Why The Link Between Breastfeeding and Depression Isn’t Black and White

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I clearly remember the moment our obstetrician said we had no choice but to go to an emergency caesarian. As if trying to negotiate terms, I asked two questions: can my doula take photos in the operating room and will I still be able to breastfeed?

Of course you’ll be able to breastfeed, my midwife reassured me, as she gingerly promised she’d do her best on the photo front.

Following our son’s birth I spent 68 hours in the hospital. I discovered that’s enough time for eight nursing shifts and approximately eight unique ways to breastfeed; each nurse seemed to tell me I was doing it wrong. Their way was the ONLY way. Hold him like a football. Squash your breast between your fingers like a sandwich. Point your nipple towards the ceiling. Express milk first so he can smell it. Don’t express any milk – you’ll waste it!

In spite of feeling prepared when I was pregnant, faced with my new reality I felt as though I would never master breastfeeding. I was terrified I’d let me baby down. Thankfully, I was lucky enough to have a trio of experienced midwives who casually and confidently reassured me that no matter how impossible things felt in those early days that I could push through it.

Still, I craved more support.

Standing at the trailhead of my unmapped adventure I yearned for someone to tell me, what lies beyond what I can see? What are the rewards of pushing my body further than it wants to go? How will I push through the pain? The tears? And how will I resist the pressure to give up when everyone is telling me its time to stop?

This is the reason I feel compelled to write about breastfeeding. Because I felt alone in those early days and nights. I want to share my rare, much loved and off-the-beaten-trail-map in hopes it may help others. To inspire and embolden those who have come to a fork in their own trail and don’t know which direction is right for them.

But, there are a group of mothers I didn’t recognize until recently.

They’re at the trailhead, fully aware of the rewards the adventure promises. They’ve broken in their hiking boots but something is stopping them from setting off. As they witness seasoned hikers cheerleading beginners they feel a deep sense of loss. And when those of us on the journey can’t help but enthusiastically share our unfiltered experiences it feels like salt being rubbed in a tender wound.

This feeling is familiar for too many mothers; for women who yearn to breastfeed but can’t for one reason or another.

Experiencing a sense of mourning over unfulfilled expectations at a time when maternal hormones are at an all time high sends fragile new mothers on a dangerous emotional rollercoaster. While I’m acutely aware of the undeniable biological benefits of breastfeeding, there is nothing more important to a child’s health and happiness than a happy and healthy mother.

Suicide as a sequelae to postpartum depression (PPD) is the number one killer of new mothers. The thought of young mothers taking their own lives leaves me speechless. And I mourn for the children who will never know the maternal superhero who birthed them into this incredible world of ours.

Looking through the lens of my own experience, I’ve been confused by recent headlines suggesting breastfeeding may cause postnatal depression, because I always though the opposite was true.

So, which is correct?

Like most things in life, nothing is black and white; both of these statements can be simultaneously true. Let’s dig a little deeper.

BREASTFEEDING PROTECTS NEW MOTHERS FROM POSTPARTUM DEPRESSION

For most new mothers who are able to breastfeed research shows it offers protection against postpartum depression. How?

There are two critical maternal hormones released during breastfeeding: oxytocin and prolactin. Oxytocin helps mothers feel happy and encourages maternal behaviour. And prolactin, the milk-producing hormone, appears to produce a special calmness in mothers. Breastfeeding mothers have also been shown to have a less intense response to adrenaline, resulting in a reduced stress response.

In addition to the secretion of mood-enhancing hormones, the extra sleep breastsleeping (breastfeeding + cosleeping) mothers enjoy plays a major role in reducing the risk for depression. A study by Dr Kathleen Kendall-Tackett, Ph.D, IBCLC, involving a sample of 6,410 mothers of infants 0-12 months of age revealed women who exclusively breastsleep reported significantly more hours of sleep, better physical health, more energy, and lower rates of depression than mixed or formula-feeding mothers.

