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Natural Childbirth and Breastfeeding After Sexual Abuse

As lactation consultants, doulas, childbirth educations and other medical professionals, it can often be daunting to work with women who were the victims of sexual assault, rape or sexual abuse. Even if you are female, it can be awkward to start a conversation about natural child birth or breast feeding when working with a mother who has experienced sexual trauma. Most articles discourage women who have been assaulted from experiencing the joys of natural childbirth or breastfeeding, often citing that it's less traumatic for mothers to opt for a C-section or choose formula. I felt these suggestions were inadequate and did a disservice to the many women I had met over the years who were able to overcome their history of sexual abuse, enjoying natural child birth and/or breastfeeding. I asked Ricki L., a community leader in my area, for an interview. She is a retired La Leche League Leader (founded LLL of McKinney TX in 2000) and currently the creator and CEO of Arani Bellydance by Raena. I hope you will enjoy her personal insights as much as I did.

Did you read over the articles I sent you on sexual abuse and breastfeeding?

Ricki: Yes, it was frustrating to read so many assumptions that discourage breastfeeding after maternal sexual abuse. Yes, the intention is to protect victims, but this attitude could undermine a potentially healing opportunity for survivors, as they become mothers. Each woman’s story is so different - the memories will reactions will vary greatly depending on the associations made during the abuse. A grown woman will process an assault or rape very differently than a teen girl on a date or young girl who experiences chronic sexual abuse at the hands of a caregiver. Some women will be very resilient but what about those who will struggle greatly to move past this physical trauma - which is sexual in nature? Modern society sexualizes our breasts, so it is common (by default) for many men and women to categorize breastfeeding as potentially sexual. It isn’t! Most women logically recognize that, but emotionally they may have negative life experiences that create a conflict. We can reinforce to these women, who have experienced sexual trauma, that breastfeeding is NOT a sexual act being expected of them NOR a sexual act forced on their child, and we can share with them how it can actually be part of an empowering and healing process.

Do you feel it was or was not easy for you to separate your breasts from sexuality?

Ricki: It never crossed my mind that they were similar. Breastfeeding was my bond with my baby. It was an intimate, physical relationship with a strong, positive emotional connection. It was a very primal, nurturing mother-child relationship that happened instantly. I evolved the instant my child was placed in my arms. In great contrast, the relationship with my step-abuser was not nurturing at all so there was no correlation for me. Both were “intimate” behavior, but I wasn’t a willing participate in my abuse. Breastfeeding, on the other hand, was initiated by me, as a mother wanting to protect, bond, and feed my children to the best of my ability. It was healing for me because I was experiencing a pure love in my relationship with my child. This connection was eye-opening and because of it I began to recognize that I was not responsible for my abuse. In a sense, loving someone so innocent (as my baby) allowed me to mother myself, my “inner child”. As a mother, I was angry for me rather than ashamed. These feelings inspired me to press charges and, despite it being over 15 years later, my step father was found guilty and spent the last 18 years in prison.

Some mothers can feel-like when they are thinking about breastfeeding, or trying to nurse their baby because of prior abuse, they are potentially the abuser OR they are forcing something onto their child unwanted. Especially in some situations when infants can be fussy or difficult to breastfeed? For example, moms will mistake a baby’s hunger cues when they can’t find the nipple and they thrash their head from side to side as a signal the child is saying "No". What are your thoughts on this?

Ricki: This is a misunderstanding that is probably rooted in the feelings of shame and unworthiness that affect many survivors. Yet this is normal infant behavior that is experienced by ALL nursing moms at some point. All new moms are sensitive and worried if what they are doing is right – women with abuse history may have a more sensitive trigger for this reaction. Helpers need to teach and remind these moms why babies cry – and it’s not always about food. A baby’s temperament is big factor! You may have a baby who has a more intense or more challenging personality. It may be more difficult for moms with an abuse history to manage their anxiety and trust themselves. They just need extra reassurance and to understand there is a learning curve to finding what works for your baby. They are in a new relationship with a person who can’t speak the language, so it’s going to take patience, confidence, and time.

