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.

The Burden of Proof

October is a busy month for me. I usually travel twice that month, once for the American Academy of Pediatrics Section on Breastfeeding Medicine meeting, and then again for the annual Academy of Breastfeeding Medicine meeting. One of my partners (who doesn’t have children) comes up to me and says: “Why are there so many meetings about breastfeeding? I mean we all know that’s the best thing for babies and we all should recommend it. How many meetings, research studies do you really need?” At first, I was stunned…not bad, not good, just surprised, I guess.

This reminds me of when I had invited Dr. Christina Smillie to Children’s Hospital of the King’s Daughters (CHKD)/Eastern Virginia Medical School (EVMS) to speak at our 1^st Virginia AAP Breastfeeding conference in 2009. The first night I had her speak to the MPH school at EVMS. As Dr. Smillie always does, she gave a wonderful talk on the public health reasons, risks of death with sub-optimal breastfeeding, how breastfeeding is natural, etc. After 60 minutes of slides, statistics and videos, a male public health researcher raised his hand and asked: “So why isn’t everyone doing this…why aren’t BF rates at a 100%?” Dr. Smillie and I just smiled knowingly at each other.

After I thought about it, I explained to my partner that while there is so much new research/things discovered about breastmilk and its properties, I told her, that as a field, Breastfeeding Medicine is constantly battling critics and having to ‘prove’ our medicine. Whether it’s against the various industries, hospital systems, colleagues, or even other physicians, Breastfeeding medicine has to prove its worth. I was telling another ABM member about this conversation and I remarked at how I had attended an acne lecture at the AAP conference. As a general academic pediatrician, I wanted to get some new information, learn the research on various conditions that I commonly see in my practice. And it hit me like a ton of bricks. The dermatologist, while very knowledgeable and a good speaker, was quoting statistics from the 70’s and 80’s…that would be 1970/1980. Of course she spoke about the newer drugs being used, but the pathophysiology and meds/ointments used to treat this condition, well that data was over 25 years old!

The First 1000 Days

The Annual ABM Meeting in Chicago this year was amazing–truly one of the best. Kudos to the conference planners, staff, and faculty.  I was particularly interested in 1000 Days: The Window of Opportunity by Lucy Martinez Sullivan, MBA.  Some of you may be familiar with this organization, but since I wasn’t, let me give you a bit of background.  1,000 Days

is a partnership between governments, the private sector and civil society organizations which promotes targeted action and investment to improve nutrition for mothers and children in the 1,000 days between a woman’s pregnancy and her child’s 2nd birthday when better nutrition can have a life-changing impact on a child’s future and help break the cycle of poverty…The partnership serves as a platform to encourage investment and strengthen policies to improve early nutrition in the developing world in alignment with the Scaling Up Nutrition (SUN) Framework, an approach that seeks to coordinate and accelerate international efforts to combat undernutrition.

It really is amazing that this organization is bringing together so many different types of organizations from all over the world to fight malnutrition and undernutrition.  It makes sense that Ms. Sullivan came to speak to a room full of lactation specialists, right?  It makes perfect sense since breastmilk is the normal nutrition for a baby/infant/toddler–and gives that child the best chance of survival.  Nutrition from breastmilk is important for all babies, but especially vital for those born in developing countries since this can mean the difference between life and death.

Physician Mothers: How do we fare with breastfeeding?

A recent study published in the Breastfeeding Medicine by Sattari et al looked at breastfeeding intentions of female physicians.  They looked at breastfeeding behavior of these women at 3, 6, and 12 months.  Not surprisingly, of the 50 women surveyed, 100% of these physicians had intentions of long-term breastfeeding.  However, as the results showed, the rates of exclusivity/any breastfeeding declined as the women were followed. Although the sample size was small, it brings to light many of the issues women physicians face when going back to work.

