Postpartum Depression

Could One Bold Move Reduce Postpartum Stress?

Reduce the pressure to breastfeed.

Posted Dec 04, 2019

A new paper from Birth: Issues in Perinatal Care, "What are women stressed about after birth?" provides insights that could be valuable in stemming an epidemic of postpartum depression.

Pregnancy, birth, and becoming a parent is a time of physical, psychological, and social changes which require ongoing adjustment. Many stressors can arise during this time which may affect women, their infant, and their relationships… [R]esearch suggests women experience a variety of worries which may contribute to the development of psychological problems.

If we can identify these worries and address them, we may be able to reduce the impact of postpartum distress and the incidence of postpartum depression. Of course, a substantial proportion of maternal stressors can not be eliminated because they are intrinsic to the birth of a new baby. These include:

... worry about how they will cope as new parents, the impact on their relationship, childbirth, the baby’s health, and the impact of their own health and behavior on the baby.

These stressors have existed since the beginning of time, across all cultures, and will never disappear. There is, however, one major modifiable stressor that is specific to our society: the tremendous pressure to breastfeed.

Postpartum, women report worries about breastfeeding. Research suggests women feel a lot of pressure to breastfeed, that they expect it to be easy and natural, and feel guilty if they stop breastfeeding. Women also report worrying about their infant getting enough milk.

The authors found:

Thirty‐five women (23.7%) reported breastfeeding stressors of feeling pressured by others to breastfeed, feeling like a “bad mum” for not wanting to breastfeed, or wanting to breastfeed and not being able to. Pressure to breastfeed was reported by 15.5% of women who wrote of finding breast- feeding “agony,” and being in “constant pain.” Women reported feeling anxious, guilty, and desperate to give up breastfeeding but feeling like they had to continue…

Another 5.4% of women wrote about feeling like a bad mum for not wanting to breastfeed, that they were letting their baby down and other people would think they were a bad mother… Similarly, 2.7% of women reported wanting to breastfeed but not being able to and feeling upset and/or that they had failed.

The quotes from mothers reveal their anguish:

"... There are so many ... out there who want to make you feel bad for bottle feeding, or even thinking about it, that no wonder many women, me included, feel anxious and guilty about how we feed our children."

And from another:

"I gave up at 6 weeks and started bottle feeding whilst expressing milk until my supply dwindled at 11 weeks. At the time I felt so guilty to have let [my baby] down… I still feel I have to justify bottle feeding. Everyone has to hear my ‘whole story’ as to why I’m a terrible mother who bottle feeds."

And a third:

"The breastfeeding really wasn’t working… I had no choice but to give up on breastfeeding and combination feed with breast milk and formula. I was extremely upset about this… felt disappointed that my baby wasn’t getting fed naturally… felt embarrassed telling my friends that breastfeeding had failed."

This type of pressure is both new and artificially generated. Mothers of my generation didn’t experience it; they were encouraged to breastfeed but the Baby Friendly Hospital Initiative did not yet exist and breastfeeding had not been moralized. My mother’s generation and my grandmothers’ generation didn’t experience it, either. No one worried about succeeding at breastfeeding; no one thought that success or failure at breastfeeding had anything to do with being a good mother.

Since this breastfeeding pressure is both new and artificially generated, it could be ameliorated to a large degree by being honest about breastfeeding. The benefits have been exaggerated and the risks have been ignored; as a result, exclusive breastfeeding has become the leading risk factor for newborn re-hospitalization leading to tens of thousands of re-hospitalizations each year.

And for what? Breastfeeding initiation rates have quadrupled in the past 45 years and we have seen NO decrease in term infant mortality, NO decrease in term infant severe morbidity, and NO healthcare savings of any kind.

Nearly a quarter of women in the study reported breastfeeding as a significant concern and we could reduce their distress with one simple step: Remove the Baby Friendly Hospital Initiative from hospitals and end the practice of lactation consultants emotionally manipulating new mothers.

There is no reason to make increased breastfeeding rates a goal of any public health program since the benefits for term babies are so small as to be unmeasurable. Breastfeeding, and in particular, breastfeeding exclusively, was not previously moralized and we should stop moralizing it now. Infant formula is an excellent method for nourishing babies and worked exceedingly well for generations.

There will be considerable resistance to this plan from lactation professionals; they will suffer economically from any attempt to ratchet down the pressure to breastfeed. But mothers and babies may benefit dramatically.

Aggressive efforts to increase breastfeeding rates harm mothers and babies. If we want to reduce the incidence of postpartum distress and depression, we should start by reducing the pressure to breastfeed.