During her research Kendall-Tackett identified a key risk factor for PPD; the number of minutes it takes a mother to fall asleep after being woken. Even the slight variation of taking twenty versus thirty minutes to fall asleep (especially when repeated multiple times in one night) can mean the difference between a depressed and non-depressed mother.

While breastfeeding mothers wake more frequently to nurse their babies they fall back to sleep more easily. Formula-feeding mothers wake up less often but they wake more fully and the time they spend awake is significantly longer.

The tiredness breastfeeding mothers feel is often referred to in a negative way, but its nature’s way of relaxing us back to sleep and safeguarding our mental and emotional health.

This potentially life-saving information deserves to be spread far and wide. It backs the case for providing unlimited support and education to mothers, ensuring that if they can and want to breastfeed, that surmountable obstacles will not get in their way.

CAN BREASTFEEDING INCREASE THE RISK FOR POSTPARTUM DEPRESSION?

When a mother is passionate about breastfeeding but is sabotaged by inaccurate advice, it may prematurely end her nursing journey. This can be a traumatizing experience and it increases her risk for PPD in two ways: through the loss of hormonal protection and the emotional distress of an unfulfilled intention.

Analyzing data from mothers in an ongoing British study, researchers investigated the effects of breastfeeding on mothers’ mental health at 2, 8, 21 and 32 months postpartum. They found the impact of breastfeeding on PPD was heavily influenced by the mothers’ intention to breastfeed.

The lowest risk for PPD was found among women who had planned to and were able to successfully nurse their babies.

The highest risk for PPD was found among mothers who had planned to breastfeed but did not go on to breastfeed their babies. Interestingly, the risk for PPD was also increased in women who did not intend to nurse their babies but went on to do so.

Maternal intention may be a key predictor for PPD.

Another group of vulnerable mothers are those who have experienced pre-existing depression during pregnancy. In these circumstances many women are advised to stop breastfeeding under the assumption it will reduce the pressure a new mother feels, but this advice may be false. One of the largest studies to date observed that women, even with pre-existing depression, are likely to experience worsening of their symptoms if they prematurely discontinue breastfeeding.

Ruta Nonacs, MD PhD of the Massachusetts General Hospital Centre for Women’s Mental Health, says this correlates with what she sees clinically. Women who do not want to breastfeed, generally cope well without it. The most distressed women are those who, despite being strongly committed to breastfeeding, encounter difficulties and ultimately are not able to breastfeed.

The take home message: when there is a significant deviation between what was expected and what actually happens, a woman’s vulnerability to PPD grows.

THERE CAN NEVER BE TOO MUCH SUPPORT

Becoming a mother is an emotional metamorphosis that challenges us in a wholly unprecedented fashion. Our vision of what being a MOTHER means to each of us is unique and individual. But, one thing is certain; we were never meant to do this alone. There were supposed to be grandmothers, aunts, friends and cousins helping us and showing us the way.

Lighting the trail so that we don’t need to feel our way down an unknown path in the dark.

This was supposed to be a slow journey, an epic adventure, not a sprint to the finish line with artificial deadlines. We need cheerleaders not competition. And new mothers need support, whether they choose to breastfeed or not. Whether they’re able to breastfeed or not.

Rather than turning against one another for our unique choices, we need to recognize the real issues and rally together to incite change. To fight for abundantly available and accurate post-natal care. To demand adequate maternity leave. To challenge the status quo so that new mothers feel supported, valued and respected.

And as mothers we need to find strength and community in our similarities rather than allowing our differences to divide us. Let’s be there for each other, whether we make the same decisions or not, because what our children need most of all is happy and healthy mothers.

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COMMENTS
  • April 04, 2017
    Nicola

    Hi Tracy, thanks again for another thought provoking post. I needed this reminder today how lucky I have been to still be breastfeeding my 20 month old toddler. I did not intend to breastfeed for this long and my son is showing no sign of weaning any time soon! I am happy to continue and do enjoy the superpowers it provides. Yet my husband and I would like to add to our family at some stage- so I am at a slight crossroads in our breastfeeding journey. Your articles give me much to ponder- Thank You 🙂

    • April 04, 2017
      Tracy Gillett

      My pleasure Nicola and you and me both – I am feeling incredibly grateful that I was firstly able to breastfeed and secondly that I’ve been able to do it so long. Not all mamas have that same ability and I have almost been in tears reading some of the heartfelt comments and emails from mothers who haven’t been able to and the emotional impact of it. Such an important topic to talk about openly without fear of judgement either way. Thank you again for reading and commenting, hugs xx

  • April 04, 2017
    Frankie

    I experienced PPD but I’m not sure breastfeeding was a factor that contributed to it. I intended to breastfeed my babe and I did just that and yet I still got PPD. The facts that breastfeeding was supposed to have all these benefits (bonding, good hormones, closeness and health) only magnified the internal pain I felt because it was such a ‘good’ thing and yet hated it. For months I cried each time I fed my son. This pain only made me feel more inadequate as a mother. I also couldn’t co-sleep or nurse my baby in bed so perhaps those factors about falling back to sleep may have contributed.

    My son weened himself at 12 months (he would have weened earlier but I wasn’t ready. I wanted to BF up to 2 years) and I’m not sure if the weening helped my healing or if I was at the point of healing that I knew I needed to let it go. Either way the upward turn in my depression happened near the time we stopped BFing.

    I don’t think PPD is just one contributing factor. It is a weight of internal and external factors together. Support is a big part of it. I had to pay for counseling that promoted healing through personal development and helped me learn how to support myself where my family and friends and spouse were unable to. I’m so glad I did. I’m not sure where I’d be without it. I pray that the repercussions of this are not that my son feels the pain we went through but instead he knows and feels a mom who loves him mightily

    • April 04, 2017
      Tracy Gillett

      Thank you for such an honest and heartfelt comment Frankie. You have inspired me to go and see a counsellor too – I think I could benefit as well with issues that I haven’t been able to deal with fully. And you are so right – like anything there are so many factors that must contribute to PPD. I have always focussed on support for breastfeeding mothers but equally there needs to be support for mothers who can’t breastfeed. Motherhood is such an emotional rollercoaster – we can’t do it alone. We need to talk. To cry. To find our new selves and be given the space to do so.

      You are a amazing mother for putting yourself through what you have for the sake of your son and I am sure he feels that and will for the rest of his life. I wish you well in your healing process. You are obviously a very self-aware and strong woman. Thank you again for reading and for such a wonderful comment xx

  • April 04, 2017
    Patricia

    Understand that being made as a bad mother for not breastfeeding seems to be the norm in hospitals and by others. I couldn’t breastfeed and I was asked so many times why I didn’t try harder. Receiving looks from nurses when I answer Formula, like I just swore or slapped them. The questions got to be too much I just stopped answering and my husband jumped in instead. So yes I agree, new mothers need cheerleaders no matter what.

    • April 04, 2017
      Tracy Gillett

      Absolutely Patricia. I couldn’t agree more. I am so sorry to hear you were made to feel that way – we all need to be each other’s cheerleaders. We’re doing the best we can either way so happy that your husband could jump in for you. You are a WONDERFUL mother xx

  • April 13, 2017
    Hilary

    Hey Tracy, really loved this article. Was such a lovely and thoughtful read. We’ve had a wonderful breastfeeding journey but some of my very close friends are struggling, and I am seeing first hand the loss and confusion they are going through despite their very best efforts. Prior to this, I thought that breastfeeding was easy and natural for everybody but I was wrong. It can be hard & emotional. I love what you say that we were never meant to do this alone. No matter our path or journey, hopefully support and love will always line our trails. xoxo.

    • April 15, 2017
      Tracy Gillett

      Thank you Hilary and thanks for a lovely comment. I’ve felt the same and recently realized how important it is to acknowledge the spectrum of experiences all mothers have had. I love how you worded “hopefully support and love will always line our trails”. So true! xx

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