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Does Breastfeeding Complicate Post Partum Depression?

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Last week's BlogHer Backtalk asked the question, why can't we shut up about breastfeeding? To which I think the only sensible response is: BECAUSE.

The longer form of that answer is, I suppose, because it's about boobs, which itself expands into a longer answer still: because it's about boobs, which means that it's about our womanhood, and about the relationship of our motherhood to our womanhood and vice-versa and so it is, to make a very serious understatement, really pretty loaded. It's loaded because it speaks to the biology of motherhood and womanhood, and so to what we often think of as the fundamentals of motherhood and womanhood, and everything in between. We're built to nurse, right? And yet we live in a world where that's sometimes controversial. Are boobs for sex or for nursing or for both? Does one trump the other? Are boobs that don't nurse less womanly than boobs that do? Are boobs that nurse less sexy than boobs that don't? Are you less of a woman, less of a mother if you don't nurse? Are you a boob-flashing harpy if you do? It's confusing in a way that unsettles our ideas and feelings about what it means to be a woman and a mother.

Which is why we shouldn't be surprised when the whole thing messes some of us up.

Katherine Stone of Post-Partum Progress held an online rally for moms' mental health this past Mother's Day weekend (in which yours truly was a participant), and breastfeeding was one of the issues that came up in the various 'Letters To New Moms.' Which was interesting to me, because I'd never really thought about the relationship of breastfeeding to post-partum depression. Which itself was also interesting, seeing as how the challenges of breastfeeding are something that I always include of my descriptions of what I call The Dark Days of PPD after the births of both my children. Pain and anxiety around breastfeeding were absolutely a factor in my depression. I'd just never really explicitly articulated that to myself.

Therese Borchard, who writes Beyond Blue at Beliefnet, articulates it perfectly in her Letter to New Moms:

I tried so hard to do the right thing for everyone else but me. I weaned myself off of my antidepressant because I wanted to breastfeed, to give my infant the best possible start … the golden
stuff right out of the boob. So my lactating breasts and I were on
call, with no substitute available, for months and months and more
months … long enough for me to make the walk of shame from the
maternity ward to the psych ward.

I don’t think I closed my eyes for longer than three hours for
four years. And I am still paying the price for that carelessness: my severe mood disorder, my pituitary tumor, my hormonal imbalance … all of them, I believe, resulted from my mission to be the self-sufficient martyr mom.

I too refused to take anti-depressants, the first time around. Even thought my doctor told me that they were safe for breastfeeding, I wasn't taking any chances: my boob juice was going to be pure. And so I slogged through the difficult first weeks of breastfeeding (my god, the pain) in a fog of depression with nothing but a few phone calls with a psychiatric nurse and umpteen visits with a lactation consultant (and the world's most supportive husband, which is probably worth an infinite supply of Ativan) to pull me through. It was hard. It was really hard. I'm glad that I breastfed my daughter, but if I could do those weeks and months differently, I totally would. I don't know whether that would mean stopping nursing, or just supplementing, or being willing to take the meds. I just know that I wish I'd done something more to cut through the dark.

Therese offers the advice that I wish had been put forward more forcefully to me: "If you need to, by all means supplement your breastfeeding so that you can take a break, so you can get eight hours of sleep at least once a week."

(For the record, I tried this the second time around, with my son, after my excellent psychiatrist exhorted me to not be afraid to put him down already, but he refused the bottle. Which I took as a sign from the gods that I was meant to be tormented.)

(Do not, however, let this stop you from trying.

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KirstinK 5 pts

I could have used it.

My son is now 2 and I am expecting again in a few months. I am terrified of the BF saga again. It definitely caused or worsened my PPD.

I am extremely concerned over this major trend of BFing in the US. There was NO support for me when I had a lot of problems, after dealing with doctors, the hospitals, and several lactation consultants. One LC YELLED at me for giving my baby some formula when I was not producing milk, over a weekend when no one was around to answer the phone. (As if it was better to let him go hungry for 12 hours?) 

