I just want to add a few more things on this topic. 1) My example was just
one example of how an LC might open the door to the topic in a
non-threatening manner--it is just one possible starting point in what
would be an ongoing conversation about many aspects of breastfeeding. I
would not say the same thing to every woman. 2) There isn't one perfectly
right way to assess sexual abuse with every single woman who has a history
of it. It makes sense that women who are ready to reveal the information
are more likely to report that a very direct approach worked well with them
than are women who are not ready (or who have no apparent memory of the
abuse). Given that the LC cannot know the readiness of a woman in advance,
it seems wise to be neither too direct (requiring a yes or no answer on the
spot) or to fail to raise the topic at all (and continue the prevailing
silence and taboo around this experience). Women's comfort with the LC's
approach will also depend on how much interaction they've had with the LC
and the nature of the relationship that has developed between them during
that time. 3) It is always good to get feedback from the women with whom we
work in counseling situations (be it psychological or breastfeeding). We
can ask questions like: What was it like to talk about this? Did anything
happen in our meeting today that you didn't expect? Did anything not happen
that you wished had happened? etc. Our need for feedback and information
are more good reasons for LCs to become familiar with the literature on
this topic: women's stories are often included in it. What better way to
learn about what survivors of sexual abuse experience and need than from
the women themselves? 4) If we suspect that our initial attempts to assess
sexual abuse (or anything else for that matter) did not yield accurate
results, we can always try again at a later point in our interactions with
a mother. What a woman is not ready for at a first meeting, she might be
ready for at a later meeting after she has had more of a chance to get to
know and trust us more. By then, the LC will know more about the mother and
can better customize her approach based on more information. 5) We do not
have to know whether a mother was sexually abused to offer her support and
information (or even a referral to a mental health care provider):
compassion, working with symptoms (whether we ever know why they are there)
and doing what we can to create a trusting environment will mean a great
deal to the survivor of sexual abuse (as it will to all breastfeeding
mothers) regardless of breastfeeding outcome. 6) Even if a woman is not
ready to talk about or reveal a history of sexual abuse to an LC, the
information provided by the LC regarding how experiences with sexuality,
our bodies, relationships impact breastfeeding can help allay guilt at
experiencing difficulty with breastfeeding. Such information can always be
provided without a woman having to confirm or deny a history of sexual
abuse. 7) Women do not have to know that they were sexually abused in order
to heal (memories of sexual abuse that occurred when a woman was pre-verbal
may never be recovered).

It is great to see this important topic being thoughtfully discussed by so
many on LACTNET.

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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