The postpartum period comes with many highs and lows. This is to be expected given the hormonal fluctuations and the new challenges that caring for a baby brings. The extent of the lows can be different for everyone, and for some it can be a time of increased susceptibility to depression and anxiety.
For many the decision and subsequent experiences around infant feeding can trigger intense emotional responses. Breastfeeding has been shown to be protective against postnatal depression, however, the pressure to breastfeed can have the opposite effect.
In this post we will explore what the research says in reference to breastfeeding and depression and how infant feeding choices and the experiences of these decisions can impact mental health.
What is the relationship between infant feeding and post-natal depression?
A research group completed a review of the literature on this question in 2022. They found that 29 studies observed that breastfeeding was associated with fewer symptoms of poor mental health. Only 1 study reported increases in symptoms of poor mental health related to breastfeeding and a further 6 reported mixed findings.
Much of the research suggests that mums who intend to breastfeed and go on to fulfill these intentions have reduced risks of depression or poor mental health postpartum.
In contrast, mums who intend to breastfeed and cease breastfeeding earlier than they wished are more likely to experience negative mental health. However, the causal relationship between the two is not fully understood and more research is needed to understand the complex relationship between breastfeeding and mental well being.
A recent study found that multiple factors were associated with postnatal depression, including being younger, having an unplanned pregnancy and not having a partner. This study found a significant, independent association between breastfeeding cessation and postpartum depressive symptoms after controlling for sociodemographic, environmental and obstetric factors.
The reasons for these associations are complex and most studies fail to explore the nuances. One study reports that women’s intention to breastfeed in pregnancy is associated with higher risks of postpartum depression when breastfeeding is not successful, and lower risks when it is. They also found a correlation between depression in pregnancy and postnatal depression.
Professor Amy Brown states that we know breastfeeding difficulties can increase the risk of postnatal depression, but that certain experiences likely increase this risk more than others. Her paper goes on to conclude that pain and physical difficulty were associated with the highest risk of postnatal depression in her studied cohort.
How does pre-existing anxiety or depression impact this relationship?
As mentioned above, depression during pregnancy is associated with increased risks of postnatal depression. Multiple large research studies report that prenatal depression and anxiety was associated with increased risks of postnatal mental health difficulties. Other factors that have been found to increase risk include having a history of depression (including postnatal depression), having a low mental health index, experiencing emotional distress during labour.
It is important for everyone to be aware that pre-existing difficulties with mental health may increase a mums risk of experiencing poor mental health postnatally. When risk factors are present, extra care may be required to ensure these mothers receive the support they need. If this is something that you are experiencing, make sure to bring it up with your midwife and health care team as early as possible.
Weaning and depression
A recent article published in Vogue addressed the question ‘Why does nobody speak about post-breastfeeding depression?’. The author talks about their own experience of weaning from breastfeeding and the depressive symptoms that followed. Their research for the article involved listening to the stories of women who experienced similar intense responses when they stopped breastfeeding. For most women mentioned in this article their symptoms were debilitating and lasted several months, something that is not discussed nor acknowledged enough.
The reasons for mood changes when ceasing breastfeeding are likely related to physiological factors including hormones, but they also come from a complex mix of grief for the stage that has gone and a reaction to the change in the mother and child’s relationship. Additionally, mothers are experiencing physical symptoms including breast fullness and pain, yet another change to their bodies as their breasts adapt to the final stage of feeding.
This article reinforces the necessity of talking about the impact weaning has on women’s mental health, and the lack of attention and research it has received to date. For mothers, it is another difficult phase in the journey of having a baby that can often be overlooked or misunderstood by others. Increased awareness is needed so that women can prepare for such a response. Awareness is also the key to improving the understanding and support for women experiencing this.
What should you do if you are struggling with your mental health postpartum?
If you are experiencing depressive or anxious symptoms after having your baby, reach out to a professional and ask for support, your gp is usually the best first point of contact for support and signposting to further care.
Reading about and connecting with others who are experiencing similar issues can be very helpful. Mother and baby groups are wonderful for this as they offer chances to connect with mums at similar stages of their postpartum journey, as well as giving the opportunity to listen and share your experience.
Talk to your partner, family or friends. Although it can be difficult, sharing what you are going through is important in order to get the support you need. Reach out to those closest to you and try to create time for conversation and connection.
There are also many wonderful support services available. If you feel you need to speak with someone and the above options are not possible or not helpful, the below websites can connect you to trained people who are ready to listen.
- Parentline.ie
- Samaritans.org
- Pandasfoundation.org
- Tommys.org
- aware.ie
- pieta.ie
References
Brown, A., Rance, J., & Bennett, P. (2016). Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing, 72(2), 273-282. https://doi.org/https://doi.org/10.1111/jan.12832
Chojenta, C. L., Lucke, J. C., Forder, P. M., & Loxton, D. J. (2016). Maternal Health Factors as Risks for Postnatal Depression: A Prospective Longitudinal Study. PLoS One, 11(1), e0147246. https://doi.org/10.1371/journal.pone.0147246
Eastwood, J. G., Phung, H., & Barnett, B. (2011). Postnatal depression and socio-demographic risk: factors associated with Edinburgh Depression Scale scores in a metropolitan area of New South Wales, Australia. Aust N Z J Psychiatry, 45(12), 1040-1046. https://doi.org/10.3109/00048674.2011.619160
He, J., Li, Y., Chen, L., & Zhang, Y. (2024). Non-biological factors associated with postpartum depression among women in Shenzhen: a case-control study. Front Public Health, 12, 1417861. https://doi.org/10.3389/fpubh.2024.1417861
Neupane, S., de Oliveira, C. V. R., Palombo, C. N. T., & Buccini, G. (2024). Association between breastfeeding cessation among under six-month-old infants and postpartum depressive symptoms in Nevada. PLoS One, 19(1), e0297218. https://doi.org/10.1371/journal.pone.0297218
Yuen, M., Hall, O. J., Masters, G. A., Nephew, B. C., Carr, C., Leung, K.,…Moore Simas, T. A. (2022). The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review. Journal of Women’s Health, 31(6), 787-807. https://doi.org/10.1089/jwh.2021.0504