So you feel like moms shouldn't automatically make an assumption something is wrong?

Ricki: Right, I think it’s a confidence issue. This may be based in their trauma history or it may be their personality. Regardless, if they doubt their ability to breastfed, any resistance will make them question themselves with “I must be doing this wrong.” They are comparing their newborn’s default fussiness to how they (Mom) would react to something with dislike. It’s not the same. We must remember they are babies. (Chuckling)

So when did you decide to breastfeed? Did your history every factor into your mind as being a negative for breastfeeding?

Ricki: My abuse past never factored in to my decision to breastfed. I waited until my late 20’s only because I’d “parented” my baby brother and wasn’t in a rush. I knew, when/if I had kids, I was going to breastfeed and stay home - because that was the way I wanted to parent. It was just a gut feeling. Once we decided to start a family, I was looking forward to natural childbirth, nursing, cloth diapers and all that nature mama stuff. I did have difficulties nursing my first baby because of poor latch - that learning curve issue. I think he was such an intense baby that he liked to clamp down and he wasn’t patient. So there was that stress of “he’s upset, he’s screaming”. But I didn’t think ever think about giving up nor experience any old negative feelings. I just wanted to figure out the solution because I admired the moms in La Leche League meetings who looked happy, carefree and relaxed. I wanted that!... (Laughing) So I thought “There has to be a solution here”. There was a physician, a Dr. Mom, who had written books on parenting and breastfeeding. Her son was active duty with my husband at Wright Patterson AFB and he contacted his expert mom to see if she had any advice. She was like, “Man, she is really hanging in there” and even suggested maybe I’d done my best. I stuck it out and never regretted it. With my second one, when I had some latch issues, I knew so much more and had a much easier time of getting through those early bumps, even with tandem nursing my oldest who was a toddler. In reflecting on this, I would say my abuse history actually instilled a strong drive to succeed. I’d survived, and I refused to let it tarnish the rest of my life.

You said your history of abuse impacted your child birth experience, can you elaborate?

Ricki: We were a military family and the base OBGYN was set up on rotation system. You delivered with whomever was on a rotation that day. In my last month, I booked appointments so that I could meet everybody who might be on call for my due date window. There was only one doctor I did not care for - immediately. He was abrasive and physically resembled my stepfather. Unfortunately, he was the physician on call the day I delivered. I was very unhappy, but I was not comfortable explaining why I didn’t want him. So, I was just stuck with him. This doctor was very traditional. He insisted on an internal scalp monitor and I wasn’t allowed to move from the bed over the next 10 hours. It was very difficult to be vulnerable and open my body for birth with this man literally in my personal space. He later performed an episiotomy, against my wishes. Yet, even when things didn’t go the way I envisioned, my dreamy, natural mama birth thing, I picked up the reigns again and pushed it away, so it didn’t affect the relationship between me and my baby.

With my second child, things were VERY different. I was ready for a fight – for what I would accept and let happen to my body. I was ready to voice my opinions and have a different, better experience.

I’d like to add that, despite my abuse history, I innately did not feel like the human body was shameful or dirty. As a small child (before the abuse), my mother was never bashful. My dad was professional an artist, so there were art books of the nude female form. I’d been in plenty of art galleries with classical depictions of nudity. To me the female form was beautiful. I wasn’t ashamed off my body, I was ashamed of the abuse because I felt like I somehow should have been capable of stopping it. My abuser often told me it was my fault, so on the surface I accepted that message that I brought it on myself”. But deep down, I knew that wasn’t true.

What did you do differently from your first birth to your second to make your experience better? This seems to be a common problem; a woman feeling like their birth was very traumatic. Is there something you would say to moms they should think about before giving birth?

