4min readHealth 01 November 2019
The postpartum period is one of the most physically, mentally, and emotionally challenging times of a woman's life. There has been a dramatic rise in the number of mothers diagnosed with perinatal mental health problems in the U.S. in recent years. Postpartum mental health disorders include depression, anxiety, post-traumatic stress disorder, and psychosis. Up to 20% of all women develop depression or anxiety in the year after giving birth, and symptoms usually emerge in the first 4-6 weeks after delivery.
The relationship between breastfeeding and postpartum mental health is complicated. Breastfeeding that goes smoothly and without significant problems has a positive effect on mothers' mental health and well-being. These effects on maternal wellness are hormonally driven. Oxytocin, one of the main breastfeeding hormones, counteracts cortisol, lowers the stress response, and promotes mother-baby bonding. This leads to a decrease in anxiety, lower blood pressure, and relaxation. Prolactin, the other hormone involved in making breast milk, induces sleep (in both mothers and babies) and fosters mothering instincts. Oxytocin and prolactin also decrease depression-induced inflammation. Thus, breastfeeding not only helps prevent the emergence of mental health problems, but it can also ameliorate symptoms of depression and anxiety after they develop.
On the flip side, breastfeeding problems, including pain while nursing, sleep deprivation, and lactation failure, can be a trigger for mental health problems during the postpartum period. According to a recent study, women who experience persistent pain while breastfeeding are two times as likely to develop postpartum depression (PPD) than women who do not feel pain. Common causes of pain while breastfeeding include a shallow latch, tongue tie, skin abrasions, and infection. Hence, it is important that mothers who feel pain while breastfeeding get help from a lactation consultant as soon as possible.
Postpartum mental health disorders can also be exacerbated by sleep deprivation. Lack of sleep is a universal problem for new moms, but it can be especially problematic for those who are experiencing challenges with breastfeeding. Mothers who experience a low milk supply, are exclusively pumping, feeding multiples, and/or trying to establish a milk supply via pumping for a premature baby are at risk for significant sleep disruption and should be closely monitored for PPD. Per the Academy of Breastfeeding Medicine (ABM):
The demands of nighttime breastfeeding can be challenging for mothers for whom interruption of sleep is a major trigger for mood symptoms. In these cases, it may be helpful to arrange for another caregiver to feed the infant once at night, allowing the mother to receive 5–6 hours of uninterrupted sleep. A caregiver may also bring the infant to the mother to feed at the breast and then assume responsibility for settling the baby back to sleep, thereby minimizing maternal sleep disruption.
Breastfeeding problems and lactation failure can trigger PPD if mothers feel significant inadequacy and shame.
Mothers who are unable to breastfeed and/or experience problems with feeding may blame themselves and feel like they are "bad" mothers if breastfeeding does not go as planned.
It's important that mothers' feelings and emotions in these settings get addressed and that a priority is placed on helping new moms to enjoy their newborns.
These sentiments are mirrored in a recent publication by the ABM:
Breastfeeding difficulties and perinatal depression symptoms often present together, and management of depression should include a discussion of the mother's experience of breastfeeding. Some mothers with depression find that breastfeeding enhances bonding and improves their mood, whereas others find breastfeeding to be difficult. For dyads struggling with milk production and latch issues, efforts should be undertaken to simplify feeding plans to ensure that mother and infant have time to enjoy one another.
Mothers who are being treated for depression and anxiety are often concerned about taking prescription medications while breastfeeding. Fortunately, all of the commonly prescribed medications for anxiety and depression are safe for mothers to take while nursing. The first line medications for PPD are called selective serotonin reuptake inhibitors (SSRIs), of which sertraline (Zoloft) is the first line. Other commonly prescribed SSRIs are Prozac (fluoxetine) and Celexa (citalopram). Two excellent and easily accessible resources about the safety of medications while breastfeeding are the Infant Risk Center and the Drugs and Lactation Database (LactMed via the National Library of Medicine). Both of these resources can also be downloaded as apps for use on phones and tablets as well.
It's not unusual for new moms who are experiencing mental health symptoms to get conflicting advice. Some moms are counseled to continue to breastfeed around the clock, others are advised to breastfeed during the day and formula feed at night, and others are told to immediately stop breastfeeding and switch to formula. As mentioned earlier, breastfeeding can help to both prevent and treat depression by releasing hormones that decrease inflammation and promote relaxation and mother-infant bonding. It's important for new moms with PPD and anxiety to continue to breastfeed if they desire, but to know that they are "good" mothers no matter what feeding choice they ultimately make.
