Mental Health, Momhood and Breastfeeding

Maternal Mental Health Day was just here a few days ago... and so I am here to talk with you about all things related to maintaining, dealing with and acknowledging the importance of your mental health while you breastfeed your baby. As a mom, you are probably quickly learning that breastfeeding and being the sole nutrition source for your sweet babe means that generally, your needs tend to take a backseat the majority of the time. Motherhood is the ultimate sacrifice, one found to be difficult to adjust to but one of the most selfless and self fulling acts. And once you are in it, you tend to think nothing of the sacrifices you make to continue the successful road ahead. However, ensuring you are in the best health physically, emotionally and mentally is essential. If any of those come second to your success- the possibility of it causing complications for you, your baby and your milk supply is inevitable and can be detrimental. 

Breastfeeding has shown in research to be a largely positive contributor to a mother's mental health and well being - when things are going well. It can work to provide feelings of fulfillment, satisfaction and confidence when you are able to adequately, effectively and plentifully provide for your baby whenever he or she needs nourishment and comfort. It has also been notably found to be one of the most bondable experiences you can ever partake in as a mother and person in general. 

Some Breastfeeding Background

Two of the most commonly released hormones during breastfeeding that help to shape the positive experiences you have are: Oxytocin and Prolactin. Oxytocin, more commonly known as, 'the love hormone' is released in many instances where love is being shown, and in this instance, it is secreted when a baby's skin makes direct contact with mom's skin. This then stimulates the letdown reflex during the beginning portion of a breastfeeding session which helps to allow milk to flow plentifully and provides adequate milk amounts to be emptied into baby's stomach. Other important purposes for oxytocin and breastfeeding is how it works to decrease cortisol (stress hormone levels) in addition to its effectiveness in instantly promoting a mother baby bond that no one else can mimic or understand. Because of these awesome components to Oxytocin release in the brain, it ultimately helps to promote mental health by decreasing anxiety, lower mom's blood pressure and promote deep and consistent relaxation. Prolactin or the "pro-lactation" hormone helps in promoting sleep in both mom and baby, while also increasing the most instinctual type feelings for mom in the natural ways that she cares for, protects and loves baby! Pretty cool that our bodies promote the most ideal environment for successful breastfeeding - just by natural release of hormones built within the body from the start, right??

But in contrast, breastfeeding has also been found to at times be potentially one of the most mentally trying experiences to walk through when you are already at war with the hormones, fatigue and struggles your body is working through in the trying postpartum months after baby is welcomed into the world. 

Mood Disorders and their effects

According to statistics in the United States, a woman has a 20% chance of developing postpartum depression within the first 4 to 6 weeks of their baby's life. This is a statistic shown to be far too high when resources are generally ever present and support is within arms reach for most mothers within our communities and society itself. This is a call for healthcare providers to better serve our mamas, to check in with them sooner and more frequently and to provide more information prior to the development of postpartum mood disorders - breastfeeding related or not. 

Postpartum mood disorders related to breastfeeding can develop for a couple common reasons. Factors common to postpartum circumstances that are important to consider when noticing mood, emotion and mental health differences in yourself or others are: excessive fatigue and sleep loss, difficulty or inability to breastfeed due to underlying & uncontrollable factors and pain not well managed in the early days of breastfeeding initiation. Though these issues seem as though they might be easy to control, they are often outside of a mother's control and are difficult to reverse the effects of. Without resources or the understanding in how to do so, a mom can find herself depressed, exhausted and unable to move forward with successfully conquering whatever breastfeeding 'speed bump' has arose. 

Additionally, if you are already experiencing this and walking through some dark days and nights as you work toward becoming a seasoned successful mama, providing for your baby with breast milk and work to manage normal life as you were just a few weeks ago - you are likely plagued with experiencing guilt, shame or anxiety about expressing these feelings to anyone. The fear that they may think you aren't able to manage this new thing called 'momhood' that you signed up for quite some time ago is paralyzing and far too common. Our society places so much pressure on moms to appear that they have it all together that we end up doing an unfortunate disservice in creating an environment where shame is associated with expressing unwanted feelings or admitting when things are just not okay.