Ricki: With my first birth, I’d only revealed my abuse the year before, with my husband and a cousin. I was reading books on the abuse during my pregnancy. I worried my baby would be somehow damaged by all the toxic emotions I was dealing with during that pregnancy. By the time of my second birth, I had done some individual therapy and group therapy. I also had a Bradley childbirth coach who was a La Leche League Leader and a close friend. Overall, because of La Leche League, I had a lot of community support. I educated myself because I had so many regrets with the first hospital birth. This is my birth experience, not theirs. I wrote a birth plan and made an appt with the nurse-midwives to let them know I was informed. I also shared my abuse history and insisted on female only staff. It was very empowering to know I was going to be supported doing it my way (if baby and I were safe). With my second birth, everything went great. I stayed at home until transition. My Bradley coach was there with us at the hospital as my go-to person for advice during my labor and delivery. She advocated for me when I was in too much pain because she knew what I wanted for my birth. I couldn’t have asked for a better experience with my second pregnancy and delivery.

So you felt like using a midwife made a huge difference?

Ricki: Yes, I was much more comfortable with a woman than a man. That being said, it’s important to find someone you like and trust whether male or female. Between my first and second birth, I experienced a lot of personal and emotional growth while parenting my first son. I realized, ” Oh, I can do this!”. I did educate myself before my first birth but my personality, combined with my abuse history, made me soft spoken and a rule follower. Afterwards, I wasn’t willing to be put in the same situation again even if it meant challenging authority. Looking back, it was a pivotal moment that I’ve applied to my life ever since – I refuse to put myself in situations where I don’t feel comfortable.

You mentioned La Leche League helping you in your journey. I found a lot of negative articles on the internet about breastfeeding after sexual abuse; La Leche League’s website had one of the few positive ones for women with your history. Do you feel they approach mothering differently? Was it helpful?

Ricki: I appreciated La Leche League as a new mother, but I became passionate about the organization after I learned the powerful histories of the founders. I respected these strong women, who spoke up in an era of breasts are taboo and women should “be quiet”. They defied the times with their persistence. It really spoke to me - even if I hadn’t initially been able to that for myself, I was inspired by their confidence. They were role models for more than just my mothering.

I recognized, in La Leche League, a sisterhood that was very empowering for so many women. It does so much good for women to hear messages like “You’ve got this.” Or “Listen to yourself, listen to your instincts”. It made sense to me that mothering and breastfeeding should be natural and instinctive. Yet, historically women have been dismissed by men for being too emotional and not qualified, even on the subject of our own bodies, birth, and feeding babies! Yet becoming a mother showed me how amazing we are as women. Only we have wombs and can grow babies and then sustain those babies on our milk. After I became a mother, I totally dismissed the patronizing attitudes as jealousy.

The other thing I benefited from in La Leche League was the diversity of membership at meetings. All these unique women were able to come together to support each other nursing their children. Judgement wasn’t a worry. You could “take what you like and leave the rest”. I thought that was 'kick ass'. I wanted to be part of that message; to be a role model to other women and show them their power and potential. I was very active in the Niceville Florida LLL, when I went through my trail against my abuser. All the members where extremely supportive of my decision to press charges. No one was put off or horrified about what had happened to me. They reacted with “It is so amazing that you are doing this” and “I’m behind you a 100%.” Many had a personal story of their own to share, so it was similar to LLL where moms share what they are going through, and other moms acknowledge it. The La Leche League attitude was supportive of me beyond just breastfeeding. I found answers to parenting questions, marital relationships quirks, dealing with nursing toddlers, and adjusting to siblings and how I was my children’s first teacher. It influences my relationship with my children even today even though they are 19 and 21 yrs.

Let’s talk about your children. There is an impression or belief nursing a daughter is fine but nursing a son is extremely traumatic. You have two sons. You said you have always been able to separate you breasts from sexuality. Did you baby’s sex ever factor into any of your feelings?

