While difficulties with breastfeeding can also impact maternal mental health and potentially lead to postpartum depression, this research holds promise for mothers struggling to connect with their babies. The overwhelming evidence was that breastfeeding is associated with better mental health, but it’s stressed in the study’s conclusion that breastfeeding is associated with more negative mental health in some cases, meaning that breastfeeding may not be right for every woman.
Understanding Postpartum Depression
Postpartum depression, or PPD, is a form of depression that occurs after giving birth. It’s relatively common, and it’s treatable. It can be normal to feel a little down in the first week or so after having a baby, often known as the “baby blues.” However, longer-lasting symptoms could be a sign of postpartum depression.
PPD can start any time in the first year after giving birth. Often, because symptoms can develop gradually, women may not realize that they have postpartum depression.
“Any new mother can experience postpartum depression,” says Annie Riha, PsyD CPsychol, a psychologist at Naytal. “But there are factors that increase your risk, including birth trauma which can also result in post-traumatic stress disorder (PTSD), a history of mental illness, ongoing pain or complications post-birth, if you have felt depressed during your pregnancy or in the past, a weak support system, stressful life events during the past year such as a bereavement or a complicated pregnancy, relationship difficulties with your partner or significant other or a bad breastfeeding experience.”
Linking Breastfeeding and Maternal Mental Health
The evidence is there to suggest that breastfeeding has positive impacts on both the child and the parent. To that end, groups including the World Health Organization and the American Academy of Pediatrics recommend that children are exclusively breastfed for the first six months of life wherever possible. Breast milk protects infants from infections and diseases. It also provides health benefits to the mother, lowering the risk of various conditions. And then there’s the evidence to suggest that it may benefit mental health too. Breastfeeding mothers have self-reported reductions in stress, anxiety, and overall negative mood, while also displaying more stable sleep patterns and lower blood pressure. Oxytocin, often called the “cuddle” or “love” hormone, is released when breastfeeding, and helps to allow mother and baby to bond. One study found that women who breastfed at two and four months after giving birth were less likely to be diagnosed with postpartum depression at four months. Meanwhile, women diagnosed with PPD at two months were less likely to breastfeed at four months, suggesting that the relationship between breastfeeding and mental health goes both ways. There’s evidence that stopping breastfeeding can be linked to depression in mothers. However, this is most evident when it comes to mothers who stopped due to pain or physical difficulty. Likewise, there’s evidence that issues with breastfeeding can be linked to lower mood in new mothers. Still, it can be difficult to know whether it’s the breastfeeding causing the poorer mood or vice versa. There’s evidence that some new mothers with higher levels of anxiety and depression take a more negative view of breastfeeding to begin with, or are more likely to stop breastfeeding at an earlier stage.
Breastfeeding Challenges
The first few days of breastfeeding can be tricky, with both mother and baby getting the hang of it. Often, it’ll work out, but while the benefits of breastfeeding are well-documented, sometimes it can continue to be challenging. It won’t be for everyone. There are a lot of common breastfeeding problems. These can range from sore or cracked nipples to mastitis—inflammation of the breast—or the baby not latching on to the breast properly. As findings have suggested, women who stop breastfeeding after difficulties may be more likely to develop PPD. This may be linked to the perceived stigma and shame around not breastfeeding, or supplementing breast milk with formula. “Changing the stigma will require people to realize that, as an outsider, they have limited information about a woman and her baby’s situation, and the best thing to do is assume they’re doing what’s best for them,” says reproductive psychiatrist Carly Snyder, MD. “It will require people to call out intrusive relatives and outspoken people when they start to shame a woman for using formula, so it becomes less taboo and more readily acceptable.” A study published in 2020 involving 250 mothers who weren’t breastfeeding found that mothers unable to breastfeed experience more internalized stigma and feel as if other people see them as failures. These mothers were more likely to hide their formula use and had lower feelings of warmth towards their children. In contrast, mothers with more knowledge around formula use and more of a support system felt less stigmatized and had higher feelings of warmth towards their children. “Sadly, due to the pandemic and a general lack of resources many new mothers do not get the support they desperately need in the early stages of breastfeeding,” says Dr. Riha. “Many mothers who have had a bad breastfeeding experience feel like a failure, which increases their risk of postpartum depression. “It is essential that mothers are given an informed choice about their feeding options so they can make the right decision for themselves and their baby. The mental well-being of a new mother has a direct impact on her baby; therefore, it is of utmost importance that we keep the mother in mind so they are supported, heard, and do not feel judged about their unique breastfeeding experience.”
How Clinicians Can Help
So what can clinicians do to help support people who aren’t able to breastfeed or are struggling with it? “Asking women how they are doing emotionally, really listening, and checking if they are struggling with breastfeeding are all important steps in supporting new moms,” says Dr. Snyder. “Lactation consultants can be helpful if a woman is struggling with latch or is in pain, as can checking for a tongue tie." “Mom’s mental and physical health is imperative to allow her to be the most present, best mom she can be. If struggling to breastfeed is a hindrance to mom’s wellbeing, then it is time to start formula feeding.” The phrase “breast is best” is still often used, despite efforts by some to replace it with “fed is best.” While we can’t ignore the benefits of breastfeeding, the pressure to breastfeed can negatively affect the mental health of new mothers who struggle to do so. Or, as Dr. Snyder puts it, “Rather than questioning a woman’s choice, we need to start supporting her however she has chosen to feed her baby. Ultimately, more than the source of nutrients, having a fed baby is what matters.”