My son didn't have a proper latch but it was not detected for weeks because he looked like he was latched, he was swallowing, and he was acting satisfied. He was not getting enough because he had a tight frenulum, instead he was chewing my nipples and it was only when they were so raw an infected that a LC diagnosed this and started me pumping, recommending I go get it cut at an ear, nose and throat specialist. I hated to cut anything to him, no matter how simple a procedure--my gut told me not to, but I really felt bullied into doing so. I am NOT a follower, but moms want what's best for baby, and new moms are so tired, confused, etc. It was an incredible struggle!

Meanwhile, while I decided to snip the frenulum or not, my milk was slowing down and I was pumping like mad and taking supplements to try and keep it going. I was exhausted and depressed. I had a very low day one day, full of morbid thoughts and desire to run away and abandon my husband and son. Not at ALL like me. I called a PPD helpline at my hospital and got a very careless "counselor" on the line who did nothing to help me at my weakest hour, just told me to see a psychiatrist. So, I made an appt. asap.

I decided to cut the frenulum. It wasn't a *big* deal, but my son cried quite a bit and I feel terrible. Even worse, he didn't latch on. It didn't work. He was used to chewing and continued to do so. Docs, LC, everyone agreed BFing was not going to work without a lot of effort and pumping. It was now 6 weeks and I couldn't take much more. I pumped as much as I could and called it quits at 8 weeks. It was the best day of my life! I felt guilty for all of 5 minutes, and the guilt was replaced with a newfound happiness and freedom that I feel saved my life.

As all this was going on, friends, professionals, and acquaintances would make comments like "Women can do it IF they want. They just don't want to try." I Googled my heart out and I found NO support for moms who DID try and had numerous issues/infections/etc. One friend emailed me an article, "10 mistakes women make trying to breastfeed" thinking it would be of help. HOW could she not know how hurtful that was?? I made no mistake; I had a condition/exceptional troubles!! Her sister, a LC who ironically is not a mother, said I could do it if I wanted to, I just have to WANT to do it. 

This was without a doubt the hardest, worst part of my life. It wasn't until I met a very supportive pediatrician who told me I should probably stop that I felt I had the green light, and I did stop over the course of a few weeks. Simultaneously, I read an article that mentioned "BEWARE of OBs or PEDs who suggest you stop breastfeeding if you have problems. Don't let a snag deter you!" A snag?? "Beware" of the nicest person I met on my breastfeeding/PPD journey? How ridiculous!

I am a strong person who isn't one to poke around looking for support, but looking back at that awful time, I am very angry over BFing being so en vogue to the point of my being ostracized by basically everyone--even in extreme conditions where the genius LCs, who later blasted me, didn't even spot the problem!

For any woman struggling a lot: I do think BFing can be hard and I see it's rewarding for many. By no means do I discourage you from trying. I hope you can! But if you are in an exceptional situation and it seems like no one understands or is on your side, and people send/say/email hurtful "tips" (like "relax!" or "play soft music") when you are suffering physically and mentally, PLEASE KNOW SOMEONE ELSE HAS BEEN IN YOUR SHOES AND CARES AND WISHES SHE COULD HELP YOU PERSONALLY! That someone is me!

By the way, the psych I went to see was awful. She ignored BFing completely, said "New moms feel this way all the time," didn't listen or care, and scribbled some RXs I didn't want.

I eventually turned to my own mind and soul to heal and move past this terrible time and it worked! After about 6 months, I started to have some joy from my "bundle of joy" and the only bad feelings that were left were KICKING myself for listening to other people's often ill-informed or trendy opinions. Just because something is easy for someone--BFing or anything else concerning motherhood--or someone's sister's friend told them to do this or that, etc., doesn't mean it applies to YOU. YOU are the baby's mom, no one else is. Listen to your heart because I was not better until I finally did. Now I say "To heck with everyone!" and I live my own life.

What caused the lapse in my usually brazen, confident spirit? Who knows. Being a new mom, I guess! But I'm back in action, ladies. Yeah!

Note to self: Read my own post in a few months should I find myself entering the crazy carousel of BFing/emotional distress again in a few months. 

