I'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 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 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:
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."
