Breastfeeding & Postpartum Depression: Fresh Debate on Nighttime Feeding

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We've talked quite a few times about breastfeeding here, only because it's such aBIGHONKINGMAJOR issue for those of us who suffer from perinatal mood and anxiety disorders.

Do I breastfeed or don't I? How will the baby be affected by the medication if I take it as part of my treatment? I'm having a hard time breastfeeding and want to quit, but will I be a failure if I do? Etc. Etc.

You know the drill.

Then I saw this yesterday on Science & Sensibility, the Lamaze International blog. It was written by guest blogger Kathleen Kendall-Tackett.

"There is a movement afoot in childbirth education and perinatal health urging mothers to avoid nighttime breastfeeding to decrease their risk for postpartum depression."

Really? I would say that there probably aren'ttoo manypeople who watch the postpartum depression community as closely as I do, and I haven't seen that "movement". I haven't seen anybody "urging" anything. What I have seen is people being more open-minded about a new mother's choice, and being more concerned about making sure that both mother and baby are healthy, not just baby.

I don't know Ms. Kendall-Tackett personally, but we have spoken via email before, and I do know she cares a lot about women with PPD. I have respect for her. I also know she cares a lot about breastfeeding, and I wonder if that colored herpost and its conclusions just a tiny bit.

The article shares some studies that found breastfeeding mothers got more sleep than those who were bottle-feeding. Well, that actually makes sense. But I don't see what it has to do with postpartum depression. Did the mothers in all of those studies have PPD? Did they look at whether mothers who had fathers doing the bottle-feeding during the night got more sleep? I just don't see how the conclusions are exactly clear here. Kendall-Tackett does, though:

"In sum, advising women to avoid nighttime breastfeeding to lessen their risk of depression is not medically sound. In fact, if women follow this advice, it may actually increase their risk of depression."

I'm not a doctor, so maybe I don't get it. I reached out to several experts I know in the field of perinatal mood and anxiety disorders and asked them to take a look at the article, and to my relief, they didn't get it either. One told me of another study that found that women at high-risk for PPD who were kept in the hospital longer and whose babies were sent to the nursery at night developed less PPD than the control group.

I will quote another, without using this person's name since I didn't ask for permission:

" … the treatment of postpartum mood or anxiety disorders is highly individualized, including whether to breastfeed or not. Blanket pronouncements that one way is best, as suggested in this article, are not helpful, and likely contribute to the guilt/shame/stigma many womenfeel when they choose not to breastfeed."

That was my reaction as well. Perhaps it's because I know for a fact that I got more sleep when I stopped breastfeeding and went to a sleep management plan with my husband that included bottle-feeding. Other women though, find that breastfeeding is CRUCIAL for them and is the only thing that gives them comfort when they're going through PPD. That's great. Whatever works.

I know that breastmilk is better. I know that. I'm not stupid. I know God gave me these "golden bozos" for a specific reason and I didn't use them as indicated. If I could have breastfed successfully and hadn't been so screwed up with postpartum OCD, I would have. Really. I also know that my formula-fed son is in the Gifted program at school and is also the healthiest kid I have EVER met. EVER. So what can I say?

Couldn't we all simply agree that the best approach is for the mother and doctor to look closely at her history, her illness, her family situation andany other important factors,and then decide what is best?

Click here for more on the topic of breastfeeding and postpartum depression & anxiety.

Photo credit: © Vladislav Gansovsky – Fotolia

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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Comments

  1. Lizzy B. says:

    I'm a breastfeeding mother of a nearly four month old and that kid isn't sleeping worth a damn. Now that I've returned to work, my sleepnessness has resulted in anxiety the likes of which I never knew possible.
    I've been considering letting my husband take a night time feed (which would mean introducing formula to my son's diet), but the guilt I associate with that is almost as astounding as the anxiety.
    Thank you for giving me some perspective. It really, really helps, Katherine.

  2. I work in a hospital NICU and I have heard doctors/nurses educate moms on how to get all the pumping (not breastfeeding because the babies are not yet home) done during the day so that they can sleep at night. However, not in relation to preventing depression…Just thought I'd offer my experience which confirms what you were thinking Katherine…

  3. Katherine says:

    If someone had told me that my 6 month old big fatty of a son did not need to breastfeed every 3 hours at that age, which he did for a month solid because he was teething, I would maybe not have spiralled into depression. So yes, it is true that to get more sleep generally helps ease symptoms of PPD. But to imply breastfeeding means less sleep, is not always correct.
    I could say more but you guys get my point.

  4. Katherine Stone/Post says:

    I don't mean to imply that breastfeeding means less sleep. I just don't think it's good to say that either breastfeeding lessens or prevents PPD, or that formula feeding lessens or prevents PPD. Each person is different and should do what helps them.

  5. Bottom line, to breastfeed or not to breastfeed is a question that should be left up to the mother to decide what is right for her situation and the baby. It's a personal choice. Info to assist with breastfeeding is very helpful but should not be used to guilt moms into breastfeeding. If the mom is experiencing a postpartum disorder, she should consult with her doctor on treatment options, which may include the possibility of having to stop breastfeeding if she needs medication. Everyone's circumstances are unique to them. Wouldn't it be lovely if we could all stop passing judgment on each other and just try to be as supportive as possible in each mom's decisions?

  6. Glad you posted this. After suffering with severe PPD and PPOCD the first time around with a horrible breastfeeding experience to boot, I have still decided I want to give it another go when our second son is born in September. I know, I know – it's a risk, but I'm willing to take it. I also know that if it doesn't work out then that is okay too. My older son got about 5 weeks of breast milk before the therapist literally begged me to stop to help with my sanity. Can't say it helped much at all – still ended up hospitalized months later. But – I'm hoping for a good scenario this time.

  7. http://marquee.blogs.cnn.com/2010/08/03/gisele-bu
    Well if Gisele gets her way, we won't have to talk about it anymore!!!

  8. Interesting. I breastfed for 14 months. I had PPD. I also pumped and my son got a bottle of EBM once a night so I could get more unbroken sleep. It helped me tremendously. But I do think it depends on the mom.

  9. You hit the nail on the head here:
    "I don't know Ms. Kendall-Tackett personally, but… I do know she cares a lot about women with PPD…I also know she cares a lot about breastfeeding, and I wonder if that colored her post and its conclusions just a tiny bit."
    Yes, yes and 1000 times yes. This is why people like you are so important, b/c we can't let the realities of PPD get clouded by other agendas. I've seen it happen too many times with the breastfeeding/formula debate. I get really angry when people imply that the cessation of breastfeeding can exacerbate PPD, when the reality is probably that PPD and the cessation of nursing are RELATED, b/c many women find that switching to formula allows them to heal, for various reasons… but then in the aftermath, we are so prone to guilt and fear about that decision. It's such a vicious cycle.

  10. I breastfed for 10 months & starting about 6 weeks into it, my husband and I did the same (he fed pumped milk at 1st night waking). Pumping worked for me because I was at home, but I know it would add a lot more stress for many moms. I do know that once I stopped BFing my anxiety went way down.

  11. I can only speak to my experience, which is that once I started my daughter on solid food at 6 months (after exclusive breastfeeding), my anxiety went through the roof. I was still breastfeeding…no formula….but my brain went haywire. Perhaps I am just very sensitive to breastfeeding-related hormone changes. Within 3 months of completely weaning my daughter, I started having nearly constant, scary-as-hell intrusive thoughts.
    And my daughter started sleeping through the night, 8-12 hours every.single.night, at age 4 weeks. So I was getting PLENTY of sleep.
    I think the best thing for women is to tell them the possibilities:
    Some women experience a mood disorder before 6-8 weeks postpartum.
    Some women experience a mood disorder due to hormonal changes associated with breastfeeding.
    Some women….due to lack of sleep.
    Some women…due to previous mood disorders (diagnosed/treated or not).
    The list can go on. Women just need information so they aren't, at 8 months postpartum like me, wondering why they have suddenly gone bonkers.

  12. Kate @thelactivista says:

    Respectfully, I think you're missing the point of the article.
    Many studies have shown a link between lack of sleep and PPD (I'm sure you've read much of the research). There's also a widely-held (erroneous) belief that bottle feeding helps babies and moms get more sleep. Because of this, *some* healthcare professionals are now giving blanket recommendations that bottle feeding at night will help breastfeeding moms get more sleep and prevent PPD.
    The takeaway here is that giving *blanket* recommendations for nursing moms to supplement at night is not evidence-based, as exclusive breastfeeding usually leads to more sleep and more sleep is associated with lower risk for PPD. I don't see how this has anything to do with a breast/bottle debate, nor do I see the author making any blanket statements about treatment of individual cases of PPD.

  13. I completely agree! We are all so different. I don't understand why, but we are. So I wouldn't want every woman with PPD to think they need to breastfeed, and I wouldn't want every woman with PPD to think they need to bottle feed. And women should know that for some, the act of stopping breastfeeding can cause a temporary depression.

  14. As in all discussions there are different ways to look at the issue.
    Let's try and take it back to the starting point.
    Not sleeping enough is not good. Period. So it should be avoided. In nature when animals are breastfeeding the "child" adjusts to the mother. In our way of life the mother adjusts to the child. In nature an animal will catch up sleeping during the day. In our way of life a mother cannot do that.
    So she shouldn't feel bad about not breastfeeding her child at night. PPD may not be a result of sleepless nights but it surely will be affectting it.
    Thanks

  15. katherine says:

    Sorry I came across as if I was disagreeing with you but I was actually agreeing with you – put it down to lack of sleep :) I thought your post was great.

