I tought I was toooo busy at this end of the semester to answer any of the stuff on Lactnet, just read it takes long enough... but... Zena's story about sexual abuse and breastfeeding prompted me to come in... Dear Zena, I admire your courage in disclosing such personal history with 2000+Lactnetters. I am sure it does contribute to help us helping sexually abused women we see anywhere in our practices... In fact, I do agree with your saying completely. Most of the women I have seen who had been sexually abused earlier in their lives experience problems, first with sexual relationships, then during deliveries... Being a perinatal nurse, teacher, and consultant, I often see women prenatally, during their labor and delivery, and postnatally at the hospital and in their homes. Many of those women get complications during labor and delivery, going directly to cesarean sections if not assisted correctly by an open-minded nurse..., and even then, since the hard part is often to deliver vaginally. I had the great opportunity of working with some women that I have followed prenatally, then during their labor and delivery, and also postnatally (that's a privilege of private practice on top of full time teaching job!). When I know about the abuse before the L+D, I can help the woman work through visualisation and support and the help of the husband, and then during the L+D, and postnatally. I also often refer them to a psychologist. But I realize that I am often the link, the important person who knows, and who is there all the time during the many months of the pregnancy, the L+D, and the postnatal experiences. That is frightening for me but also so rewarding. But I would also say that generally, for any woman I work with in L+D, when something is going wrong during the L+B and that I don't know about the abuse, for example, a very slow labor or labor arrest, I ask the question more or less directly...(not easy but important when you have established a good relationship with her). Sometimes it is fear of tearing, sometimes it is abuse, sometimes it is something else...but there is always something special, not physical stuff, hindering the descent of the baby. If we can work out at least a little of this matter together so that this woman can deliver her baby vaginally, then boy! the breastfeeding part is soooo easy! I have also worked with women who only experience difficulty when putting the baby to the breast; they often have mixed feelings about the role of the breast and my job is to work with them on this matter. I think it depends probably on the type of abuse they sufferred, the reality of the abuse or the feelings still present in mind and body after the years... I truly believe however that being able to breastfeed their babies gives these women a lot of empowerment, a boost of self-confidence in their capabilities of being a good mother and also of being an 'o.k.' person. Of course, they need extra help and extra support from their husband, their significative others, and from bf supporters, but I am convinced we can make a real and long-term difference in these women's lives, if we just put the effort it demands... Sincerely. Louise Louise Dumas, R.N., M.S.N., PhD Professor-researcher in Nursing Sciences University of Quebec in Hull (Western Quebec where we had our first snow yesterday and it is still on the ground!) mailto:[log in to unmask]