We must work towards creating a culture of saying - it is okay to not be okay. 

And then, must quickly come alongside you to help fix whatever situation is working to create stress, anxiety or feelings of depression.

When pain is crippling and you have done all of the comfort remedies recommended by your local lactation help.

When you find yourself exhausted beyond belief because baby does not yet have an internal sleep/wake clock that guides them to sleep more than an hour at a time. 

And when you have tried everything you learned in your prep for breastfeeding class, but you still aren't able to provide breast milk for your baby like you always dreamed you would.

You have to come to a point of realizing that mental well being, clarity and peace is just as important as the mode in which you deliver food to your baby. 

In addition to postpartum hormones and the complications they can cause for a mama learning their newborn while simultaneously learning breastfeeding, there are a few phenomenons that can be occurring to contribute to these negative emotions you may be experiencing during feeding times. These are important to read about so that you can sort through whether your emotions and feelings are as a result of postpartum blues, depression or from the letdown reflex and experiences you endure while actually feeding your baby.

Breastfeeding Aversion and Agitation (BAA)

When experiencing BAA, a baby begins suckling to initiate a feeding and the mother soon after begins to have intense negative feelings, intrusive thoughts and a strong urge to de-latch the infant. It can begin as early as the letdown reflex which occurs early in a feeding session but can extend all the way through the feeding, at times.

 

Some negative feelings you may have are:                            Some intrusive thoughts usually experienced are:

-Anger                                                                                      -Wanting to ‘run away’ so as to not be feeding                      -Agitation                                                                                  -Overwhelming urge to stop breastfeeding

-Disgust                                                                                     -‘Feeling trapped’ or like a prisoner

-Irritability                                                                                -Wanting to ‘pinch’ the infant or child so they stop suckling

-Anger/Rage                                                                             -Thoughts and feelings about being ‘touched out’

-Skin Itching/Crawling

-Shame & Guilt (Usually Afterwards)

This is a very difficult and unexpected phenomenon that can develop in a mom and baby's breastfeeding relationship at any time. It is unpleasant and usually leaves you as a mom feeling very alone, shameful and sad about what the experience has developed into when previously, breastfeeding was such a desired choice and hopeful experience to partake in. There are many theories as to why this occurs but nothing is written in stone or proven to be the sole cause of the issue. 

Some believed causes are: 

• Hormone levels that fluctuate as a mother begins to have monthly cycles again, causing differing levels of hormone secretion during ovulation and menstruation - this is further contributed to the nipple tenderness and breast discomfort that can occur pre-menstrually 
• Breastfeeding dynamic changes that evolve such as: a baby's sleep patterns change, frequency in how often baby feeds (especially when an on demand schedule remains consistent throughout the entire breastfeeding journey), tandem nursing or nursing an older child as well and stress components related to life circumstances
• Lack of self care for mom or the "touched out" feeling you may get as baby is constantly near you, breastfeeding from you frequently and needing consistent touch and love as they are young and thriving off of what you are are to and for them

How can I make this go away?

Again, there is no definitive way found to be helpful for every single mama who endures this. But there are a few resources that have been found to be helpful for some and others helpful for another. Try the following to try to achieve relief from breastfeeding aversion and agitation before calling it quits and ending your breastfeeding journey all together. 

