In 2014 the journal Maternal and Child Health published a study looking at breastfeeding and maternal depression. It found that mothers who planned to breastfeed and went on to do so were around 50% less likely to become depressed than mothers who had planned to, and did not, breastfeed1.
This study emphasises how crucial it is for mothers to know how to get support so they can continue breastfeeding for as long as they want to. Furthermore it shows that access to support may play a key role in helping to prevent postnatal depression.
Breastfeeding can protect against Postnatal Depression
The study showed that breastfeeding has well-established benefits to babies, in terms of their physical health and cognitive development. It also showed that breastfeeding benefits the mental health of mothers.
Kathleen Kendall-Tackett, PhD, IBCLC and La Leche League Leader agrees in her book Depression and New Mothers. She reports that “rates of depression are lower in breastfeeding mothers than their non- breastfeeding counterparts”2. She also notes that “breastfeeding is protective of maternal mental health because it reduces the stress response”.
Breastfeeding has been demonstrated to enhance interactions between mothers and babies: mothers who breastfeed show increased physiological and social responsiveness to their babies3. Breastfed babies have been shown to be more alert and responsive4 and more reciprocity and affection has been observed in breastfeeding dyads5, 6.
When Postnatal Depression is diagnosed
If a woman becomes depressed while breastfeeding some health care professionals consider breastfeeding a risk factor, and they might urge her to stop in order to recover. This does not take into account the research demonstrating breastfeeding’s protective effect on maternal health. Many medications for postnatal depression are compatible with breastfeeding: it should be possible to discuss a treatment plan with health professionals which is right for each individual circumstance.
In Depression and New Mothers Kendall Tackett explains why breastfeeding protects babies from the harmful effects of maternal depression. One reason is that by simply breastfeeding mothers are more likely to touch, stroke, and make eye contact with their babies. She says another possible explanation for the beneficial effect includes the release of feel-good hormones when milk is produced. This is one more reason for encouraging mothers to continue to breastfeed even while depressed.
A 2004 study7 also found that breastfeeding protected infants from the harmful effects of maternal depression. The study compared four groups of infants: infants of depressed mothers who were either breast or bottle-feeding, and infants of non-depressed mothers who were either breast or bottle-feeding. The infants of depressed bottle-feeding mothers had abnormal brain activation patterns, such as those found in previous studies. But the infants of depressed breastfeeding mothers were no different than those of non-depressed mothers.
Stress can affect depression
Writing in Leaven, a publication produced by La Leche League International, August-September 2005, Kendall-Tackett explains how stress and fatigue can increase risk for depression, but lowering stress can be protective. This is an area where breastfeeding can make a difference.
A 2002 study8 compared maternal stress levels after both breast and bottle-feeding, with 28 mothers who were doing both. They measured stress immediately after breastfeeding, and immediately after these same mothers bottle-fed. The design of this study allowed the authors to account for pre-existing differences in mothers who chose to breastfeed rather than bottle feed since each mother was compared to herself. They found that the act of breastfeeding decreased mothers’ negative moods, and when these same women bottle-fed, bottle-feeding decreased their positive mood.
Support needed for breastfeeding difficulties
While breastfeeding is very effective in lowering stress, breastfeeding difficulties can increase stress and this may contribute to developing depression. It is vitally important that women who want to breastfeed get the support they need.
Dr Iacovou says “However good the level of support that’s provided, there will be some mothers who wanted to breastfeed and who don’t manage to. It’s clear that these mothers need a great deal of understanding and support; there is currently hardly any skilled specialist help for these mothers, and this is something else that health providers should be thinking about.”.
La Leche League GB agrees with her comments that “Lots of mothers and babies take to breastfeeding pretty easily. But for many others, it doesn’t come naturally at all; for these mothers, having someone with the training, the skills, and perhaps most importantly the time to help them get it right, can make all the difference.”
Postpartum Psychosis is a severe form of postnatal depression which affects around one in a 1000 women. If a woman develops this while breastfeeding either she, or a relative, can let her doctor know how important continuing to breastfeed is to her and provide information about the protective effects. Some mothers have said that even if their thoughts were illogical, breastfeeding was the one thing they felt clear about. The stress caused by ceasing breastfeeding could add to their difficulties.
If a woman is hospitalised the hospital may agree to her having her baby with her as long as another family member is also present and agrees to be responsible for the baby. Family support can be vital at this time and breastfeeding can help in the healing process.
One valuable source of accurate information is Dr Thomas Hale’s reference book (and online access) Hale’s Medications & Mothers’ Milk 2021: A Manual of Lactational Pharmacology. It may be possible for a mother, or her relative, to ask a psychiatrist to look up the psychiatric medications he plans to prescribe. Dr Hale’s book gives accurate information about drug levels and when they peak. The dose can then be managed so that peak levels in the bloodstream fit around breastfeeding. It may be possible to nurse a baby as much as possible before the medication to allow as much time as possible before nursing again.
Sometimes it is necessary to ask for a second opinion in order to find a doctor who understands how important this is for a mother.
Where to get support
Being aware of factors which may lead to depression will hopefully enable women to get the support they need before things escalate. Protecting the breastfeeding relationship between a mother and her baby is of significant consequence.
LLLGB Leaders offer telephone counselling, group meetings, leaflets, and support by email and social media. Most of all they are a listening ear when things are not going well with breastfeeding. They offer accurate information so that women can decide what feels right for them and their baby. Our official La Leche League GB because Breastfeeding Matters page offers information and support.
Written by Anna Burbidge
Depression and New Mothers Kathleen A Kendall-Tackett, Routledge, 2009
Non-Pharmacologic Treatments for Depression in New Mothers Kathleen A Kendall-Tackett, Hale Pub. Jun 2008
LLLI articles & stories
Why breastfeeding is good for mothers’ mental health, a new article by Katheen Kendall-Tackett
Breastfeeding: what’s in it for mothers
1. Borra, C., Iacovou, M. and Sevilla, A. “New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions”. Maternal and Child Health Journal: 20 Aug 2014
2. Dennis and McQueen, 2009
3. Wiesenfeld, A. R., C. Zander Malatesta, P. B. Whitman et al. Psychophysiological response of breast- and bottle-feeding mothers to their infants’ signals. Psychophysiology 1985; 22:79-86.
4. Worobey, J. Feeding method and motor activity in 3-month-old human infants. Perceptual and Motor Skills 1998; 86:883-95
5. Bernal, J., and M. Richards. The effects of bottle and breastfeeding on infant development. Journal of Psychosomatic Research 1970; 14:247-52
6. Dunn, J., and M. Richards. Observations on the developing relationship between mother and baby in the neonatal period. In Studies in Mother-Infant Interaction, ed. R. Schaffer. New York: Academic Press, 1977
7. Jones, N.A., McFall, B.A. and Diego, M.A. Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: The mediating role of infant temperament. Biol Psychol 2004; 67(1-2):103-24.
8. Mezzacappa, E.S. and Katkin, E.S. Breastfeeding is associated with reduced perceived stress and negative mood in mothers. Health Psychol 2002; 21:187-93
Copyright LLLGB 2016