“Toughing It Out” With Postpartum Depression To Breastfeed: An Expert Weighs In

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postpartum depressionI’d say by the looks of it that this week’s earlier post “Should This Mom Tough It Out With PPD So She Can Breastfeed Her Baby?” was a hot topic. I knew it would be, since this breastfeeding during postpartum depression is an issue that so many of us struggle with. Still, 83 comments is quite a lot for this little website!

I was happy to see that the comments were generally very respectful. At the same time, I know that the perspectives offered were mostly by moms and survivors. I wanted to make sure that I got professional input as well, so I went to one of my very favorite resources.

Dr. Marlene Freeman is an Associate Professor of Psychiatry at Harvard Medical School and the Director of Clinical Services for the MGH Center for Women’s Mental Health. (She is also a board member of Postpartum Progress the non-profit, which is awesome.) She is a respected expert on perinatal mood and anxiety disorders and was kind enough to offer her input on the situation of the pregnant mom who previously had postpartum anxiety and worries about whether she should breastfeed this time:

“Every woman suffering from postpartum depression or anxiety is unique, as well as her treatment preferences. Her decisions may be different than another woman’s decisions, even under similar circumstances. There is a reasonable list of treatment options for perinatal depression and anxiety that can be individualized, but suffering and pursuing treatments that are unlikely to work are not on the list.

For many women, treatment includes medication. In the risk/benefit analysis regarding medication used in breastfeeding (or during pregnancy), it makes no sense to have exposure to a medication that doesn’t work for that woman. If a particular medication or combination of medications has worked best in the past, a woman can spare herself medication trials and a longer duration of suffering by considering that regimen first (or at least near the top of the list).

Here are my own thoughts about breastfeeding, medication, and postpartum mood and anxiety disorders like postpartum depression:

1) The mother’s wellness is more important than feeding method. Decades of research demonstrate the negative consequences of maternal depression for the mother and baby. It is absolutely true that breastfeeding has great nutritional value, but it is not more important than the mother’s health and ability to bond with her baby and function.

2) Some medications are better studied than others in the context of breastfeeding. When there are unknowns involved, it is especially important for a woman to make collaborative treatment decisions with her health care providers.

3) When a medication has not received extensive study in breastfeeding, choices can be difficult. For some women, the benefits and experience of breastfeeding make some unknowns about medication acceptable in breastfeeding. For other women, they might select to formula feed rather than breastfeed on a medication with limited information. Some women may choose a combination of breastfeeding and formula feeding.

4) For some women, breastfeeding is difficult and stressful. It is important to remember that adding distress in a situation in which a woman is at risk carries its own consequences. If breastfeeding adds to a woman’s depressive or anxious symptoms, it is reasonable to stop. Sometimes it is necessary to stop.

5) Remember that your identity as a mother is far greater than if and how long you breastfed your baby.

6) There is something about pregnant women and women holding babies that makes a large segment of our population think they can say anything they want. No matter what you do, someone will have an opinion and tell you about it. Try and remember that you are making the best decisions for yourself and your baby, and intrusive judgmental comments from others are ignorant.

7) Breastfeeding exclusively from the breast means that no one else can feed the baby except the mother. For women suffering from mood and/or anxiety disorders, having breaks for sleep and self-care are essential. Please seriously consider giving bottles of either pumped breast milk or formula so that others can support you in caring for your baby.

These can be difficult decisions. I am grateful to have colleagues with whom I can discuss these issues. Please see our website for more information.”

Photo: Fotolia – © Vladislav Gansovsky

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Tell Us What You Think

  1. Thank you for soliciting an expert opinion on this Katherine. I imagine that even among experts there are going to be a variety of opinions on this topic though.
    One important thing that I think was missed in this post is best expressed through a quote I once read from a nurse who works with moms and babies. She said:
    * Never overestimate a mother’s desire to breastfeed her infant.
    * Never underestimate a mother’s desire to breastfeed her infant.
    I think this is critical to understand because, for some women, their depression could be made worse by feeling they were forced to give up on breastfeeding, if that was something that was incredibly important to them. Listening to the mother and supporting the mother with information and resources (e.g. options, evidence, etc.) is incredibly important.

  2. Thank you For the list of helpful points to consider when learning about how to handle PPD, etc especially concerning breastfeeding.
    Thank you Annie for your comment, that perfectly describes me. Had my health team understood how important the initial start up of exclusive breastfeeding (w/in hours of giving birth) was so that the option to breastfeed was still open, I can imagine the treatment of my PTSD/PPD would have taken a quicker more successful route. I don't think I heard one option until 6months post Parton when I found a new psychiatrist who let me breastfeed my baby during the appointment. The most freeing moment was when he said "we can try lots of things so you can continue breastfeeding. If you take medication it doesn't necessarily mean you'll have to forever." With that, my healing journey began. I am going to print this out to share. It would have helped me from pregnancy to understand there are so many factors to consider.

  3. point #4 describes my experience perfectly.
    Being the sole provider of nutrition for my baby, and having a difficult time with breastfeeding (emtionally and technically) only made worse my thoughts of self harm and desire to abandom my family during the worst of my PPD/PPA.
    It's good to keep in mind that EVERY mom is different and no one thing will work best for us all.

  4. Thank You Katherine for having an expert weigh in on this issue. Hope that it is helpful to moms that need it most.

  5. I am thankful for all three of you – as my husband and I follow each of you often!
    I was/am one of those mothers for whom breastfeeding is most important. It is something I truly love and have with each pregnancy – depressed or not. I also support a mother's decision not to breastfeed when it negatively impacts her health and well- being – I am not in her shoes, and mommy wars do us far more harm than good. I do wish donor milk was more readily available.
    Recognizing a woman's/mother's/family's uniqueness and individuality is so often missed – and to me seems the critical step in providing what is best for the health of all involved. Thank you, ladies, for seeing that in each of us and offering us your best! <3

  6. You wrote "for some women, their depression could be made worse by feeling they were forced to give up on breastfeeding, if that was something that was incredibly important to them." I wholeheartedly agree. That's why each situation is so individual. I'd hate for a mom to be traumatized by being made to feel bad for quitting BFing if she wants to you. I'd ALSO hate for a mom with PPD to be further traumatized by being forced to stop breastfeeding when she doesn't want to for treatment. There are so many options!

  7. It's great to hear you had a psychiatrist who listened to your concerns and worked with you to create a positive outcome.
    -K

  8. Amen. #1 nails it. It is so so SO important that the mom is well so that she can take care of not only the baby but herself.