• Cognitive distraction- This is where you begin to do something enjoyable to you and distracting in nature just as you begin feeding your baby. Immersing yourself in a good book, catching up with your closest friend via a text to her or turning on the next episode of the TV series you are loving can help to distract your brain from the negative emotions you are having when focusing solely on the feeding at hand.
• Supplements- Magnesium, B12 and Vitamin D have been found to be helpful in diminishing the effects of BAA. The thought process is that these supplements help to replenish and restore energy that you as a mom may be missing out on because of fatigue and lack of self care while ensuring baby is cared for, loved and safe on a constant basis.
• Mom peer support groups- Go to your favorite social media forum and search Breastfeeding Agitation and Aversion groups and you will likely find some great groups to utilize and aid in allowing you to feel surrounded by others who understand what you are walking through. Similarly, a breastfeeding support group within your community or connected to your OB practice can work to provide you with community, friends and support!

Dysphoric Milk Ejection Reflex/D-MER

D-MER is classified as negative feelings or "dysphoria" that occurs as early as 30-90 second before the letdown reflex is initiated by your baby's suckling efforts. Before or once the initial letdown of milk is released into your baby's mouth, mother's will often describe extremely negative emotions and a sort of 'pit in their stomach' like feeling. This usually goes away 30 seconds to 2 minutes after the reflex has completed releasing the initial amount of milk needed to successfully begin the baby's feeding.

Mom's experience emotions such as:

• Anger
• Dread
• Anxiety
• Sadness 
• This happens in conjunction with a stomach churning sensation, an empty feeling or that typical dread/nervous butterfly sensation you might experience prior to something you are anxiously anticipating even aside from breastfeeding. 

It is important to note that this also occurs during pumping sessions when letdown is initiated. And additionally, can also occur multiple times per feeding since the reflex also spontaneously occurs more than once throughout feeding sessions. These feelings usually do return when the letdown is again initiated later in the session. 

The difference between BAA and D-MER is that with the currently discussed phenomenon of D-MER, a mother generally feels completely fine prior to the letdown reflex initiation and also returns to baseline emotional well being 30 seconds to 2 minutes after the reflex has finished releasing its milk amount. 

This phenomenon does not rule out a mom's desire or success in continuing to breastfeed - as long as the symptoms remain mild or manageable enough to experience general mental well being other than during those few short minutes. It also does not mean it will forever remain that way until a breastfeeding relationship ends between mom and baby. Encouragement should be given to verbalize and work through these feelings but caution should also be taken to ensure that the emotions do not reach levels of desire to commit self harm or harm towards baby or others. Though these words may seem scary to read and take in, shame or guilt should never be associated and help should always be sought out immediately so that safety remains top priority!

Of note: Breastfeeding Agitation and Aversion (BAA) and Dysphoric Milk Ejection Reflex (D-Mer) do not mean that a mother has postpartum depression or should be worked up for it. These are two conditions directly correlated to hormone release during breastfeeding in a mother who is otherwise emotionally stable during most other times.

I want this to go away - what can I do??

Though nothing is the "perfect fix" - the idea behind D-MER is that when a baby latches to your breast, oxytocin levels increase quickly and in very high levels because of the hormone release baby's mouth stimulates by beginning the letdown reflex that is working to sustain them and comfort them. However, as a result of the oxytocin increase, dopamine decreases quickly and plummets to relatively low levels which cause the general negative feelings towards the feeding process and your baby.

Ways to ensure that this dopamine release doesn't keep effecting your letdown experience during feedings are:

• Avoiding Caffeine- D-MER has been shown to be specifically triggered by caffeine intake so if you are able to avoid or decrease your intake of coffee, tea and caffeinated sodas, it should help in the long run!
• Allow time to do it's work- Evidence shows that with time, the effects of D-MER should diminish and your brains hormone levels should even out. This is not always the case though, so care should be taken in determining the length in which you can withstand enduring D-MER before needing to re evaluate ways to alleviate symptoms or choosing to wean as a result of the issue.
• Sudafed- This antihistamine has been shown to help inhibit such sudden drops of dopamine levels - however, the medication has also shown to drop milk supply levels drastically and should be only used in severe circumstances or situations where a mother is using it as her last effort before deciding to wean.

