Cynthia,
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.
I'm thinking of two particular cases right now. The first one I wrote about
this past summer. The mom had a history of milk coming in but no milk
ejection; her first LC believed that perhaps mom did not produce oxytocin,
as all labors had to be induced as well. But as I tested this out prenatally
(she called me before the birth of #4), we discovered that she got
braxton-hicks contractions in response to nipple stimulation, and she also
experienced orgasms. I don't remember if it was before or after, but I spent
quite a lot of time with the mother, and discovered that she had a past
history of sexual abuse. I explained to her that sometimes there can be
psychological inhibitions, and suggested that if she had not done any
counseling for these things before, she might find it beneficial.
Breastfeeding wise, the same thing happened again despite all of my best
efforts. Mom was going to seek out counseling until she found out that she
knew the person I was recommending through their teenage children (counselor
is also a lactnetter)-- she chickened out.
A year or two later, however, and in part because of what I shared with her,
this mom did finally make an appointment with the counselor, and they've
been doing sessions for 2 years now. I did not know this until recently, and
in talking to the mom, she now wishes that she would have followed through
sooner on my suggestions. She has agonized over whether it would have made a
difference-- well, there were far too many issues to resolve to fix the
breastfeeding in that moment, but it would have been nice for her to have
someone suggest this years earlier. I think it was a motivating statement
to her that buried issues, which so many people just try to shrug off, could
have such physical ramifications. I am glad that I brought it up, and so is
she.
I remember another mom--- had come to my prenatal breastfeeding class only
so that she could get the free carseat. I discovered that she had not
planned on breastfeeding, and when I inquired (privately during break) about
her concerns and aversions, she gave off some vibes that suggested something
more was under the surface. So I asked........... and it turned out that she
did indeed have some bad abuse experiences that gave her very negative
feelings about her breasts. I gave her lots of empathy, and we had a very
good conversation; I encouraged her to seek some counseling whether she
chose to breastfeed or not. It was eye-opening for her to realize that her
negative feelings might be rooted in her past and that these feelings could
change.
In my experience, when I have felt the need to ask and the answer was
affirmative, there have sometimes been tears, but very carthartic tears. And
I'm sure I've had my share of denials, too. -- perhaps my question will
plant a seed that later helps mom recognize and deal with her hidden past.
That's my 2 cents-- given my experiences, I don't quite understand the
blanket statement that LCs should not even *ask*-- I try to know my role and
limitations, and I work hard on my empathetic communication skills.
Lisa Marasco IBCLC
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