Physicians know the benefits of breastfeeding, and it’s interesting to see that most plan on breastfeeding.  The authors point out that not only does breastfeeding benefit the mother and her baby, but our personal stories can usually help a patient.  In my case, breastfeeding didn’t come easy.  My personal struggles to provide breastmilk for my 3 children have helped me counsel mothers in my pediatric practice.  But ironically, even though I work in a field that should obviously support breastfeeding, this wasn’t my experience.  I struggled with finding the time and space to express milk—and yes, I did pump in a bathroom stall!! Ironically, it was after my 3^rd child, when I was working in a Pediatric emergency room, that I was given the most support: nurses told me in the middle of my shift to go pump, with my director even offered me a hospital-grade pump!!

This study highlights that specialty and stage of career can and do affect breastfeeding longevity.  Attendings are generally in the best position to alter their schedule to accommodate pumping breaks, as opposed to residents.  During residency and fellowship, I had many friends who chose to breastfeed only for the 6 weeks of their maternity leave, or found, after returning to work, that the long hours and stress of call nights severely diminished their supply.  A primary care specialty is more likely to be favourable, compared with a surgical specialty where women struggle to find time to pump during the day.  The authors point out that the logistics of timing of surgeries and proximity of lactation rooms make it difficult for women in surgical subspecialties to express milk.  I’ve seen this among my friends as well—regardless of stage of career.  One friend mentioned that due to the timing of the cases and fear of missing an interesting case, she would have to choose between eating or pumping since there wasn’t enough time to do both.

Although the study didn’t address this, I suspect that many women in surgical specialties still have to deal with the fact that they may still be in a male-dominated specialty, and bringing up the topic of time and space for expressing breastmilk would not be well-received.

As the RRC has instituted a decline in resident work hours, this may work favorably for women doctors who choose to continue to breastfeed.  However, every woman, every specialty, and every institution is different.  What works for one may not work for another.  But I have to ask: with the passage of the new health reform bill and the increasing popularity of the Business Case for Breastfeeding, can these programs catalyze change within our medical specialties?

There is a light on the horizon. As a breastfeeding community, our efforts to educate and advocate have put the terms breastfeeding, expressing breastmilk, and workplace in the forefront.  10, 5, or even 3 years ago, we wouldn’t even be having this discussion.  My hope is that with this increasing attention, women in the medical field will feel that they have more options to continue nursing after returning to work—regardless of specialty, work hours, or stage of career.

I ask my medical colleagues: what were your experiences, and what changes can make to support our own?

Natasha K. Sriraman is a general pediatrician and a 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.

The Breastfeeding Cheerleader

Support of our peers is important in so many aspects of our life, and for women it is very true for the new mother who is breastfeeding.  As we celebrate The Ten Steps to Successful Breastfeeding this week, we can’t forget the importance of breastfeeding support after the mom leaves the hospital with baby in tow.

Breastfeeding Backlash

Many of you may be familiar with Salma Hayek’s work: movies, television, humanitarian work.  To be honest, aside from seeing some of her films, I wasn’t really familiar with her work.  Then I began to hear her very distinctive voice in commercials. As a UNICEF spokesperson, Ms. Hayek was promoting Tetanus awareness in Sierra Leone with corporate partner, Pampers.  As part of the campaign, Ms. Hayek went to Sierra Leone in February 2009. While she was there, she was being filmed by ABC news. Then something completely unplanned, unscripted happened:  Ms. Hayek nursed a starving baby.

At first, when I read about it, I couldn’t believe it. Then, once I watched the news footage, I was moved, in awe, and speechless.  Needless to say, Ms. Hayek became much more than a ‘Hollywood actress’ to me. At the time, Ms. Hayek was nursing her then one-year old baby; ironically, the African baby she nursed was born on the same day as her daughter.  During the interview, she explained her reasons for nursing a baby she just encountered: with permission from her mother, who was so malnutritioned that she didn’t have enough milk, she wanted to help nourish a starving baby.  She explained that her great-grandmother nursed another child in Mexico (wet-nurse or cross-nurse) under similar circumstances.  Initially, she felt as though she was betraying her own child by nursing another baby, however, she realized that her daughter would be happy with her decision to help this baby.

You don’t have to be a lactation consultant or breastfeeding advocate to acknowledge and appreciate the complete selflessness and beauty of Ms. Hayek’s gesture.  I’m sure many of you, if faced with similar circumstances, would do the same.

