When Is It Okay Not To Breastfeed?

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breastfeeding problemsFor some women with postpartum depression or anxiety — not all, thankfully, just some — breastfeeding doesn’t end up being the best choice. I quit, because I had to save my sanity.

Many others with PPD, of course, don’t quit. Postpartum depression and anxiety and quitting breastfeeding do not go hand in hand, nor should they. I’m grateful that we are doing more to make sure mothers understand that you absolutely CAN be treated for PPD or anxiety and continue to breastfeed. A breastfeeding mother should be supported 100% and not be made to or encouraged to quit for no reason.

I’m always keenly attuned to any policies that might hurt mothers who cannot breastfeed, and there are mothers who cannot breastfeed. Yesterday I waded into the breastfeeding/formula feeding debate, thanks to a new policy in New York City to promote breastfeeding that I believe goes one step too far. I was so pleased to find the discussion on Postpartum Progress’ Facebook page to be very intelligent and constructive for the most part. That’s one of the things I love about our group of Warrior Moms. We are 99.9% troll-free, probably because we’re populated by women who’ve been through enough in their lives (partially thanks to PPD) that they fully understand empathy and the idea that there are always two sides to any issue.

On my personal Facebook page, however, things didn’t go quite as smoothly. I was accused of being against breastfeeding. For example:

What do you have against infants getting breastmilk Katherine?

I can’t believe any person would try so hard to stop the encouragement of breastfeeding our children. It’s incomprehensible to me.

I have to question the accuser’s ability to read and comprehend, given that I think I was pretty clear that I do support breastfeeding. People like this tire me out. I mean, why on earth can’t we have a reasoned conversation about this? I think that, for some, there is never a time when it’s okay not to breastfeed.

Anyway, in case I wasn’t clear enough:

1) I think breast is best.

2) I think that for far too long formula companies have had too much influence on maternity wards. I agree that there hasn’t been an even playing field. I have no problem with that influence being severely restricted or even wholly removed. None at all.

3) I agree that we don’t do enough to help moms succeed at breastfeeding. Some hospitals are very quick to hand mom a bottle rather than muster up the time and patience to support her and guide her to success. I know I reached out for help because I wanted to breastfeed, and I didn’t get it. That’s a shame and it’s something that needs to be fixed.

4) In the end, I still believe that even if I had gotten all the help in the world, I would have quit because of my postpartum anxiety. I don’t believe quitting was the wrong thing for me. My children are very healthy, and I mean so healthy that they rarely get sick. My son has a cold right now, for the first time in probably two years if not more. My children are also very smart. They both just scored in the 99th percentile of the US on the standardized Iowa test. I can’t believe I have to say that, because it sounds so freaking annoying, but I get TIRED of having to defend whether formula-fed children are healthy or smart.

5) My concern with the Latch on NYC program is with the requirement that nurses must tell a mother how much better breastfeeding is for her baby every single time she asks for a bottle. That’s it. The other elements of the program don’t concern me. I believe that repeating over and over how you are essentially making the wrong decision for your baby, without any regard to why the mom has made that decision and why in this case it might be the best one, could end up being tantamount to shaming. I have read story after story of moms who could not breastfeed for very real reasons who are pained by the idea of this program.

6) I believe people who would judge a mother with a maternal mental illness for electing not to breastfeed so that she can recover, perhaps because it causes her too much anxiety or perhaps because she takes a medication that doesn’t allow it, don’t know a whole lot about how serious mental illness is. As Dr. Marlene Freeman, clinical director of the Massachusetts General Hospital’s Center for Women’s Mental Health, explains, “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.”

6) No matter how important breastfeeding is, I will not stand for any mother who quit due to a maternal mental illness like postpartum depression to be made to feel bad, to be shamed, to be guilted, to be made to feel that she is selfish, or wasn’t willing to work hard enough on behalf of her baby.

Period. The end.