Hugs and wishes for mothering success, health and happiness,

Kirstin 

TheFeministBreeder 5 pts

I had severe PPD/PTSD with my first son - who was formula-fed.

I had NO PPD with my second son - who is still breasfed a year later.

Anecdotal?  Sure.  But still fact nonetheless.  I just don't understand why so many people are convinced, and perpetuate the myth, that bottle feeding is automatically going to make you a happier/saner mother.  How about when bottle feeding depresses you beyond belief, not because you failed society's expectations, but because you feel in your soul that you're missing out on an incredible experience with your child?

Besides that, the science suggests that exclusive breastfeeding can help ward off postpartum depression (re: Oxytocin - powerful stuff).  Makes sense to me.

Now, if a mother truely feels like she's got problems that only formula can solve, then more power to her.  But why oh why are we throwing the breastfed baby out with the bathwater all the time?  Formula is not necessarily a prescription for happy mothers, and can have the exact opposite effect, especially when you weight it against all the health benefits (specifically for mothers) of breastfeeding.

The Feminist Breeder
http://thefeministbreeder.typepad.com/

clairejess 5 pts

Sometimes it takes a lot of work to figure out what really makes us healthy and happy. In order to even get pregnant, I had to go through a health journey to heal my thyroid and ended up making a bunch of changes (diet, lifestyle, etc) that finally got to the core of my history of depression. With all I learned about nutrition, I got even more committed to breastfeeding. If I hadn't gotten to such a healthy place pre-pregnancy, I'm sure I would have sunk into PPD. I had plenty of challenging mental health moments while nursing, and it was very clear that breastfeeding was a drain on my reserves. However, I cared so much about it that I was determined to figure out how to support my own body so that I could continue nursing - good food, childcare so I could go to appts, etc. I had to take time for me if I was going to keep doing this thing I cared about (extended nursing). But it was a struggle to keep us all in a good place. And I never would have known how to really care for myself if I hadn't had a major health crisis before getting pregnant.

After three years of nursing, I'd hoped to take time to replenish enough that I might feel comfortable trying to conceive #2. But other life stress (employment, moving) has cropped up such that the idea of entering into that major energy drain seems scary. I know that getting pregnant without all my reserves (and with my husband not in a great place, either) is not a recipe for success. And yet time is ticking. I don't want to have another child and then fall over the side of the cliff I glimpsed while nursing my son, and I don't want a second child to miss out on the benefits of extended nursing either.

There's no cultural pressure to breastfeed at issue here. It's just my own priorities and needs to sort out.

Jess

http://crunchychewymama.blogspot.com/

Alcomum 5 pts

Thank you for this very well written piece.  I have 2 sons, and have suffered from severe depression since the birth of my first 7 years ago.  I was as determined as others here seem to have been about breast feeding.  The problem was that while I had been told "breast is best"  I had not been told that it was not the easy option. 

 I expected it to be natural and wonderful, and in many ways it was.  But when I was prescribed anti-depressants and was afraid to take them because of breast feeding, I feel I compromised myself.  In retrospect, I was doing my best to be a good mother.  Thankfully, I had a friend who had suffered badly with depression after 2 of her children.  And she found me in a heap one day unable to cope.  She explained to me - and I will never forget her words - "this baby needs his mummy more than he needs your milk".  I saw that she was saying being a good mummy wasn't always about making the obvious choice.  Of course - being me! - I struggled on anyway for another few weeks! 

I breast fed my first son for 4 months, and my second for 3.  Both times I put my own health - physical and mental - on hold. I regret that, because I still suffer the effects.  My depression led me into alcohol abuse, and that robbed me of part of my relationship with my children and robbed me of part of myself as well.  Thankfully, I am now in recovery and my boys are fabulous.  But I have learned they are fabulous because they have as much of their mummy as I can give.  So I would certainly think twice about putting myself under such pressure to "do the right thing" again.  Sorry that all took so long!

www.alcomum.blogspot.com ( http://www.alcomum.blogspot.com/ )

mysailorsmistress 5 pts

I had a rough labor with my daughter. I fought NOT to have the csection that I did get.