Then a couple of weeks ago, Selma Hayek was in the news again.  In this month’s In Style Magazine, when asked about her breastfeeding the baby in Sierra Leone, Ms. Hayek revealed that not only was she shocked with all the attention her act received, but surprisingly, she received a great deal of hate mail.  Many people were offended that she breast-fed a black child.

WHAT??!!  I had the same questions many of you may already be asking: How can a beautiful, maternal, selfless act of feeding a starving child garner such hatred and racist remarks?! To be honest, after my disbelief, I was moved to tears…first happiness by her selfless act, but then sadness to the backlash she faced.  Maybe I’m nieve, but to make this act into a political, racial, or any polarizing issue completely baffles me.  Whether or not people support breastfeeding, others shouldn’t judge. Ms. Hayek not only gave a baby life-saving nutrition, but also gave the mother a much-needed respite to heal her own body, so that she could eventually make enough milk for her own baby.

Although such a simple gesture, it spoke volumes.  It demonstrated how empathy can transcend social, political, and racial boundaries.  Her gesture was 100% genuine, done only with the best intentions.  It was not a photo-op or media stunt–it was just Ms. Hayek’s maternal instincts shining through.

All I can say to those people who were offended and worse, put a racial tilt on the whole scenario, my guess is, these people have never been faced with nor experienced that kind of immense poverty faced by so many in Third World Countries. Kudos to Salma Hayek…for your act of kindness and being an inspiration to so many of us.

Natasha K. Sriraman is a general pediatrician and a 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.

Appearances Mean Everything…or Do They?

What does it mean when a pediatric health professional group makes a video on behalf of the Infant Formula Council (IFC)?  Do they, in some ways, becoming the ‘face’ of the organization??

This is the question that crossed my mind when I heard of NAPNAP’s (National Association of Nurse Practitioners) plan to partner with the Infant Formula Council (IFC) to film an educational video on infant formula preparation.  Why, I wondered, do you need a pediatric health professional to show the general public, mothers, women how to properly mix formula? Why can’t an IFC member do that?

Conflict of Interest: The connections between ABC News, Dr. Beard, & Nestle

As many of you already know, a recent Harvard study by Bartick and Reinhold, showed the cost savings and lives saved if babies were breastfed exclusively for 6 months.   Especially in this era of health care reform, it’s tremendously important that breastfeeding (which doesn’t cost any money) could actually save the US health care system $13 billion dollars per year!

Most of the media coverage regarding the statistics was positive, including reports from media outlets such as  CNN and CBS News.

However, as with many studies, especially those showing the benefits of breastfeeding, there were a few who challenged or disregarded the impressive findings.  One of the detractors of the study was Dr. Lillian Beard, a pediatrician and professor at GWU and Howard Universities.  Instead of looking at the cost-savings, instead, she focused on the COSTS of breastfeeding during an interview on ABC News.

She is quoted as saying

“The biggest barrier to mothers continuing to breastfeed seems to be the fact that more mothers are in the workplace. It’s a very impressive number,” she said of the $13 billion estimate, “but I want to know: Did the study take into account the cost for breastfeeding mothers?” She goes onto say, “I think this report puts an unfair slant on it. It’s not taking into account that for almost two-thirds of U.S. families, women are either the co-breadwinner or the breadwinner. Returning to work is germane for the survival of the family.”

Many in the lactation community, including ABM, Best for Babes, Blactating.com, and the Motherwear Breastfeeding Blog all questioned why a medical professional from the pediatric community would question the study findings.  And why did ABC choose Dr. Beard to respond to the study findings, instead of using their own medical correspondent?

It turns out that ABC Family has teamed up with infant formula giant Nestle for several commercial promotions and sweepstakes.    Furthermore, Dr. Lillian Beard, Professor of Pediatrics, sits on the Nestle Board and is one of their paid speakers!! Luckily, via the internet, including the very active ABM Facebook page, ABC and Dr. Beard’s connections to Nestle were exposed and addressed rapidly.

Jerry Calnen, ABM President, addressed these concerns in a letter to ABC News: