Supporting Breastfeeding

La Leche League Canada

The Continuum from Baby Blues to Postpartum Depression

on May 2, 2016

Almost every new mother has had experience with being completely overwhelmed and wondering what the universe was thinking leaving her in charge of a tiny human being. For most mothers, this feeling is mild and it passes as her pregnancy and birthing hormones wane, breastfeeding gets established and she starts to feel more in control of the pace of life with a baby. This feeling may come and go in waves over a few hours or days but it generally dissipates a few weeks after baby is born. This is the “Baby Blues” and about 80% of mothers experience it. Unlike the baby blues, postpartum depression (PPD) symptoms don’t fade away after a few weeks and in fact they can start at any time during the first year after birth. If the underlying causes aren’t dealt with, the symptoms may continue to get worse over time. Mothers experiencing PPD report feeling that they are not doing a good job of parenting, guilty for having had a child, despair that they will never feel happy again. They may have difficulty concentrating and making decisions. Often their appetite and sleep patterns are disrupted (beyond the level that is normal with a young baby in the house). Mothers experiencing PPD often become isolated because they don’t have the energy to get out of the house or to interact with other people.
A mother who is experiencing relatively mild postpartum depression may not recognize what is happening to her. Because our society expects women to be happy to have their babies and enjoying their new role as a mother, it can be hard for someone who is not experiencing this to feel safe speaking up about her feelings. Although she may be struggling with feelings of inadequacy as a parent, she may also be afraid of being judged for not being thrilled about life with a baby. One mother remembers her son’s first birthday and feeling a huge wave of relief that he had survived in spite of her (self-perceived) inept parenting. Looking back she recognizes that from that day onward, life felt easier and the joy came back into it. Neither she nor anyone around her recognized that she was dealing with PPD throughout that first year because she appeared to be functioning just fine.
Post-partum depression can also be confusing for those around the mother. Partners can be unsure of how to help or unable to understand that the mother can’t just “snap out of it and cope like other new mothers”. Older children may feel neglected and uncertain about the changes in behaviour from the mother they had before the new baby arrived. Newborns are at risk of long term health, social and behavioural problems if their mothers are chronically depressed because the depression prevents their mothers from engaging with them. When PPD is more severe, it is often those around the mother (partners, relatives and friends) who put together the clues and help her get proper diagnosis and support.

Meeting

La Leche League group meeting

Some of the predictors of postpartum depression are:
* previously diagnosed depression or other mental illness
* high levels of systemic inflammation
* pain from childbirth or breastfeeding
* the mother’s perception that she had a negative birth experience (this is different from having an actual negative outcome of the birth)
* having a baby with a “highneeds” or “intense” temperament
* a pessimistic personality
* a dysfunctional family situation
* lack of social supports
The Edinburgh Postnatal Depression Scale is the most common tool used to help diagnosis postpartum depression.

The treatment of PPD generally focuses around three major strategies: medication, getting enough good quality sleep and family/community support. Finding a combination of strategies that considers all these areas and respect the beliefs and structure of each family is of the utmost importance.
Lack of sleep is one of the biggest factors in exacerbating and dealing with PPD. One mother, whose four week old baby had only ever slept for 20 minutes stretches, found herself one afternoon hallucinating her husband’s voice downstairs. When she went downstairs to find out why he was home from work so early (for which she was deeply grateful) there was no one there. She recognized that things were not normal and called a friend who took her and the baby to the doctor. The mum didn’t feel that that the doctor’s suggestions were compatible with breastfeeding which was very important to her. There weren’t any postpartum depression resource groups in their town so she didn’t get a referral to a support group. Fortunately for her, the local La Leche League Group mothers offered suggestions from their own experiences and a combination of better breastfeeding technique and learning to nurse lying down worked for this family and helped this mother overcome her severe sleep deprivation. Some resources for mothers with postpartum depression have sleep promotion ideas which are not compatible with breastfeeding. Breastfeeding mothers who are struggling with sleep deprivation need support to find ways in which to maximize their sleep while not interfering with milk supply. Like all families, they need to figure out what will work best for them and it may need to be re-evaluated on a night-by-night basis in the early weeks and months.

