Breastfeeding After Sexual Abuse: How Can We Help

I have read a big pile of research studies related to breastfeeding after sexual abuse. But my recent interview with Elizabeth Johnson helped me to  better understand how to actually help women in this situation. I’d like to share with you some ideas I would consider priorities for helping women in this situation.

1. Realize that sexual abuse does not preclude breastfeeding

Several studies have shown that women who have been sexually abused are just as likely to initiate breastfeeding as anyone else. Many realize it’s the best thing for their babies, and therefore begin breastfeeding.

However, it’s also good for them. It appears to have a healing effect. A recent study showed that “sexual assault survivors who were [exclusively] breastfeeding were at lower risk on all of the sleep and depression parameters than sexual assault survivors who were [using mixed feeds] or formula.”

2. Realize that survivors of sexual abuse are less likely to continue breastfeeding

Compared to other mothers, abused mothers are more likely to stop breastfeeding early in the game. Several studies have shown this, but no study has identified a clear reason why. It may take many years before such a reason is identified. In the meanwhile, we all need to provide more support–or help a mother find more support.

Older infants are more likely to get “off task” while nursing. You’ve probably seen older infants who are easily distracted and often come off the breast leaving the mother completely exposed. Older infants sometimes twirl the nipple or otherwise “play” in a way that might make the mother feel uncomfortable. Help the mother find ways to minimize or overcome those situations.

3. Try not to touch

Over the years, I’ve learned to put my hands behind my back and “talk through” how to get a baby latched or repositioned or whatever. (But I tend to be “hands-off” when teaching a kid to crochet, too.) I can’t tell you how to acquire this “talking-through” skill; I’ve just learned it through lots of practice.

But in the case of a mother who has been touched in ways that are uncomfortable, it seems that we should all make an effort to avoid even a “clinical” touch.

4. Reduce “negative” stimuli

Penny Simkin tells the story of a woman who dreaded breastfeeding because it triggered memories of her perpetrator touching her breasts. Nonetheless, although it was horribly uncomfortable for her and she dreaded each nursing, she continued to breastfeed her baby.

Pumping might be your first suggestion to overcome the direct contact. And that might indeed be a good suggestion! But you might also suggest a nursing necklace or ask the mother to hold the baby’s hand. There’s no one “right” suggestion here.

Most women have breast/nipple sensitivity in the first several days. But continued discomfort or dread is worrisome. It’s not necessarily attributable to abuse, but whatever the underlying reason, it deserves follow-up.

5. Beware of the nighttime

Typically, sexual abuse survivors don’t sleep well anyway. Having a baby interrupt sleep to nurse might be especially bothersome.

Pumping at night might be one option. (Many women awaken when their breasts feel full.) Or, if that option isn’t acceptable — suggest setting an alarm clock at the time when the baby will be hungry. It’s still nighttime, but there’s no interruption by someone touching her breasts when she is awakened at night. It’s a small action, but  might make a big difference.

6. Have the conversation

I’ve often had colleagues criticize me for mentioning breastfeeding if the woman has a history of sexual abuse. In the interview, Elizabeth Johnson made it clear that it’s okay to have the conversation. She focused on goal-setting.

Who are we to presume that someone does or doesn’t want to breastfeed? However, the key is that the conversation is aimed at identifying and supporting the mother’s goal, not ours.

7. Understand that she might not want to talk anymore

All of us have issues we simply don’t want to discuss. Even if we realize that the other person could help us better if we’d talk about it, we choose not to. Beware of signals that she just doesn’t want to talk about it.

8. Build a relationship, meet her where she is at

This was the most important point I took home from my interview with Elizabeth Johnson. Please, listen to that interview; she says it better than I ever could.