A complex, bidirectional relationship exists between early cessation of breastfeeding and perinatal depression and anxiety. Hence, it is important for breastfeeding support to be provided to mothers with Perinatal Depression and Anxiety (PNDA), both antenatally and postnatally.
The information and support required will vary depending on a mother’s breastfeeding goals, feelings about breastfeeding, their support network, diagnosis, medications, and any breastfeeding problems they have had. Having a positive experience of breastfeeding support has been related to improved maternal psychological health. An individualised approach is vital.
Continuing breastfeeding may be beneficial for mothers with PNDA as the breastfeeding hormones, including oxytocin, lower inflammation and the stress response, and promote relaxation and nurturing. Breastfeeding helps mothers sleep, as breastfeeding mothers are more in-sync with their baby’s sleep cycles and this combined with the breastfeeding hormones help mothers fall back to sleep easily after a breastfeed.
However, this may not be the case for all mothers with PNDA and, in some cases, having another caregiver or support person available to take the load of other household tasks can enable her to continue with breastfeeding. In very few extreme cases, breastfeeding-related difficulties may compound the mother’s mental health issues and she may require support transitioning to mixed-feeding or weaning.
Medications, weaning and relactation
There are few medications which preclude breastfeeding. Doctors and pharmacists can use their expertise and knowledge of medications to support the mother with combining breastfeeding and any medication she may need for her PNDA. It is important to recognise that product information provided by pharmaceutical companies may provide little or no information relating to a medication’s safety in lactation or be legally defensive, hence may err on the side of caution and not provide the full picture to make informed decisions.
Other sources about medication and breastfeeding include NPS Medicines Line (1300 633 424), which mothers can be encouraged to phone, and Lactmed, a free online database with information on drugs and lactation aimed at health professionals and the breastfeeding mother. The Australian Breastfeeding Association (ABA) has a useful table listing resources for information about prescription medications and breastfeeding: https://abaprofessional.asn.au/prescription-medicines-and-breastfeeding
While in most cases mothers with PNDA can be supported to continue breastfeeding, in some cases there is need to support mothers with PNDA who have chosen to wean. Some may be looking for permission to wean or some may have already weaned.
Different mothers have different emotions around weaning. If a mother finds weaning an emotional experience and her identity as the one who feeds her baby is important to her, she can be encouraged to ensure bottle-feeding is still a special time for mother and baby and something only she does for her baby. Just because other people can feed a bottle-fed baby does not mean they have to.
Conversely, you may encounter a mother who has already weaned but wants support to relactate. This is a reasonable option for mothers even if they are not able to bring back a full milk supply. Any breastmilk they provide for the baby has immunological and nutritional benefits. While the process of relactation takes much dedication and support, mothers whose stories are included in ABA’s Breastfeeding: relactation and induced lactation booklet (2018) describe it at as a fulfilling and healing process.
In providing breastfeeding support to the mother with PNDA, it is important to validate her feelings, her opinions, her decisions, wherever she is at that moment even if it seems she is not very well at the time. Encourage and affirm her for seeking support even if she has mentioned something like wanting to use donor milk or choosing to relactate and it seems unusual or unfamiliar.
Encourage her to contact the ABA for some breastfeeding counselling around such issues or encourage her to access its website so she can make an informed decision about breastfeeding alongside her recovery from PNDA.
Part of the breastfeeding support can include referring expectant and new parents to the ABA, which has many resources.
Key messages
- Receiving breastfeeding support can help a mother with PNDA to overcome breastfeeding difficulties and improve her mental health
- Few prescription medications preclude breastfeeding, but PI may offer a cautious approach. There are dedicated prescription medicine helplines in each state
- Sometimes breastfeeding does not work out and mothers may need practical and psychological support to wean or even to restart (relactation).
– References available on request
Author competing interests – nil