It’s serious problem, but sadly Avital Norman Nathman dares not speak its name.
Norman Nathman wrote an entire piece on the detrimental impact of “idealized representations of ‘perfect’ motherhood” on the development of postpartum mood disorders without naming or acknowledging the most important culprits: the natural childbirth and lactivism industries.
In a piece entitled What impact does the ‘Good Mother Myth’ have on postpartum mood disorders?, Norman Nathman writes:
… For the most part, many of us are able to push through these idealized representations of “perfect” motherhood, but for others the inundation of these types of images can have a more drastic and damaging effect.
The period of time immediately after having a baby — especially if he or she is your first — can be an incredibly fragile one… It can be even more challenging when faced with images of “ideal” motherhood everywhere you turn…
She speaks with an expert:
Dr. Jessica Zucker, a clinical psychologist specializing in women’s reproductive and maternal mental health explains the impact that these idealized notions of motherhood can have on the mental health of new mothers. “Cultural ideals surrounding motherhood serve to stimulate shame and secrecy when it comes to postpartum challenges,” Dr. Zucker told me. “As a result of media’s portrayal of idyllic early motherhood, women who don’t fit perfectly into this ubiquitous image often report feeling like “failures” and take their troubles underground.”
The media’s portrayal of idyllic early motherhood? While the media may play a part, the primary culprits in promoting “cultural ideas surrounding motherhood” are the natural childbirth and lactivism industries.
What are these cultural ideals surrounding motherhood that stimulate shame and secrecy?
These claims include:
- Women who have pharmacologic pain relief in labor have “given in” and put their own needs above the “risk of exposing their babies to drugs.”
- Women who have C-sections have “failed” at birth.
- Women who follow their obstetrician’s advice and have inductions are personally responsible for the “cascade of interventions” that led to their ultimate failure.
- Women who have pain relief can’t bond to their babies.
- Women who have C-sections have ruined their baby’s gut microbiome AND changed the baby’s DNA in harmful ways.
- Women who don’t have enough breastmilk are either failures or liars, since “every woman has enough breastmilk.”
- Women who give a baby even one drop of formula have permanently destroyed the baby’s microbiome as well as sabotaged the chance for a successful breastfeeding relationship.
I could go on and on, but I think you get the idea.
Leave aside for the moment that none of these claims is supported by scientific evidence and most of them are lies. As Norman Nathman points out, such idealized representations (even if they are lies) have the power to harm fragile new mothers. Who would be so cruel as to promote these accusations to a new mother? Not anyone who cared about women’s mental health, right?
Yet new mothers are bombarded by these accusations, either directly or as insinuations, before, during and after giving birth.
Why? Because there are entire industries that PROFIT by monetizing the shame and guilt thus created.
Follow the money!
The natural childbirth industry, encompassing midwives, doulas, childbirth educators, and lobbying organizations such as The Childbirth Connection, Lamaze International and the International Cesarean Awareness Network (ICAN), not to mention purveyors of books and DVDs promoting natural childbirth, PROFITS by insisting that these purely arbitrary, and thoroughly idealized representations of birth are “better” for babies.
They PROFIT by demonizing epidurals.
They PROFIT by convincing women that a C-section is both a personal failure of the mother and a health risk for the baby.
The lactivist industry PROFITS by convincing women that breastfeeding problems are their own fault.
They PROFIT by convincing women that every breastfeeding difficulty can be solved by a $100/hour lactation consultant.
They PROFIT by hijacking government public health policy to promote breastfeeding (which, in industrialized societies, has real but trivial benefits) and then using those same policies to harrass and humiliate women who can’t or (heaven forbid) don’t want to use their breasts in the way that lactivists think they should.
Norman Nathman writes about potential solutions to this problem of maternal anguish:
One way to help combat this range of detrimental representation is to provide safe spaces for mothers to talk without judgment…
Another solution is to provide a much more varied and diverse picture of what motherhood truly is about… Dr. Zucker agrees, suggesting that, “Maternal images that include the full spectrum of lived experiences would better serve women and their burgeoning families.”
Great! Who’s going to tell the natural childbirth and lactivist industries that they ought to provide a much more varied and diverse picture of what GOOD motherhood is truly about?
Sadly, it won’t be those who bemoan the effect of “The Good Mother Myth” on postpartum depression, but dare not mention the names of the industries who gain the most from the myth: the natural childbirth and lactivism industries.
I believe that the expectation that I would have a lot of control during labor very significantly contributed to the PTSD I suffered after my first labour which was a near-disaster. That expectation comes from the natural childbirth movement, of course. I believed I would be lucid and able to ask for what I wanted, but there are at least 2 hours of second stage I just can’t remember at all and I was not able to demand of the nurse-midwife that she call the doctor when she told me my baby was passing meconium. I couldn’t speak at all. I spent the best part of 3 hours believing my baby was going to be either brain-damaged or dead and it was my fault for not being able to dilate fast enough or push him out. The conditions that create PTSD are believing that you or someone close to you is in mortal danger and you are unable to do anything about it. I experienced exactly those conditions and developed PTSD as a result. I do blame the natural childbirth movement for perpetuating the myth that a woman has a lot of control over how the labor goes. It would be better to tell women that in the end you are at the mercy of your smooth muscle and your pelvic proportions and no amount of mental control or ‘positive thinking’ can change that. It would also be better to tell women that you have to make sure before you ever go into labor that the caregivers share your priorities, because you may be overwhelmed by pain and exhaustion and in the hands of a person who thinks vaginal childbirth is more important than the baby’s safety. That’s what happened to me.
I don’t know how much lactivism and the woo-addled childbirth cult contribute to causing PPD, but I do know that much of their rhetoric can play an enormous role in discouraging mothers from seeking help for postpartum or *any* depression, or any psychiatric issues at all.
I had to check into an inpatient ward when my youngest was five months old. I might have been able to avoid such drastic intervention had I been willing to consider medication beforehand, but that was off the table—-you can’t breastfeed while taking any SSRI I’ve ever heard of. As it was, the only way my doctor was able to convince me to check myself in was by reassuring me that I could pump regularly on the ward to keep my supply up, that there was no reason why I shouldn’t be able to go back to breastfeeding after my issues had been straightened out. A damn lie, of course, but I’m grateful to her for telling it to me—after a few days of sleep and not being literally worried sick about how badly I was screwing up everything even remotely related to my child’s care, supplemented with intensive cognitive behavioral therapy, but most importantly being completely cut off from the Internet and all its self-hate-inspiring BS, I was able to see that a healthy, happy mom was actually a far better advantage to give my baby than whatever magic properties my breastmilk was supposed to contain.
I got PSTD with my first baby and the same hospital would not let me have any medication during my subsequent two pregnancies and lactations, so I suffered untreated until I broke down during my fourth pregnancy and was put on clomipramine at another hospital. Clomipramine has a long history of safe use in pregnancy. When that baby was 3 months old they were quite happy to switch me to Prozac although I was lactating and continued to breastfeed until the baby was 16 months old.
I do think lactivism can contribute to PPD. I think the pressure when you are already pre-disposed to mental illness can help push a mother over the edge. What happened when I was heading into severe PPD is that if I was not breastfeeding maybe I would have taken some unisom/sleeping pills without even thinking about it and would have gotten some sleep. Sleeping seemed to help my severe anxiety the most.
I have shared this before but it is important to this post again. My good friend had a traumatic (30 hour!) homebirth that included a birth injury to her anus. She knew she was at high risk for PPD since she struggled with depression anyway. She was in pain daily and then doing everything she could to try and make her supply go up. Long story short she got to the point where she would leave her baby in another room crying and did not want to even be around her. Because we are close, I strongly suggested she wean her baby so she could take anything she wanted, have overnight help, and sleep without being afraid of being woken up to feed the baby.
