Breastfeeding and maternal mental health

This week is maternal mental health awareness week and so it’s important that we speak up about the often misunderstood relationship between maternal mental health and breastfeeding. I hope this blog complements the fantastic offerings from Dr Wendy Jones’s live Facebook session in conjunction with the Perinatal Mental Health Partnership, and information offered by Dr Louise Santhanam of GP Infant Feeding Network (GPIFN). Both the Facebook session and GPIFN website are must-reads to any breastfeeding mother who is concerned about her mental health (that’s all of us by the way) or indeed for dads, partners or grandparents or anyone supporting a mother. It’s also the week BfN have been told that there is no funding available to continue breastfeeding peer-support in Blackpool. Since 2007 Blackpool Star Buddies have helped thousands of parents, babies and families to breastfeed against the odds and it is disappointing that such a high-performing scheme is being forced to close. Yet, still feeling the glow of BfN winning Charity of the Year award at the Mama Conference 2017, I am trying to work out how to feel about these highs and lows that are hitting the world of infant feeding, the charity sector and parents and families who are seeing services declining.

For those of you who had never thought about the connection between breastfeeding and maternal mental health or those who aren’t convinced, please read on. For those of you who are well versed in this you may want to make a friend a cup of tea.

The relationship between infant feeding and mental health is complicated, not least because a mother’s pre-natal mental state, pregnancy and birth experience can all result in stress and trauma – all of which can influence how a mother feels about breastfeeding. In other words the cause and correlation between breastfeeding and mental health isn’t a tidy one – it’s complicated.

There can be a lot of pressure on mothers to breastfeed fuelled by the ‘being the best’ campaigns, only slightly softened by the addition of ‘be the best you can be’. We know that pressure is not good for mental health so let’s just stop this rhetoric now!

What you may not know is that evidence suggests that ‘not breastfeeding’ can significantly increase the risk of postnatal depression, particularly if a mother wanted and intended to breastfeed. A 2014 study of over 10,000 mothers found that those who didn’t plan to breastfeed and who gave formula from birth were significantly more likely to become depressed than those who planned to breastfeed and who did so exclusively for at least four weeks. The same study found that those who planned to breastfeed, yet were unable to do so were at a higher risk of postnatal depression. This research tells us that breastfeeding is important to women and that good support is needed for women who want to breastfeed, but also good support is needed for women who intended to breastfeed but who find themselves unable to do so. So why are breastfeeding peer support services being closed down?

Supporting mothers for over 20 years we at BfN know that establishing pain-free, comfortable feeding makes for a good breastfeeding experience. So, we have to break down the culture of silence around pain and offer mothers as much support as they need, especially on positioning and attachment (typical cause of pain can be poor positioning of baby at the breast). Pain and injury are not acceptable characteristics of breastfeeding – if you are experiencing pain, don’t suffer in silence – talk to a mum who knows about breastfeeding. Call the National Breastfeeding Helpline on 0300 100 0212.

Scientists are trying to understand the relationship between breastfeeding and maternal mental health. Some theories say that the act of breastfeeding supports the hormonal surges of both oxytocin and prolactin which encourage a mother to feel more relaxed and reduce anxiety. Also breastfeeding helps to regulate / reduce the body’s inflammatory response – depression is associated with inflammation.

We know that some GPs lack time, training and opportunities to support a breastfeeding mother who is experiencing issues with her mental health. GPs can lack knowledge on breastfeeding and often are not sensitive to the needs of someone who is breastfeeding, unwittingly overlooking the issues or value the mother places on continuing to breastfeed. So, it is important to encourage awareness and better training for GPs. Information for GPs is available through the GP Infant Feeding Network and through the BfN’s Drugs in Breastmilk Information service.

Perhaps most importantly we should all be listening to mothers carefully. They know their baby more than anyone else and their experience is informed by instinct and regular contact. If something isn’t going well for them they are the best people to explain the situation and they shouldn’t feel worried about how it is coming across. A non-judgmental approach is essential.

With services to support breastfeeding cut to the bone we are all going to need to understand breastfeeding better – partners, grandparents, friends of new mothers will need better information to offer support. It’s vital that we share information and research on the relationship between breastfeeding and maternal mental health.

Shereen Fisher is Chief Executive for the Breastfeeding Network @shereen_fisher