Jay,

Sharon Calverley, IBCLC in Sunnyvale has called me about a client of hers.  I
can usually give some help to her when it comes to abuse issues, but I
thought you could be a great deal of help to this mom.

Baby born 2-10 at 1:30 am.  This is a second baby. Baby born at home with my
favorite midwife.  Mom got through labor by screaming and pounding on
furniture (her arms are still sore).  Mom has an unacknowledged history of
sexual abuse.  Sharon saw her after the first baby and the mother brought up
abuse once.  She has never acknowledged it since.  The first baby was not
breastfed, it was just too difficult for the mother.  Amazingly, she called
Sharon for breastfeeding help with this baby.  She apparently wants to give
it a try again.

She doesn't want anything near her breasts.  She will NOT use a pump.  She
will put the baby to the breast with a nipple shield between them, but the
mother can't look at the baby at her breast.  There is no MER happening; no
uterine contractions.  She holds the baby with her palms.  Basically, she
holds the baby there, throws her head back and breathes like she's in pain.
 She says she's trying to "check out" so she can breastfeed.  She gets very
nauseated when she tries to breastfeed him.  I don't think this is a reaction
to oxytocin since there isn't any uterine contractions or MER.

Intervention ideas:
1.  desensitize the breasts with massage.  She "can't" pump and will only
feed with a shield.  This is the only thing I can think of that can protect
her milk supply right now.

2.  bathe with baby.  I don't know if this could even be a possibility with
this mom.

3.  help her find a way to "check out" so she can be successful with
breastfeeding

4.  find positions that reduce the amount of physical contact

This is an extremely strong woman.  She got herself through labor.  She
survived abuse as a child.  I was very surprised when Sharon called and said
this woman had another baby and wanted to try breastfeeding again.  Last time
it was an incredible struggle and she didn't breastfeed.

Anyway, if you have time, could you e-mail me and let me know if you have any
insights or suggestions that might help this woman?  My personal history just
made me more determined to breastfeed.  I think I made it through labor
without drugs partly because I needed to be in complete control of the
situation (as if you can be in control of labor!)  The clients I've worked
with with abusive pasts have usually been more concerned that they'd be
abusing their child if they breastfed, especially if the milk wasn't in yet.
 They've also been concerned about privacy and how to deal with their
physical and emotional feelings about their child.

Any help would be greatly appreciated if you have the time.

BTW, Penny Simkin will be speaking at Providence-St. Joseph Hospital in
Burbank on March 23.  It's Advanced Childbirth Assisting, but focuses on
helping the woman with a history of sexual abuse.  It costs about $100.  A
roundtrip plane ticket on Southwest is $44.  If you're interested the phone
number is (818) 445-5126.

Thanks, Jay.

Elizabeth Novelo Puzar, IBCLC  in San Jose.