I nursed her for 3.5 months. Sometimes I was up for 24 hours, I slept when I could. Thank the lord she was my first baby.

I was in a rut from lack of sleep, the doctors were on my case cause she was not gaining weight, she was ALWAYS nursing.

I gave up nursing at 4 months got sleep but I was still upset and sad. I couldn't figure out why.

I was depressed still. Nothing was going right with her coming into this world other than she was a perfect baby when she was bottle fed.

I felt like a failure, I felt wrong, I felt like I had not given her a good start on life because she was not born naturally and was not nursed for 12 months.

I got help for my depression when she was 8 months old.

I had my son when my daughter was 23 months old. He was born via csection and I nursed him for 20 months, was never deprived of sleep and I have felt 100% better than I did with my daughter.

Do I blame the fact of not being able to nurse her and take care of myself. Yes, to this day I do. She is 4 years old. Do I let it get me down. NO! I tried. I did what I could do.

I do think breastfeeding has to do with PPD, I also think birth has to do with it as well. If both things fail the mom might feel that way as well 

Jennifer

www.mysailorsmistress.net ( http://www.mysailorsmistress.net )

Her Bad Mother 5 pts

Seeking external validation, holding ourselves up against the model - whatever it is - of 'perfect mom' - that IS the root of the problem, absolutely.

She Who 5 pts

"Framing bottlefeeding as a failure" is the problem. It's a cognitive problem.  It's part of a larger cognitive framework of "women are a heartbeat away from total failure" that permeates our society. Heaven forfend we should fail at being heterosexual, or skinny, or corporate killers, or tireless vamps, or attached moms, or... because only by creating a 3-dimensional maze of MUST DO  and conflicting realities can we keep women feeling invalid and unempowered. What we need is to stand up for a definition of 'real women' that includes everyone.

 "Mental wellbeing" may not be compatible with breastfeeding, but it ALSO may not be compatible with any number of other things, including bottlefeeding. Feeding choice isn't the determining factor. While I know bottle feeding moms that feel inadequate, I know quite a few who think breastfeeding is DISGUSTING. They don't feel inadequate for not doing it. They're skeeved even to discuss it.  They're happy and smug about it, which is cool. My sister is a working mom. She thinks everything in her life would be perfect if she stayed home. She's wrong. When she gets that particular wish she will HATE it. Not because everyone hates it, just because she will.

My cupboard, growing up,  always featured a bottle of Karo Syrup. No one would have thought twice about giving that to a hungry baby who came to visit. Today, that sounds appalling, but we all lived through it. 

When I was a young mom on WIC, it would have been a lot easier to be on formula. Formula, they'd give you. Most of the people I knew in THAT income category didn't breastfeed, and didn't worry about it. So, I say again, it's not the breastmilk (or the formula) that's the problem. It's that women are waiting for an exterior validation that's never getting here. They're trying to reach a construct of 'perfect mom' that's ridiculous.

How do we fix THAT?

http://www.blogher.com/blog/she-who

Crunchy Carpets 5 pts

can make PPD far worse.

I was a physical and then mental wreck after my first born....for me bottle feeding was admitting defeat and with all the high expectation of new motherhood....it did me in.

Rational thinking is not really up there in the first few weeks of new babydom either.

Realizing that me with sleep and rest and a baby with a belly full of whatever was better than me a sobbing freaking wreck with a kid feeding of my anxiety unable to latch and freaking out.

I approached it all a tad better with the second one.

THIS time I have an awesome midwife who has LISTENED to my concerns and is happy to make a plan now and see what happens...bless her.

With new babies....confidence is everything. 

Look for me at http://crunchycarpets.com or check out the ladies at www.wetcoastwomen.com ( http://www.wetcoastwomen.com )

V_Joy_S 5 pts

with each of my three babies before I woke up one day, and I was back to myself.  My head was clear, I could think, multi-task, etc in a way that I couldn't, literally, the day before...

