By Dianne Cassidy, IBCLC
When I first began working with new mothers, it was with a local community program. The more women I met, the more I saw a link between breastfeeding and trauma. Most of the women that I assisted had a limited support system available to them, and limited education. In many instances, we were the only ones who offered the support they needed to initiate breastfeeding. As a bond was built during pregnancy, sometimes a new mother would open up and talk about her personal history, things that she may have endured during childhood, or in the not-so-distant past.
I have heard some terrible stories. Many of these stories come with a happy ending of sorts – the fairy tale where the woman finds her strength and confidence and realizes that she is capable. Some are not as favorable, and can haunt you for years. I became more and more interested in how abuse can impact a woman’s decision to breastfeed. I decided to make this the topic of a research project while completing my Bachelor’s degree a couple of years ago. While important, coming face to face with the emotional scars of many of these women was very challenging.
While doing my research, the literature review unearthed some interesting information about abuse and breastfeeding, particularly child sexual abuse (CSA) and how it may impact breastfeeding initiation. When working with the community programs, one of the focuses of breastfeeding support was teen age mothers. We have a high rate of teenage pregnancy here (enough that there is an entire high school dedicated to teen mothers) and teen mothers have been known to have a low breastfeeding rate. Childhood sexual abuse prevalence among adolescent mothers is close to 50%. Adolescents who have been abused as children are more likely to become sexually active at a younger age than those not abused. Adolescent survivors of CSA were 3x likely to become pregnant than those who were not abused. Studies reflect that breastfeeding is not readily initiated among adolescent mothers. This is not to say that these mothers will not initiate breastfeeding at all, but those who do initiate are more likely to wean earlier than adolescent mothers who are not victims of CSA.
One of the most wonderful things about breastfeeding is the close, intimate connection between mother and baby. For a survivor of CSA, this may be an unfamiliar, unwelcome sensation. Intimacy disturbance and dissociation are consequences that are likely to influence feeding decisions of adolescent mothers. CSA victims and survivors may struggle with trust issues, building relationships and emotions. Abusers are often someone that the victim is familiar with – family friend or relative for example, leading to feelings of betrayal and vulnerability.
Trust is a tricky thing. It’s important that a woman has a good relationship with her provider, a trustworthy relationship. Without this, information is skewed. Communication is key. It may be difficult for a survivor to confide her concerns regarding her feeding choice to someone if a relationship of trust has not been established. When preparing for labor, a provider can gain the trust of their patient if they listen carefully and validate her feelings, exploring what concerns she may have in regards to breastfeeding. When working with expectant women, or in particular adolescent mothers, education is an important part of breastfeeding initiation. Educate expectant mothers about their feeding choices in a non judgmental manner. Mothers with CSA history are likely to have come from a family environment that is chaotic, deprived and emotionally dysfunctional.
As a lactation consultant, it can be difficult to explore options other than breastfeeding with a new mother. We know that breastfeeding is the optimal choice, and mothers know this to be true as well. Sometimes, exploring other alternatives is necessary. The role of the provider is to offer the patient evidence-based information so that the patient can make the appropriate decision. Once the information has been disclosed, it is the role of the provider to offer support, no matter what that decision is and how the provider feels about that decision.
Every new mother and baby deserves the opportunity to enjoy a breastfeeding relationship, free of distress, no matter what the history may be. I feel honored that I have been able to assist with offering this to survivors, encouraging mothers and babies to get the best start in their life together.
Bowman KG (2007). When breastfeeding may be a threat to adolescent mothers. Issues in Mental Health Nursing, 28(1), 88-89.
Brooks, EB (2012). Legal and Ethical Issues for the IBCLC. Jones and Bartlett.
Dianne Cassidy is a lactation consultant in Rochester, New York. She became interested in the field of lactation consulting after breastfeeding her own children. After spending thousands of hours working with new mothers and babies, she was able to sit for the board exam, which qualified her as an International Board Certified Lactation Consultant (IBCLC). In 2010, she completed her Advanced Lactation certification and BS in Maternal Child Health/Lactation. She is dedicated to serving mothers and babies, and has the unique ability to identify with the needs and concerns of new mothers. She also has experience working with older babies and mothers returning to work and wishing to continue their breastfeeding relationship. She has worked extensively with women who have survived trauma, babies struggling with tongue tie, birth trauma, milk supply issues, attachment, identifying latch problems, returning to work and breastfeeding multiples.