Self-care is essential for mothers struggling with postpartum mental health issues. This may include enlisting help at night to get extra pockets of sleep, reaching out to friends and family for help with cooking, cleaning, and housework, or making time to exercise. The majority of mothers who experience perinatal mood disorders go on to have successful breastfeeding relationships with their babies.
The keys to successful breastfeeding in the setting of a postpartum mental disorder is to reframe goals and expectations; to recognize that breastfeeding is not an "all or nothing" process; and to focus on self-care, rest, nourishment, and enlisting help. It's important to remember that adequate support during the "fourth trimester" is the key to preventing the development of both breastfeeding problems and mental health problems.
Brown, A., Rance, J., Bennett, J. Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. J Adv Nurs. 2016. 72(2): 273–282.Sriraman, N., Melvin, K., Meltzer-Brody, S., and the Academy of Breastfeeding Medicine. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeeding Medicine. 2015. Volume 10 (6): 290-298.
5 Min Read
You may recognize Judge, Tanya Acker, from her political and legal commentary on different networks and shows like Good Morning America, The Talk, Wendy Williams, CNN Reports or The Insider. Acker is more than an experienced commentator. She is also a Judge on the fifth season of Emmy nominated CBS show, Hot Bench.
The show, created by Judge Judy, is a new take on the court genre. Alongside Acker, are two other judges: Patricia DiMango and Michael Corriero. Together the three-panel judges take viewers inside the courtroom and into their chambers. “I feel like my responsibility on the show is, to be honest, fair, [and] to try and give people a just and equitable result," Acker says. She is accomplished, honest and especially passionate about her career. In fact, Acker likes the fact that she is able to help people solve problems. “I think that efficient ways of solving disputes are really at the core of modern life.
“We are a very diverse community [with] different values, backgrounds [and] beliefs. It's inevitable that we're going to find ourselves in some conflicts. I enjoy being a part of a process where you can help resolve the conflicts and diffuse them," she explains.
Acker's career has been built around key moments and professional experiences in her life. Particularly, her time working right after college impacted the type of legal work she takes on now.
Shaping Her Career
Acker didn't foresee doing this kind of work on television when she was in college at either Howard University or Yale Law. “I was really open in college about what would happen next," Acker comments. “In fact, I deliberately chose a major (English) that wouldn't lock me into anything [because] I wanted to keep all of my options open." Her inevitable success on the show and throughout her career is an example of that. In fact, after graduating from Yale, Acker served as a judicial law clerk to Judge Dorothy Nelson who sits on the Ninth U.S. Circuit Court of Appeals.
It was not only her first job out of law school but also one of the formative experiences of her professional life. “[Judge Nelson is] certainly, if not my most important professional influence," Acker says. “She is really the living embodiment of justice, fairness, and believes in being faithful to the letter and the spirit of the law," she exclaims. “She delivers it all with a lot of love." Judge Nelson is still on the bench and is continuing to work through her Foundation: The Western Justice Center in Pasadena, California, where Acker serves on the board. The foundation helps people seeking alternative ways of resolving their disputes instead of going to court.
"I enjoy being a part of a process where you can help resolve the conflicts and diffuse them," she explains.
“It was important to her to try and create platforms for people to resolve conflict outside of court because court takes a long time," Acker explains. “I'm proud to be a part of that work and to sit on that board."
After her clerkship, she was awarded a Bristow Fellowship and continued building her career. Outside of the fellowship, Acker's legal work incorporated a broad variety of matters from civil litigation, constitutional cases, business counseling, and advising. One of her most memorable moments was representing a group of homeless people against the city. “They were being fought for vagrancy and our defense was, they had no place to go," she shares.
As part of her pro bono work, Acker was awarded the ACLU's First Amendment Award for her success with the case. Though, she has a hard time choosing from one of many memorable moments on Hot Bench. Acker does share a few of the things that matter to her. “Our show is really drawn from a cross-section of courtrooms across America and the chance to engage with such a diverse group of people really means a lot to me," she discusses.
How Did Acker Become A Judge?