Sleep
Many people are under the impression that breastfeeding is contraindicated when treating PPD with medication. This belief can make some mothers reluctant to consider medication as an option. Mothers who are considering antidepressant or anti-anxiety medication and who wish to continue breastfeeding may want to ask their health care provider the following questions:
Can I breastfeed while taking this particular medication?
If the answer is “no” then a follow up question would be “Is there an alternate medication that would be effective and compatible with breastfeeding?
Other treatments such as increased consumption of long-chain fatty acids, exercise, SAMe and Cognitive-Behavioural Therapy, either in a group or individual setting, can be discussed with the mother’s health care team and used alone or in conjunction with medication. The New Hampshire Breastfeeding Task Force’s documentA Breastfeeding-Friendly Approach to Depression in New Mothers” is an excellent resource for parents and professionals who want to look at all the options for treating PPD including drug therapy.

While successful breastfeeding can be both protective against developing PPD and helpful as one of the coping strategies, every mother will need to decide for herself whether to consider treatment options that are not breastfeeding friendly. “I know some mothers who suffered from PPD that felt incredible relief when they decided to stop breastfeeding, while others found their depression worsened. The decision to breastfeed or not is a very personal one and it is critical to recognize that breastfeeding is more important to some mothers than it is to others (whether that is biologically, intellectually, or emotionally determined).Katherine Stone

For more information check out Why Breastfeeding is good for Mothers’ Mental Health here.

Breastfeeding friendly resources for PPD can be found by clicking here.

Very occasionally (less than 1%) mothers with PPD have thoughts of hurting themselves or their baby. Immediate mental health help is needed in these cases. Often hospitalization and medication is required to stabilize their symptoms and to keep themselves and their babies safe.

https://www.lllc.ca/sites/lllc.ca/files/LLLConnections-2015-Issue-2_0.pdf in http://www.lllc.ca/publications

 

May 4, 2016 is World Maternal Mental Health Day

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

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LLLC Spring Appeal Campaign for the support of breastfed babies: Help LLLC Grow – If you, or someone you know, has benefitted from the support of LLLC, a donation is one way you can “pay it forward”.
Donate Today!
Over 385,000 babies are born in Canada each year and we want to ensure every mother has access to La Leche League Canada support whenever she needs it. We are working hard to grow and we need your support. Every donation helps us provide more support to more families!
Thanks to past donations, we have been working hard to grow our services:
Our volunteer Leaders are the cornerstone of LLLC and the support we provide. We have increased our Leaders by 10% in the past year and Leader Applicants by 40% over the past 2 years!
More than 13,000 mothers attend LLLC meetings and another 20,000 receive one-to-one phone support from Leaders.
We have doubled our community and health professional outreach in just one year!
5 new Information Sheets in various languages were made available free of charge to mothers and health professionals
A new Communication Skills program was developed to strengthen health professional and breastfeeding peer support skills and our Best for Babies pre-natal program continues to grow.
Our Leaders are a vital part of LLLC’s breastfeeding foundation. They freely devote their time to help other parents give their children the optimal start in life. You, the donor, make up the other part of the foundation on which the LLLC breastfeeding services rest. Your gifts mean that our Leaders can carry out the valuable help families need. Frankly, we would be unable to deliver services to families without you or our Leaders so please take a moment to consider how valuable your support is and make a donation, either online or by using our pledge form. If a one-time donation is not suitable for you, perhaps spreading your gift over a year would make sense. Our pledge form has the monthly donation option for your convenience.
We are proud of our growth – but we want to do so much more! We need your support to help us serve even more mothers. Please donate today so we can grow to serve the mothers and babies of tomorrow.
Thank you for taking the time to consider supporting La Leche League Canada and our continued efforts to support all breastfeeding families who need us.

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