Postpartum Mood & Anxiety Disorders in Breastfeeding Mothers: To Treat or Not To Treat

May 2^nd is World Maternal Mental Health Day.  Here in my home state, The Governor and General Assembly, back in 2015, declared May as Maternal Mental Health Month in the Commonwealth of Virginia.  The Blue Dot Project has defined this year’s Maternal Mental Health Week (#MMHweek) by removing the stigma of perinatal mood and anxiety disorders. Women (and men) all across the world are posting their stories (with a pastel blue dot) about the trials and tribulations of parenting, while showing the face of postpartum anxiety and depression.  #noshame #realparenting

On my iPhone early this morning, I saw a #MMHW post where a women posted a picture of her feeding her child with a bottle. She told her story about the guilt she felt (and still feels) about not being able to breastfeed her child and how that exacerbated her depression.  What followed were comments by so many other moms, how they also felt that guilt when their ‘body didn’t work’ making them unable to breastfeed their child.  Many of these women commented on how they felt shame when giving their child a bottle in public.

As a pediatrician with an interest breastfeeding medicine and postpartum mood and anxiety disorders (PMAD), I am faced with this question frequently. Although we screen in our pediatric health system for PMAD, many women still do not get the help they need. While there is a paucity of resources in some areas, many women are still afraid to get the help they need.  When I speak on this topic, I often am approached by and/or contacted by women, mothers who know they need help but are too afraid because they are breastfeeding.  One particular mother, a woman who worked in the healthcare field, knew that she needed to see a therapist, but told me “breastfeeding is the one thing I can control, and I don’t want to stop if I need medication.” Years ago, a friend and I, a local perinatal psychiatrist, started speaking at conferences, at Grand Rounds, and met with OB and Psych department faculty.  During this time, we realized how much misinformation was out there. Many physicians told mothers to stop breastfeeding before they would restart their medications (often SSRIs).

Luckily, this is changing. Now what I see is that mothers often take themselves off their medications during pregnancy for 1) fear of harming the fetus and 2) they won’t be able to breastfeed.  The Academy of Breastfeeding Medicine (ABM) has written a protocol so that all health professionals have access to evidence-based medicine when treating PMAD in breastfeeding mothers.

As a pediatrician, I am also in the position of supporting moms who decide to stop breastfeeding.  If breastfeeding is worsening her ability to sleep, increasing her anxiety, and generally making mom’s mental health worse, as pediatricians, when we see the baby (and mom) so frequently in those first few months, I can (and I have) tell mom that it is okay to stop and/or limit breastfeeding. There is no shame in giving the baby formula; the mom has to do what is going to help her get better.  Many times, that helps. Sometimes it doesn’t. This is a decision that she must make. However, for many moms, receiving that validation that they are allowed to stop breastfeeding is a relief for them, and hopefully minimizes their guilt. What we can do is to empower our mothers so they know that they are doing what’s best for their baby…while also taking care of themselves. Happy Mommy=Happy Baby.

Natasha K. Sriraman is a general pediatrician and an Associate Professor of Pediatrics at Children’s Hospital of The King’s Daughters/Eastern Virginia Medical School in Norfolk, VA.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.