 

For more on this, read Toughing It Out with Postpartum Depression to Breastfeed: A Psychiatric Expert Weighs In

For a different view on the Latch on NYC program, read Ask Moxie’s The Illusion of Choice, the Free Market & Your Boobs

 

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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. Michelle Spengler says:

    Is it weird if I told you that I love you? I didn’t breast feed and I feel like I have to hide that fact from people. I suffered from PPD also and I just couldn’t nurse. I felt guilty for years (my babies are 20, 17, 14 and 8 years old). I don’t now, because I’m a stronger and healthier woman…..but, in my darkest PPD days I felt so much guilt it was almost debilitating and I know for sure it worked against my recovery. And for the record, my 4 children are very healthy, very smart, well rounded and well adjusted. Their SAT scores….some of the highest in the state, 4.0 GPA, almost perfect scores on MCAS testing (standardized test in Massachusetts), straight A’s on report cards, advanced in all academic areas…..not one of them ever had a drop of breast milk…not a single drop. I agree, breast IS best when feasible but it is NOT for EVERYONE!

  2. Tarah Evans says:

    I am so sorry you’re constantly having to justify your reasons for not BFing and, especially, that you have to “defend” your decision by frequently having to state that your kids are healthy and smart. Bless you, woman! You have the patience of a saint, you really do. And your gentle, calm and clear way of communicating helps elevate this conversation.
    After my twins were born I had an ass-whupping case of PPD and was unable to BF. My body just didn’t produce any milk, even after weeks and weeks of pumping. The doctors and lactation consultants tried to help, but nothing worked. If I had been confronted with a nurse in the hospital telling me EVERY TIME I bottle fed my newborn twins that breast was best, I would have REALLY lost my s#*&. I knew that. I wanted to BF, I really, really did. Rarely have I met a mother who just doesn’t want to BF, who chooses to bottle feed just…because. There are so often these mitigating circumstances (like anxiety, medical issues, etc.) that prevent us from doing so.

    It was hard enough suffering from terrible anxiety, feelings of guilt that my body wasn’t working the way it was “supposed to” not to mention being a new mother to twins. God ladies, can’t we just give each other a freaking break and support each other’s decisions?!?

  3. The fact that this has to be written saddens me.

  4. You knocked it out of the park, friend.

  5. Such a good article. Thank you Katherine. I am wrestling with this issue again now that I am pregnant with my second. In my line of work, I come across this issue of breastfeeding daily and I am shocked at how someone I just met can start ranting about breastfeeding as the only way and then asking me all about my experience with it. Or, I get other comments by breastfeeding gurus that say, “If you breastfed, it would have helped your PPD.” That makes me so frustrated because they have no idea how mental illness works, how it affects breastfeeding etc. Gosh, if breastfeeding cured PPD, sign me up! But, unfortunately, it doesn’t. Anyway, I keep reminding myself that breastfeeding is a very personal decision and bless my OB and doctors for encouraging me to personalize the experience to my needs, not necessarily follow a general “formula” for all mom’s once their baby is born.

    I also wonder how much of this policy in New York is motivated by money (at least at a political level). I wonder if the state wants to encourage breastfeeding to lower the cost of formula for WIC progrmas.

  6. Can I just say that I love you too…??! Thank you. SO much :)

  7. I wrote a very long comment in response, and the internet ate it. So I re wrote it even longer, and the internet ate it again. @#$%^&*(!! Here is a summary:

    You are awesome. The end.

  8. When is it ok not to breastfeed?!–When the mother cannot breast feed for whatever reason, or chooses not to, for whatever reason–that’s when! and it’s no body else’s damn buisness to interfere or judge, and a mother should not have to justify herself to anyone for any reason! It’s no one else’s damn business. and certainly not the goverenment’s!!

  9. I block my anti-formula and c-section FB friends’ post from my newsfeed because it’s not that I don’t like them personally, it’s that each time I read one of their biased and accusatory posts I lose respect for them and beat myself up a little more and then try to over justify with myself why I made the choices I did or why I couldn’t control the circumstances that required the medical decisions that were made. It’s not fair. I can’t get all gushy about my newborn experience after L1 because PPD robbed me of that. I’m certainly not gonna let other people tell me I am essentially a bad mom because I feed my children differently or they exited my body from a different part than they’d prefer. That I can control. So screw them and their agendas and judgment. I’m over it. And, BTW, I hope we can all get to a point that we can admit that breast is not only not always best, but might not be best, or at least better, period. There’ve been lots of studies recently that breast milk isn’t the liquid platinum that lactivists like to claim it is. Wouldn’t it be ironic if we all found out that it really (like REALLY) doesn’t matter, as long as you are nourishing your child with clean, safe, healthy food?

