Stop Blaming Breastfeeding for Maternal Mental Health Issues

maternal_depressionIn an article published in The Washington Post on March 3, 2016, three physician authors, Vivien K. Burt, Sonya Rasminsky, and Robin Berman caution that despite its many documented health benefits for mother and baby, breastfeeding is not best if it leads to maternal stress, guilt and shame.

The authors are reproductive psychiatrists who treat mothers in the childbearing years for mental health issues, and all three share their own breastfeeding stories in the article. As professionals in the field of maternal mental health they failed to follow their own advice when encountering breastfeeding difficulties. Instead, they punished themselves emotionally, despite the fact that in their professional practice, they “see far too many tearful new mothers for whom breastfeeding is a source of self-recrimination.”

One author stated “For me, nursing was harder than medical school. My milk was slow to come in and my baby howled whenever I put him to the breast. It hurt so much that I cried. I was so determined to feed him breast milk that I didn’t realize that he was getting dehydrated.” This heartbreaking quote demonstrates that when breastfeeding doesn’t go as planned, mothers blame themselves first. Over time, this internal guilt often turns on the bearers of the breastfeeding message. We need to shift the blame from the mothers and the messengers to the systems surrounding mothers for breastfeeding failure.

The scenario described above is an all-too-typical example of how even well-educated, motivated women with ample financial and health care resources struggle because they do not receive timely education, skilled assistance, emotional support, or time away from other obligations that is often necessary for breastfeeding success. They didn’t fail, we failed them; as a society, as health care providers, employers, legislators, and as a community. We as a society do not give mothers the education and on-going support they need to be successful at breastfeeding. Mothering is a social activity, not done well in isolation.

Many mothers have never seen a breastfeeding newborn before having their own. Their obstetrician never talked to them about breastfeeding, and did not explain how medications and interventions during labor can cause breastfeeding problems. Few mothers have their baby placed skin to skin immediately following birth, nor are they told how important skin to skin contact is for triggering baby’s breastfeeding behaviors and milk production.  Few mothers have a lactation professional at their place of birth to help with initial concerns, or in-home professional support to continue to answer questions as they arise.  As a result, moms are left to struggle alone.

Once started, breastfeeding difficulties tend to snowball. Most new mothers are not taught that newborns are proximity seeking, and parents are commonly surprised when their baby likes to be held and breastfed often. Because of other household obligations, mothers do not sleep when baby sleeps, and wind up with sleep deprivation. The weariness being on call 24/7 with a newborn baby takes its toll on a new mother.

Often mothers are not surrounded by knowledgeable and supportive peers who offer both reassurance and practical help with food, laundry and older children.  They may have little to no paid time off from work, and may have to worry whether their employer will be supportive of their desire to pump milk at work.  When mothers are not provided with correct information, knowledgeable supportive professionals, and the time necessary to make breastfeeding work, it’s not surprising that many are forced to abandon their breastfeeding goals.

Research shows that breastfeeding is a protective factor against postpartum depression – but only if it works. If it doesn’t, breastfeeding difficulties become a risk factor for postpartum depression in their own right. When we blame postpartum depression that follows breastfeeding failure on breastfeeding itself, we are targeting the wrong culprit. The mark should be on the lack of adequate systems without which breastfeeding is often fated to fail, no matter how hard an individual mother struggles to make it work. It’s harder to be angry at “lack of systems” than at breastfeeding advocates.

Mothers want to breastfeed, but the cumulative effect of their barriers often proves too much for many of them. The frustration, anger, self-recrimination and shame mothers feel when they do not meet their breastfeeding goals are real. This is not a breastfeeding problem. This is a community health problem.

Let’s stop blaming breastfeeding, breastfeeding mothers and breastfeeding advocates for the mental health problems that surface when breastfeeding fails. Let’s place the blame squarely where it belongs: on the lack of adequate support systems for breastfeeding mothers.