Women’s Health Today

Protection for maternal mental health

Kathleen Kendall-Tackett, PhD, IBCLC, FAPA

Each year, hundreds of thousands of mothers worldwide become depressed after having a baby. Professionals are more aware of depression than they ever have been, and that’s been a positive change. Unfortunately, the number of women with depression also seems to be increasing.

We used to say that 10% to 20% of all new mothers had depression. The more recent range seems to be 15% to 25%.

This increase can partly be explained by increased surveillance, meaning that professionals are identifying more cases. But it also could be that more mothers are getting depressed. And when you consider the isolation, lack of support, history of abuse or other trauma, and in the U.S., the need for mothers to immediately return to work, it is not surprising.

In 1994, I wrote an article  on postpartum depression. My first book, Postpartum Depression: A Comprehensive Approach for Nurses, had come out the year before. My article opened the floodgates. Suddenly, I was getting calls from across the U.S. from mothers after they had been diagnosed with postpartum depression. Their physicians had told them to wean immediately. Yet so many of them told me:

Breastfeeding is the only thing that is going well for me.

I was determined to find some answers for them. And so began the work that has occupied so much of my time over the past 20 years.

A slow shift

Fortunately, there has been a major shift with regard to depression and breastfeeding. When I first began my work, breastfeeding was not even on the table with the postpartum depression folks. Practitioners told mothers flat out that:

• they did not need to be “supermom”
• formula was fine
• they needed the sleep
• it was important for them to heal, etc…

In order to do that, they needed to wean. I still hear some of that, but it is less common.

Meds

The next major shift was that breastfeeding was accommodated. It wasn’t preferred. But if a mother insisted on breastfeeding, practitioners (mostly) were willing to work with her. This was definitely better. But mainly, this approach focused on what medications they could take while breastfeeding. That was important to know. I still remember what it was like to work with a mother and not have that type of information available. Having it was a Godsend and I think we all owe Tom Hale a debt of gratitude for his pioneering work.

What else?

But what about the mother who did not want to take antidepressants? In the natural-birth/breastfeeding committees, there are quite a few of those mothers, which I think led to the next major change in the PPD field: complementary and alternative treatments for depression. The good news is that there are many of these.

The alternatives include:

•  exercise
• bright light therapy
•  omega-3 fatty acids
•  St. John’s wort
• psychotherapy

The important thing to keep in mind is that mothers have a lot of choices. I get concerned when mothers are only offered antidepressants without any follow-up.

Patients have high rates of non-compliance with antidepressants (in one study, only 28% were still taking them at 3 months). If mothers do not take these, for whatever reason, they are still depressed and their depression is not being treated. It’s much better to talk with mothers and find out what they want to do. The more options that mothers have, the more likely they are to find one (or a combination) that works for them. There is still some resistance to these treatments, with practitioners being skeptical that they can work for “serious depression.” But they all have good evidence to support their use. [For more detail, read the articles I’ve highlighted above.]

All these changes have been good. And they have helped many mothers. But breastfeeding was still something that was accommodated, not considered something that actually protects mothers’ mental health and is important to her recovery.

And that is where the new research comes in.

Mental health

Research over the past decade has shown that breastfeeding and depression intersect in some interesting and surprising ways. All of this work has shown something that makes sense. Breastfeeding does not deplete mothers, nor does it cause depression. Breastfeeding problems certainly can do both of these things—all the more reason why women need good support and accurate information. But in terms of the survival of our species, it doesn’t make sense for something so critical for our well-being to be harmful for mothers. And it is not.

Stress

One of the initial areas of research was in examining the role of breastfeeding in turning off the stress response. Of particular importance was breastfeeding’s role in lessening mothers’ levels of inflammation (which is part of the stress response). The molecules that cause inflammation can lead to depression. When inflammation levels are high, people are more likely to get depressed. When inflammation levels are lower, the risk of depression goes down. The great thing is that breastfeeding is specifically anti-inflammatory. This is one way that breastfeeding protects women’s health throughout their lives. It lowers their risk of depression. It also lowers their risk of diseases such as heart disease and diabetes. [To read more about this, click here.]

Sleep

The next line of research is regarding new mothers and sleep. I thought for many years that breastfeeding mothers got less sleep. Just the opposite proved to be true; breastfeeding mothers got more sleep. In this case, it turned out that the biggest effects were for the exclusively breastfeeding mothers. This research indicates that there is something physiologically different about exclusive breastfeeding than mixed-feeding. We never want to discourage a mother who is mixed-feeding. Mothers do what they can. And their babies are reaping the benefits. But they may be sleeping less and getting less of the stress-reducing effects of exclusive breastfeeding.

Do breastfeeding mothers get more sleep?

See How Do Mothers Get More Sleep?

Overcoming previous sexual assault

To me some of the most exciting data are on breastfeeding’s effects for women who have survived sexual assault. Some assume that women who have had these kinds of experiences will not want to breastfeed. However, two smaller previous studies found that women who had histories of child sexual abuse were more likely to say they wanted to breastfeed and to initiate breastfeeding. This is not to say that it is always easy for these women. But we would be wrong to make assumptions about what women want to do without asking them.

Breastfeeding’s healing impact on sexual assault trauma

In our data, we looked at the impact of rape, the most serious kind of contact sexual abuse. About 13% of the women in our sample reported that they had been raped (994 women). Women with a history of sexual assault had a rate of exclusive breastfeeding that was identical to the non-assaulted women: 78% for both groups.

Not surprisingly, sexual assault had a pervasive negative effect across all the sleep and depression variables we looked at. But here’s the exciting part; when we added breastfeeding into the analyses, we found that exclusive breastfeeding actually lessened the effect of previous sexual assault! I almost couldn’t believe it when I first saw the data.

The exclusively breastfeeding mothers with a history of sexual assault did sleep somewhat less than the non-assaulted mothers. But much more than the mixed- and formula-feeding mothers.

We found a similar pattern with depression: still at increased risk, but so much less than if they were mixed- or formula-feeding.

I also thought this finding on anger and irritability was interesting. The exclusively breastfeeding mothers were pretty much “chill” (i.e., low levels of anger/irritability). This was not true for mixed- or formula-feeding mothers.

Why would breastfeeding do this? I think the answer can be found in understanding breastfeeding’s role in turning down the stress response. Researcher Maureen Groer is the one who has documented this effect. Trauma survivors often have a stress response that is overly reactive and responsive to stress. The slightest stressor can set it off. Breastfeeding seems to counter that effect.

Why breastfeeding is important for trauma survivors

I love the message of this. Our bodies know that we don’t have our babies in a perfect world; that bad things happen to mothers. But breastfeeding allows mothers to essentially have a “do-over,” that they can parent differently than maybe they’ve were parented. That’s an incredibly hopeful bit of information we can share with mothers. [Click here to read the full article.]

Does this mean that there is not benefit for a mixed-feeding mother? No, not at all. Clearly, breastfeeding is good no matter how much she is able to do. She benefits and her baby does too. We just need to recognize that they may not be getting all the stress-reduction benefits they would if they were exclusively breastfeeding and support them accordingly.

Conclusions

What can we conclude from all of these recent findings? I think it’s this: breastfeeding makes a difference, and it’s not all about the milk! When a breastfeeding mother is depressed, we need to support her. Others in life, usually well-meaning, will probably be telling her to wean. If a mother indicates that she wants to continue breastfeeding, we can help her a lot by telling her that is a great thing for her to do.

Photo with title: Kelly & Lilah by Karen T. Smith.