  10. I have a slightly different perspective on this, I guess, based on my experiences. I decided long before my daughter was born that I was breastfeeding, no excuses (Mind you, there was no way in hell we could have afforded artificial milk which would have taken our entire grocery budget every week, so I didn’t have much choice anyway). So I did.

    I was hospitalised with postpartum psychosis at 5 days pp, and postnatal depression at 6 weeks pp. Those were a walk in the park compared to 3 years of severe, crippling PPOCD, in my case consisting of incredibly violent intrusive thoughts of stabbing my child, cracking her skull open, drowning her….. you name it, my mind presented it to me in technicolour for three years, hundreds of times a day.

    Then just after my daughter turned three, she weaned, mutually and happily. Within two weeks of her weaning, the PPOCD was gone. Just gone. Like finally surfacing from deep underwater and being able to breathe again.

    I have now had six weeks of mental peace. Perhaps if I’d not breastfed I could have avoided it entirely. Perhaps if I hadn’t ‘extended’ breastfed for a year I could have been well a lot earlier. But to me, that wasn’t my job. I thought I was dying, but here I still am. It was never my job to not have a mental illness. It was my job to feed my child. So I did.

    Obviously, other people will do what works best for them, but I’m glad I didn’t do what may have worked best for me. I’m glad I fed my child. Three years of horror was totally worth it, for that.

    • If a mother has PPD or any other related mental illness, and it is having a negative affect on the way that she is able to care for herself and her baby, then yes it IS her job to get rid of the mental illness to the best of her ability in order for her to be able to care for herself and her child. A lot of moms may feel guilty/selfish about taking care of themselves, but this is a situation where taking care of yourself is taking care of your family, and that’s not selfish. I’m not saying that the way you did it is wrong though, just, like you said, each mom needs to do what is right for them! I’m glad you are free now and that both you and your baby are healthy!

    • Kate: If what you did was the right decision for you, great. The one thing that would horrify me would be if any mother felt she was *expected* to continue breastfeeding despite it having those sorts of terrible effects on her, or that she was less good a mother for having made a different choice from you in that situation.

      But one thing I really do want to clarify: For goodness’ sake, the discussion here isn’t about whether you *fed* your child. Of *course* that was the right thing to do and you’d regret it, rightly, if you didn’t do it! The discussion is about *how* you fed your child. If you hadn’t breastfed her, you’d have fed her in other ways. (And presumably for much of those three years you *were* also feeding her in other ways.) Mums should get to take what’s best for them into account when deciding how to feed their baby. If they feel their situation is such that that trumps benefits of breastfeeding, that’s their call and their choice. Sometimes that is going to be the case.

  11. Great post as always! I think that breast is best for most babies but not the right choice for all moms. But really, who am I to tell women how to nurture their babies? Such a very personal choice with so many individual factors that most people don’t consider in a general discussion. This policy by Bloomberg is a slippery slope that goes beyond the usual formula vs breast feeding debate and into anti-women’s rights territory. I wonder how the discussion would change if a policy was implemented by a hospital that would refuse to deliver any mom over the age of 25. Because really, there is more science that suggests women should have babies at a young age than there is literature supporting the science touting the benefits of breast feeding.

    • I love you for writing this post. You always defend moms. When I felt my weakest while suffering from PPD, you were a light that made me feel I would eventually get better. And I did. I know posts like this would have helped me when I was suffering. And I know they will continue to help others!

  12. You are always so measured and reasonable, that I have to say…yes. Anyone who leaves comments like that have not taken the time to read your points. I also think some people live in such a black and white world when it comes to issues like this that it’s very very hard to see the grey. Thanks for helping us all see it.

  13. Annemiek says:

    I cried almost every time I breastfed my daughter overcome by the surge of emotions and hormones that surged through my body like a jumbo jet. Not even the lactation consultant knew what it was when I described how distressing it was and told me to continue. I quit after a month, exhausted, the best thing that happened since her birth for the both of us.
    My daughters open bloody rash on her behind was gone within two days of formula feeding ( did I mention I stopped eating anything that could possible have caused it, until I ate nothing but dry toast and green tea ? )

    Breastfeeding is the best solution, but let’s put some common sense to this debate, when it’s hurting either mum or child or both,
    formula is the best for all involved.
    Formula will make her grow into a tall HEALTHY woman with a tall HEALTHY (sane) mum to guide her! What more can I ask for?

    Katherine, you are so right!! thanks for sticking up for us!

  14. Thank you…thank you…thank you! I made it 7 months…it was the most rewarding and hardest experience in my life! There I was nursing my beautiful baby boy…knowing that I was doing right by him and at the same time bawling my eyes because I was so anxiety ridden and losing it! When I weaned I mourned the loss and at the same time my son (and husband) gained a much happier and peaceful mother.

  15. this is wonderful. i’m so grateful for your site, your advocacy for us hurting women and your gentle spirit in communicating your thoughts. what a blessing you are.

  16. Yes. This. For me, breastfeeding was an anxiety trigger with my first child and I’m still on the fence if I’ll even attempt it when we have our second. I can imagine that if I gave birth in a hospital where this policy was in place, the constant “information” about the benefits of breastfeeding would be incredibly detrimental to my mental health which would then in turn actually do the exact opposite of what the nurses are trying to achieve – it would have a negative effect on my child.

    And I agree with Michelle – I love you! (But I don’t care if it’s weird. Ha!)

  17. mammacockatoo says:

    Kate, I’m fascinated by your story, and wonder if you write about your experiences elsewhere. My experience is somewhat similar to yours. I wasn’t hospitalised, and my OCD thoughts are different, but at 21 mths I’m still pretty deeply in the trenches. For myself, BFing probably has drained my resources enough that it has exacerbated my problem, but I believe I would have tortured myself even more if I had formula fed (also, the $$$ for formula would have taken its toll, especially since baby had some dietary issues and standard formula would have been bad for her).

    My particular fun variety of OCD would have been fed heartily by the washing and sterilising of bottles, and I’m incredibly grateful that I’ve never had to pump and clean that equipment too. I know how lucky I am that breastfeeding has been relatively easy, even if it’s affected my mental health. My toddler is nowhere near ready to wean yet, but I live in the hope that when she does, my healing will be so much quicker than it has been so far.

  18. mammacockatoo says:

    It does seem ridiculous that a mother would get “you’re doing it wrong” lecture every single time she asks for a bottle. I would have thought that, on her chart, it could be noted each time a bottle was given, but that it also be noted that she had been advised once during her stay about breastfeeding (and offered real help). If you’re going to initiate something like that, there needs to be accompanying support, in the form of lactation consultants AND monitoring and assistance for PPMDs.

  19. Hi Katherine, sadly there are always those who jump the gun and there are those who will condemn others for not following their advice etc. You know the saying…you can’t please all of the people all of the time! Great review by the way, and I am an advocate of breast is best. My daughter was allergic to formula!

  20. Very nice. I hadn’t even seen this or heard about the NYC thing when I posted my blog posts the last few days about how Breast is not always best.

    A huge part of why I put off getting help for my PPD until it reached crisis level was because I was sure I would have to stop nursing, that I would have no other option, and that it would just be another reason/more evidence that I was a Bad Mom. When I did end up hospitalized, my PPD was to the point where I did need medication that I couldn’t BF while taking and the amount of guilt and condemnation I felt for exactly the type of reasons you’re talking about was just whoa.

    Thank you for this post. You rock.

  21. “No matter how important breastfeeding is, I will not stand for any mother who quit due to a maternal mental illness like postpartum depression to be made to feel bad, to be shamed, to be guilted, to be made to feel that she is selfish, or wasn’t willing to work hard enough on behalf of her baby.”

    Yes, yes, yes. A thousand times, yes.

    Thank you for writing this.

