In our clinic, we often see women who come in for the treatment of depression and/or anxiety after the cessation of breastfeeding. Many question if breastfeeding may protect against postpartum depression and if the cessation of breastfeeding is a trigger for postpartum depression and/or anxiety. However, the research examining the association between postpartum depression and breastfeeding has been somewhat difficult to interpret.
A new study (published in its entirety on Medscape) explores the link between breastfeeding and postpartum depression and anxiety. Researchers examined data from 42,225 pregnant women in the Norwegian Mother and Child Cohort Study, a prospective, population-based pregnancy cohort study performed by the Norwegian Institute of Public Health. Levels of depression and anxiety were assessed at 17 and 30 weeks gestation and at 6 months postpartum. Additional information was gathered from the Medical Birth Registry of Norway (MBRN).
The findings:
- Women with anxiety or depression during pregnancy were more likely to stop breastfeeding before six months postpartum
- Breastfeeding cessation was associated with an increase in levels of anxiety and depression
- Women with anxiety and/or depression during pregnancy experienced a greater increase in depression and anxiety after breastfeeding cessation than women without depression or anxiety during pregnancy
This is the largest study to date examining the association between breastfeeding cessation and postpartum depression and anxiety. Some questions remain. Would treating symptoms of depression and/or anxiety extend the duration of breastfeeding? If women had more support around breastfeeding, would this help to decrease levels of depression and anxiety? What is clear is that women who experience depression and/or anxiety during pregnancy are an extremely vulnerable population; not only are they more likely to stop breastfeeding early, they are also more likely to experience worsening of their symptoms after breastfeeding cessation.
Ruta Nonacs, MD PhD
Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth 2012;12(36).
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As a nurse who works with postpartum women and infants, I feel there is definitely an association between cessation of breastfeeding and postpartum depression.
It seems me that often this connection is often interpreted in the following way: Women stop breastfeeding, they become depressed. Therefore, breastfeeding is preventive for postpartum depression.
I feel that the reason a good portion of women who become depressed after stopping breastfeeding isn’t because they simply stopped; it’s because they tried and either couldn’t do it, or it became too difficult and then they decided to, or had to stop. Possibly, their babies didn’t latch, they had delayed LOG, supply issues, cracked bleeding nipples, or any number of other problems that can happen while breastfeeding.
Women are very strongly encouraged by the media, doctors, nurses, etc to breastfeed; basically they are told that they will be putting their babies at risk for all sorts of chronic, serious, and scary conditions if they don’t. They are also often given the impression that every woman can breastfeed, if there are problems, those can and should be surmounted.
The ease and success of breastfeeding is not a given. I have spoken to many women who have tried everything, gotten plenty of help and still couldn’t exclusively breastfeed. The guilt and frustration these women feel is heartbreaking. I’ve also spoken to a handful of women whose fully breastfed infants have been admitted for dehydration. There is plenty of research out there on breastfeeding failure and low milk supply that seems to be ignored in most breastfeeding literature for the general public.
Of course new mothers are going to feel depressed if they are unable to successfully breastfeed their babies, and quit early. They are sleep deprived, their hormones are out of balance and they feel like failures–they are probably thinking…. I can’t feed my baby, and now he might grow grow up with asthma, allergies, diabetes, eczema, become obese, and have a low IQ (even though the research to back up these claims is incredibly thin–but that is a whole different story), and it’s my fault.
I feel that if we took some of the pressure of of women to breastfeed at all costs, some of this PPD associated with breastfeeding cessation would decrease. Women need accurate information about the benefits of breastfeeding (not weak science and scare tactics) as well as a ‘head’s up’ that breastfeeding can be very difficult sometimes, and some women are unable to.
Studies to back up my claim of research on low supply and breastfeeding failure
http://www.ncbi.nlm.nih.gov/pubmed/11076327 125 infants dehydrated Kansas City
http://www.ncbi.nlm.nih.gov/pubmed/18265538 2.3% dehydrated
http://www.ncbi.nlm.nih.gov/pubmed/12949292 Risk factors for suboptimal infant behavior, delayed onset…..12% excess weight loss
http://www.ncbi.nlm.nih.gov/pubmed/16140676 Breastfeeding -associated hypernatremia: are we missing the diagnosis?
http://www.ncbi.nlm.nih.gov/pubmed/22348493 hyperbilliubinemia —1/4 BF babies — 2012
http://www.ncbi.nlm.nih.gov/pubmed/18279201 Breastfeeding associated neonatal hypernatremia — as study of 169 term infants. 4.1%
http://www.ncbi.nlm.nih.gov/pubmed/18265538 2.3% dehydrated
http://www.ncbi.nlm.nih.gov/pubmed/17496322 116 BF infants —Turkey