  16. katherine says:

    One other slightly related thing – I had to suddenly wean when my child was a year old due to well meant but bad medical advice. That sudden weaning really set back my recovery from ppd. As women we attach a lot of importance to breastfeeding – any decision should be taken slowly if possible. One can also combination feed or pump to get more. Sleep – it doesn't have to be all or nothing.
    Katherine this is a great topic!

  17. Katherine Stone/Post says:

    Thanks Meghan for sharing your experience!

  18. Katherine Stone/Post says:

    No worries!

  19. Katherine Stone/Post says:

    Gisele put her Manolo-ed foot in her mouth bigtime. I hear she has already apologized for the comment.

  20. Katherine Stone/Post says:

    I pumped for about 2 or 3 months, but I just gave out because I was so exhausted. I would throw out whatever was closest to when I'd take my medicine, and would give him whatever milk I'd pumped furthest away from when I'd taken it. That just served to make me even more anxious. But that was just me.

  21. Katherine Stone/Post says:

    Yes. You never really know why a woman may not be breastfeeding. Does she have an illness that prevents her? Does her child? There may be a very good reason, so don't make assumptions that she just doesn't care. I cared. It just didn't work out.

  22. Katherine Stone/Post says:

    Couldn't have said it better myself.

  23. Katherine Stone/Post says:

    I have heard from several women who suffered setbacks, or experienced depression for the first time, when weaning. The only advice I've heard regarding that is to take the weaning process very slowly to give the body more time to adjust.

  24. I know someone who was given instructions by her physician while pregnant not to breastfeed at night in an attempt to decrease her likelihood of postpartum depression. Specifically, that she HAD to get 8 hours of uninterrupted sleep at night.
    I generally feel that women are discouraged from nursing at night for MANY reasons including the idea that it negatively affects their "mental functioning" and can increase their risk for postpartum depression. I say this not as a professional but simply as a mom in the trenches constantly bombarded by advice, opinion, and studies.
    I'm guessing that the night nursing/postpartum connection is not seriously espoused by PPD professionals because they know what a complex and individual issue PPD is. But, I do feel that the idea is getting traction in lay media and women are being warned of the dangers of night feeding. We seem to be at a place where women are told that nursing their babies at night is good for their babies but bad for them.
    I agree that some women sleep better when they breastfeed and some sleep better when they formula feed. But I don't think we need to see each women's sleep situation as immutable, that there are only "breastfeeding sleepers" and "formula sleepers". For instance, I think that sleeping with your nursing baby is partially skill based and many (but not all) women can learn these skills and improve their sleep.

  25. Katherine Stone/Post says:

    Thanks for sharing this JJ. I haven't come across what you're talking about, so it's interesting to hear your perspective. I never heard anyone suggest that I shouldn't breastfeed at night in order to prevent PPD — what an odd thing to for healthcare professionals to say, especially as a blanket statement!

  26. Hi Katherine:

    You've raised an important topic, and as it is my paper that you are discussing, I thought that it was important to I weigh in. I'd like to address the specific concerns you raised.

    First, this is an issue that I have run into in many locations. I speak all over the world and have seen variations of the advice to provide mothers with PPD "protected sleep" (i.e., no nighttime breastfeeding) in many locations. My concern is that this advice is not consistent with recent available evidence.

    Second, it is inaccurate to characterize this discussion as a bunch of lactation people "trying to make mothers feel guilty." It's no such thing. My concern is with the mothers' mental health and whether a recommendation is a good idea. We now have a number of excellent studies that have addressed this issue. In considering the issue of sleep and feeding method, we need to look at some specific parameters. 1) how long does it take for a mother to get to sleep? This is a key risk factor for PPD. The longer it takes, the higher the risk. 2) how many hours are the mothers reporting they are sleeping? BF mothers report more hours of sleep. Consistent with that, they report more daily energy, better physical health, and better self-rated emotional health. They have lower levels of anhedonia and depressive symptoms, and are lower on depression measures overall. These findings are based on our study of 6410 mothers worldwide. 3) BF lowers the risk of depression. This is from our data and a meta-analysis of 49 studies published in Pediatrics. The reason for this finding is physiological. BF downregulates the stress and inflammatory response system, lowering this risk for depression. (see my UppityScienceChick.com site for more info on this.)

    As someone who has been in this field for more than 20 years, has authored 3 scholarly books on PPD, and who edits 2 scientific journals, I feel I must speak out when I see a policy that flies in the face of strong evidence and could potentially aggravate women's depression. Unfortunately, individual experience is NOT evidence and should not be the basis of policy.

    It is my duty to mothers to speak up when I see something that is consistent with the evidence. You are welcome to disagree based on your experience. But that should not form the basis of treatment decisions for mothers. You can bring up the old yarn about trying to make mothers feel guilty, but it is irrelevant to this discussion. I'm concerned about the mothers' health. Period. End of story.

    I'm willing to discuss this further with you at PSI if you would like. If you would like to read our more recent article with 6410 mothers, it is available at http://www.kathleenkendall-tackett.com/CLkendall-