When she told her midwife she was formula feeding that @#$%! midwife had the audacity to tell her that she “would be feeding her baby but not providing her nourishment”. My friend had a doula insinuate that her baby would end up with celiac like she has if she moved to formula. I shudder to think what would have happened to my friend if she did not have her mother and I encouraging her to take care of herself first. That is how lactivism contributes to PPD. My friend was in such a dark place that she could have been a PPD horror story and these idiots are worried about breastmilk over STAYING ALIVE. Why is it ok to treat women this way? Like they are just there to breastfeed no matter the cost to themselves, even unto death.
OT, but I think pertinent to the discussion.
When I was dealing with PPD, anxiety, and some pretty nasty intrusive thoughts, one of the many reasons I didn’t seek help was that I was utterly terrified that if I outlined some of my symptoms (i.e., suicidal thoughts several times a week, though no intention of following through; persistent terror that I’d do something horrible to my daughter, though again, no intention at all of doing those things, etc) to a medical professional, they’d call CPS in a heartbeat and DD would be taken away from us–mandatory reporting, and all that. Could someone here with a background in this, either as having had it or as a medical professional dealing with it in patients, reassure both me and other moms out there who felt that way that that’s unlikely to occur? What is SOP if a mom comes to her doctor and says those things?
Oh my gosh! I felt like this too, like if I told the doctor I just wanted to lay down and die that I would be locked up involuntarily. I wasn’t go hurt myself because I didn’t want to hurt my baby but it was scary trying to spell that out to my doctor. What happened was I ended up telling her just that and I got a referral to a psychiatrist. Not just any psychiatrist either, one who had started out doing a residency in OB and saw how many women had anxiety or depression during pregnancy and postpartum and wanted to help them, so did a residency in psychiatry too. I don’t know that there are a lot of doctors like this but I wish more women had access to them.
I have never heard of CPS taking kids away for PPD.
I had very severe PPA/OCD/PPD after my first child and did end up on a 72 hour psych hold. The weird thing is that I was not suicidal and I was afraid that I was going to die. I had not slept in over a week.
I am so sorry you went through that; it sounds awful.
That was how my close friend’s PPD manifested itself. She was terrified that she was going to die and leave her new baby. It took weeks for her to shake this fear. Luckily she had her mom and husband to help her. I had been her labor nurse and fortunately had the sense to tell her (when she asked)that she could try breastfeeding and if she didn’t like it she could stop-at least then she’d know. She chose to bottle feed, with the full support of all but a few around her. I’m afraid of what would have happened if she’d had the additional pressure of nursing. She was able to get adequate sleep and the PPD resolved. Her son is now a healthy, strapping, 19-year-old athlete and college student. I think he missed nothing by being bottle-fed, but he would have missed a lot if he hadn’t had his mother.
Hmmm. Please bear in mind that I am not a medical professional, and I didn’t even stay in a Holiday Inn Express last night.
It seems to me likely that the natural childbirth/lactivism movements can trigger PPD, but in moms who are predisposed to it for one reason to another: i.e., the NCB/lactivism is the final straw on the overburdened camel, not the entire weight. Perhaps “straw” is a bad metaphor–it’s a lot more than that, proportionately speaking–but it’s as close as I can get.
Postpartum, *all* moms are in a very nasty hormonal storm that’s wreaking all sorts of havoc with their body and emotions. Some get through it with no more than a brief incident or two of “baby blues.” Others, thanks to some combination of hormones/their expectations regarding childbirth and parenthood (including feeding)/the social response to them in their new role/sleep deprivation/prior historical issues/any and every combination of the above, get PPD and all its oh-so-charming variations. I do think that NCB/lactivism helps set women up for PPD, though, and perhaps more than any of the other factors there.
This is especially true, I suspect, for women with a strong community/family pressure to birth naturally and breastfeed exclusively for *insert fairly long period of time here.* For a bit of background, I’m a fairly conservative Catholic. In NFP-using Catholic circles, there is extremely strong pressure to both have one’s babies naturally and breastfeed, with a heavy spiritual aspect laid atop the usual (and often inaccurate) messages about how NCB/EBF will prevent everything from cancer to tonsillitis in mom and baby. (This pressure is partly due to the grossly over-exaggerated likelihood of long-term breastfeeding-related infertility in those circles: hey, just ecologically breastfeed, and you don’t have to chart or avoid sex!) As a result, when I both had a C-section and couldn’t breastfeed, I felt like I wasn’t in the “cool moms club” in my particular niche, so to speak: in fact, almost as though I was doing wrong in my religious tradition (though, theologically speaking, there’s nothing wrong with CS or FF) by the way that I had and fed my daughter. Needless to say, that didn’t help my PPD situation in the least.
I believe any added pressure, or any perceived pressure, can worse PPD, or turn ‘baby blues’ into PPD. Women in the NCB movement are very influenced by their peers (just read birth stories that were one hairsbreadth away from disaster turn into magical moments for the rest of the community). When you are unsupported, any type of depression worsens. PPD or garden variety. When your community, your peers, those you’ve counted on from the beginning and even yourself under the guidelines of the movement label you “a failure” if life happens, that certainly doesn’t help.
“Women who have pharmacologic pain relief in labor have “given in” and
put their own needs above the “risk of exposing their babies to drugs.””
This, despite research showing that PROMPT and liberal administration of pain relief lowers the incidence of PTSD in compat veterans.
OT: Got a flyer in the mailbox yesterday from a local painting crew trying to drum up business. They advertise that they carry $1 mil in liability insurance. For PAINTERS
But you know, midwives can’t be bothered to carry any for themselves, despite having lives in their hands…
Exactly.
My husband does mobile paint repair on cars through dealerships. Not only does he have to be fully licensed, registered with the Clean Air agency (this is who oversees that he doesn’t practice in a way that is harmful to the environment), he has to carry a massive amount of liability insurance. He is self employed and makes his money per job done (like a CPM) but no dealership would let him set foot on the lot without those things.
Wow — did not know that. I am a *dog trainer* and it is considered professionally unethical for me NOT to have liability insurance! Seriously?!
And let’s not forget that these claims about birthing and breastfeeding don’t just come from people working in the industry. Some women out there will have husbands or partners (or other close family members) who have been sucked into the woo. And when that happens, it leaves you feeling pretty awful with not even your own family to turn to for unconditional support. It’s easier to forgive strangers for this kind of thing, but I don’t think I’ve ever really forgiven my ex for saying I was a weak person because I “failed” to breastfeed. I’m not alone with that – a close friend’s husband also put a lot of pressure on her to keep breastfeeding when she was struggling badly and really wanted to stop. It’s probably more common than we’d like to believe.
I see it not infrequently.
I talked to an ex of mine about breastfeeding once. I told him that I would try but was not going to go to heroic lengths. He told me that his child would only receive the very best and and he would not let me quit for a trivial reason. We are not together any more.
Already have the husband on board with FF. It was a bit of a struggle – he’d only ever had that influence from media and family that BF was ‘natural’ and easy and that it was so much healthier. Just a little google time helped him out with that, and my saying that I should have control over my own body convinced him bottles and formula were fine.
🙂
Go team! I hope there is a special hell for men who decide that they have the right to make decisions for a woman’s body, particuarly where childbearing is concerned. I work with this toolbox who will tell anybody who will listen about how epidurals should be illegal because you are drugging a defenseless child and women should be prohibited from working after having a child because of the breastfeeding relationship and I just want to stange an intervention with his wife.
I should think that an HR report would be in order if he was ever stupid enough to say that bit about women not working to a coworker who happened to be a mom, no?
Our HR department trades predominantly in polite suggestions to get along better.
Ah. So, totally useless recipients of paychecks, then. 😉 My sympathies. 🙁
Natural childbirth activism and lactivism are not helpful for women with PPD, especially when anyone who deviates from the ideal is a “failure”, but I don’t think that’s the same as causing PPD. Depression is a chemical problem.
Depression is sometimes a very complicated mix of chemicals and situational issues.
