Breastfeeding and sanity are not mutually exclusive

Venn diagrams are useful.

If I had a dime for every time I heard someone say that someone should stop breastfeeding to save their sanity, I would be writing this from a villa in the south of France and not in my dining room surrounded by half-eaten peanut-butter-and-jelly sandwiches and babies covered in cottage cheese. Postpartum mental health is of the utmost importance, but one thing tends to be missing from much of the support given during this time: help that tries to protect breastfeeding AND a mother’s sanity.

An all-too-common scenario is that of the exhausted, sore, upset breastfeeding parent takes goes in for a well-child visit and, when asked how breastfeeding is going, answers honestly. Instead of referring parent and baby to a lactation professional, supplementing with or switching entirely to formula is suggested. After all, breastfeeding isn’t going well, and this parent is obviously upset and mental health needs to be considered for the sake of parent and baby. Certainly, giving permission to quit is best for everyone… right?

Or there’s another scenario, where parent and baby do connect with qualified lactation help, and receive instruction on how to pump after each feed, give baby a supplement of pumped milk—but make sure you don’t use a bottle—take this herb and eat these foods and drink X amount of water. Are you exhausted just reading that? How would you feel at a few days postpartum?

There are ways to make exclusive breastfeeding work without leaving a parent’s mental health out to dry. Most breastfeeding parents and babies do not need extreme measures for breastfeeding to happen. In our rush to DO SOMETHING to fix a problem, we can end up doing too much. Making breastfeeding too complicated makes mixing up a pitcher of formula and heating it up as needed seem like a very tempting proposition.

I hope most of you see the lack of logic behind offering formula as a solution to breastfeeding problems. Maybe even worse than this lapse in logic is the lapse in judgment: people want to breastfeed, and honoring their choices is important. As of 2010, 73.4% of women initiated breastfeeding (and consider that there are those who wanted to breastfeed but did not initiate it for whatever reason); obviously, breastfeeding parents consider breastfeeding to be important to them, for whatever reasons. Care providers would do well to keep this in mind.

Dissatisfaction with feeding method (which could mean that someone is not happy with how baby is being fed, or that the feeding method is not working out well) could be a risk factor for postpartum depression. Postpartum mood disorders can also contribute to a someone’s confidence in their ability to breastfeed. It’s a bit of a chicken-or-egg issue. Here’s a paper examining the issue; the conclusion seems clear that the goal should be to improve infant-feeding outcomes (that is, increase breastfeedig duration) AND help preserve the well-being of breastfeeding parents:

PPD is a serious condition that affects many women from diverse cultures. The review findings suggest that in addition to the well-documented maternal and infant health consequence of PPD, women in the perinatal period who experience depressive symptomatology may be at increased risk for poorer infant-feeding outcomes including decreased breastfeeding initiation, duration, and exclusivity. These findings support the need for early identification and treatment of pregnant women and breastfeeding mothers with depressive symptomatology to improve infant-feeding outcomes. Research to determine effective interventions to support depressed breastfeeding mothers is warranted.

“That’s all well and good,” you may be saying. “But how does any of that help when someone is struggling?” I’m glad you asked. Here are some suggestions:

  1. I sound like a broken record, but get lactation support from a lactation specialist. Your baby’s pediatrician or family doctor means well, but unless there’s an “IBCLC” after his or her name, he/she is not necessarily an expert in lactation, and “offer bottles” is NEVER the first solution to a breastfeeding problem. If your care provider is unable to offer advice that doesn’t work for breastfeeding, ask for a referral to a lactation specialist or seek one out on your own. La Leche League and Breastfeeding USA are two options for free peer-to-peer support.
  2. Seek lactation support that is compatible with your goals and honors your needs. If the lactation consultant you find gives you a laundry list of things to do that seems overwhelming, tell her that. Work together to try to find solutions that are doable for your family. If s/he’s unable to offer this to you, seek a second opinion. Becoming burnt out and resenting breastfeeding makes achieving goals more difficult.
  3. If you reach that point of desperation where you feel like your only choice is to offer formula, that does not point to failure. Pick yourself up, brush yourself off, and try again. Maybe that one bottle (or two) gives you enough energy to tackle the challenges you’re facing. (On the other hand, using expressed milk or formula instead of feeding at the breast on a regular basis can severely impact your milk supply and ability to meet your goals in the long run. My point is that “giving in” does not need to mean there’s no going back or that it’s been proven that breastfeeding doesn’t work for you and your baby.)
  4. Know that you do not always have to like breastfeeding. You won’t always like breastfeeding. it will sometimes feel inconvenient. It might sometimes hurt. You might feel touched out. This is all normal and common and okay. It does not mean you don’t love your child or are a bad parent, and neither does it mean you will always dislike breastfeeding. The first six weeks, especially, are hard, but many, many people report that breastfeeding is much more of a positive than negative experience after the initial hurdles are overcome.
  5. Sleep—get whatever you can. As everyone says, sleep when your baby sleeps. Learn about safe bedsharing/co-sleeping practices and see if those will work for your family. Hand off your baby (or babies) to a co-parent, grandparent, friend, relative, or postpartum doula and sleep on your own for awhile; babies will sleep more soundly if they’re held rather than placed in a bassinet, which means you might get the chance at more shut-eye. Here are more suggestions on maximizing sleep while protecting breastfeeding; this is very useful link because much of the information about how to get more sleep while a new parent does not take into account the importance of protecting and maintaining milk supply.
  6. Breaks—take them! Little breaks from a baby who seems to nurse constantly can be a lifesaver. Even if your little one has to cry in someone else’s loving arms while you shower, you’ll emerge from the bathroom refreshed physically and mentally, and it might be just a little easier to tackle whatever you’re facing. Sometimes partners feel left out of bonding because mom is always breastfeeding their new baby; instead of having someone give a bottle, just give them a baby and take a half hour or an hour to yourself. They’ll get time to get to know each other, and you will get time to recharge.
  7. You can sometimes give a bottle at night. Once your milk supply is established, which is normally around six weeks postpartum if breastfeeding is going smoothly, you might feel comfortable occasionally sleeping a longer stretch at night without waking up to pump. Sometimes a parent will say they want to pump so that a partner can give a bottle at night, but if exclusive breastfeeding is your goal, doing this on a regular basis is not advised. However, when it comes to mental health and feeling like there’s no way you can keep going without sleep, skipping a nursing session or pumping session occasionally is better than stopping breastfeeding entirely.
  8. Focus on healing your body and feeding your baby. It’s so tempting to get up and do things after giving birth. Sometimes the pleasure in doing things outweighs the stress it might cause, but that’s not always the case. Take pressure off yourself as much as possible: enlist others to help with household chores, have friends/family/strangers bring you meals, have friends take older kids out of the house for a trip to the park. Give your body time to heal from pregnancy and birth and yourself time to adjust to motherhood. Your baby is only tiny once, and no one can nurture your baby quite like you can.

In addition to the above, it cannot be emphasized enough that using (most) medication for (most) mental health issues does not mean you need to stop breastfeeding. Particularly with postpartum depression, anxiety, and OCD, the most efficacious medications (SSRIs) are considered to carry the lowest risk. If you have any questions about whether your medications are compatible with breastfeeding, contact THE experts on medications and milk at The InfantRisk Center.

Note: This was edited on October 12, 2016, to use language that is more inclusive and for clarity.