Breastfeeding and Depression
Being a new mother means navigating a multitude of things, like physical, hormonal and lifestyle changes.
You're now responsible for caring for another human being, while getting the least amount of sleep you've likely ever had.
It isn't surprising then, given our Western culture's poor level of support for new mothers, that up to 22% of new mothers experience postnatal depression (PND).
In the past, when a mother experienced depression, the most common advice she was given was to wean and switch to formula.
Breastfeeding, along with many aspects of motherhood, can be challenging.
This advice was given without even finding out how breastfeeding was going and without offering breastfeeding support.
Should Mothers With PND Wean?
When a mother presents with depression, it's important for her health professional to find out what helps her symptoms and what makes them worse.
For some mothers with depression, continuing to breastfeed may be the best thing to do. For others, weaning may be best.
Doctor Alison Stuebe is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. “If breastfeeding is the lifeline that is holding her and her baby together, then we’ll build her treatment around protecting that breastfeeding relationship,” she says.
However, “If she grits her teeth for every feed and counts the minutes until it's over, then breastfeeding may be contributing to her symptoms, hurting her relationship with her baby.”
In such a situation, Doctor Stuebe says that when breastfeeding is stressful, it needs to be talked about. “It should be discussed to see if there are strategies that can make the experience better — or whether she and her baby would be better served if she weaned”.
If breastfeeding is going well, or if there are strategies that can be implemented to make a mother's breastfeeding experience better, breastfeeding can actually help a mother cope with depression.
Understanding Our Stress Response
In order to explain how breastfeeding can help with depression, it's important to understand a little bit about our stress response.
Our stress response is meant to be an acute response – to get us out of danger. However, if any part of our stress response stays turned on, this can contribute to long term health problems.
Our stress response has three parts to it.
- The fight or flight response that involves the hormone adrenaline
- The production of cortisol. This is our ‘get up and go’ hormone.
- The production of inflammatory proteins that cause inflammation. Inflammatory proteins help fight infection and heal wounds. It makes sense that our immune system does this so that our bodies are prepared in case we get injured.
Depression Can Overwhelm Our Stress Response
Under normal circumstances, the three parts of the stress response are perfectly balanced. So when the inflammatory response, for example, gets too high, then cortisol (which is anti-inflammatory) turns it down.
With depression, the system can become overwhelmed and one can become resistant to cortisol. Hence, with depression, there can be high levels of cortisol and inflammation.
Breastfeeding Can Help Reduce Stress
Due to its anti-inflammatory and cortisol lowering effects, breastfeeding can help reduce a mother’s stress by helping to turn off the stress response.
For example, research shows that when a baby suckles at the breast, a mother’s cortisol levels reduce. These researchers also found that breastfeeding mothers couldn’t be stressed for about half an hour after a breastfeed – hence providing her with a little cloud of stress protection. Because breastfeeding typically occurs several times each day, breastfeeding mothers receive this little cloud again and again every day.
Breastfeeding also has an anti-inflammatory effect. So, it can help turn off the inflammatory response to stress. This may be why breastfeeding for 12 months or more might be important for reducing the risk of cardiovascular disease (one of many conditions linked to inflammation).
What About When There Are Problems With Breastfeeding?
Breastfeeding problems can upregulate the stress response. Hence, mothers need good support and accurate information.
Research shows that mothers with severe breastfeeding pain in early days/weeks are more likely to be depressed at 2 months. For example, significant nipple damage in the early days/weeks can lead to an inflammatory response which may increase a mother’s risk for developing depression especially if not appropriately and promptly dealt with.
Getting assistance (e.g. from a lactation consultant) with breastfeeding problems helps protect a mother’s mental health – even if her pain is moderate to severe and doesn’t settle straight away.
Research also shows that not being able to breastfeed as planned increases the risk of depression, whereas breastfeeding as planned reduces the risk of depression. The provision of knowledgeable breastfeeding support to mothers who want to breastfeed is important. Equally as important is the provision of compassionate support to mothers who intended to breastfeed, but for whom breastfeeding didn’t work out.
Infant Feeding And Sleep
Another way breastfeeding helps improve a mother’s mental health is due to its impact on her sleep.
Research shows that compared to exclusively breastfeeding, mixed feeding or formula-feeding reduce a mother’s total sleep time and increases the time it takes to go to sleep. Even though the reduction in mixed feeding or formula-feeding mothers’ total sleep is only about 20 minutes or so, this appears to be sufficient to make a difference on their reports of daytime energy levels, sense of wellbeing and depression rates.
Regardless, every mother is an individual and it is important that she does what is in her own best interest.
Breastfeeding And Oxytocin
During pregnancy, research shows that mothers with lower oxytocin levels had higher levels of depression. At 8 weeks after birth, mothers with higher depression had lower oxytocin levels and felt more stressed, irritated and overwhelmed during breastfeeding.
This research could be showing that mothers with lower oxytocin levels have more trouble breastfeeding and also feel more depressed. Or it could be that, for mothers whose baseline oxytocin levels are lower, breastfeeding may provide them with an oxytocin boost to help them feel more connected to their babies.
See BellyBelly's article on 5 ways a new mother can boost her oxytocin levels.
A breastfeeding mother who is depressed needs support. Some well-meaning people will likely tell her to wean. However, if a mother indicates she wishes to keep breastfeeding, continuing to do so could be helpful by reducing her stress response and improving her sleep.
For breastfeeding support contact an Australian Breastfeeding Association counsellor, a La Leche League leader or a lactation consultant (IBCLC). For help with perinatal depression, contact your doctor, who may be able to refer you to a specialist perinatal counsellor.
PANDA (Perinatal Anxiety and Depression Australia) is also a great resource for perinatal depression.