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Breastfeeding and Maternal Touch After Childhood Sexual Assault

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Breastfeeding and Maternal Touch After Childhood Sexual Assault Breastfeeding and Maternal Touch after Childhood Sexual Assault Janice Yvonne Coles Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy September 2006 Centre for Health and Society University of Melbourne Abstract Introduction: The study is a qualitative exploration of breastfeeding and maternal touch with new mothers who are survivors of childhood sexual assault (CSA) by a family member. Objectives: The objective of this study is to explore the experience of breastfeeding in mothers with a past history of CSA perpetrated by a family member. Methods: Using an interpretive framework, eleven women were interviewed with an in-depth semi-structured method and the transcripts coded and analysed by themes. All participants were new mothers who volunteered in response to a community based advertisement. Each woman self- identified as being sexually abused as a child by a family member. Results: Significant themes that emerged about breastfeeding were the importance of breastfeeding to the maternal-infant relationship and infant development. Other more challenging themes included detachment and dissociation, exposure and control, lack of pleasure, and splitting of the roles of the breasts into maternal or sexual objects. During the course of the study maternal-infant touch was raised as an important theme associated with body boundaries between the mother and her child and related to the mother’s past CSA experience. Baths and nappy changes were two areas in which some mothers encountered difficulties associated directly with their CSA. Some participants encountered difficulties associated with their healthcare. These were largely associated with the participants’ lack of control in the professional encounter and intimate examinations. Baby ii examination was also problematic with women reporting being concerned about their ability to protect their children within the professional encounter. Conclusion: Many participants described breastfeeding as a positive experience which enhanced their bonding to their babies. They faced challenges as CSA survivors due to the duality of the breasts as sexual and maternal objects. Touch and maternal-infant boundaries emerged as important themes after CSA. iii Declaration This is to certify that 1) the thesis comprises only my original work towards the PhD, 2) due acknowledgement has been made in the text to all other material used, 3) the thesis is less than 100,000 words in length, exclusive of tables, maps, bibliographies and appendices. Student Signature iv Dedication For mothers, sisters, and daughters \Ç `xÅÉÜç Éy `tåA v Acknowledgements First and foremost my thanks to the women who participated in this study. You trusted me with your stories and this thesis is in honour of you. I am grateful and express my thanks to my three supervisors, Dr Alison Brookes, Professor Jill Astbury and Associate Professor Marilys Guillemin. Ali: For your patience, good humour and for assisting me to better understand qualitative methods. Your support through the emotional pain involved with the interviews and data analysis was invaluable and critical to the completion of this study. Thank you. Jill: For your support in the development and assistance with the conceptual underpinnings of this project I am grateful. Your ability to extend my academic thinking and writing framed in such a positive way is something I treasure and enabled me to speak. Marilys: Thank you for the rigour of your reviews and opening the door and letting me see the different “sandpits” I could spend my academic life playing in. To my friends of the journey, firstly my PhD support group Dr Elizabeth Deveny, Dr Jo Wainer, Dr Lyn Clearihan, Dr Ruth McNair, Dr Deb Colville and Ms Rhonda Brown. Thank you for sharing my journey with your support, love and friendship. I am forever grateful. To two special friends, Dr Ranjani Ratnam and Ms Ann Maree Nobelius, who ‘held the space’ that let me write, my love and thanks. To my friends and colleagues at work, Dr Louise McCall, Dr Mee Yoke Ling, Dr Carol Lawson, Dr Natalie Wray, Dr Kay Jones and Ms Jennifer Lindley, thank you for your assistance and support. The senior faculty members who supported my PhD endeavours, Deputy Dean Leon Piterman, Professor Chris Goddard, Professor Michael Berndt and Associate Professor Neil Spike. Finally to my family: My mother, who showed me that emotion and intellect work best together, and my father, who valued education. They have both believed in and supported me over a lifetime. To Dr Martin French and Ms Hisako Fukusawa who spent many a Saturday afternoon discussing, debating and helping me write clearly. My partner, Andrew Watkins, who loved enough to let me fly. My three children: Huw, Kate and Evan who have grown up as the thesis was born. In the process I have been both your mother and myself and I thank you for this gift. Thank you all vi Table of Contents Abstract.............................................................................................................. ii Declaration........................................................................................................ iv Acknowledgements........................................................................................... vi Chapter 1 Introduction.................................................................................. 1 Reflections .................................................................................................................2 Situated Research.......................................................................................................4 I Speak .......................................................................................................................7 I Seek .........................................................................................................................9 Finding Voice ..........................................................................................................11 Chapter Outlines ......................................................................................................14 Chapter 2 Why Childhood Sexual Assault is Important in Mothering and Breastfeeding: A Literature Review.............................................................. 16 Introduction..............................................................................................................16 Working Definitions ................................................................................................17 Who is a Child?....................................................................................................18 Defining Child Sexual Abuse ..............................................................................20 Contact and Non Contact Child Sexual Abuse....................................................21 Prevalence................................................................................................................21 False Positives and Negatives in Child Sexual Abuse Research.............................25 Long-Term Associations and Effects of Child Sexual Abuse .................................29 Physical Health ....................................................................................................30 Mental Health.......................................................................................................33 Post-Traumatic Stress Disorder ...........................................................................36 Sexual Behaviour and Interpersonal Relationships. ............................................38 Resilience and Vulnerability................................................................................42 Models to Explain Long-Term Outcomes ...............................................................45 Post-Traumatic Stress Disorder Model................................................................46 Traumatogenic Model..........................................................................................50 Somatisation and Somatoform Disorders ............................................................52 The Developmental Coping Model......................................................................54 The Attachment Disruption Model ......................................................................55 The Transactional Model .....................................................................................55 CSA and Pregnancy.................................................................................................56 CSA and Breastfeeding............................................................................................59 vii CSA and Mothering.................................................................................................64 Gaps in the Literature ..............................................................................................65 Chapter 3 Research Design.......................................................................... 66 Aims.........................................................................................................................67 Purpose.....................................................................................................................67 Research Questions..................................................................................................68 Methodology............................................................................................................69 Using a Qualitative Method.................................................................................69
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