shame, which then leads to more secrets..."
and advocated asking directly about sexual abuse to make "it clear that she
is interested and that there won't be recriminations to the client if she
tells." Karen Gromada, in a forwarded post, stated that "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." and
that "Asking assessment questions about any possible abuse/other mental
health history cannot take control of any revelation from the mother."
My own thoughts on this issue are based on my work with women in the
context of both breastfeeding and psychological counseling, my training in
clinical psychology, my training and experience working in a women's
shelter, and diverse readings on this and related topics...
Women who have been sexually abused have had major violations of their
trust, emotional and physical boundaries, physical and psychological
integrity, the timing, nature, and experience of their sexual development,
... They have experienced a lack of safety at a profoundly fundamental
level. The LC does not have the right or ability to determine for the
mother that it is safe to reveal a history of sexual abuse. Only the mother
can make this determination for herself.
The creation of an environment of safety is critical to accurate assessment
of sexual abuse. When LCs listen with empathy, reflecting their
understanding of the information and feelings a mother expresses, offering
suggestions and alternatives in a nonjudgmental manner, they do a great
deal toward creating that environment of safety. In addition to this
general way of interacting, LCs can directly state their willingness to
talk about sexual issues by saying something along the lines of:
"Breastfeeding has many aspects--from beliefs to feelings to techniques.
Women often don't get the chance to learn how to breastfeed by watching
other women. Even when they know how to breastfeed, they may not have the
social support that they need to continue to breastfeed as long as they
want. And the experiences that women have had with relationships, their
bodies and their sexuality during childhood and adulthood impact
breastfeeding. We can talk about any of these things and more--and I can
help you find information and support for your own situation." Such a
statement is direct, holistic, matter-of-fact, conveys to the mother that
the LC does NOT consider anything taboo, conveys a critical message of
respect for the mother's choice to have or not have the conversation, does
not put the mother "on the spot," gives the mother as much time as she
needs to assess safety and opens the door to a future conversation if the
mother is not ready at the time.
In contrast, "Were you sexually abused?" (as a standard assessment tool for
sexual abuse) requires an exact answer to that exact question at that exact
moment. She and the LC know that a "yes" or "no" is expected as an answer
to that question. She and the LC know that a truthful answer is expected to
that question. If the answer is "yes" and the mother is ready to reveal
that information to the LC, the LC has accomplished the assessment of
sexual abuse and can go on to referral to mental health care and to
providing specialized breastfeeding help in the context of past sexual
abuse. If the true answer is "yes" and the mother is cognizant of her
sexual abuse but not ready to reveal that information to the LC (and so
says "no"), the LC has NOT accomplished the assessment of sexual abuse AND
has put the mother in a situation that may be experienced as very
frightening. Such a mother, who may not have remotely been expecting such a
question, must decide in the fraction of a second (lest she unintentionally
reveal the truth by her body language, delayed answer, tone of voice, etc.)
to tell the truth or to lie. She must evaluate in the fraction of a second
the safety of revealing the information to the LC. And while the LC may
believe that it is safe for the woman to reveal that information to her,
the woman may not (and it is her belief that counts): she may need more
information, more time, and/or more interaction with the LC before she can
feel safe. If the true answer is "yes" and the mother is NOT cognizant of
her sexual abuse, she will answer "no" and the LC has still not
accomplished the assessment of sexual abuse.
So the RISKS involved in assessing sexual abuse by asking directly "Were
you sexually abused?" include (at least) 1) the failure of the assessment
tool to get an accurate answer, 2) the violation of the woman's right to
FULLY determine when and whether it is safe to talk about the topic (and
ultimately reveal--or not-- a history of sexual abuse), and 3) the creation
of an environment that does not feel safe to the woman.
Some references for anyone wanting to learn more about this topic are
below. These are the resources listed in the bibliography for the session
"Breastfeeding and the Sexual Abuse Survivor" presented by Deirdre Knowles,
MA at the LLL of Washington Area Conference on October 7th, 2000.

Bass, E. and Davis, L. (1984) The Courage to Heal. New York: Harper
Perennial.
Banyard, V. (1997). The impact of childhood sexual abuse and family func
tioning on four dimensions of women's later parenting. Child Abuse and
Neglect, 21, 1095-1107.
Digman, D. M. (1995). Understanding intimacy as experienced by
breastfeeding women. Health Care for Women International, 16, 477-485.
Gallop, R. McKeever, P., Toner, B., Lancee, W. and Lueck, M. (1995).
Inquiring about childhood sexual abuse as part of the nursing history:
opinions of abused and non-abused nurses. Archives of Psychiatric Nursing,
9:3, 146-151.
Hall, J. (1997). Breastfeeding and sexuality. British Journal of Midwifery,
5:6, 350-354.
Hastings, A.S. (1998). Treating Sexual Shame. New Jersey: Jason Aronson,
Inc.
Hastings, A. S. (1996). Body and Soul. New York, NY: Insight Books.
Hastings, A. S. (1993). Discovering Sexuality that will Satisfy You Both.
Tiburon, CA: The Printed Voice.
Herman, J.L. (1994). Trauma and Recovery. New York: Guilford.
Kendall-Tackett, K. (1998). Breastfeeding and the sexual abuse survivor.
Journal of Human Lactation, 14:2, 125-130.
Kendall-Tackett, K. (1997). Breastfeeding and the sexual abuse survivor,
Leaven, 33:2, 27-29.
Rhodes, N. and Hutchinson, S. (1994). Labor experiences of childhood sexual
abuse survivors. Birth, 21: 4, 213-220.
Robohm, J.S. and Buttenheim, M. (1996). The gynecological care experience
of adult survivors of childhood sexual abuse: a preliminary investigation.
Women and Health, 24:3, 59-75.
Schnarch, D. (1997). Passionate Marriage. New York: Henry Holt and Co.
Weiner, R. (1995). I am a survivor: childhood sexual abuse's effect on
medical consultation. British Medical Journal, 311: 7007, 758.
Williams, N. (1997). Maternal psychological issues in the experience of
breastfeeding. Journal of Human Lactation, 13:1, 57-60.

A reminder to all that I post to LACTNET not as a representative of La
Leche League, rather, in my other roles.

Cynthia Good Mojab, MS Clinical Psychology
(Breastfeeding mother, advocate, independent [cross-cultural] researcher
and author; LLL Leader and researcher in the LLLI Publications Department;
and former psychotherapist currently busy nurturing her own little one.)
Ammawell
Email: [log in to unmask]
Web site: http://ammawell.homepage.com

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