Kathleen Kendall-Tackett, PhD, IBCLC, FAPA shares her professional insight into breastfeeding following sexual abuse and what is unhelpful to say to women about it.

For more than 30 years, I’ve been a researcher in sexual abuse and assault. As a new mom, I became a La Leche League Leader, and later an international board-certified lactation consultant (IBCLC). My breastfeeding work was separate from my research, but soon, colleagues in the breastfeeding world started asking me to talk to them about sexual assault. Over the years, I’ve talked to hundreds of mothers who are sexual abuse survivors and thousands of colleagues about breastfeeding following sexual abuse or assault.

The experiences of mothers vary widely. Some mothers love breastfeeding, while others hate it. And some are in between. Each mother has her own goals and that’s what we always need to pay attention to. Unfortunately, now that professionals have “discovered” the issue of sexual abuse/assault, many have been offering opinions to mothers that are frequently not helpful. Here are a few I’ve heard.

7 unhelpful things people say to women about breastfeeding following sexual abuse

  1. “You don’t need to do this.” I consider this the downside to trauma-informed care. Professionals jump in and make assumptions about what mothers want to do. This attitude is very paternalistic and undermines the mother’s autonomy. The mother’s goals are the ones we need to heed, not our own. If she wants to breastfeed, then we should be there to support her. If she doesn’t want to, we should support her then too. But more women than you might think will breastfeed with a history of abuse or assault. Our study included 994 rape survivors. The sexual assault survivors exclusively breastfed at exactly the same rate as the non-assaulted women (Kendall-Tackett, Cong, & Hale, 2013). This is consistent with what previous studies have found.
  2. “You can’t force a woman who’s been raped to breastfeed.” This is something another professional said to me at a conference. I’m not sure how she heard that from what I had just said. It’s ridiculous. Just for the record, you can’t force anyone to breastfeed—including sexual assault survivors.
  3. “Breastfeeding’s easy.” Not necessarily. Depending on the severity of the abuse, there may be some trauma-related hormone changes that may make things more challenging (e.g., chronic hyperarousal following trauma may lower oxytocin). Be careful not to communicate to mothers that you don’t think they can do it. They can. But it may be more difficult at first. All new mothers in the U.S. encounter the same lack of postpartum support. We need to make sure that we don’t put negative expectations on the mothers we work with, regardless of their background.
  4. “Breastfeeding doesn’t help you parent.” I guess that depends how you define parenting. We know that breastfeeding, when it is going well, provides mothers with a short-term lessening of the stress response by releasing hormones such as oxytocin (Heinrichs et al., 2001). Breastfeeding mothers are less tired, less anxious, and less depressed (Kendall-Tackett, Cong, & Hale, 2011). In one 14-year study, the children of breastfeeding mothers had better mental health at every age (Oddy et al., 2009). In another 15-year study, breastfeeding mothers were significantly less likely to physically abuse and neglect their children (Strathearn, Mamun, Najman, & O’Callaghan, 2009). However, breastfeeding doesn’t provide these benefits if breastfeeding is not going well (e.g., mom has chronically sore nipples). So, it’s another good reason to make sure these mothers have all the support they need.
  5. “If your birth was bad, you can’t breastfeed.” Rubbish. Yes, a difficult birth can make breastfeeding more challenging, but certainly not impossible. Skin-to-skin contact can counter some of these effects, as can early breastfeeding (Uvnas-Moberg, 2015). If the baby is in the NICU, help the mom protect her milk supply by starting pumping right away. Also, interventions, such as mindfulness and skin to skin, can help lower her stress. Massage helps too. Any activities that reduce mothers’ stress will help them breastfeed.
  6. “It doesn’t matter whether mothers feel safe.” Mother’s feelings of safety are absolutely critical for everyone, but even more so for trauma survivors. In the hypothalamus, there are two systems that are operating: the oxytocin system and the stress system. They are a toggle system: when one is up, the other is down. If mothers feel safe, their oxytocin system is upregulated and milk ejection works. When oxytocin is constricted, milk-ejection is impaired. Trauma survivors often have a hyperresponsive stress system (Ruglass & Kendall-Tackett, 2015; Uvnas-Moberg, 2015). This effect is compounded following a difficult birth. In the postpartum period, do whatever you need to do to make sure the mother feels safe. That may include limiting people’s access to her (including staff and family members).
  7. “Your current partnership doesn’t make a difference.” For better or worse, partners do make a difference in breastfeeding success. When partners support breastfeeding, it helps. When they don’t, women are more likely to stop. Not surprisingly, women involved with abusive partners are even more likely to stop breastfeeding earlier than they intended (Sorbo, Lukasse, Brantsaeter, & Grimstad, 2015). However, some women have reported to me that breastfeeding saved them during a time when they were living with an abusive partner. Support for all a mother’s needs, including access to partner violence resources, increases the likelihood of maintaining breastfeeding.
Ken Tackett

