Breastfeeding and the Sexual Abuse Survivor

Kathleen Kendall-Tackett
From: LEAVEN, Vol. 33 No. 2, April-May 1997, p. 27

We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time

Becoming a mother can be at once joyous and stressful. For women who have been sexually abused, the transition to motherhood can bring unique challenges. As LLL Leaders we may be asked to help. Knowledge about sexual abuse can help a Leader in two ways:

It may explain concerns or behaviors we might not otherwise understand;
It can make us more comfortable and therefore more effective when mothers choose to share this information with us.

General Characteristics

In the past 20 years there has been a veritable explosion of knowledge about sexual abuse. The long-term effects of child sexual abuse have been carefully documented in hundreds of studies. Leaders need to keep in mind several cautions about this information:

Not every woman who has been sexually abused responds in the same way. There is a tendency to think that all sexual abuse survivors will look and act the same or experience the same types of difficulties. Sexual abuse survivors vary in the amount of trauma they've experienced, influencing the severity and type of symptoms they might exhibit. Experiences tend to be more traumatic if a family member or close friend was involved, if sexual penetration was involved, if force or coercion was involved, if the abuse happened often and was repeated over a period of years, if there was no adult to believe or support them during childhood. But even women who have had similar abuse experiences may respond quite differently to them.

Other traumatic events during childhood can cause symptoms similar to those caused by sexual abuse. Sexual abuse is not the only form of trauma children can experience. Physical abuse, neglect, divorce, death of a parent, even invasive medical procedures can all cause difficulties for children when they grow up. Occasionally women who have experienced one of these other types of trauma have been told they "must have" been sexually abused. We need to walk a fine line between realizing sexual abuse may be a possibility and not attributing every difficulty a mother experiences to sexual abuse.

The process of healing is individual. Where a woman is in her healing process will influence the types of symptoms she has and feelings she must deal with. Just as the type of trauma a woman experiences varies, so too does the level of healing. We cannot assume that because we see women at the same time in their lives (when they have a new baby) that they are at the same place in their healing process, but may find that they still have some questions and concerns.

Reactions Leaders May Observe

The long-term effects of sexual abuse are listed in Table 2. Not every survivor will experience all or even most of these. However, this listing demonstrates the wide range of repercussions sexual abuse can have. In addition to these long-term effects, Leaders may observe some other reactions:

Lack of confidence in her body. A mother may feel that her body has been damaged by her experience. She may have learned not to trust her feelings about her body. Sometimes this lack of confidence is reinforced if the woman has had a difficult birth. She may not expect that her body will function correctly when it comes to producing milk and may be quite anxious. She may experience intense shame over her breasts. The physical sensations associated with breastfeeding may remind her of her sexual abuse experience.

Intense need to do everything "right." A mother may try to parent her children very differently from the way she was parented. This is a laudable goal but can be taken to extremes. A mother with a difficult childhood may try to be perfect. This may manifest in "selfless devotion," meeting baby's needs to the exclusion of all of her own. With older children, a mother may be reluctant to set limits, only later to explode with anger and frustration. She may also be highly critical of the parenting practices of other mothers.

Tendency to see herself as very different from other mothers. The effects of child sexual abuse can be stigmatizing. A mother may believe she is different from other mothers in ways not directly related to the abuse. For example, she may mention feeling as though the difficulties she has with her children-be it tantrums, defiance or other acting out-are due to her past history of sexual abuse. In other words, if she were not a sexual abuse survivor, all would be well between her and her children. Most Leaders can offer lots of reassurance to mothers in this regard.

How Leaders Can Help

Leaders can help mothers who are sexual abuse survivors in a number of ways. In all situations, remember that every mother is different; what may be a problem for one mother may not even bother another.

Offer suggestions that will make breastfeeding more comfortable. It is not a good idea to approach a mother about possible sexual abuse, as some recent literature recommends. Some mothers may tell you about their experience; others will not. Whether she does or doesn't, a Leader can offer information that can help make breastfeeding a more comfortable experience.

Through your conversation with a mother, try to determine which situations make her uncomfortable. For example, she may have trouble with skin-to-skin contact, a playful older baby or nighttime nursing. Help the mother set limits and boundaries. Some mothers limit breastfeeding to daytime because nighttime nursing reminds them of nighttime sexual abuse. Some mothers want to give their babies the benefits of breast milk but cannot tolerate the baby at the breast. These mothers may opt to pump and give bottles of expressed milk. Be flexible and creative to help the mother find a solution that works.

