Sleep Management, Breastfeeding & Postpartum Depression

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breastfeeding postpartum depressionMy longtime readers are aware that, for me, quitting breastfeeding was helpful in my recovery from postpartum OCD. I was so anxious about breastfeeding, and so sleep-deprived, that in the end I think it helped to switch to a bottle. BUT, many moms do not feel the way I do. In fact there are a lot of moms who feel very strongly about continuing to breastfeed and who say it’s the only thing that makes them feel good during PPD. So I asked an expert, Annie of PhD in Parenting, to share the best ways to make sure you get enough sleep to help you recover from postpartum depression or anxiety while continuing to breastfeed. She had lots of great input, so I’ve broken her guest post into two parts. I hope you find his helpful!

Being a new mother can be overwhelming. You don’t get enough sleep. Breastfeeding can be difficult. Some babies seem to cry and cry and cry and you don’t know why.  This can be incredibly trying for any new mom, but it can be debilitating and dangerous for a mom with postpartum depression (PPD).

What does the research say?

There is research that indicates that mothers with PPD who do not get enough sleep are at greater risk for more severe depression.  According to an article by April Hirschberg, MD on the Women’s Mental Health website:

Women with PPD had poorer sleep quality and lower sleep efficiency than women without PPD.  ….  Poor sleep quality significantly predicted increased PPD symptom severity.

The authors conclude that clinicians must address measures to improve sleep quality in depressed mothers in order to decrease the severity of depressive symptoms.  Furthermore, researchers must develop interventions which facilitate better sleep quality in women with postpartum depression.

There is also research that demonstrates a link between weaning and depression. However, according to an article by Alison Stuebe, MD, MSc on the Academy of Breastfeeding Medicine’s blog the cause of that link is unclear:

There’s considerable data showing that moms who are successfully breastfeeding are less likely to be depressed than those who are not. It’s far from clear, however, whether depression causes weaning or weaning causes depression.

To complicate matters even more, there is also research that shows that mothers who are not exclusively breastfeeding have poorer sleep quality, but a mother who is being woken constantly during the night by a newborn baby may laugh at that research (I certainly would have in the early days with my first child, even though I later enjoyed the benefits of breastfeeding hormones as a sleep aid).

I don’t want this article (or the comment section) to turn into a debate on whether or when it is a good idea to switch from breastfeeding to bottle feeding if you are experiencing PPD. I know some mothers who suffered from PPD that felt incredible relief when they decided to stop breastfeeding, while others found their depression worsened. The decision to breastfeed or not is a very personal one and it is critical to recognize that breastfeeding is more important to some mothers than it is to others (whether that is biologically, intellectually, or emotionally determined).

When it comes to PPD and sleep advice, that is incredibly important to remember. Yes, sleep is important in helping mothers to manage and overcome PPD. But if being able to breastfeed is also incredibly important to them (and to their mental health) and if the mother is breastfeeding successfully, then the sleep advice needs to be compatible with maintaining a healthy milk supply. Bad sleep advice could cause the mother’s milk supply to plummet and unnecessarily compromise her ability to breastfeed her baby.

Note: Although it is not the topic of today’s post, I want to note that it is possible to breastfeed and take medication for postpartum depression. For more information see: Which Psychiatric Medications are Safe During Breastfeeding?

The Importance of breastfeeding frequency

According to kellymom.com’s tips on breastfeeding your newborn, frequency is incredibly important.

Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 – 12 times per day (24 hours). You CAN’T nurse too often–you CAN nurse too little.

This can mean different things for different babies, which is why listening to their cues is so important. My son nursed every 2 to 3 hours around the clock. My daughter nursed more frequently than that during the day (at least once per hour when she wasn’t napping), but slept longer at night (usually got a 4 to 5 hour stretch in).

In the past, Katherine has talked about her family’s two nights on, two nights off approach. She wrote:

My doctor at Emory believes sleep management is extremely important. My husband and I had a “2-nights-on, 2-nights-off” plan. I knew that soon I would get two full nights of rest, and that went a long, long way in helping me to try and keep it together and to recover from PPD. Sleep deprivation is a form of torture, after all.

She also expressed agreement with a Huffington Post article that suggested a different approach, based on a similar idea:

Split nighttime baby duty so you each get at least one five-hour uninterrupted block of sleep. One of you is “on” from 8:00 p.m. to 1:00 a.m., and the other from 1:00 a.m. to 6:00 a.m. (adjust these figures to your family’s schedule). When you are “off duty,” sleep in a separate area, and try earplugs, a fan, or a white-noise machine. The on-duty parent can sleep, too, but he or she will be the one who has to wake up to respond to and feed the baby.

While these tactics may work for a formula fed baby, it could be incredibly detrimental to a breastfeeding mom’s milk supply, especially if they become a permanent solution rather than a one-time “catch up on my sleep” tactic.

How to combine breastfeeding frequently with good sleep

So, if you need more sleep but want to keep breastfeeding and don’t want to compromise your milk supply, what can you do? Start by implementing general practices that help promote good infant sleep. But beyond that, there are other things you can do to help protect your milk supply and get more sleep.

Stay tuned tomorrow for Annie’s tips on how to do just that!

