Monday 19 February 2018

Depression a possible factor in breastfeeding difficulties

The link between breastfeeding and post-natal depression has been extensively researched. Photo: Getty Images
The link between breastfeeding and post-natal depression has been extensively researched. Photo: Getty Images

Patricia Casey

Breastfeeding Week ended yesterday. The World Alliance for Breastfeeding Action is hoping to raise awareness of links between breastfeeding and the Global Goals for Sustainable Development. Despite its obvious value, I am always surprised when I ask expectant mothers if they intend breastfeeding their newborn babies.

Of course some are enthusiastic but many have definitely decided against this for a variety of reasons. One that crops up among my patients is that they tried it before and it didn’t go well. They are afraid that if they try it and fail, that it will intensify their sense of failure or perhaps make them depressed. And since some of these women will be attending me with pre-existing depression, and others because they want to prevent a recurrence of their previous depression, this is a not unreasonable concern to have. Or is it — does failing at breastfeeding increase the risk of developing depression?

The lack of enthusiasm for breastfeeding among Irish women is supported by data from several sources. A study in the Lancet in early 2016 showed that Ireland has a shockingly low rate, at only 55pc, the lowest of the 27 highest income countries in the world and according to the Growing Up in Ireland study, 56pc reported that their child had never been breastfed and only 6pc were still exclusively breastfeeding at six months. These figures are dramatically less than the European norms.

Everybody knows that breastfeeding is good for mothers and for babies. Not only does it intensify the bond but it also boosts the baby’s immune system. For the woman it reduces her risk of breast cancer, especially if it lasts over a year. So when a woman does all she can to give her baby a good start in life, yet fails in this most universal of feeding methods, her perception of herself as a good mother may be dented. She may feel guilty and ruminate about it. Of course some will just accept this and get on with being a good mother anyway, but it may cause doubt and self-questioning in others. This is especially true if her friends and peers are enthusiasts.

The link between breastfeeding and post-natal depression, if any, has been extensively researched. It is known that curtailing breastfeeding and ending it before the recommended period of six months is linked to an increase in the risk of depression. Is this because the woman is already depressed and that the depression impacts on her ability to successfully breastfeed? Alternatively, is it that the relaxant effects of breastfeeding are followed by an increase in anxiety and depression when it finishes? It is known that breastfeeding stimulates the production of oxytocin, a relaxant hormone, and so if breastfeeding is abruptly stopped, it is possible that baseline anxiety/depression may increase. Finally, if the person’s innate coping ability is poor, then demands of breastfeeding may further compromise and exacerbate the person’s vulnerability. Studies from a variety of countries including the US, Denmark Australia, Britain among others have confirmed that all three factors provoke effects of breastfeeding discontinuation and the role of pre-existing problems with coping.

The implication of these findings is that when a new mother describes problems with breastfeeding, she should be screened for post-natal depression and treated for this if it is diagnosed. Post-natal depression can impact on the mother-baby relationship and on the infant’s development if untreated. Young mothers are invariably reluctant to take medication that they fear will harm the baby. There are now medications that are not secreted in breast milk to any extent and so nursing mothers can be reassured. The scales are definitely tipped in favour of receiving evidence-based treatments for post-natal depression, rather than not. Talking therapies may also be helpful in some, but not all cases, especially when the symptoms are severe and impact on day-to-day functioning.

If depression is not present but yet the mother describes feeding difficulties she should receive breastfeeding support. Other relevant factors that studies have identified relate to the relationship between the woman and the father of the child as this can also impact upon her motivation and willingness to breastfeed, but this may be difficult, if not impossible, to modify.

“Breast is best” as the slogan goes and most mothers agree. If a young mother cannot initiate breastfeeding or sustain it, enthusiasts might be tempted to point the finger and hold laziness or disinterest as responsible. In many cases it is a marker for possible depression and for lack of support from the partner. Reassurance and, when necessary, treatment is what is required, not criticism or judgement.

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