Ricki: No, I never thought twice about the sex of my children. I tandem nursed and weaned each one around age four. They don’t recall nursing at all. Honestly, I was relieved to have boys because they were likely at less risk for being molested. I still worried about that and we didn’t use a sitter, besides grandparents, until both boys were very verbal and understood personal privacy. Overall, I didn’t see boys as a negative in any way. Nursing established a great bond with both sons, and as they’ve grown up, I’ve focused on raising good men. I’ve demonstrated to them how a strong woman is a great thing and that it’s not something to be afraid off. I want my sons to respect women and see them as equal partners. I shared my abuse history when they became teens because I felt a personal association would help them really recognize the damage that can be done by sexual assault. It’s such a prevalent issue in our society and I feel men are the best position to holding their peers accountable and bring about change.

Is there something you wish lactation consultants, OBs, midwives or doulas knew or where more sensitive to when working with mother’s with a history of sexual abuse?

Ricki: I think that anyone who is providing care to expectant or new mothers needs to be very aware of potential fallout from sexual trauma. Hormones are already all over the place, sleep loss is the norm, and emotions are erratic, so you must consider various reasons for a negative emotions or reactions in a mother.

Ideally, I strongly feel the topic should be brought up in educational materials before baby’s arrival. Childbirth and breastfeeding educators can cover the topic respectfully and with minimal fuss along with all the other usual subject – and include a simple “if anyone wants additional support related to this concern please contact me privately” and that woman can decide if she wants to reach out. She may not BUT she’ll know there are resources. In the very least she’ll be aware of the connection if memories or feelings arise over time. In my experience, the memories are always there so it’s not suddenly triggering if the topic is presented in a gentle, brief way. For mothers of newborns, if a client/patient has raised some red flags, a caregiver can approach the subject without causing offense by already having a plan for such situation. Survivors may never plan on telling someone (I didn’t) but it’s much better to be offered a kind, listening ear from a professional versus nothing at all. I compare it to when some loses a spouse or child. The worst thing people can do with any type of survivor is to avoid them, to not acknowledge their pain, or to avoid listening about their trauma because it is uncomfortable to see someone suffering emotionally. However, that leave survivors feeling like social pariahs when instead they could be supported immediately and even given resources for counseling, etc. to help them heal.

The best you can do for someone who has gone through this is to be like, “Hey, I’m here. You want to hit a pillow? You need to cry, I’m here. You can’t shock me”. We have such a hard time in this society with strong emotions - everybody runs from them. I was at a dance event years ago and people were going around the circle sharing why dance was so important to them. A couple of people shared, some through tears, that dance helped them with their past trauma of sexual abuse. Later, someone expressed (in a small private group) that it was a big downer when those women shared their sexual abuse. She was made uncomfortable by it. It reminded me that lot of people – even females -have a hard time hearing about sexual trauma. If I stood up in restaurant and said, “I was molested by my step father from age 11-16” the whole room would go dead silent. Everyone would be be horrified. I would not be as uncomfortable as them and I was the victim. Now, it was uncomfortable to tell the first few people. They were loved ones and that made it complicated. But, as many know, telling a terrible secret often releases its power over you.

My personal experience was breastfeeding was an amazing way to bond with my child and to create the ideal relationship I wanted as a mother. We all need to have good life experiences to override the bad ones. For me, breastfeeding was an opportunity to focus on the rewarding experience of mothering rather than ruminate on my trauma. I really feel the hormones involved in breastfeeding, the oxytocin and dopamine, was medicinal for me since I revealed my abuse shortly before becoming a mother. I went to trial two years later while my second son was an infant. Nursing them was very therapeutic and kept me focused on the positives when I felt overwhelmed. I believe it that Mother Nature set it up that way! That’s another thing that women and care providers may not be factor in when considering whether breastfeeding would be emotionally healthy for them or their patient.