I think breast-feeding exclusively was part of the problem, but a symptom of a larger ill - the lack of a wider community to help.  I was lucky to have befriended a group of new, first-time moms, whose babies were born within six weeks of my first.  Without that group, I would have completely been lost in the darkness.  But we kind of the blind leading the blind (pardon the expression), my mother lived far away, we had no family living close, and while my husband was, and is, wonderfully supportive, he couldn't fill all roles at all times. My babies were demanding and needy, and didn't sleep through the night until they were at least 2 1/2.  People (not part of my inner sanctum) told me to put the baby down, or supplement, but I COULDN'T.  I was more stressed when not holding my crying, awake child, than when I was awake and sleepless and trying to cope.  As for leaving the house???  You would have had to sedate me to get me out of the house.  Symptoms of a larger problem... perhaps, but we made it all through to the other side, largely sane.  ;)

I fully agree that breast is best, but if, for whatever reason, a mom can't, then that is OK, too.  I agree that reading WAY too much, and stressing/obsessing over every little decision has contributed to me, at least, trying to be a perfect super-mom, making the perfect decisions for the baby, even if they were not so great for me.  Hanging out with other moms, with children of all different ages, and being open to considering different parenting styles, would have been hugely beneficial to me.

Her Bad Mother 5 pts

I don't know - I think that framing bottle-feeding as failure can absolutely contribute to problems related to depression for women who can't breastfeed, or who have trouble breast-feeding. For me the issue was less that I went off my meds, and more that nursing was brutally, brutally hard and I felt as though if I didn't figure it out, I'd be a fuck-up. I *did* figure it out ('alhtouhg it wasn't so much figuring it out as it was more or less brute forcing my breasts and my psyche to cope) - and I am in many respects glad for this - but it also made for *weeks* of sobbing on the couch about pain and failure and suckage, which, you know, didn't help my depression.

I'm %100 pro-breastfeeding. But I'm also %100 pro-mental-wellbeing. I don't think that we do ourselves any favors by refusing to acknowledge that for some women, these things might not be entirely compatible.

Loralee's planning to bottle-feed because she knows from experience that nursing is, for her, a challenge that she just won't have the resources to overcome. That's not failure - that's her making a choice that's right for her.

Stephanie ODea 5 pts

that I was living in a depressed fog during the first year of motherhood. I thought everyone had weird hallucinations and felt on the edge of completely losing it every single minute of the day.

I went into motherhood at age 25 knowing that I would breastfeed no matter what, so I did. I ignored the bleeding nipples for the first 11 weeks, then turned to Dr. Google and self-diagnosed thrush (wrongly!) and turned my baby purple with gentian violet. I held and wore her constantly, because Dr. Sears told me to. I cloth diapered and hated every minute of it (ugh, they are SO disgusting!). I worked full time with her on my lap, and let her nurse as often as she'd like, day or night. I wore the plastic smile well, and rarely handed her off to anyone. I could do it. All of it. This was my job, my calling in life. After all, that's what the books and message boards said...

I'd love to re-live that first year again, with the confidence and self-respect I now have (I'd also like to re-live highschool, but that's another post--). I don't think I would have listened to any suggestions of taking time for myself then, or let anyone give the baby a bottle (I was all freaked about nipple confusion), but I would have liked the assurance that I was doing it "right" and that everything was going to be okay.

That's what we all want. We want to hear LOUDLY that we are doing it right by our kids, and they're going to turn out ok. 

so that's my new thing. I tell my friends who are pregnant with their firsts to not read the books, and to stay away from the computer. It's all going to be okay. Do what you want, and what feels right. Knowledge is power, but sometimes it makes us go absolutely nuts and ignore our instincts.

xoxo steph

Totally Together Journal  ( http://www.totallytogetherjournal.com/ )

A Year of CrockPotting ( http://crockpot365.blogspot.com/ )

She Who 5 pts

Of course people should be cautious about that.

