That word, and the process that accompanies it, can bring about immediate stress for women suffering perinatal mood disorders. It's a highly charged issue. For some of us, difficulties in being able to do it at all send us into a tailspin, and can either cause or exacerbate postpartum depression and anxiety. I thought, if breastfeeding is one of the few things a female body was meant for, why the hell can't I do it? What a defective mother I was!! For others, breastfeeding is one of the only ways suffering moms feel connected to their babies, and the idea of taking medication is terribly distressing. They'd rather continue to be ill than take meds and have to stop breastfeeding, and are nervous about the risks of continuing and passing trace amounts of meds in their milk to their babies. No matter how we try to look at it, we are filled with dread, guilt and indecision. I've been meaning to write about this topic for a long time, but then I received an essay in my email this week from Lisa Sniderman. It is very poignant, and I've decided it will be more powerful to share her confrontation of this issue than mine, with her permission, of course:
My name is Lisa, and I have a 2-year-old daughter. Unlike some mothers, PPD was far from my first experience with mental illness. I have been diagnosed with bipolar disorder since age 22, although that diagnosis took 4 years of frequent hospitalization and medical guesswork. I have a "treatment-resistant" illness; most medications simply increase my symptoms. In 1993, I finally found my miracle in a combination of doxepin and lithium. I got on with my life goals, thanked my lucky stars and never looked back — until 2005, when I was newly married and hoping to start a family.
It turns out that while my medications could be titrated during pregnancy, because of my history I really, really needed them in full dose immediately after delivery. Just when my daughter would really, really need to breastfeed. Thus commenced a frantic search for safety information about the drugs.
The outlook couldn't have been worse. Doxepin had been shown to cause respiratory distress in nursing infants whose mothers took one-third to one-eighth of the dose I needed. Meanwhile, the lactation and neonatal experts were divided on lithium; some recommended 'extreme caution' and frequent neonatal bloodwork, while others said it was completely contraindicated. Call me nuts, but I couldn't really see myself, in my vulnerable postpartum state, carefully monitoring my newborn for apnea and hepatoxicity 24/7. I don't think I ever would have slept.