  22. Parenting is hard enough, I agree that the last thing we need is some extra guilt to make it harder.

    I just got back on Zoloft (generic) and am glad that I feel I can safely continue to nurse. But if I couldn’t, that would be okay too. I just wrote about it today.

  23. Its horrendous that you had to defend yourself like that. Sorry you had to go tthrough that. I agree with you 1000%, as a woman who went through PPD and PPA it was very hard for me to breastfeed. I tried and felt like a complete failure at it too. The state of NY should be concentrating on the mental health of mothers more than making sure they know the benefits of breastfeeding.

  24. Kathrine, I take issue with the fact that you’re misrepresenting this public health initiative and insisting that it does things that it, in fact, does NOT do. That’s irresponsible journalism and irresponsible advocacy. Getting people up in arms saying “They’re gonna lecture you!” isn’t helping women. Or babies. In case anyone’s interested, here’s an FAQ about the actual initiative – what it does and does NOT do (including the things you’re accusing it of doing.) http://www.nyc.gov/html/om/pdf/2012/latch_myth_fact.pdf

    Any monitoring of formula usage is designed to hold PROVIDERS accountable, not the mothers. It’s designed so that hospitals can track whether or not their nurses and doctors are actually providing breastfeeding support, or if they’re just continuing to hand out formula any time a mom asks for help with breastfeeding (as many hospitals do now.)

    Katherine, as a maternal/child public health professional, and as one advocate to another, I would love to see you sit down with a Maternal Mental Health professional who ALSO has expertise in lactation science. Health professionals in general are wicked ignorant about breastfeeding, but a mental health professional with a background in lactation science is the only person I’d trust to tell me the science on whether breastfeeding causes PPD (spoiler alert, all available studies show it does NOT.)

    I appreciate your personal story, and I admire the work you do. But in this instance, I think you’re uninformed about this particular cross-cut issue and perpetuating damaging misinformation. Hey – I’ve had to rethink a lot of my wrongly-held opinions over the years. Evolving your views to support the best maternal science we have ISN’T a failing. But perpetuating myths that harm public health is.

    • I follow both The Feminist Breeder and this blog every day and I’m always interested in and respect both of your opinions on these issues. :)

      Katharine, you’re right when you say “no matter how important breastfeeding is, I will not stand for any mother who quit due to a maternal mental illness like postpartum depression to be made to feel bad, to be shamed, to be guilted, to be made to feel that she is selfish, or wasn’t willing to work hard enough on behalf of her baby.” I’m a doula and I had a homebirth; I’m still breastfeeding my 11 month old and he has never had anything but breastmilk. It has been the most rewarding experience of my life to breastfeed him. But in my case, breastfeeding issues DID contribute to my major post partum depression and anxiety. No, breastfeeding in and of itself did not “cause” my PPD and PPA. But my baby was tongue-tied, would not latch at ALL, and required bottlefeeding for three months. I could pump about 60% of what he needed. It was miserable. And I am someone who had a team of lactation consultants at my HOUSE – I can’t imagine how it would be for a mom without that support.

      We got a breastmilk donor, so avoided the whole formula vs. breastmilk issue. But had donor milk not been a possibility, I would have given him formula in two seconds and never looked back, because he was hungry and after two weeks of setting an alarm to pump every two hours, I was on the brink of a nervous breakdown. These situations are why formula was invented. I was in a post partum stress support group and several mothers quit nursing because they were on strong anti-anxiety meds. Giving up breastfeeding was both heartbreaking and relieving to them, because they just could not handle the sleep deprivation. When breastfeeding is going well, I think it can help some moms heal from PPD. When it’s not going well, my experience is that it can make PPD worse.

      I was able to persevere with a combination of my milk and donor milk for the four months until my son’s tongue got better, and I’m glad I did. But I appreciated my therapist’s comment that “all things being equal, breast is best. But often all things are not equal.”

      However, I’m not sure if any of this is relevant to the Latch On program, the purpose of which is to change institutional habits and to counter long-entrenched marketing practices by formula corporations. I support these goals 100%. New York hospitals will have formula on hand for babies who need it, and I certainly hope that nurses will be given training to recognize signs of distress in mothers that would indicate that breastfeeding help and/or formula is needed. But my understanding is that all New York is doing is stopping the practice of automatically giving away free formula to new moms at hospitals. What’s wrong with that?