CBT wouldn’t work for PPD if it was solely about tweaking neurotransmitter levels.
Someone who is vulnerable because of their genes and upbringing and hormones and sleep deprivation could be tipped over from just feeling down to full on PPD if they were getting external messages that they were a failure or selfish or a bad person or a bad mother and were in a vulnerable enough position where those messages were internalised rather than dismissed.
This is not saying that depression is a sign of weakness, or that depressed people are somehow to blames for their illness. This is saying that sometimes depression is caused by a big toxic soup of stuff interacting, and messages which tear down self esteem and make people feel like failures can be an important ingredient in that soup.
That middle paragraph said much more succinctly what I was trying to say in my all-too-long post above, and also summarized my experience with DD to a T. Thank you. 🙂
Situational depression contributes heavily to PPD, imo. I probably have always had depression, but after the birth of my second child I had severe PPD, in part because of the shock of finding out she has Down syndrome and the feelings of guilt, shame, and embarrassment that come with it. And make no mistake, those feelings come whether people like to admit it or not. What did I do wrong? What will people think? So on and so forth. Add to that fear of the unknown it was a huge ol’ mess of contributing factors on top of the hormonal issues.
OT: I’m 3.5 weeks postpartum, and I’m having an achy back at the epidural site. I didn’t have this with my first son at all; I don’t remember any pain associated with the epi. This time they had to stick me 3 times (my husband thinks the anesthesiologist was incompetent lol).
I have (crunchy) friends who insist that they have achy backs years after the epidural, so I can’t help feeling a little concerned. I could call my doctor and I suppose talk to a nurse, but I honestly feel like some of you guys probably know as much as they do and won’t treat it like a stupid question. If it lasts till the six week checkup I’ll definitely ask, but in the meantime…
Is this normal? It almost seems worse in the last couple of days. And I don’t think it’s regular pp back pain; it’s right at the site of the injection. My other aches are mostly gone.
Is there anything I can/should do besides maybe a heating pad and/or ibuprofen? Stretches?
Will it go away? I didn’t want to believe epi’s could have lasting bad effects (in the normal course of things). Sure, this pain is not nearly as bad as having gone through labor without pain relief, but if it turns out to be long term I’ll be rethinking that.
Thanks for any insight some of you professionals may have.
Check the Adequate Mother’s site on this – she probably has an email there, too. https://theadequatemother.wordpress.com/
she’s an anesthesiologist. Hope I spelled that right.
I’ve read things that suggest it may be a lack of general core strength, which could be more likely on kid #2! Look up Sahrmann core exercises. They’re AMAZING for postpartum core rehab regardless.
The problem is that you’ll never know if it was from the epidural or not, and you’ll never know how long it takes to get better until it’s better!!!!
I had a patient who had zingy pain up and down her back for 3 months after each of her first two kids, with whom she had epidurals, so she blamed the epidurals. So for her third kid she went natural. She wound up having the exact same pain after birthing the third kid, and swore she’d never do natural childbirth again.
I’d go get physical therapy.
I second the recommendation for PT. I did a little about 2 months after my son was born, because my back was pretty bad. Best idea ever, I had no idea how deficient my core strength was.
I also had a rough epidural administration with my second birth, and I had an achy back for some weeks (months? It’s all a blur) afterward. 3 years later I have no pain there any more, so it did eventually go away. 🙂 With my first, I honestly didn’t feel the needle and I had no problems afterward. Bodies are weird.
3.5 weeks isn’t a lot of time. It’s worth mentioning to your doctor now, But I’d give it more time before you start to assume it’s a permanent condition. COngratulations, by the way!
I think the “profit” argument is incomplete, however. That might be part of it, but those in the NCB industry really believe their ideology and practices to be THE BEST for women and children and I don’t hear them talk about making a profit. It seems more like a strongly held, idealized world view that is almost independent of profit for many of them. This is what I have observed.
For the most part I agree about the “profit” notion. Not only include monetary benefits, but validation, admiration, attention, control, prestige, status & power as well. The textbook goals for a Narcissist.
I too think it’s ego as well as money. It’s nice to “help” others make decisions more like yours (eg in Emma by Jane Austen).
I do not agree. A real healthcare provider is happy to change his or her views.
I have changed mine a hundred times during my career in light of new scientific discoveries and also after learning from other colleagues and even patients. My knowledge is not monolythic, it changes over time and I am happy it is like that. If I read a paper about a great new treatment I want to implement in on my patients. If I hear that I am not needed anymore I would be happy to dedicate my life to working at a laboratory or changing my career. I would be more than happy if the diseases I look after are gone forever.
What happens when those people hear that home birth is not safe? They lie, they try to distract your attention, etc, etc. I make exactly the same profit if I have one patient a week or a hundred. They do not. They depend on natural childbirth because they can not provide any other service.
I think it depends on the individual. Some of the home birth midwives, it is about the money. Others, especially the volunteer LCs, it’s not about the money but about their conviction that they are helping women.
Perhaps I’ve seen and met more of those types than the homebirth midwives. That is what I based my comment on.
OT: recommending miranda july: the last bad man. A novel which wades through a lot of woo, a homebirth gone badly, and, I guess, what it is like to be stupid. Without celebrating it in any way, the logic of stupid is actually kind of interesting and the book really humanizes stupid people in a way that makes you feel empathy for them – like, -if I had been born under different stars. My feeling after reading (so far, half of the book) is, yes, this is how life works and there is nothing good or bad about it, it just is.
I love Miranda July! Even that movie with the crazy narrating cat.
This is the logical extension of the theory proposed in the original piece. It is not a leap of logic in the slightest – but I wonder if it is a leap that was not taken because doing so would alienate those that the writer of the original piece was seeking to help. There is a large group of women who have “bought into” in a big way natural birth/natural parenting – it forms part of their identities and when part of who you are fails to serve you well, it is an incredible challenge to identify that and to overcome it. A therapist who starts out with “your views are wrong to begin with” likely will never work with a client long enough to earn their trust and work toward a different set of views on the issue. Its a more flies with honey approach.
Which is why, Dr. Amy – you are an excellent person to take the original piece to a logical desitination. I wouldn’t assume that the original authoer doesn’t accept the premise, but rather that she can not publicly accept the premise out of fear of being locked out by her client base.
sorry on ths sp mistake on author…
“but rather that she can not publicly accept the premise out of fear of being locked out by her client base.”
This may be the case, but what a complete lack of guts on her part. I think it borders on unethical to talk about it as general pressure to be perfect without mentioning the elephant in the room. Certainly she could have found a way to make it clear while at the same time not seeming too dogmatic. For example she could have at least included NCB pressures along with other pressures saying something such as “Pressure to have an idealized mothering experience can take many forms. Examples include pressure to “fall in love” with the baby immediately, have a perfect birth experience, return to pre-pregnancy body shape quickly, breastfeed without any hitches, be 100% fulfilled by the baby without need for any adult time”
It’s my impression that in a world where intensive mothering is the dominant ideology, the connection between NCB/lactivism and postpartum mood disorders is the third rail. Everyone is afraid to touch it.
Absolutely – and I respect you and admire you for doing so, calling it out for what it is and what it isn’t but thought to be.
If you love Breast feeding and want to continue it while you get help for PPD- no problem, we’ll make it work.
If you hate BF, or you are finding it exhausting or painful, but feel guilty about that and you are caught in a big guilt/ shame spiral- we’re going to have to work on that as part of treating your PPD.
It might mean giving yourself permission to FF.
It might mean trying something simple to improve latch and attachment.
It might mean managing a previously undiagnosed case of thrush or tongue tie.
It might mean combo feeding.
Ellen Mary, are you paying attention?
No one is going to tell someone with a great Breast feeding relationship and PPD that she has to start FF. But, we might tell someone who is nearly killing herself trying to BF her baby that it is more important to prioritise her mental health over exclusive BF, and IF that means FF, then it means FF.