Do you feel it is wrong if someone knows this person has a history of abuse to ever bring up natural child birth or breastfeeding as an option?

Ricki: You are taking away their choice if you don’t give them all their options – and consider that their choice was also taken away when they were assaulted. Don’t do that to them. They can decline breastfeeding. Again, this issue really needs to be put into resources pregnant women are reading. It’s the ideal scenario because they won’t feel self-conscious, like they could if a caregiver asked them on the spot. If in written materials, women could assimilate the information at their own pace. For example, a chapter titled “If you have a sexual abuse history, continue reading to help yourself avoid some common concerns”. These materials could recommend talking to their OBGYN or, if that isn’t comfortable, talking to an experienced therapist. Survivors would learn how sexual abuse can affect their pregnancy and breastfeeding experience and then determine how they want to move forward. Abused women benefit from being told there is a big difference between sexual violence and the intimate physicality of nursing their baby. Currently, abuse history is the “elephant in the room” but these are big burdens to bring into marriage and parenting. Women need to know they aren’t alone and that there are great people out there who can help them navigate the trauma and thrive.

The last few years many think to even ask or give women the option to breastfeed is stressful. Do you feel this is true? Should it never be brought up in the hospital or during appointments?

Ricki:Health care providers are in the perfect situation to help these women find much needed support for healing from their sexual trauma. After all, science has discovered many physical and mental health issue are connected to PTSD so to avoid the topic is akin to negligence in my opinion. People are at different stages so you can’t assume it’s going to be a trigger for them. If it IS a trigger for them, at least you found the problem and the next move can be assessed.

Yes, women need to make mothering decisions based on where they are at right now. But a conversation about breastfeeding could be an opportunity for them to realize they can take back their body – and in some cases taking control will mean saying “NO” to the idea of breastfeeding their baby. Even if there is the risk a woman will fall into that category, I don’t think HCPs should hold back the opportunity to discuss breastfeeding. Doctors don’t hesitate to encourage women get their annual Paps, mammograms, or push for base line colonoscopies after a certain age. Breastfeeding has numerous health benefits and needs to be recognized as a health decision, too. A good HCP will immediately sense if their client is not okay with the discussion and can then decide to explore that resistance gently and then move on.

Any last thought you would like to share?

Ricki: When abuse has occurred, I think therapy is extremely helpful. Group or individual therapy. I’ve done both and found individual was a bit awkward because I felt like a bug under a microscope while I shared very personal stuff. I still felt too different and damaged. Group therapy for me, was sort of like sharing in a LLL meeting with nursing problems. You realize you are not the only one with abuse history, this has happened to a lot of people. The more confident women began sharing and I found myself being able to identify and share my own similar feelings. The setting of shared stories didn’t minimize my experience, rather it put things into perspective for me and gave me a sense of connection that I really needed. However, you need to be ready to hear the other women’s stories. Some of the women had endured extreme abuse. My compassion for them had the strange effect of increasing my compassion for myself and my own trauma. After the group sessions, I did a lot of thinking and self-imposed therapy of sorts which was so helpful in my own healing.

Sexual abuse would become rare if we removed the stigma. Prevention via education is always the gold standard. We have to empower school-aged girls to be outspoken while guiding boys on what behaviors constitute a good man. India and Africa are great examples of communities who are really working hard on the problems facing their girls and women. But it’s not a women’s problem! Every person, of all ages, should be taught about boundaries and consent in every day human interaction. Sexual boundaries and consent would fall in line. We can’t just say men need to behave themselves, we need a collaborative societal effort that focuses on all human beings deserve respect. Sexual abuse would be a rare thing if these things were implemented.

Special note: I would like to personally thank, Ricki for her time and candor. When I first started researching this topic, I quickly realized how wide spread this problem is and that I needed an expert on the subject. Someone who was not afraid to express their opinion or give new insights into a subject most Healath Care Providers would like to know more about, to help each mother find her voice and regain her power as a woman.

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