Annie has been blogging about parenting, feminism and social change at PhD in Parenting since May 2008. She is a social, political and consumer advocate on issues of importance to parents, women, children and the earth. She regularly uses her blog as a platform to create awareness and to advocate for change, shedding light on positions, policies and actions that threaten the rights and well-being of parents and their children.

 

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Tell Us What You Think

  1. I had terrible PPD the first couple weeks after my daughter, Khloe, was born and it got worse from lack of sleep. I got relief when I decided to co-sleep with her. She breastfed whenever she needed to and I only needed to wake up enough to position my boob in her mouth and then I could fall right back to sleep.

  2. This is a very important topic. My psychiatrist stresses the importance of a mom experiencing or prone to PPD getting at least six *uninterrupted* hours of sleep at night. My husband (God love him!) took over all night time duties and I slept from 10:00pm to 6:00am… in another room and with the help of a little Ambien. He fed the baby formula at night and I didn’t wake to pump at all. It’s so true that every woman is different but in my case, it didn’t hurt my milk supply at all. We ended up breastfeeding for 18 months.

  3. I’m so thankful to see this. Breastfeeding has been one of the few things I know I’m doing right through PPD and has helped quiet my anxiety on many occasions. We just weaned at 19 months and I’d like to go longer when we have #2.

    I would *never* put down a mother for choosing early weaning or formula if that is best for them & their family but it is nice to see information for women who choose to continue breastfeeding. Breastfeeding is tricky work, especially right at first, and I’m looking forward to tomorrow’s tips! Also, love the kellymom site you reference, it has been a huge help to me in troubleshooting and support while breastfeeding.

  4. There is also research out there (a researcher in Australia – I don’t have my files at home, as I”m on mat leave, so can’t remember her name) who studies whether baby sleep training can help a woman’s postpartum depression. She has concluded that it DOES help, and women should be offered that option (e.g. to do a form of CIO). I wonder what you think of this Annie?

  5. Co-sleeping saved me with my first, but my second wouldn’t co-sleep, while my first was still waking up regularly. I ended up resorting to controlled crying which was against my philosophy at the time . . . but it saved me (and therefore my kids). My (now ex) partner never got up.

  6. Annie – I love your work and I know you are an advocate for women & families. Nice job! I,too, am puzzled by the research that says that women who are bf-ing get more sleep. My son fed alot and I was tired, man. As Lindsey says, on a personal level, I would never put down a woman/family who chooses a different infant feeding method. It’s not a subject to be judgmental on, it’s not a reflection of parenting ability. And on a clinical level, my goodness, I am ALL FOR what my clients need to do to feel well.In fact (big exposure here for me as I am active in the NJ birth world and studying to be a CLC) I often gently suggest that SOME women wean or reduce pumping at work (as it soo stressful for them to be pumping rather than feeding..i’m talking not ALL women, but look at the individual) so as to migitate anxiety & depression and stress and plain old mommy-has-to-do-it-all angst. We DONT have to do it all. Often, we just plain old CANT. Thanks for this post, Katherine & Annie. Warmly, Kathy .

    • I was lucky enough to attend a CE by the lead researcher involved in a sleep study with similar several years ago…. It isn’t the bf-ing mothers get “more sleep” (in fact they get less) it is that they get “better sleep”, particularly when sleeping in proximity to (in the same room as) their baby. At the time she believed the reason for this was that breastfeeding mothers and infants share synchronized sleep cycles so that when baby wakes to eat mother is significantly more likely to be in light sleep, where as non-breastfeeding mothers (and other caregivers) are likely to be in a deep sleep when baby wants to eat. Not sure if more information has been gathered since then. http://www.uppitysciencechick.com/sleep.html

      I am so glad this issue is being addressed. As a hospital based IBCLC I am too often in the position of having to help a mother “put breastfeeding back together” after she has followed some well-meaning, but really bad advice for loved ones and/or health care providers who were worried about a postpartum mood disorder and/or lack of sleep. These mothers consistently report being much worse off in a clinical sense when breastfeeding has been sabotaged.

  7. Excellent post, Annie (and Katherine). It’s nice to see a balanced piece on breastfeeding and PPD which acknowledges that women’s experiences may differ, and offers real-world suggestions to those who have decided take a particular path. Really nice work, here.

  8. ALthough I completely agree that sleep is important and can help with PPD, anxiety about not being able to sleep was one of the worst symptoms of my PP Anxiety. And being told over and over by many well meaning supporters that I needed more sleep and that my PPA would worsen if I did not sleep, only made matters worse for me. I now encourage mothers to rest (whether they sleep or not) but to also believe that they will survive through many months and even years of broken, less than ideal sleep. Eating well, being able to take rests throughout the day, and trying not to worry about how much sleep I was or was not getting was helpful for my recovery. As well as the invaluable support from this site! Thank you, Megan

    • Hi Megan, I’m a new first time mom & my daughter was born prematurely, 2 months early. Besides the traumatic experience of that, she’s now 4 months old & still nursing every 2 house around the clock. For the past 2 weeks I’ve had major anxiety in the evening hours, unable to sleep even when the baby is sleeping. It’s an awful feeling & what you had posted really resonated with how I feel. Is there anything else that had helped you fall asleep? My daughter is becoming more and more alert during the days now & it’s crucial that I have energy for her :(

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