It doesn’t make you selfish or a bad mother if you decide to give up BF because it makes you miserable, you need to sleep, your baby isn’t thriving on breast milk or you need a more effective antidepressant that isn’t safe with Breast feeding.
Which more effective antidepressant is contraindicated in BF? Efficacy & BF contraindication aren’t related like that. Xanax et al can sometimes be considered contraindicated but not absolutely.
Many women still are given a false dichotomy of treatment v. BF by less than up to date clinicians & also by society at large because of false beliefs, that is what I am saying.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902256/
Knock youself out! It’s a meta-review from 2009 on studies done on exposure to assorted anti-depressants in breast-feeding infants. On the good side, relatively few side effects found. Bad new- extremely small sample sizes – so very small that I would not feel comfortable recommending the studies as being highly effective.
This happened to me. My GP basically told me that even tylenol was forbidden. I had an ear infection and he refused to prescribe ANY antibiotics.
I hate that crap! When I have a dentist telling me they don’t want to fill my pregnant patient’s cavity, I really wonder if he thinks the resulting abscess will be safer for the baby.
um what? I’m not a doctor, but i don’t see how allowing an infection to progress is good for a fetus.
That might be more because most middle ear infections are viral and current guidance is that antibiotics should be reserved for children under 2, with 4 or more days of fever and bilateral red, bulging ear drums or perforation with pus, or adults with tympanic perforations and chronic purulent discharge.
http://www.nhs.uk/Conditions/Otitis-media/Pages/Treatment.aspx
This is somewhat off topic, but I have been told by several physicians that they wouldn’t prescribe medication for me while pregnant and nursing. It is incredibly frustrating to be refused safe treatment for years at a time because of being pregnant or breastfeeding.
Depends entirely on the woman–Zoloft doesn’t do me any good, but the price I pay for using a successful antidepressant is low supply. If I really dove into PPD, we’d put me back on MAOIs, which are definitely not kosher while breastfeeding.
She said IF you need a MORE EFFECTIVE antidepressant that isn’t safe with breastfeeding, not “you don’t get treatment for your PPD unless you quit BF-ing.” Personally, knowing what I know about benzodiazepines and MAOIs I certainly wouldn’t be down with using those during lactation. MAOIs themselves are a veritable grab-bag of potential side effects and thus aren’t used a whole ton; they’re not widely studied in lactation to the best of my knowledge, and I wouldn’t feel comfortable recommending them in lactation. However, they’re the only antidepressant that works for some folks. Risk/benefit.
On a side note, anyone who would use the argument that epidurals make the baby lethargic/whatever, while supporting the compatibility of benzodiazepines with breastfeeding, should have their common-sense-o-meter checked out.
” should have their common-sense-o-meter checked out”
Oh it’s not a deficit of common sense. It’s that they totally lack empathy and are blinded by dogma.
You’d think that the choice between giving the baby lithium and giving the baby formula wouldn’t be fraught.
It sure is if you’re off your lithium during pregnancy and you’re manic and not necessarily rooted strongly in reality.
All the more reason the professionals, support network, and parenting culture surrounding the mother should be supportive of the mother’s mental health. Weaning may be a difficult choice for a woman that is currently suffering from mental illness, but not for those around her, and honesty and compassion matter. There is no benefit to lactivists’ making treatment any more difficult than it already is.
Absolutely- if the only way she’ll take the Lithium is if she continues to breastfeed, well that is better than remaining unmedicated, but less ideal that FF and taking Lithium.
If she is unwilling to formula feed, you have to work with what you have and document everything to the max, but the risk of untreated mania in their mother is obviously going to be higher for an infant than ingesting lithium in breastmilk.
At the end of the day, the person signing the prescription is responsible for any adverse outcomes, and the buck stops with the doctor.
Which is what annoys me about people like Ellen Mary.
It ISN’T usually that Doctors are being obstructive or ignorant or not up to date, it is that if it goes pear shaped it comes back on them, and most just don’t see breast feeding as a big enough deal to be worth risking seizures or death or unknown adverse effects.
Armchair quarter-backing by lactivists who don’t actually have any clinical decision making responsibilities (or medical training, or pharmacology knowledge) is therefore pretty unhelpful.
“Armchair quarter-backing by lactivists who don’t actually have any clinical decision making responsibilities (or medical training, or pharmacology knowledge) is therefore pretty unhelpful.”
No it’s worse than that. It’s downright dangerous.
There’s also the social networks dimension to it that is the same kind of dangerous as anorexia and other eating disorders forums – women are pushed and shamed to endanger their own and the health of their newborn over any and all obstacles. The mother and her needs are especially ignored when it comes to the warning signs of PPD. How that crap ended up being sold as feminism beats me.
“Armchair quarter-backing by lactivists who don’t actually have any clinical decision making responsibilities (or medical training, or pharmacology knowledge) is therefore pretty unhelpful.”
Bingo. It took me 2 years of listening to the false medical advice from my lactivist friend to realize this.
When I saw her review last month of a natural supplement that was contraindicated for breastfeeding – and that she had been taking while breastfeeding – I realize just how idiotic her advice was.
Glad to be out from under her rock of mis-education.
I am disgusted by the attitudes I see here. Women can’t offer informed consent if they have PPD. No drugs besides SSRIs are safe in BF (not according to Hale). Giving a mother lithium = giving a baby lithium. Just gross & not evidence based. Prejudice based.
But giving a breastfeeding mother lithium *does* = giving the baby lithium. Here is the ACOG’s statement on it:
“The use of lithium during breastfeeding has been associated with a number of adverse effects; however, only 10 maternal-infant dyads have been studied. Effects included lethargy, hypotonia, hypothermia, cyanosis, and electrocardiography changes. No long-term studies have examined the neurobehavioral consequences of lithium therapy during breastfeeding.”
Do you hear that Ellen Mary? Looking at just 10 babies exposed to lithium in breastmilk, they already found lethargy, abnormal muscle tone, inability to regulate temperature, cyanosis and EKG electrical changes. In addition, there are NO studies that look at long term neurological safety (probably because who the hell would continue breastfeeding after their baby turned blue and had an abnormal EKG?). You have been told this many times but listen again: newborn livers and kidneys are NOT the same as adult livers and kidneys. Babies can have fatal build ups of drugs given to them in small amounts because they *can’t detoxify and eliminate them*.
YOU are the one who isn’t evidence based. YOU are the one denying women informed consent (by telling them that meds are “safe” when in reality we have no proof that they are). YOU are the one with prejudice based opinions.
Maybe ACOG should check http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~bLLFYv:1
LOL. You do know what TOXNET is right? It’s the clearinghouse for poison control. It’s a resource to use when somebody says “Oh shit, this person has come in contact with this chemical. What outcomes have others had after that?” Yes, there have been babies whose mothers have breastfed them on lithium who have survived without apparent harm. That certainly does not mean it is recommended. As TOXNET clearly states up front in your link, all published expert consensus guides consider lithium in breastfeeding to be contraindicated for the newborn. The most liberal of guides move it off the contraindicated list once the neonate is 2 months old (working kidneys by that point). NONE recommend it.
Only crazy lactivists recommend mothers continue breastfeeding on lithium.
“Only crazy lactivists recommend mothers continue breastfeeding on lithium.”
This is why I think Ellen Mary is very disingenuous in claim that she’s just not respected for her time enough by us and that she’s only interested in advocating for breastfeeding as being a worthwhile activity for those who want to. Why would Ellen Mary know anything about breastfeeding while on lithium or think it’s a poor decision of a doctor to recommend against breastfeeding while taking lithium?
Exactly. The reason Ellen Mary believes she knows something about breastfeeding while on lithium and believes it’s a poor decision for doctors to recommend against it is because she is totally indoctrinated in lactivism. One of Lactivism’s big talking points/lies is that virtually *any and every* medicine is compatible with breastfeeding and that doctors only recommend women stop due to ignorance and/or underlying desire to sabotage breastfeeding. Lactivists will ignore a body of evidence that indicates a med is not safe and cling to isolated case reports where everything apparently turned out fine. But you can do this with anything. Thousands of babies born after thalidomide exposure had major birth defects….but thousands didn’t. Shall we cling to the ones that didn’t?
Lithium has major potential risks including death. If it’s the only thing that works for a pregnant mom, it may still be worth the risk while she is pregnant. At least she has working kidneys and if her dose is followed closely it is unlikely to cause acute fatal toxicity. But once the baby is born there is an excellent and safe feeding alternative that does NOT cause heart arrythmias, cyanosis, lethargy, loss of muscle tone and potential for irreversible thyroid failure: it’s called formula and it’s what doctors recommend to their patients who take lithium.
Here’s a pullquote for ya: Lithium may be used in mothers of fullterm infants who are willing and able to monitor their infants.
What is your obsession with lithium? It works for a handful of conditions, but there is a great array of medications that works, too.
What is, according to you, the reason for treating PPD? Treating the mother, or protecting the crunchy scoreboard?
Lithium isn’t even particularly relevant to PPD, it was used an an extreme example by another poster of a drug with a hard contraindication in BF except that they were incorrect.
Then funny what we keep coming back to lithium. There are lots of drugs that can’t be used during breastfeeding and pregnancy. There are lots of conditions that require those drugs for the ensured survival of the mother.
If the choice is not treating the mother exclusively to preserve the breastfeeding relationship, I find that negligent, disgusting and unethical.
Lithium is used to treat BPAD which isn’t exactly uncommon in women of childbearing age, it is also used in some cases for severe treatment resistant unipolar depression.
Lithium is by no means an extreme drug. And yes it is contraindicated in the neonate. As Dr. Kitty says, some women (indoctrinated in lactivism) continue anyway because they have been misled by the likes of you that lithium is safe and that formula is poison.
Look, it’s not extreme. I deal with women all the time who have pre-existing mental disorders including schizoaffective disorder and bipolar disorder. They get pregnant and sometimes cold-turkey off all their meds out of fear of harming their babies. Usually it’s with no medical oversight at all. So they get sicker and sicker throughout their pregnancy, you just know post partum is going to be a disaster, and you’re trying to persuade them that it’s in both theirs and their baby’s best interest to go back on the meds that had kept them stable. One of the reasons they don’t want to is that it means they can’t safely breastfeed with clonidine, lithium, or some fancy atypical antipsychotic. If this sounds way out there to you, take a look at your life and feel gratitude.
What proportion of women who have just been newly commenced on Lithium do you think are both “willing” and “able” to monitor their infants?
So I identify the source of my quote as the ACOG position statement on it. And your quote comes from…..? You are not inspiring confidence here Ellen Mary.
Yep, our consistently disgusting attitude, conveying that the mother’s and baby’s health, wellbeing, and life is more important than the AP badge of glory. So gross.
” Women can’t offer informed consent if they have PPD.”
But they can in excruciating, mind-bending pain during birth?
I can’t take SSRIs. if my depression had gotten bad enough during PP, I would have stopped breastfeeding and treated myself. I’m one of those selfish people who things a dead mother is of no use to children.
“Giving a mother lithium = giving a baby lithium. Just gross & not evidence based. Prejudice based.”
Which prejudice, exactly? Motherhood is a blessed event and mothers don’t need antidepressants because their world is rainbows and joy?
If the mother needs lithium, she needs lithium. If she needs to stop breastfeeding to protect her child from it, then that’s what has to happen. This is FOR the children, if you remember. Not for the ego.
You’re just wilfully obtuse, aren’t you?
Do try and read what people actually write.
You still haven’t actually said what the benefits of breastfeeding are for the baby of a mother with severe PPD.
What makes breastfeeding for the baby so worthwhile that it is worth monthly blood tests and ECG (maternal Lithium) or a risk of respiratory depression, sedation and withdrawal seizures (benzodiazepines) or unknown side effects (many other drugs)?
We’re talking about daily medication for more than six months for most women with PPD.
What is so wrong with formula?
We know that formula fed babies don’t risk any serious long term harms, so what is the benefit of breastfeeding that outweighs the risks posed by exposure as a neonate to possibly toxic drugs?
Everything I have about medication in pregnancy and breastfeeding says “use only if benefit outweighs risk”. Unless the woman refuses to formula feed, despite advice, the risk of continuing breastfeeding outweighs the risk of given formula.
Convince me otherwise Ellen Mary.
Tell me, what is so great about breastfeeding that it is worth risking a baby’s health for?
I don’t get it- and I breast fed my daughter for over a year and never gave her a single bottle of formula.
Out of curiosity Dr. Kitty, based on Ellen Mary’s categorical assertion that women with PPD can’t give informed consent – would they also not be able to adeptly monitor an infant? Thus this entire argument unravels rather neatly.
I never said that. Who is functionally illiterate now? Apparently a ton of posters here. I posted that I was disgusted with that attitude.
“Women can’t offer informed consent if they have PPD.” Ellen Mary dixit.
“Here’s a pullquote for ya: Lithium may be used in mothers of fullterm
infants who are willing and able to monitor their infants.” Ellen Mary dixit AGAIN.
Wait, what? If a woman can’t consent while suffering from PPD, there is a good chance she will be unable to monitor her infant no matter how willing.
Wait. Did you seriously just say that women with PPD can’t offer informed consent? Because that is completely wrong and a really, really scary attitude.
No, she’s claiming that I said that in my post above.
I don’t think women with PPD can’t give informed consent, I said that it might be difficult to convince a jury, coroner or medical board that your PPD patient was fully aware of the risks of continuing to breastfeed in the event that there was a medication related adverse event, which is not the same thing.
Just as it has been successfully argued that people didn’t really understand the risks of VBAC, despite signing consent forms, if there is a rupture. Because 0.5% sounds like a small risk until it is you. I imagine that “a unknown and unquantifiable risk” would go over even less well, given the safety of formula.
holy christ Ellen Mary SHUT UP! do you not understand what a profoundly ignorant and HARMFUL statement that is? JEEZ. THIS IS WHY WOMEN DO NOT SEEK HELP FOR PPD IN SO MANY CASES!! They are scared they will be perceived as unfit mothers. as weak hysterical women incapable of rational thought. They are scared if they let someone know how they feel their baby will be taken away. Or that they will be seen as less than. that they will be perceived as crazy, shitty mothers.
seriously, go home, you’re either drunk or just really mean
Please don’t tell anyone who is trying to participate to shut up or go away. Everyone is welcome here.
I think Ellen Mary meant that “women with PPD can’t give informed consent” is one of the attitudes on this board that is disgusting her. Of course, no one ever said that at all, or even implied it, but whatever.
My sincere apologies. I misread her comment and I was a jerk. I’d delete, but I’m going to own my assholery.
Someone dear to me tried to commit suicide when her son was five months old. I can be pretty knee jerky on the issue
Atypical antipsychotics are a big question mark when it comes to breastfeeding safety. Tiny amount of data. And sometimes they can really help.
Prescribe many psychoactive drugs, do you?
SSRIs are first line, but they do not work for everyone.
Safety data is limited or breastfeeding is thought to be unsafe with MAOIs, Tricyclics, Lithium, Pregabalin, Buproprion and atypical antipsychotics.
We therefore have three options if someone has a mental illness that is not managed well with drugs we think are safe to use while breastfeeding.
1) Prioritise breastfeeding and don’t treat them. Hard pass on that one.
2) Advise them of the unproven safety record of these drugs and suggest they continue Breast feeding regardless.
3) Advise them of the unproven safety record of these drugs and suggest that they switch to formula, as we know that this will be safest for baby and unlikely to cause the mother any issues.
The problem with option 2 is that we are talking about getting informed consent for something potentially risky from someone who may not be in a good position to weigh up her options.