In addition to Judge Nelson, Judge Judy is certainly among her top professional influences. “I think it's incredible [and] I feel very lucky that my professional career has been bookended by these incredible judges," she acclaims. “I've really learned a lot from Judy about this job, doing this kind of job on television." Before Acker was selected for Hot Bench, she hadn't been a judge. It was Judge Judy who recommended that she get some experience. Acker briefly comments on her first experience as a temporary judge on a volunteer basis in traffic court. “I was happy to be able to have the chance to kind of get a feel for it before we started doing the show," she comments. “Judy is a wonderful, kind, generous person [and] she's taught me quite a lot. I feel lucky."
Photo Courtesy of Annie Shak.
Acker's Time Away From Home
Outside of Hot Bench, Acker took recent trips to Haiti and Alabama. They were memorable and meaningful.
Haiti, in particular, was the first trip she excitedly talks about. She did some work there in an orphanage as part of LOVE Takes Root, an organization that is driven to help children around the world whether it's basic aid or education. “Haiti has a special place in my heart," she began. “As a person who's descended from enslaved people, I have a lot of honor and reverence for a country that threw off the shackles of slavery."
She was intrigued by the history of Haiti. Especially regarding the communities, corrupt government and natural disasters. “They really had to endure a lot, but I tell you this when I was there, I saw people who were more elegant, dignified, gracious and generous as any group of people I've ever met anywhere in the world," she goes on. “I think it left me with was a strong sense of how you can be graceful and elegant under fire." Acker is optimistic about the country's overall growth and success.
“[Judge Nelson is] certainly, if not my most important professional influence," Acker says. “She is really the living embodiment of justice, fairness, and believes in being faithful to the letter and the spirit of the law."
“There are certainly times when people treated me differently or made assumptions about me because I was a black woman," Acker says. “I've got it much better, but that doesn't mean it's perfect...it certainly isn't, but you just have to keep it moving."
Her other trip was different in more ways than one. She traveled there for the first time with her mother as part of a get out to vote effort, that Alabama's First black House Minority Leader, Anthony Daniels was organizing. “It was incredible to take that trip with her [and] I've got to tell you, the South of today is not the South of my mother's upbringing," she explains. Originally from Mississippi, Acker's mother hasn't been back in the South since 1952. “Every place has a ways to go, but it was a really exciting trip [and] it was nice for me to connect with that part of the country and that part of my history."
Overcoming Racial Barriers
As a black woman, Acker has certainly faced challenges based on her race and gender. But it doesn't define who she is or what she can accomplish. “There are certainly times when people treated me differently or made assumptions about me because I was a black woman," she says. “There's no sort of barrier that someone would attempt to impose upon me that they didn't attempt to impose on my mother, grandmother or great-grandmother." In a space where disparity is sometimes apparent, she recognizes that there is no barrier someone would try to impose on her that they didn't attempt to impose on her mother or grandmothers. “I've got it much better, but that doesn't mean it's perfect...it certainly isn't, but you just have to keep it moving," Acker states. The conversation continues truthfully and seriously. Acker shares what it can be like for black women, specifically. “I think we're underestimated and we can be disrespected, whereas other folks are allowed the freedom to enjoy a full range of emotions and feelings," she articulates.
At times black women are often restricted from expressing themselves. “If someone wants to make an assumption or jump to a conclusion about me because of my race or gender, that's on them, but their assumptions aren't going to define me," Acker declares. “If something makes me angry or happy I will express that and if someone wants to caricature me, that's their pigeonholing; that's not my problem." A lifelong lesson she learned and shared is to not let other people define who you are. It is one of three bits of wisdom.
Three Pieces Of Advice From Judge Acker
The Power Of Self-awareness
“It's really important that you have a really firm sense of what you want to do and be, and how you're moving in the world because when people try to sway you, judge you or steer you off course you've got to have some basis for getting back on track."
Know Your Support System
“Have a strong community of people who you trust, love and who love you," she advises. “But also learn to love and trust yourself because sometimes it's your own voice that can provide you the most comfort or solace in something."
Learn From Your Experiences
“Trust yourself. Take care of yourself. Don't be too hard on yourself. Be honest with yourself.
“There are times when it's not enough to say this is who I am. Take it or leave it. Sometimes we've got things that we need to work on, change or improve upon," she concludes.
Acker stands out not only because of her accomplishments, but the way she views certain aspects of her life. These days, she's comfortable accepting what makes her different. “I think there's a time when you're younger when conformity feels comfortable, [but] I'm comfortable these days not conforming," she laughs. She enjoys being a decision maker and helping people work through it on Hot Bench.
This article was originally published May 15, 2019.