But this "womanhood=boobs' business is not universal. Also, don't knock oxytocin, THAT is some badass stuff. :D

I breastfed exclusively, slept through the night, and wouldn't have done it any other way. That woman in the Atlantic, bitching about her unsupportive husband? Not my problem she married a selfish moron. Also, not related to breastfeeding. Women lost time on the fast track because they breastfed? Uh Uh. They lost time on the fasttrack because they were born women, (a) and because they decided to reproduce (b). What they fed was incidental.

Most of the decisions we make about childbearing and rearing will be a wash. Where and how you birth, how many books you read beforehand, breathing exercises, vaccinations...people get bent out of shape and uncompassionate about them, and really, humans are pretty resilient, and we could turn off the red alert siren. People come through some really BAD stuff and contribute as adults, so if you're in a twist because your copy of "Goodnight Moon" isn't bi-lingual, it's pretty safe to say you're over reacting.

So use a bottle, if you want to. But don't promote the idea (because it's not true) that breastfeeding, per-se, is related to PPD. People breastfeeding, people bottle feeding...even women who have surrendered their kids may have PPD. Also people who have suffered from depression may have depression, may have PPD (which is different) or may have neither. So planning to bottlefeed as a way of avoiding PPD just sets new moms up for failure AGAIN, and that's part of the problem, isn't it?

Magical thinking. Hit it with a stick. Then do what works for you...which might be breastfeeding, and might not.

http://www.blogher.com/blog/she-who

AmberS 5 pts

My breastfeeding struggles contributed to my PPD after my daughter was born. Sleep deprivation plus a baby who refused to nurse when I desperately wanted her to left me seriously distraught. The feeling of failure when she wouldn't nurse did me in. We supplemented (because we had to, I was pumping and not getting enough) and that did me in, too. I felt...inadequate. It was quitting the supplement and breastfeeding successfully that actually helped me overcome the depression.

Once we worked through our nursing struggles, and my baby was actually breastfeeding well those nursing hormones were fabulous. They left me feeling relaxed and better able to cope with the difficulties of transitioning to new motherhood. I would sit down to feed the baby feeling upset and angry and after nursing I would feel much more centred and able to cope. I realize other mothers will have different experiences, but I know I'm not the only one who gets the warm fuzzies from breastfeeding.

Breastfeeding is complicated, like motherhood is complicated. It's terrible that we send new moms home, alone, with babies and no support system or community. I had spent under an hour, combined, with newborns before I had my own. I think that having a better support system to take care of me so that I wasn't trying to do it all on my own would have been more helpful than supplementing with formula ever was.

~ Amber

www.strocel.com ( http://www.strocel.com )

Wilma Ham 5 pts

Oh, how come we mothers are such a great target for wanting to do it right and thus so gullible for any advice that is given with enough authority to make us want to follow it and it doesn't matter if it nearly kills us in the process.  
We are so bombarded with 'good however often contradicting' advice that how on earth do we know what is good for us?

I now have lived long enough to have experienced that the hard decisions I have made in my life against public opinion to put myself first always have worked out. 

AND I have decided that I WON'T REGRET any decision I have made based on what I feel is right for ME, whatever the outcome.
That is absolutely freeing and it makes me strong. 

Wilma Ham

www.wilmasblog.com ( http://www.wilmasblog.com/ )

Her Bad Mother 5 pts

I'm so glad.

I wish that I'd seen discussion about this before Emilia. I would have done things differently. As I said, I don't know what that means, but I wish that I'd felt as though I had more options.

Healthy babies need moms who are doing their best to keep body and mind healthy. Whatever that looks like.

 xo 

loraleechoate 5 pts

You probably don't know this but you wrote this for me.

While I have touched on it and alluded, I haven't had the courage to write bluntly about how bad my depression anxiety and stress actually is on my blog. How very fine a line I feel like I'm walking.

Everyone pretty much thinks PPD is a given in my situation and so I'm preparing for it the best I can.

PPD is not the only reason I'm not nursing this baby once he's born, but it is by far the biggest. The decision to not breastfeed has made me feel like crap, even though I KNOW I am doing the right thing.

This helps. 

xo