Help mothers learn what is normal. Mothers who have been sexually abused may have difficulty knowing what is normal when breastfeeding. Most mothers derive at least some sensual pleasure from nursing but mothers who have been sexually abused may be concerned about these feelings. You can offer reassurance, perhaps even bringing up some of the pleasurable aspects of nursing. Also, emphasizing the biological function of breasts may tone down their sexual connotation.

Some mothers from abusive homes can be so anxious about doing a good job parenting they are reluctant to set limits for their children. They may not know the normal range of behaviors for various ages. A discussion on loving guidance can help a mother who has not had positive role models learn more effective and loving ways to parent her children.

Suggest she see a qualified counselor. If a mother tells you that she been sexually abused, talk with her about the importance of seeing a professional who can help (if she is not already doing so). We need to remember that as Leaders our primary objective is breastfeeding support. While it is important to be sympathetic and encouraging, be careful if you find yourself becoming the main source of emotional support for issues only tangentially related to breastfeeding. A mother experiencing serious difficulties or difficulties outside the realm of breastfeeding needs to be encouraged to seek appropriate help.

Help educate health care providers about the normal course of breastfeeding, for example, breastfeeding on demand, co-sleeping and late weaning. This is an area where a Leader's expertise can make a significant difference. A surprising number of health care providers in the sexual abuse field feel that attachment-parenting practices are a negative result of the sexual abuse experience. We can educate mental health providers, directly or through the mother, about normal breastfeeding practices, especially from a global perspective.

Helping a mother who has been sexually abused can be one of the more challenging situations you encounter as a Leader. It can also be one of the most rewarding. I've known many sexual abuse survivors who have grown past their abusive experience to become nurturing mothers, fathers, even LLL Leaders. With encouragement and breastfeeding support, we can help make that happen.

What Leaders Can Do to Help Breastfeeding Mothers Who Are Sexual Abuse Survivors

Offer suggestions that will help make breastfeeding a more comfortable experience.
Help a mother learn what is normal for breastfeeding.
Encourage a mother to seek qualified professional help with problems beyond the scope of breastfeeding.
Help educate health care providers about the normal course of breastfeeding.

Table 1 - Overview of Sexual Abuse
Incidence:	Around 20% of all women
Peak age of vulnerability:	7-13 years of age (but can occur earlier or later)
Abusers:	90% are male; 70-90% are known to their victims. For girls, 30-50% of abusers are within the family.

Table 2 - Overview of Long-Term Effects of Sexual Abuse
Post-Traumatic Stress Disorder (PTSD)	A mother may experience sudden and intrusive flashbacks perceived in the present.
Cognitive Distortions	A mother may overestimate danger to herself or her baby. She may perceive herself as weak or helpless.
Emotional Distress	A mother may experience depression, anxiety, panic disorder, obsessive-compulsive disorder, anger, chronic irritability and difficulty expressing anger.
Impaired Sense of Self	A mother may have difficulty separating her emotional state from the reactions of others. She may have difficulties with self-protection, leading her to become a victim again.
Avoidance	A mother may experience dissociation, which includes alterations in body perception (including feelings of separation from her body), emotional numbing, amnesia regarding painful memories, and multiple personality disorders. Other types of avoidant behavior include substance abuse, suicidal thoughts and attempts, "tension- reducing activities" such as indiscriminate sexual behavior, bingeing and purging, or self-mutilation.
Interpersonal Difficulties	A mother may have problems with interpersonal relationships. She may adopt an "avoidant" style, characterized by low interdependency, low self-disclosure and lack of warmth. Or she may adopt an "intrusive" style, characterized by extremely high needs for closeness, excessive self-disclosure and a demanding, controlling style.

References

Finkelhor, D. Current information on the scope and nature of child sexual abuse. Future for Children 1994; 4:31-53.

Becker-Lausen, F and Mallon-Kraft, S. Pandemic outcomes: the intimacy variable. Paper presented at the 4th International Family Violence Research Conference, Durham, New Hampshire, July 1995.

Briere, JN and Elliot, D. Immediate and long-term impacts of child sexual abuse. Future of Children 1994; 4: 54-69.

Page last edited Sun Oct 14 09:31:17 UTC 2007.