If there IS an adverse outcome for baby due to medication, it may be difficult to explain to a coroner, a jury or a medical board that your patient was really making an informed choice and truly able to weigh up the risks of formula feeding appropriately against the risks of taking a drug with an unproven track record of safety in breastfeeding women.
For that reason most physicians will recommend women on psychoactive drugs which have limited safety data do not breastfeed. The benefits simply don’t outweigh the risks, given the data we have, which is that formula is safe and these drugs might not be.
Most medical practitioners seem pretty risk averse when looking at using drugs during breastfeeding. I thought breastfeeding was important enough to continue until I was faced with that decision too. I found it incredibly difficult to weigh up breastfeeding vs taking a medication that “theoretically should be OK, but we don’t have any data because it is a new drug and rarely used by breastfeeding women”.
In the end I left the research and decision to one of the specialist paediatricians who was interested in looking into it for me (and pro-breastfeeding and specialised in immunology so would be able to understand the links between breastfeeding and the immune system better than most others). He recommended formula feeding. That’s when I really understood that most women are not getting an honest picture of the benefits of breastfeeding.
“Most medical practitioners seem pretty risk averse when looking at using drugs during breastfeeding.”
And shouldn’t they be, given what we know about the lack of substantial outcome differences between breast and bottle? Yes, Breast Is Best, all else being equal, but having drugs with unknown long-term effects and some with known negative short-term effects being distributed to your baby seems a bit the epitome of all Not Being Equal.
Here’s a question. Are there any antidepressants that don’t have the GI bleeding risk of the SSRIs?
It does seem to be a class specific effect of SSRIs, so Tricyclics, MAOIs etc don’t have the same risks, although their side effect profiles are different and not necessarily better.
The perfect antidepressant doesn’t exist.
Mostly you’re looking for one where the improvement in mood is enough to outweigh any negative side effects.
I can’t argue with this. Anecdotal to be sure, but I have two friends who were really shattered by their inability to breastfeed, because the pressure was so intense and they’d wrapped so much of the concept of “good motherhood” up in that activity. One friend struggled with the feelings of inadequacy for years; it became a really unhealthy focus for all of those first-time-mom issues.
I suffered post partum depression which wasn’t caught or treated (largely due to my insistence on insisting everything was FINE) and I didn’t realize how bad it had been until I moved overseas and things started to get better.
I was a “failure”. I allowed pitocin, which led to an epidural. and I couldn’t make enough milk for my baby. I eventually got over the epidural, but the breast feeding still stings even two years later. I don’t know if I could have avoided the PPD if I had made rivers of milk. maybe my obsessive thinking and obsessive calculations of ratio of formula to breast milk divided by ounces gained and trying to figure out the precise number of calories my daughter needed would have been funneled to another issue. Maybe I would have cried about all the weight I’d gained (which definitely didn’t help). Maybe I would have spent all that anxious obsessesion on her sleep habits…I don’t know. I really don’t.
But I do feel that if I hadn’t built up breast feeding so high, I might not have suffered the way I did. If I hadn’t had such crazy anxiety about formula, I could have gotten some sleep and been less nuts. If I hadn’t been so obsessed with breast feeding I possibly could have slept even a few hours at the hospital and put myself on the right path towards recovery.
so, I can’t say 100% my problems were caused by breast feeding, but signs point in that direction
I read that article yesterday and remembered the author’s name from some other post Dr. Amy did recently, so I was thinking that Ms. Norman-Nathman is an NCBer. The article itself is actually fine–there’s no suggestion that natural childbirth or breastfeeding is the solution to PPD. But I noticed the definite omission of specifics and could easily see this woman, or other NCBer types inserting the old “they RUINED my breastfeeding relationship by offering me formula at the hospital! It’s all their fault that I have PPD, so we must ban formula from hospitals!” Or “I have PPD because I felt like my choices were taken from me at the big evil hospital, so I must inspire fear in expectant mothers, and convince them that if they can’t control every aspect of a birth, and especially, if the doctor can be blamed for wresting control, they are at risk of PPD too!”
Luckily, none of that is actually said in the piece, it just says women should be heard and have reasonable expectations. I agree with that, and I also think they should have resources in case that isn’t enough. If the NCB community really cares about women’s mental health, they will recognize that it doesn’t matter how a woman gives birth or how she feeds or cares for her baby, and that if they dwell on that, they are only adding to the problem.
I actually had PPD after my second baby. My first was a c-section, had trouble nursing and hated all the AP things like slings and co sleeping (though he will happily crawl into our bed now if allowed). I did not have PPD with him. My second was a VBAC, nursed like she read the manual in the womb, loved all the AP things and basically if the woo was right I should never have come close to PPD with her. In my own case, breastfeeding was one of the only things I felt I could do right in the midst of PPD.
However, despite my own personal experience I am fairly sure that for women who are likely to get PPD the whole NCB & lactivism stuff does not help at all if their experience does not match up with expectations.
I’m not sure if it is fair to claim causation though, or simply a negative effect once PPD is already in place.
I had PPD too, and it had nothing to do with NCB or expectations. It had everything to do with 1)predisposition ,2)sleep deprivation and 3) job stress. However, I can see how it could be a factor in someone who is predisposed. I’ve read so many stories of women who couldn’t breastfeed, who were so depressed—odds are they were already depressed or heading that way, but the breastfeeding struggle tipped them over the edge (like the sleep dep did for me).
I’m not expert on depression, but I know that sometimes, depressed people get in a cycle of anxious/depressive thinking where they just hang on to one idea and can’t let it go. For some women, its how they are failing at breastfeeding. For me, my job was undergoing a merger and layoffs were looming—I had convinced myself that I would be laid-off, have to find a job that would be a 2hr commute one-way from where we live and that I’d never see my babies because I’d leave before they awoke and get home after they went to sleep.
At any rate, women who are at risk of depression don’t need to be told “Oh if you just do it like THIS, all will be well!” They need to be told “It’s ok to get help, and we love you and are here for you. And you are a wonderful mother.”
Predisposition! My brain just couldn’t find the word. Jet lag sucks.
Reposting bc I originally put this in the wrong thread…
We’re formula feeding our twins, both because we had a rough postpartum period (me hospitalized and very ill, them in the NICU) that made nursing extremely difficult so my milk didn’t come in in sufficient quantities, and because it turns out (who knew!) that taking care of preemie twins while recovering from your own complications is extraordinarily difficult and the only way to pump enough is to spend like 6 hours/day attached to a breastpump as opposed to actually taking care of your babies.
I’ve felt really bad about that, *even though* I’ve seen the studies indicating that the benefits of BF are minuscule in the developed world, so I can well imagine a woman who was truly steeped in the woo feeling horrifically depressed. Get this: a lactation consultant I went to told me that one thing I could do would be to “hire a doula for two weeks to help with the babies so you can pump enough to find out whether you’re capable of producing enough to feed both babies.” Of course, since you have to pump every three hours, that would mean having a doula there around the clock. And it would also mean pumping while someone else (the doula and my husband) took care of my babies.
In other words, the suggestion was to spend several thousand dollars (postpartum doulas are easily $20+/hour), and to watch my newborn babies spend two solid weeks not being cared for by me but instead by doulas we barely know and will never see again, in order to FIND OUT **IF** I was capable of producing enough milk to feed them both.
But it recently occurred to me, as we were sitting there feeding our babies the super high-end, calorie-dense, “biodynamic” (ultra-organic) European formula we chose, that the formula was probably actually better for them than my breast milk: it came from cows who’ve literally spent their lives eating grass and local organic hay in Alpine meadows, not from a mom who’s spent her life in polluted cities and sometimes eats at Qdoba.
And I’ve heard of women whose breastmilk seems totally adequate but turns out–when investigated due to the babies’ failure to thrive–to be very poor in calories and/or nutrients. For instance, I saw a news story about an EBF mom whose baby was diagnosed with rickets because the mom had very low vitamin D; also, a woman on Fearless Formula Feeder posted about how her breast milk only had half the calories it should have.
