In the early days postpartum, breastfeeding moms are on call 24/7. Long stretches of sleep are rare, midnight nursing sessions go on forever, and breaks are hard to get. So, it’s easy to assume that breastfeeding automatically puts you at risk for postpartum depression and other PMADs. The truth is more complex. Depending on the circumstances, breastfeeding can either decrease or increase risk.
Lower Risk…
When breastfeeding is going well, it lowers the risk of PMADs. This is probably because the feel-good hormone oxytocin is released during feeding. Also, while babies who only have breastmilk eat more frequently, moms don’t have to get out of bed and prepare a bottle to nurse if the baby is close at hand (or deal with cleaning bottles!). Wakings may be more frequent, but they’re less disruptive. And, the hormones make it easier to fall back asleep.
This is the good news!
…And Higher Risk
The bad news is that if breastfeeding is hard (and it often is), difficulty and unmet expectations increase the risk of postpartum mood difficulties.[i] If you start breastfeeding and end up stopping for any reason, PMADs are even more likely.[ii] Mental health during pregnancy also matters: one study revealed that moms who had prenatal anxiety and depression were more likely stop breastfeeding, and that stopping increased their mood and anxiety disorders.[iii]
Another study summarizes: “Our most important finding relates to the majority of mothers who were not depressed during pregnancy, and who planned to breastfeed their babies. For these mothers, breastfeeding as planned decreased the risks of PPD, while not being able to breastfeed as planned increased the risks.”[iv]
What to Do When Breastfeeding Isn’t Going as Planned
So, what should you do if breastfeeding isn’t going as planned? Based on the research above, if you’re not ready to stop yet, the best first step might be to get help. If you can, find an International Board Certified Lactation Consultant (IBCLC)—you can search on directories like this one or just Google your city + IBCLC. Many hospitals have lactation consultants that can help with some breastfeeding difficulties, but often don’t have as much training and aren’t always able to spend as much time with you or catch tongue ties (which can contribute to PMADs[v]). Some IBCLCs take insurance, but many have sliding scales for their fees—and some will even come to your house!
Whether you see a lactation consultant or not, protect yourself by putting parameters on your goals.
- How long are you willing to keep trying for?
- What would signal to you (in your mood, baby’s weight, physical pain, etc.) that it’s time to be done?
- What would be an indicator of improvement, that would make you want to continue on through difficulty?
I myself wanted to and have breastfed my babies. I have enjoyed it, with varying degrees of struggle along the way. But I can attest to difficulty negatively impacting my mood: pain from tongue ties, mastitis, overactive letdown, being always on call, and D-MER. Breastfeeding is a good, understandable desire! What’s not good is the pressure moms feel to continue and the shame they experience when they stop or choose not to in the first place.
Whether they stop because of medications they need to take,[vi] difficulty, low milk supply, or a plethora of other reasons, many women feel like a failure if they discontinue breastfeeding. It’s no wonder that mothers who stop nursing are more likely to have PMADs.
But there should be no shame for a mother who stops breastfeeding: as Christians, our worth and identity are in Christ, not how we feed our babies. The measure of a godly mother is not how long she breastfeeds, but Christlikeness. This doesn’t make it easy to stop, but it does mean that there’s freedom to do something different without compromising faithful motherhood.
[i] One such breastfeeding difficulty is a tongue tie, the difficulty of which I can personally attest to. Richard Baxter, DMD, and MS, “Are Tongue-Ties and Lip-Ties Linked to Postpartum Depression?,” Alabama Tongue-Tie Center | Dr. Baxter & Dr. Trego | Birmingham, AL, accessed August 23, 2023, https://tonguetieal.com/are-tongue-ties-and-lip-ties-linked-to-postpartum-depression/.
[ii] See the following studies on PMADs and breastfeeding: Clayton J. Shuman et al., “Postpartum Depression and Associated Risk Factors During the Covid-19 Pandemic,” BMC Research Notes 15 (March 14, 2022): 102, https://doi.org/10.1186/s13104-022-05991-8; Cristina Borra, Maria Iacovou, and Almudena Sevilla, “New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions,” Maternal and Child Health Journal 19, no. 4 (April 1, 2015): 897–907, https://doi.org/10.1007/s10995-014-1591-z; Eivind Ystrom, “Breastfeeding Cessation and Symptoms of Anxiety and Depression: A Longitudinal Cohort Study,” BMC Pregnancy and Childbirth 12, no. 1 (May 23, 2012): 36, https://doi.org/10.1186/1471-2393-12-36.
[iii] Ystrom, “Breastfeeding Cessation and Symptoms of Anxiety and Depression.”
[iv] Borra, Iacovou, and Sevilla, “New Evidence on Breastfeeding and Postpartum Depression,” 903.
[v] Richard Baxter, DMD, and MS, “Are Tongue-Ties and Lip-Ties Linked to Postpartum Depression?,” Alabama Tongue-Tie Center | Dr. Baxter & Dr. Trego | Birmingham, AL, accessed August 23, 2023, https://tonguetieal.com/are-tongue-ties-and-lip-ties-linked-to-postpartum-depression/.
[vi] Many medications used for treating PMADs areactually safe for nursing mothers. See the websites Mother to Baby and Infant Risk to check on specific medications. “Home Page,” MotherToBaby, accessed September 5, 2024, https://mothertobaby.org/. “InfantRisk Center,” accessed September 5, 2024, https://www.infantrisk.com/.
The Sorrows of Eve 