Awareness is a good thing. Lactation specialists are becoming more aware of the impact of previous sexual assault, and that is a good thing. The downside is when these same professionals undermine mothers’ goals and ambitions because they are trying to “protect” them. That attitude is inappropriate and disempowers mothers. As always, we need to find out what the mother wants to do and go from there. Breastfeeding can do much to help mothers heal following sexual assault or abuse, even when that’s no easy matter. Allowing a mother to make choices about breastfeeding can be an important first step in helping her to heal.

References
In store

Heinrichs, M., Meinlschmidt, G., Neumann, I., Wagner, S., Kirschbaum, C., Ehlert, U., & Hellhammer, D. H. (2001). Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology & Metabolism, 86(10)4798–4804. doi:10.1210/jcem.86.10.7919

Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22–26. doi:10.1891/215805311807011593

Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine, 8(1), 16–22. doi:10.1089/bfm.2012.0024

Oddy, W. H., Kendall, G. E., Li, J., Jacoby, P., Robinson, M., de Klerk, N. H., . . . Stanley, F. J. (2009). The long-term effects of breastfeeding on child and adolescent mental health: A pregnancy cohort study followed for 14 years. Journal of Pediatrics, 156(4), 568-574.

Ruglass, L., & Kendall-Tackett, K. A. (2015). The Psychology of Trauma 101. New York: Springer.

maternal-oxytocin-its-role-in-milk-ejection-and-warmth-provision
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Sorbo, M. F., Lukasse, M., Brantsaeter, A. L., & Grimstad, H. (2015). Past and recent abuse is associated with early cessation of breast feeding: Results from a large prospective cohort in Norway. BMJ Open, 5(12), e009240. doi:10.1136/bmjopen-2015-009240

Strathearn, L., Mamun, A. A., Najman, J. M., & O’Callaghan, M. J. (2009). Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study. Pediatrics, 123(2), 483–493. doi:10.1542/peds.2007-3546

Uvnas-Moberg, K. (2015). Oxytocin: The biological guide to motherhood. Amarillo, TX: Praeclarus Press.

Kathleen Kendall-Tackett, PhD, IBCLC, FAPA

kathleen-kendall-tackett-womens-health-todayDr. Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. She is Editor-in-Chief of two peer-reviewed journals: Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the Board for the Advancement of Psychology in the Public Interest. Dr. Kendall-Tackett specializes in women’s health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2016 Outstanding Service to the Field of Trauma Psychology from the American Psychological Association’s Division 56.

Dr. Kendall-Tackett has authored more than 400 articles or chapters, and has just completed her 35th book, The Phantom of the Opera: A Social History of the World’s Most Popular Musical. Her most recent books include: Depression in New Mothers, 3rd EditionWomen’s Mental Health Across the Lifespan with Lesia Ruglass, and The Science of Mother-Infant Sleep with Wendy Middlemiss. Her websites are:

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