In addition to causing problems for the baby in infancy, I wouldn’t be surprised if calorie-poor breastmilk caused epigenetic changes that inclined the child towards obesity, because the baby’s body would “learn” from that breast milk that it was in a deprived environment and needed to store all the fat it could.
Hi! I’m Mel and I’m a well-functioning adult. My twin sister and I were born prematurely and Mom spent lots of time attached to pumps collecting breast milk when we were in the hospital. It worked reasonably well for me, but my twin needed specialized, pre-digested formula to survive. When I came home, Mom was able to breastfeed me while Rachel was still hospitalized. When Rachel came home, the demands of two preemie infants who needed early intervention was too much to combine with breastfeeding and I got Similac (or something similar) while Rach was still on pre-digested formula.
We turned out fine. I’m sure your babies will too.
Thanks. 🙂
🙂 And if you need another anecdote, my twins, now 6, were formula fed and they are fine too. They are in kindergarten, and a few months ago, their teacher told us (BRAG TIME) that they were both reading and doing math above grade level, so clearly they are not stupid as a result of formula. They are also not obese, or sickly, basically, they’ve gotten the colds and stomach bugs one would expect of children who went to daycare at 3mos old.
How are you feeling now? How old are your babies? They are growing and thriving? Are you getting what you need?
Guys, I’m really touched that you’re trying to make me–a total stranger on an internet forum–feel better. Thank you!
Our twins are almost six months old, tall and strong and heavy for their age, fat and gorgeous, thriving. I’m pretty much getting what I need, too, and that looks like it will steadily improve.
Yay! So glad to hear that things are going well.
I am really glad your kids are doing well.
The combox here, not to mention our hostess ;), are very good about that. When I found the Skeptical OB, it was during tear-filled midnight attempt-to-nurse-with-SNS-system-and-raging-yeast-infection #527 (give or take a session). In all seriousness, whenever the next kid is born, though some other blogs may go by the wayside in the inevitable postpartum haze, I will make a point to check in here every so often. Reading kind, supportive, nonjudgmental comments about FF, CS, PPD, etc made a serious difference to me in a very dark time.
How are your babies? I am the mother of a premature baby too. He was born early due to severe preeclampsia. I did not have enough milk myself. I tried to pump every hour for a weekend while my son was still admitted and my husband was doing kangaroo care with him. It did not work. After that I decided that I would only give him as much as I had and supplement with a very expensive european formula for premature babies. He is doing great. Neurological development great and no respiratory or ear infections in almost 5 months. I am producing very little milk now but he is still on combo feeding.
I hope your babies are doing fine. You are a great mom. Seriously, you were ill and you managed to look after two (two!) premature babies. Do not feel guilty.
As someone who suffered from ppd 2x and did not buy into woo, I’ve actually been wondering something else–if people are going to the woo b/c they have PPD. As in, they feel that unexplained unexpected feeling of dissatisfaction, that they are not *supposed * to feel, and they don’t know it’s PPD (I didn’t, the first time, despite being well educated etc), and they need *something* to blame it on, such as their failed birth that didn’t go as planned.
I do have to say that the same group of folks where I live that promote some home birth woo also run PPD support groups hotlines etc.
“I do have to say that the same group of folks where I live that promote some home birth woo also run PPD support groups hotlines etc.”
This makes me think of those crisis pregnancy centers that run abortion counseling lines and support groups. No matter what your problems are, an abortion will always be wrong and if you’ve had an abortion you’re supposed to be really traumatised and ruined because of it.
Not sure how you leapt to that. I actually attended the support group and it was all about support. Nothing to do with home birth bf etc. nothing about failure. I was pointing out that the wooey people here are ok when it comes to PPD.
It’s my bias showing. Those are two groups I wouldn’t trust if I felt at all vulnerable and was looking for help with pre or post partum issues. There are probably worthwhile groups within those categories (and if you found one that benefited you when in need-great) but there are too many bad acts to reliably recommend them as a whole, and it’s too much fuss sorting them individually.
It’s a bit like emotional vampirism from some of these women that are trying to “help”..
I would’t doubt it. I think maybe some of it is that everything you see/hear in the media and even from other parents is all “baby joy” “babymoon” ” never loved anyone like I love this little person” ” the wonder of the birth experience” and then you have the baby and I don’t know about anyone else but, for the first day or two especially, what I felt was “Oh My God, I am responsible for this helpless baby, what the hell was I thinking? Ouch, Ouch OUch I have 8 million stiches in my perinium and I can’t sit, walk or stand without pain! and I sprained my ankle pushing and that hurts too!” ” I can’t fall asleep because what if she stops breathing” Yeah there were really lovely moments of cuddling and feeding and everything, but I could not help feeling like a complete fraud for a little while, and even though I did not want to breast feed the encouragement to “just give it a try” made me feel even worse.
I am happy to say my daughter survived our clumsy first attempts at parenthood and is now a reasonable well adjusted 20 year old.
Additionally I just have to note that we have worked HARD to get to the point where medical treatment for PPD/A can be available to BF women without forcing them to choose between BF & treatment. This is a huge, science-based achievement as many medications truly are compatible. However there are always people saying that really they are not (antiquated ideas about medications & BreastMilk) & theorizing that BF is really the cause through some mysterious hormonal or social mechanism. When will we just support BF as a legitimate choice?
It is sometimes a hormonal mechanism.
We do just support breastfeeding as a legitimate choice. For feeding a baby. Not for anything else. And that formula is an equally legitimate choice.
BF also can have a hormonal mechanism that is protective against PPD . . . The hormonal issue at play are not completely understood but my concern is for the woman who wants to BF & treat her PPD & goes into the therapist & hears, well lactivism caused your PPD & it isn’t even feminist, so if you just shake off those retrograde ideas (and pick up some formula), you will be cured!
If just not BF or not caring about BF & divorcing yourself from NCB (the opposite of cause) PPD/A, the world would be a much simpler place. Women under the ‘spell’ of lactivism & NCB are not the only ones who experience PPD/A, far from it.
Sigh. Ellen Mary there is no known protective effect against PPD from breastfeeding. Please stop spewing your undigested biases out all over this page.
I read an article recently breaking down a study that showed that for some women, oxytocin boosts (such as you see with breastfeeding) actually made these women feel bad/depressed. I think the physiology is way more complex and individually dependent. Saying it has protective mechanisms is misleading. Plenty of women have PPD/A while breastfeeding.
Dysphoric Milk Ejection Reflex being a well defined example.
DMER =/= PPD/A
“who wants to BF & treat her PPD & goes into the therapist & hears, well lactivism caused your PPD & it isn’t even feminist, so if you just shake off those retrograde ideas (and pick up some formula), you will be cured!”
I’m not getting the feminism reference here, therapists are concerned with treatment, not the patriarchy.
And a woman that is breastfeeding and is depressed deserves to know about the possible link between those two states. That’s not anti-breastfeeding, that’s treating the patient.
Just supply one citation that establishes BF as a cause of PPD strong enough that women ‘deserve to be informed’ of it at a therapist appointment. Just one.
I can’t speak for Cobalt, but I don’t think anyone is saying that BF causes PPD directly. More that for women who are already prone to PPD, struggling to BF, or hating BFing (even if it is working) in a world which puts it as the only thing a good mother would do [to feed her baby], can be a factor that contributes to the PPD or exacerbates it. Even if BFing is going swimmingly, its a lot of work, and the potential for a lot of lost sleep, depending on the mother/baby in question. Sleep deprivation is known to contribute to depression. That’s not to say that all BFing mothers are sleep deprived, but most certainly some are, and it can’t be helping their mental state.
Dr Amy is not. Plenty of commenters here are actually saying that.
