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Is Breastfeeding the Secret to Understanding Maternal Mental Health?

4min read
Health

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.

References

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.
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Sneak Peek: Female. Likes Cheese. Comes with Dog: Stories About Dating, Divorce, And Saying "I Do"

Dating. Divorce. Marriage. Being single. None of it is easy.


I don't think any of us have the right answers or know exactly what we are doing when we navigate through relationships or breakups, even if we do take every Buzzfeed quiz there is out there. What I have found out though, is by writing this book, Female. Likes Cheese. Comes with Dog: Stories about Dating, Divorce & Saying "I Do" most everyone can relate to some part of it, whether it is having an awkward date, being dumped, or falling in love. The short stories read as if we are talking over drinks at a bar gossiping about our love life. It's as if, you, reader, are one of my best friends. I hope by reading this book you are reminded that you don't have to be anybody but you and your mistakes are simply memories to learn upon. Get comfy, grab a glass of wine (or your beverage of choice), cuddle with your furry companion (pet or otherwise), and enjoy…

From the chapter "Kansas & The Firepit" from Female. Likes Cheese. Comes with Dog: Stories about Divorce, Dating & Saying "I Do"

I had lost my dog to my ex. I was a mess. I thought this man was going to be by my side the rest of my life, I had gained a lot of weight. Not the kind of weight you gain when you tell your friend "OMG, Kelly, I, like, put on five pounds this summer because of all the partying I've been doing at the rooftop bars," but real weight. The weight that makes you feel totally inadequate. The weight that makes you say, Hey I might as well keep eating because it doesn't matter anymore. I was inconsolable during that summer.

I still wasn't completely out of my trash TV and alcohol phase, but I had switched to vodka, at least. Which, let's be real, just hides the fact that you're an alcoholic. I wasn't really talking to anyone about my problems. My mom tried to take me to fat camp. Yes, fat camp. When your mother says the reason why you're not happy is because you're fat, there comes a point where you really don't know whether to laugh, cry, or drink. I think I did all three. The reason why I wasn't happy was because I was going through a divorce, and my life was unraveling. I was not only unhappy but also fat, so I guess there was some truth to that. It was just what I needed to hear to get myself back to reality.

While cleaning the kitchen one day, I walked by a pair of boxing gloves. Boxing was something I had always been interested in. Watching it on TV and having some friends that had done it professionally, I figured I would take the plunge and put this "body after breakup" into motion.

There was only one boxing club in our area for fitness. I walked into the afternoon classes knowing that I was going to be a little out of my element, but I'm not afraid of a challenge. I'm an outgoing person and being sports savvy, I knew that I would catch on quickly. The guy teaching the class, Kansas, was very attractive. Ladies, you know how in yoga when you have to do the sun god pose? Well, let's just say he was what you would hope a sun god looked like. With sweat glistening down the side of his face, it was almost as if the ceiling parted and angels started singing as he stood over you telling you, "Ten more!" as you got down for ab rounds between punches. This guy was exciting. He was energetic. He was. . . constantly checking on me during class to make sure my form was correct, since I was new, and let's face it—I was totally OK with the attention. After class I signed up for a one-year membership and became addicted, not just because I loved the workouts but also because of the hot trainer.

I started coming to class three times a week, initially taking only Kansas's classes, but not wanting to look obvious when I really started crushing on him, I had to mix it up. I mean, this is Crushing 101. This was my first crush out of the gate post-divorce, so exactly what you think would happen, happened. Kansas became my rebound guy. I would make any excuse to linger after class (which, looking back, just made me look desperate), but then sometimes I would switch it up and leave. I mean, it was a game. I was trying to figure out if he was interested or not. It was exhausting. After talking after class for a few weeks, I happened to mention a home improvement project I had been thinking of working on. Being the good listener (stalker?) that I was, I knew he just happened to be interested in home improvements, as he did many of his own. I figured that would be a great way to get to know each other better and for him to fall completely in love with me, of course. Duh. Now I had a reason to cross something off my "list". I love sitting outside and having a glass of wine and listening to music by a fire. I wasn't really sure how I was going to accomplish this task on my own, but recruiting a fine gentleman like Kansas would be a good start. So, he agreed to my firepit project, and after gathering supplies at Home Depot, he came over, and I quote to you from my journal, I kid you not:

So today he shows up, and we are in the backyard digging the hole, and he takes his shirt off. His body is a wonderland! I mean sweat is just glistening down his torso. So I had to change the subject somehow and shut my gaping mouth, so like an idiot I say, "Oh, look, a callus on my hand," and he says, "Those on a woman are sexy." FML.

Ladies and gentlemen, do you want to know what I did that day? Something so adult and so mature: I pushed him into the dirt. I pushed that beautiful body into the dirt. I couldn't take it. I was like a schoolkid on a playground. Because that is the type of tantrum this lady used to throw. Kansas took it as flirting. I took it as frustration, because I couldn't tell a boy I liked him at the time.

This whole awkward flirting game went on for a few more weeks. Kansas would come over, and we'd dig more holes (to bury my dignity in) or set stones—I don't know. I thought rebound guys were supposed to be fun, casual things, but this wasn't fun at all. This was like homework in school. Every day I'd come home from "class," and I'd strategize on what I needed to do to make better "grades." If I had actually spent half the time in real school that I spent on Kansas, I would've had a 4.0. I was having to chase him, but I almost didn't know what race I was running. After all, I hadn't dated since 1884. So I figured if the firepit thing didn't work, then I'd write him a poem... Like a moron...