      Either way, let’s be realistic – breastfeeding success (at least for moms like me) requires a LOT more than a nurse chirping “breast is best!” every time she comes into a room. It requires pre-birth planning and education, supportive family members, and ongoing breastfeeding support once you get home. If governments want to encourage breastfeeding, let’s focus on insurance coverage for lactation consultants/post-partum doulas and paid maternity leave. Anything else is a just a bandaid solution that runs the risk of polarizing women.

    • I am sure you are a lovely woman, and you may be many things, such as an advocate for children. But you are in no way a feminist, because of the blatant disrespect you show to so many women who struggle with breastfeeding. Being a feminist means trusting that women can make the best choices for themselves and their families. So if that’s not you, then perhaps you should choose a new name.

    • Gina: I’ll freely admit I haven’t made an in-depth study of the research into breastfeeding and mental health, but, from what I have seen, it seems to me to be fraught with potential problems with reverse causality. Or, in plain English – if a study shows that women who aren’t breastfeeding are more likely to be suffering from PND, then does that mean that not breastfeeding caused the PND… or that the PND caused them to stop breastfeeding? Or that a lack of support put those women at increased risk of both PND and breastfeeding problems?

      However, I think a more fundamental issue here is that both mental health and breastfeeding are such complex, individual experiences that ‘the science on whether breastfeeding causes PPD’ just isn’t going to be universally applicable.

      Analogy here: I’ve seen anti-abortion writings pooh-pooh the idea that a woman might need an abortion for the sake of her mental health, because studies show that *overall* women’s mental health is actually better during pregnancy, so obviously staying pregnant would be the best thing for a woman to do for her mental health. It was an astonishingly dismissive passage that simply did not seem to take into account the fact that pregnancy can be a very positive experience for the majority of women and nevertheless be an impossible stress for some – and that there is no contradiction in that statement, because women are individuals with their own individual circumstances and experiences.

      You could draw similar analogies with marriage (if there’s no data showing that marriage in general is a cause of depression, does that mean we can ignore the experience of a woman who’s so distressed by the problems in her own marriage that it’s contributing to her depression?) or with employment (we know that overall being employed has a positive effect on mental health, so does that mean that if someone says they’re so stressed out by their job that it’s contributing to their depression then we should tell them that can’t possibly be true, or that we should insist that a person with mental health problems keeps working even when they’re not up to the stress?)

      Similarly, I would say that breastfeeding can go either way when it comes to mental health. A good breastfeeding experience could well build confidence or be protective against depression. A bad one could well contribute to depression. Why is it so hard to believe that both those statements could be simultaneously true?

      • I’m just chiming in to say that breastfeeding, for me, was my lifeline to normalcy. Yes, the first six weeks were challenging, with me battling some serious oversupply issues, and my baby battling colic-like behaviour, but breastfeeding got me through some serious SAD and when I was experiencing PPD, breastfeeding always made me feel competent as a mother, when everything else wasn’t going so well.

        In my case, if a care provider had encouraged me to give up breastfeeding in the first six weeks to help my stress level, it would have improved things temporarily, but would have harmed me in the long run. I also know three women, personally, who were hit with hardcore PPD/PPA when they weaned over a few weeks instead of gradually over a few months. Weaning suddenly can be a hormonal gamble!

  25. This debate is very difficult for me, because breastfeeding has been an integral part of my relationship with my baby. In fact, now that I feel my body is telling me to stop (by tanking my supply), I am in absolute denial and can’t bring myself to think it could be over. Do I want more healthcare providers to champion breastfeeding in their hospitals? Yes. Do I want mothers to have access to formula? Yes. But I think the unfortunate reality is in many areas of the US, formula is the rule, and not the exception. And I do think that needs to change. But certainly not at anyone’s personal expense. I don’t think anyone should be judged for their personal choices. But I do have to say that I think any “studies” saying breastmilk isn’t beneficial or amazing for babies is absolute hokum. The fallacy of saying otherwise is harmful to advocates of breastfeeding, in my opinion. Slightly unrelated, but still important.

