Dear colleagues:

I visited Lactnet last night and noticed the thread about women who absolutely do not want to breastfeed and about the mother who revealed that she had experienced abuse targeted at her breasts.

One thing I want to add is that everyone who works with new mothers--from IBCLCs and lay counselors to nurses and doctors--needs to be prepared to hear about abuse and needs to know what to do when they hear about it. *Many* women have histories of sexual abuse, physical abuse, rape, and/or domestic violence. This is not a rare situation. We need to know how to acknowledge what has been revealed, we need to be able to state the limits of our ability to respond to what has been revealed, and we need to be able to refer a mother to a source of support that is knowledgeable about both mental health and breastfeeding. Our ability to do this well will *never* be forgotten. If the health care provider is not a mental health professional, and depending on a great deal of context that would vary tremendously from situation to situation, it might look something like this:

"Thank you for trusting me enough to share this with me. I imagine it was difficult for you to do so. I'm not an expert in this area, but I do know that many women have had experiences like yours and have struggled with infant feeding decisions because of those experiences. With a chance to talk with someone about what has happened in the past and what they are feeling now, many mothers have become comfortable with breastfeeding, and have even found the breastfeeding experience healing and empowering. And, regardless of whether a mother breastfeeds directly, expresses her milk and feeds it to her baby, feeds her baby donor human milk, or formula feeds, talking with someone can help them move toward healing, which is important to the mother and to her children. Here's the name and phone number of a counselor/psychologist/psychiatrist/therapist I know. She specializes in women's issues like this and has a very good reputation in our community...."

There's a million ways to say all this, it would get changed with every verbal and nonverbal response a mother made in the conversation, and there ought to be a whole lot of listening done by the person saying it, but I hope it gives a general idea. The point is, it acknowledges what the mother has said as well as gives her options she might not have known she had. It also requires the health care provider to have tracked down--in advance--a mental health care provider who is knowledgeable about and supportive of breastfeeding. This may not be easy to accomplish.

I always address this issue up front whenever I teach pregnant couples about breastfeeding. I talk about how comfort with breastfeeding is more than physical--it's also emotional and social, how histories of abuse can impact breastfeeding, and how support is available to help mothers work toward healing and become more comfortable with breastfeeding. I've had women come seek that support after class. It is very unlikely that they would have done so without my first letting them know it was OK to do and that they were not alone in experiencing these kinds of challenges. The same mothers that are struggling with infant feeding decisions because of past abuse, are also the ones who will struggle with mothering. (Although any mother can struggle with mothering; it's just plain a difficult job!!) They are at higher risk of developing postpartum depression and other mental health challenges. They need a ray of hope that help is available before they sink into despair.

Still nomail from Lactnet,

Cynthia

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Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC, CATSM 
Ammawell 
Website: http://home.comcast.net/~ammawell 
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