This comment really caught my eye:
<<I twice rented a pump to a mom who fed her babies expressed milk in bottles
for over a year each child.  She was unwilling to have her babies at the
breast at all, ever.  Hmmmmm....>>
Moms who do this are often sexual abuse survivors. I think I've posted this
info to lactnet  before. Just think of the dedication involved to exclusively
pump for over a year! Twice!
The OB/GYN nurse practitioner tells me they now believe the  incidence of
childhood sexual abuse is about 1 in 4 of every mom seen. Sounds high but I've
seen it too often to disagree.  There are a lot more walking wounded out there
than we will ever know.
If you feel comfortable, ask her in a way that acknowledges the abuse and lets
her know you are willing to talk about it. "You know when I have moms who are
uncomfortable with having the baby at the breast I often find that they were
sexually abused. Has anything like that ever happened to you?" She may or may
not give you the truth but it is an opportunity for some understanding and
acceptance and hopefully the healing will begin.  The abuse was not their
fault but so many have told me that they did something to cause it and have
kept silent because of their own guilt feelings. The guilt these women carry
around is unbelievable. Having a baby and breastfeeding (especially if the
breast was involved) exacerbates her memories of the abuse.
I am often the first person that mom has ever told . It is a difficult
situation and be prepared to deal with your worst fears and your own feelings
about sexual abuse. The floodgates often open wide and everything in your
office MUST come to a screeching halt. You can't leave her hanging. Let her
give you as much information as she is comfortable giving you. Cry with her if
you feel the tears coming. Ask if you can hold her hand or hug her as she
opens up. It will take as long as it takes.
Please make sure that you have referrals available to local support persons
and that she has them in her hand before she leaves.
Marie