  26. I always feel like these explanations for not breastfeeding are dripping with guilt. It is our body our choice end of. No explanation needed. It is no ones damn business how I choose to feed my child. Woman have a whole life time and a bunch of social constructs that judge our choices and shame us. I wish we could just support and inform our peers and move on. Thanks for the article Katherine.

  27. I’m expeting my first in November, and am already suiting up with my “I’m not breastfeeding and it’s none of your d@mn business why” armor. My situation is a little different – I have rheumatoid arthritis, diagnosed when I was 24 (I’m 36 right now). I am on medication that is contraindicated for both pregnancy and breastfeeding. The first half of my pregnancy (except for the terrible, awful, endless morning-noon-and-night sickness, the migraines, and the utter exhaustion) was an absolute breeze. No low-grade fever (I run one almost daily), no malaise (a difficult phenomenon to describe other than saying, “You just feel gross,”), not even so much as a swollen pinkie joint. I was so optimistic, the pregnancy hormones were doing just what everyone says they would, keeping me in remission without my meds, and if I just kept going this way breastfeeding for the first six months would be a breeze.

    Then at just about the mid-point the temperature in my area shot up and the RA came flooding back as if none of those good pregnancy hormones existed and certainly very aware that my medication is no longer there to keep it under tabs. Something has swollen on me almost every day. A couple of times it’s been my hips (both of them). Mostly it’s my wrists (where the disease started, and the one joint I’m most concerned about because I already have some mild, irreversible damage) or my elbows. Today it happens to be my knees. You think the pregnant waddle looks hilarious? Try pregnant-waddling up a flight of stairs when your hips and knees won’t bend. My husband has had to help me out of my bra more than once, and not in a fun “We’d better get some lovin’ in before we have a screaming baby” way. I’ve lost whole Saturdays and Sundays to sitting in agony on the couch trying to feed myself when my elbows and wrists won’t bend. It has become VERY clear in the last two months that staying off my medication after the baby is born so I can breastfeed is simply not an option. I’m not anywhere near in a true remission. I’m not even close to the medically induced remission I’ve been in for 12 years, and it’s clearly not going to last once the baby is born. When you have trouble picking up and holding your 10lb cat who can land on her feet if you happen to drop her, the prospect of trying to pick up and hold a 10lb baby who will fall and break her head open if you drop her becomes very, very frightening. And I really, genuinely shouldn’t have to explain this to ANYONE if I’m spotted out somewhere with a bottle, because it’s none of their business, and I shouldn’t have to worry about being bullied by nurses (I’m giving birth at a “Baby Friendly” hospital) for choosing to protect joints that I will need for literally my child’s entire life.

    The point of this whole thing is THANK YOU for speaking up for women who can’t or don’t want to breastfeed, for whatever reason. Given the transformation my boobs have gone through in just the first two trimesters, I’m quite positive I would have no trouble breastfeeding (and frankly am not looking forward to the pain as I go through the drying up process), but to me it’s not even worth the risk of attempting it. I know there are women who do stay off their RA medications so they can breastfeed. I also know that a lot of them end up needing their thyrod irradiated, or have their medication stop working, or are never in good enough health to have another child. To me these just aren’t options. I’ve always been an extremely active person, even with my illness, and I don’t want my child growing up with a mom who can’t take a walk in the park or finger paint or braid her hair because my joints have been destroyed. A good friend went five years after her daughter (and only child) was born before being diagnosed with RA, and she has extremely limited range of motion in one elbow, has had surgery to fuse all the joints in her toes, and has gained close to 50lbs from the high doses of prednisone she is now on (every other RA medication has stopped working). I’m already sick every day of my life. I don’t have to invite the kind of permanent damage my friend has just so I can breastfeed. And that is absolutely nobody’s business but mine and my family’s.

  28. I love to breastfeed but no matter how much I am assured by doctors that Celexa is “safe enough”, I won’t bf. Even if I was prescribed Zoloft (drug of choice for breastfeeders) I don’t feel I have the right to past any medications to my child no matter how small the amounts. I’m dealing with the loss of bfing. Thanks for your articles.