Mental Health Resources

As a mom - breastfeeding or not, motherhood can become very isolating. Life develops into an evolving, busy and fast paced world where often it seems friends fade away as you become more focused on your baby, family and accomplishing what needs to be done day to day. It is easy to become so hyper focused on how to make the world keep moving forward, that we begin to forget to care for ourselves and ensure we are in the best state of health for not only ourselves - but especially for the baby we are raising who needs our utmost potential. Whether you are walking through the adjustment phase of mom-hood, enduring postpartum depression, experiencing an adverse breastfeeding phenomenon or continuing on with your chronic depression or anxiety - I want to share some resources and tactics to be able to focus on self care and health maintenance. 

• Mom Groups- As a new mom who was an experienced labor and delivery nurse by the time my first girl arrived, I thought I had an advantage and that I would, in a sense, be "ahead of the game". Boy, was I wrong! Motherhood rocked my world and took me down with it! One of the things I thrived on the most was integrating myself into a breastfeeding support group that one of the local OB practices held each Thursday. The normalcy it provided to get up at least once a week and have purpose in getting "ready", the way it allowed me to feel excitement about going to see and talk with other moms and receive support from a certified lactation consultant - helped me so much. I would highly encourage you to seek a group out and make yourself a regular attendee. Camaraderie with others who are in the same walk of life as you can really work to decreasing postpartum depression intensity and increase your satisfaction with the new phase of life you have entered in to.
• Activity and Fresh Air- There is a lot of research and evidence that shows hormone levels - specifically the ones that contribute to happiness are released at much higher and more consistent levels when you expose yourself to fresh air and experience your outside surroundings on a daily basis when postpartum. Our home and inside walls can become far too familiar, depressing and isolating. Take the baby in their car seat or wrap them in your favorite wrap that you were so generously given as a baby shower gift , click that seat into a stroller and get out for a walk 30min a day to help decrease levels of stress, anxiety and depression.
• Antidepressants- According to the Academy of Breastfeeding Medicine's 18th protocol, it has been demonstrated to be safe for a mother to take an SSRI medication for the sake of chronic or postpartum depression or anxiety. Virtually every class of depression medication does show to cross through a mother's breast milk - however, Zoloft (Sertraline) in particular has shown to be transferred in such minuscule amounts which therefore makes it the medication of choice. 
• Counseling/Cognitive Behavioral Therapy- Since we as moms so often find ourselves surrounded primarily with family, your baby and your co workers - it is easy to fall into a place of not having someone outside of your every day life to talk with unabashedly about your struggles, thoughts and difficulties you are experiencing. There are often times a specialized group of counselors within major cities (this does stand true for Albuquerque) that deals frequently with postpartum emotions, infertility, miscarriage, etc. It is a wise idea to incorporate this into a regular routine when learning to cope and work through postpartum emotion and mood issues, especially in conjunction with medication to help overcome and learn to understand where the problems are stemming from. 

And at the end of the day...

It is so important to remember that mental health and the care we must take to maintain it must be at the forefront of our own minds, our OB providers minds and society as a whole. Without the health of each mom caring for a sweet baby being important, we will quickly see more & more moms fall into the difficult valleys of postpartum emotion and mood disorders. There are so many resources, if you are courageous enough to simply say - 'help me'. Depression and anxiety do not discriminate. The ones you see who appear to have it all together, are the ones who are struggling silently, the most. Breastfeeding moms, formula feeding moms and everything in between. So reach out, speak up and advocate for yourself. You will never be sorry that you chose to. And we as healthcare providers, will be so grateful you did.

An additional resource:

This book has been a personally loved and recommended resource for those walking through thoughts that are surprising, scary, confusing or difficult to navigate. The infographic posted at the top of this blog is similar to what the pages of this book are filled with. Real life scenarios, thoughts that cross more moms minds than we could ever realize and ways to work through them with life giving tactics and creative ways to embrace and overcome the difficulties of mom life!