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.
We are living in a time when women are rising to new heights which means they are regularly being confronted with the fear of being "too much". For women in business this is pervasive and costly.
A few ways women can be perceived as "too much" are:
Speaking up about their successes and achievements.
Sharing one too many photos of their cute kids.
Telling one too many people about that date night.
Looking a little too good in that swimsuit.
These can lead to being publicly attacked on social media or privately slandered which in turn leads to women dimming their light and walking on egg shells in hopes of avoiding conflict and judgement.
The minute a woman feels it's unsafe to shine she will begin to overthink, worry, and fear how she shows up in the world.
Forgetting to announce the book is done and the interview is live.
Choosing to focus on what's still on the to-do list rather than what's been checked off.
Many female entrepreneurs are subconsciously altering their behavior in an attempt to not attract too much attention to themselves, rather than focusing on allowing authenticity and magnetism to attract their ideal clients and community.
Women are afraid of being criticized, ostracized, and abandoned by other women for simply being who they are. This leads to quite the quantum when being who you are is simplest way to accelerate the growth of your business.
New research shows men are far more comfortable with self promotion than women are. Researchers found that men rate their own performance 33 percent higher than equally performing women. What we know is that self promotion pays off and this is where women are missing the boat.
The world needs more women to step into leadership roles and no longer be intimidated about creating six and seven figure careers.
Here are five ways to release the fear of being "too much":
1. Approve of yourself.
While it feels good to receive outside validation it will never be enough if you don't first appreciate yourself. The key to having a healthy support system is to make sure you are part of it. Being your biggest critic is what your mother's generation did. It's now time to be your biggest cheerleader. Becoming aware of self talk will reveal what belief is ready to be re-wired. Create a simply mantra that affirms how incredible capable you are.
2. Connect deeply to those you serve.
One powerful way to shift out of people pleasing behavior is to get clear on who actually matters to the wellbeing and success of your life and business. Leadership is not about being the most popular, instead it's a decision to be brave for those who can't be. Take a few minutes each day to visualize and meditate on those your business serves and supports. See your future clients moving toward you every time you choose to stand in your power and use your authentic voice.
3. Remember the legacy you wish to leave.
Having your life purpose and legacy in writing is one of the most transformational exercises you can do. Reading this often will keep you focused on what matters. Knowing what you wish to leave in the hearts of those you love most is incredibly grounding. You didn't come here to keep your mouth shut, dilute your truth, or dim your light-you came here to make a difference.
4. Forgive those who have been unsupportive in the past.
The past has a way of informing the future in a negative way when there is unresolved pain. Take a few minutes to get quiet and ask yourself who you have unforgiveness towards or maybe their name came to mind as you read this article. Listening to a forgiveness meditation or writing a letter to the person you are ready to forgive are both simple and effective ways to process and heal.
5. Be part a community of bright, successful women.
Meaningful relationships with others who have similar aspirations is what will keep you out of isolation and playing small. These connections can happen in a networking group, online community or a local Meetup. Thriving in every area of life is depend on you knowing where you belong and being celebrated there. Don't wait to be invited, go actively seek out people and places that support your dreams and desires.
6. Accept you can have it all.
Women have been fed a lie for generations that says, you can have love or money. Decide you can have it all and allow it to flow to you. You can have a successful career and an amazing mother. You can balance motherhood and loving marriage. Don't let anyone write the rules for you. This is the time to create the life you desire on your terms.
7. Celebrate everything!
The fastest way to leave the haters in the dust is to celebrate everything! At the end of each day lay in bed and recall the best moments. At the end of each week, publicly acknowledge and celebrate what's good in your life. Once a month, have a celebration dinner and share it with those who have helped you in the journey. If there's something good happening, talk about it with everyone who will listen!
May you be a woman who chooses to shine so that others may be reminded of all they can be and do.