Guest Blog Post – Katie

I’m writing in response to the section on The Postpartum Stress Center’s Web site titled “Is Breast Always Best?” Your editorial resonated with me and gave me a new idea. I’m certainly not writing to argue your thoughts, because I’ve been in that grief-inducing spot of having to choose whether to continue breastfeeding my baby in the face of severe postpartum depression and anxiety. Pressure clearly doesn’t help anything. But I am wondering – and perhaps this will simply play out as more prompt PPD treatment becomes the standard of care, or perhaps it takes a mom like me to raise the question – if there is a healthy alternative for many moms who want to breastfeed to work through recovery.

I struggled with breastfeeding from the get-go, and it became an all-enveloping nightmare in the course of the first three months of life with my daughter. I received well-intentioned but faulty advice from the inadequately trained lactation help at my doctor’s office, advice that made matters much worse. By the time I sought out an international board-certified lactation consultant in another city, the help I really needed was beyond the scope of a breastfeeding professional. I ended up checking myself in at my local hospital for several days, where I found appropriate mental health care.

I never was pressured to continue or stop breastfeeding by my psychiatrists or my family, thank goodness – the decision would have been so much more challenging had that been the case. The doctors prescribed me an anti-depressant and an anti-psychotic, which they cleared me to take while breastfeeding if I desired, and they advised me how to go about weaning if I opted to do so.

When I arrived home from my hospital stay, I hammered out a “pros and cons of continuing to breastfeed” list to try to make a final decision so I could move forward with recovery. The cons had the pros beat, so I readied myself to use up my pumping stash and pick out a formula. But every time the baby whimpered…I just wasn’t ready yet, and I nursed again. I don’t think I was trying to prove anything to anyone, at least not consciously; every ounce of me just wanted to feed my baby with my own food. After several days turned into several weeks of “not ready,” I found myself slowly slipping into a more comfortable place with breastfeeding. My comfort came in no small part from the out-of-town IBCLC’s advice, which also made the baby more comfortable at the breast. The anxiety surrounding feeding time became controllable and, after many months, non-existent (aside from dysphoric milk ejection reflex…who knew such a thing existed?! Which as it turns out probably has nothing to do with underlying anxiety and everything to do with breastfeeding hormones – knowing that in itself made me feel a lot better.)

I’m in agreement with you that the message “breast is best” can be dangerous to the mother who has a difficult weaning decision to make or whose recovery is not going to happen without letting go of breastfeeding. And to hear “It’s OK not to breastfeed” from a mental health professional might be exactly the permission and relief a particular mother is seeking. Infant feeding is such a personal decision, and one that can come with enough pain, anxiety and guilt to smother an elephant, never mind the added message from society that you’re not doing the best by your child if you formula-feed. I’m just feeling like there’s a missing piece of the puzzle based on my personal experience. Permission to stop is important, but isn’t it just as important to provide each mom who wants it with the means to succeed at breastfeeding? (Each woman would need to define her own success, of course.)

If I had stopped breastfeeding in the face of my own emotional upheaval, it’s very possible I still would carry around that guilt today, and it’s possible that stopping could have made the depression and anxiety worse. Or maybe stopping would have made things better faster.  I’ll never know for sure, but for me it doesn’t matter now anyway. I sincerely believe that personally, the benefits of maintaining that relationship overall have far surpassed the costs of our struggle at the start.

I will not say I’m proud I’ve been able to continue nursing my child because to be proud would imply I’ve made a better choice than some other mothers. In reality, breastfeeding is far from a choice for many mothers, among them women dealing with postpartum mood disorders. And I don’t know that the relationship I share with my daughter would be any less fulfilling and intimate today had I stopped. But because I was able to continue breastfeeding, the confidence I gained in that arena spilled over into so many different facets of parenting and helped me take pride in my abilities as a mother, where before there had been only shame.

We know postpartum mood disorders can be caused or exacerbated by breastfeeding difficulties. We’ve got a multi-generational gap of sensible breastfeeding guidance from our own families, so we turn to our health care providers, many of whom are lacking breastfeeding education. It’s a recipe for a lot of disasters. I’m one of those moms who heard “It’s OK to stop breastfeeding” – from the under-trained breastfeeding counselor who couldn’t correctly diagnose our problem – and it both broke my heart and fired me up enough to turn somewhere else, because, as it turns out, adequate breastfeeding help WAS out there. Thanks to my postpartum experiences, I started a La Leche League group in my city, so I could do my part in finding other mothers the help they need.

The majority of new mothers set out intending to breastfeed. The majority of those mothers don’t reach their goals. In talking with mothers, grandmothers, great-grandmothers about that loss, I’ve seen confusion, regret and guilt that linger long after life starts to move on. Wounds heal in time, but little scars can remain below the surface.

The instinctual drive to feed one’s child isn’t crazy at all. When it starts to cloud a woman’s ability to function, there’s a problem. What I believe needs to exist is postpartum help that values that instinct to a deeper extent. We need help for a suffering mother to try to preserve that breastfeeding relationship, if that’s what she desires.

Since breastfeeding offers health benefits for most babies and small children, since screened donor milk is not readily available or affordable, and since so many moms can stand to gain so much from finding success, I would love to see a push for IBCLCs working in tandem with PPD mental health providers. Women absolutely should not be pressured into breastfeeding at the cost of their own well-being. But they should be able to find breastfeeding help when that help could significantly improve their mental health. If that help isn’t there, those women fall through the cracks, too.

Do you think it ever will be possible to provide breastfeeding help hand-in-hand with counseling? IBCLCs on staff at the PPSC? Maybe this happens to some extent already. (Really, every mother deserves immediate professional breastfeeding help and PPD screening at her OB/GYN or pediatrician’s office…but one step at a time, I guess.) I would love to hear what you think, as a premier provider of postpartum mental health services. I feel so lucky to have gone through PPD at a time when the issue is no longer shoved under the rug. Thank you for playing a part in that, and thank you for doing what you do!

Katie Ward

 

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