Postpartum Depression
Do you know anyone who acts “hormonal” around the time of her menstrual period? Well, during pregnancy there is huge increase of the hormones estrogen and progesterone, and they drop drastically when the placenta is delivered. The shift in hormones can cause some moms to experience Baby Blues in the days and early weeks after birth, as their bodies adjust to the new hormonal levels. Other moms are more sensitive and take longer to recover, or find that the Baby Blues become Postpartum Depression.
About 15% of new mothers are affected by postpartum depression (PPD). Conventional wisdom claims that breastfeeding prevents PPD. But does it?
It’s hard to tease out if breastfeeding is really preventative, or if not breastfeeding can cause depression, or if prenatal depression can cause a mother to stop breastfeeding her baby (or never begin).
In the past, researchers found that women with depressive symptoms reported more breastfeeding problems. Does a depressed mother’s negative mood, low self-esteem, and anxiety change the way she views common breastfeeding problems? Stress and pain can inhibit letdown, which may cause the baby to suck harder, causing more pain and continuing the cycle. Is her depression making a painful latch hurt more, or is anxiety leading her to excessively worry about baby’s milk intake…or even interfering with letdown?
One study found that if a mom was depressed before giving birth, she was more likely to wean earlier (or not start breastfeeding) than moms who weren’t depressed. Moms who breastfed longer found they reduced their symptoms of depression.
Interestingly, this study didn’t find a connection between exclusive breastfeeding and depression. Instead, at three months after birth, they found that the more often a mom breastfed and the higher the percentage of breastmilk feedings in non-exclusively breastfeeding moms, the greater the decline in her depressive symptoms over time!
Could oxytocin be the reason? Oxytocin is the hormone that causes milk to “let down” when breastfeeding, and it’s the “cuddle chemical” that is released when bonding with baby…and with your partner. Moms who are breastfeeding frequently throughout the day will have more oxytocin flowing throughout the day than moms who are spacing feeds or feeding more supplements than breastmilk. Interestingly, a recent study found that at 8 weeks postpartum, moms with higher levels of depression had lower levels of oxytocin, and responded differently when the researchers gave them oxytocin nasal spray.
A mother and baby who are engaged with each other both release oxytocin. A quiet, alert baby with a strong suck can move more milk and establish milk production to meet his needs. An anxious mom may interact with her baby less often and therefore breastfeed less, driving down her milk production. Less responsive moms may be more intrusive when the baby isn’t ready to interact.
Addressing a woman’s anxiety and depression may help her cope better with her new life as a mom, not just help with breastfeeding.
Before giving birth, let’s set up our postpartum support system to reduce the stress after birth: Who will help out with cooking, cleaning, and shopping so mom can nap when the baby sleeps? Who will take care of her while she takes care of her new baby?
Moms should be screened for depression by their health care providers during pregnancy and after birth. Moms with PPD need appropriate therapy (our own Jen Leopold is a therapist!) or treatment, or medications that are compatible with breastfeeding. Perhaps hospital discharge papers should include the Edinburgh Postnatal Depression Scale for moms to hang on their fridge and fill out every week. With a weekly review, moms can see if their Baby Blues are lifting, or if they need to ask for help.
