Advocacy

Breast is not always to blame

"Sometimes the strong need reassurance," is what the photographer titled this photograph. How true. (Image credit Leon Fishman via Flickr Creative Commons)
“Sometimes the strong need reassurance,” is what the photographer titled this photograph. How true. (Image credit Leon Fishman via Flickr Creative Commons)

There’s an essay on the Postpartum Stress Center website called, “Is Breast Always Best?” This is a powerful, well-written piece—but it’s wrong.

Breastfeeding isn’t “best.” It is normal. We need to nudge the idea out of the way that a breastfeeding woman who is experiencing postpartum depression is experiencing it because of breastfeeding. I have heard criticism that lactation professionals fail to look at the whole woman and instead focus on getting a woman to breastfeed at whatever cost, but how is it looking at the whole woman to ignore her lactating breasts, the biological imperative to breastfeed, and her desire to breastfeed?

The essay echoes this:

This is because breastfeeding, to the depressed mother, is more than breastfeeding. It is a lifeline. It’s as if it provides the single opportunity for her to feel that her presence is making a difference.
So why, later in the essay, does the author take this lifeline away, telling these mothers:
…I’m afraid for the women who continue to work so hard, with painstaking determination, against such formidable odds, to stay on track, to prove something to someone. I’m not sure what they are trying to prove, exactly.

Breastfeeding is not indicative of wanting to “prove” something. It is indicative of a mother wanting to feed her baby. It is a mammal’s body doing what it is designed to do. The breastfeeding in this equation doesn’t need to be treated any differently from, say, eating. It’s normal to eat. Sometimes we might eat something that upsets our stomach. Do we say, “Well, best not to eat anymore. Time to get a feeding tube”? No. There’s a continuum of considerations that your doctor will explore before jumping to such a drastic conclusion. It should be the same when it comes to suggestions of weaning, or even the idea that breastfeeding is the cause of difficulty.

Discussion of breastfeeding and postpartum mood disorders often focuses on mothers who are experiencing breastfeeding problems. But not all breastfeeding is difficult. You can have a wonderful breastfeeding experience and still have postpartum depression. Mothers are told that breastfeeding is the problem when breastfeeding is going well!

What do you blame for postpartum depression, anxiety, OCD, PTSD, or psychosis when a mother isn’t breastfeeding? Do you still blame the feeding method?

Do you know what is hard and we don’t have adequate support for, besides breastfeeding? Parenting. Motherhood. How about, instead of asking a string of questions with the underlying thread of “breastfeeding is doing you harm,” we try to explore the whole issue? Maybe we could ask questions like these (I’ll keep the first three from the essay, because they’re good questions):

  • Does she need medication?
  • How does she feel about taking medication while breastfeeding?
  • Is it possible that breastfeeding may somehow contribute to her feelings of despair? (I doubt that this is what the question is referring to, but there is a condition where a mother may have negative/strange feelings associated with letdown, called dysphoric milk ejection reflex. There is help available for this; with the right support, breastfeeding can continue.)
  • What in particular about breastfeeding is causing difficulty or potentially interfering with treatment? What can we do to change those things? (For example, is mom struggling with low milk supply and pumping frequently? Maybe it’s time to reassess goals and aim for producing as much milk as possible without going to extreme measures.)
  • Is this mother getting good support with lactation? Are the plans that were developed reasonable and the goals achievable? Is the mother following the plans?
  • Does this baby exhibit normal behavior, and, if so, does this mother understand what normal newborn behavior looks like? Is the baby healthy?
  • How confident does this mother feel about motherhood? How can we help her feel more secure?
  • Does this mother have enough support with every other consideration around parenting, and, if not, how do we get her more? (Bottlefeeding does not fix a lack of a supportive partner, isolation from family or friends, financial troubles, struggling with returning to work, or any of the other logistical considerations that come with parenting.)
I have no doubt that, for some women, breastfeeding might contribute to symptoms of depression or other mood disorders, and that, for some women, weaning may be the answer. As this post on the Academy of Breastfeeding Medicine blog states:
If breastfeeding is the lifeline that is holding her and her baby together, then we’ll build her treatment around protecting that breastfeeding relationship. Conversely, if she grits her teeth for every feeding and counts the minutes until it is over, then breastfeeding may be contributing to her symptoms and hurting her relationship with her baby.  We need to talk about why breastfeeding is stressful, and whether there are strategies that can make the experience better — or whether she and her baby would be better served if she weaned.
This is what we need: More working with mothers on an individual level and allowing room for protecting the breastfeeding relationship and offering strategies that take into account the whole picture, and less talk making the assumption that it’s breastfeeding that is the problem. I would have liked to see the essay that prompted this blog post to leave room for the possibility that a mother wants to keep breastfeeding, and that her breastfeeding exists for more than trying to “prove something to someone.”
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4 comments

  1. I read Karen Kleiman's essay a couple years back and knew something important was missing, so I wrote her this: http://postpartumstress.com/2013/03/04/guest-blog-post-katie/ Wasn't crazy about the choice of bolded words. I do wish people in the PPD community like her would recognize the big potential for healing that a healthy breastfeeding relationship can provide.

  2. Thank you for writing that, Katie, and for sharing it here! You did a wonderful job telling your story, and I hope it can make a difference for other moms.

  3. I loved the last paragraph! Sometimes breastfeeding is the only thing that IS going well for a postpartum mom. Many medical and mental health professionals still fail to see the importance of a positive breastfeeding relationship.

  4. The thing that’s missing from these questions and I think is generally missing in considerations of bfing and PND is the effect of a traumatic birth. A traumatic birth is one of the biggest factors in PND (though of course not the only one, it is a complex issue). It’s also a factor likely to interfere with bfing.

    For example on the issue of proving something, after a traumatic birth a mother might feel she has something to ‘prove’ with bfing if she feels she’s ‘failed’ in some way by not being able to have an intervention free birth.

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