Breastfeeding and Maternal Mental Health

By Ruthie Porter, RN, BSN, IBCLC

Becoming a parent for the first time is: exciting and exhausting, amazing and anxiety-inducing, fantastic and frankly overwhelming. The first few weeks after a new baby is born the birthing person’s body goes through a whirlwind of changes, both physical and psychological. It is not unusual, therefore, for someone going through this emotional roller coaster to find themselves feeling “a little off.” Around 1 in 7 women will experience some degree of postpartum depression during the first year of their baby’s life (1). Can and should these mothers breastfeed their babies? The answer will be unique to each situation.

First, it’s important to know what’s normal and what’s not. Maternal mental health issues can be broken down into two main categories: “The Baby Blues” and “PMAD.” Treatments and breastfeeding recommendations will differ depending on which of these a mother is experiencing.

  • The Baby Blues”: Fluctuations in maternal hormones, pain, and fatigue cause many mothers to experience periods of tearfulness during the first few days after birth. This is known as “The Baby Blues” and usually resolves on its own without any treatment needed.
  • PMAD (Perinatal or Postpartum Mood & Anxiety Disorders): Includes the following mental health conditions when they occur during pregnancy or the first year after the birth of a child:
    • depression
    • anxiety disorder
    • panic disorder
    • obsessive-compulsive disorder
    • Post-traumatic stress disorder
    • psychosis

The most common PMAD disorders are postpartum depression and anxiety. Postpartum depression (PPD) symptoms last longer than 2 weeks after delivery and may occur any time within the first year after birth. Symptoms may include:

  • Difficulty sleeping (unrelated to baby waking for feeds)
  • Unable to enjoy the baby or anything else
  • Feeling very tired, overwhelmed, unable to cope, unmotivated
  • Difficulty remembering things and making decisions
  • Feeling sad, hopeless, negative, or irritable
  • Excess anxiety, panic attacks, crying
  • Loss of appetite (or comfort eating)
  • Thoughts about self-harm (2)

PMADs are complex and there are many contributing factors, including stress, pain, inflammation, diet, disordered sleep patterns, hormonal imbalances, predisposition to mental illness, birth trauma, and, lack of support. Early diagnosis and treatment of PMADs are very important for both mothers and babies.

Most PMAD disorders can be safely treated while a mother continues to breastfeed. There are several non-pharmacological treatment options including:

  • Exercise
  • Bright light therapy
  • Omega-3 fatty acid supplements
  • Vitamin D supplements
  • John’s Wort
  • Psychotherapy

If medications are needed, most are safe with breastfeeding and a healthcare provider can tailor the treatment plan to fit the needs of a nursing mother. For more information on medications and their safety with breastfeeding call Dr. Thomas Hale’s Infant Risk Center at (806) 352-2519. 

Breastfeeding can help prevent depression because it reduces stress and promotes nurturing behaviors. It also causes the release of the “feel-good hormones” oxytocin and prolactin which promote bonding, reduce maternal anxiety, and help nursing mothers feel more rested. If breastfeeding is going well, it helps boost maternal confidence and should definitely be continued.

If breastfeeding is painful or is causing stress or exhaustion, it may actually contribute to postpartum depression. PPD rates are higher in women who wanted to breastfeed but didn’t meet their feeding goals. If a nursing mother is experiencing difficulty with breastfeeding, working with a lactation consultant can help preserve the nursing relationship and support mental health

Breastfeeding is a very personal decision that each mother must make for herself. If breastfeeding is helping a mom bond with her baby versus contributing to her symptoms, then her PMAD treatment can and should be designed to protect that breastfeeding relationship. If breastfeeding is contributing to her PMAD symptoms, she should not feel guilty if she chooses to seek alternative forms of feeding.

WMMC offers outpatient lactation consultation services with Internationally Board Certified Lactation Consultants Monday-Friday from 9 am-2 pm. To schedule an appointment, call (660) 262-7519.      

For Postpartum support and help to find local resources contact your OB provider or you can call the Postpartum Support International Helpline at 1-800-944-4773 or text “Help” to 800-944-4773.