I read it as Dr. Amy suggesting that lactivism might cause PPD, not breastfeeding itself. The external pressure/bullying/expectations set on a new mother, not the act of breastfeeding.
My personal opinion is that lactivism in and of itself probably doesn’t directly cause PPD, but that in a woman who is predisposed or high-risk, it may contribute.
Communism as social and economical system was nowhere near a bad idea by itself, it’s what the zealots upgraded it into in their mad fanaticism that had negative consequences. When your starting point is that every other existing, reasonable option is less worthy and must be fought against is when the really bad things start to happen.
A lot like what happens when breastfeeding turns into lactavism and is propagated as not only maybe a better option, but as “the best” and the only option that prevents…everything. Just squirt some breastmilk onto whatever is the problem and let it work its magic.
Actually, could you please first supply a citation to support your claim that BF also can have a hormonal mechanism that is protective against PPD?
This isn’t about breastfeeding. This is about lactivism and the pressures that it brings to bear on new mothers.
“When will we just support BF as a legitimate choice?”
When will Ellen Mary support formula as a legitimate choice? When will Ellen Mary believe women who say that *for them* formula was a better choice for their mental health?
The bigger problem isn’t supporting breast-feeding; it’s the immaturity of human infant’s kidneys and much smaller size compared to their mother when drugs are passed across breast milk.
Humans are born with really incomplete kidneys. They aren’t very efficient at all so drugs that pass through breast milk can have an outsized effect on the infant compared to the mother.
There’s no easy or simple answer to that problem.
An infant doesn’t receive a dose comparable to an adult dose through breast milk. In most cases they receive a tiny percentage of the equivalent weight based dose.
It’s not just dose dependent, Ellen Mary. A much smaller dose can have an out-sized effect because infant’s underdeveloped excretory system.
Infant kidney function =/= adult kidney function
Infant kidney function << adult kidney function
Infant liver function =/= adult liver function
Infant kidney function << adult liver function
Unfortunately, a strong desire of the mother to breastfeed does not magically change infant physiology.
Those are fundamental truths about prescribing to a breastfeeding mother, but there are many antidepressants that can safely be prescribed. Meds are only the start of treating PPMDs! There is the big ol elephant in the room which is sleep deprivation, and sorry, but exclusive breastfeeding is not always compatible with a minimal amount of continuous sleep.
And your antiquated ideas about the compatibility of medication & Breastfeeding don’t change the fact that highly effective medications for PPD/A are perfectly compatible with BF & it is well established that they are.
As a pharmacist I’d like to point out that there is actually not much data on breast feeding and antidepressants/antipsychotic medications. What data we do have comes from small observational studies (as randomized double blind studies would be rather unethical).
Babies do metabolize drugs very differently than adults and even older children, so small amounts of drugs excreted in breast milk do need to be kept under consideration. For example, an a neonate and a 5 month old would require different doses of most antibiotics even if they weighed the same amount. Infants, especially newborns have liver enzymes that do not work the same as adults, they can’t break down many drugs as quickly, or at all in some cases. Also, they kidneys don’t clear drugs the same as adults, so toxicity can occur at different dose per body weight.
In Ellen Mary’s world everything causes cancer and breastfeeding is a panacea.
Does major stress because of and obsessing over breastfeeding cause cancer?
Oh, the irony!
When will you get it through your thick skull that nobody is arguing against breastfeeding or support for breastfeeding? There is NOTHING resembling that in the article or the comments, and you’ve been repeatedly told, both here and on previous threads, that the issue being discussed is LACTIVISM. Lactivists, the ones who say a drop of formal ruins everything, who guilt and shame mothers for choosing to combo feed or not breastfeed at all?
‘Cause’ is a dangerous word here. Contribute? Sure. But acting like if you just shift your paradigm or buy some formula that a serious condition with a biological basis will abate is dangerous. If simply not Breastfeeding was the cure for PPD we would have discovered that in the 1950s & all lived happily ever after. Women with PPD/A/P need more sophisticated approaches that simply advising them to stop Breastfeeding or wishing for a different birth.
And just like determinism isn’t limited to a certain type of parent, nor is idealized images of motherhood. We had those well before the postmodern era.
For some women, breastfeeding (or not breastfeeding) is completely unrelated to depression. That is true.
There is a connection to shaming over choices though, and that is something our society can and should change. There are also women for whom lactation, as a biological process, causes anxiety and/or depression, and that needs to be acknowledged and treated with honesty and sensitivity.
Yes, Dr. Amy sometimes has a narrower focus, but someone needs to shine a light on these specific issues.
But I wasn’t asking if breastfeeding caused PPD, I was asking if lactivism caused PPD.
Most women who value Breastfeeding enough to spend their precious time engaging in it could be said to subscribe to some tenets of what you define as lactivism. Are they then the cause of their own PPD?
Most women who spend their time breastfeeding are not lactivists, lactivists are women who spend their precious time claiming how BFing is the only option for any mother who really cares for her baby. I don’t know if they are causing their own depression (I assume they probably enjoy or enjoyed breastfeeding, and were successful in it and felt very good for it, or they wouldn’t be lactivists, but I might be wrong), honestly it’s not my main concern.
I didn’t say they ‘were lactivists’ I said they subscribe to some tenants of what passes for lactivism at SOB, which can include even believing that ‘breast is best’ in any way or apparently that BF is basically compatible with medications for depression or that BF is not the straight up cause of PPD.
NOBODY SAID THAT. Are you actually functionally illiterate?
I am beginning to think she is.
I would love to have a post on SOB about the dangerous philosophy of Lactivism without Ellen Mary getting her feelings hurt over nothing. It always derails from meaningful discussion. I used to think she was being deliberately obtuse but maybe she is just that wilfully…dense?
No. Like many lactivists she thinks that if you are not mirroring her choices back to her, you are criticizing her. But, of course, we aren’t discussing her at all.
So lactivism = activism about BF, but wait, I’m a lactivist just because you say I am, even tho I spend 0.0% of my time on BF activist activities. So I guess if I experience PPD I caused it by expressing any ideas that anyone could describe as lactivist.
You spend an awful lot of time here lactivating.
Cobalt’s Mirror: When you insist on maintaining ignorance after ample educational opportunities, you are directly responsible for the results of your willful ignorance. It’s a refutation of allowances made according to Hanlon’s Razor.
“what passes for lactivism at SOB”: lactivism = activism about
breastfeeding, do we agree on that? Activism, as in actively adovcating
for the sheer superiority of breastfeeding and acting to impose this
view in the public discourse (media, policies…).
So we’re not talking about women who choose to breastfeed their own baby because they think it’s
best (or for whatever reason). Only of those who try to influence other women’s choice pushing on them the breast is best philosophy (be it with judgemental talks or more formal steps like dedicated facebook pages, conferences etc.).
You’re just pulling things out of your ass and showing your privilege. “Most women”, please. Most women who breastfeed do it because THEY LACK THE CHOICE TO DO OTHERWISE OR BECAUSE THE CHOICE TO DO OTHERWISE COULD MAKE THEIR BABY SICK OR KILL IT.
Seriously, get some perspective before you open your mouth. We get it, breast breast breast Ellen Mary breast. This is your identity here, this is what you apparently value as a key priority with respect to how you parent. But guess what, this post wasn’t about you and not everyone is the same as you or makes the same choices, you navelgazing narcissist.
Said the woman who doesn’t own a sofa because she believes the cushions will cause cancer.
I happen to own a sofa at this exact moment, just as a FTR. I still think it is basically a regrettable festival of Flame Retardants, cardboard & PolyUrethane Foam, and I will be divesting at my earliest convenience, but your statement about me happens to be factually false right this moment. <3
Just because you are in possession of a sofa doesn’t mean you don’t think it will poison you.
I don’t have to think something ‘will poison me’ to understand that it contains substances I would rather not expose my family or the people who make couches to. Fortunately my couch is used, so no furniture industry workers were harmed. 😉
Invest in better furniture. It’s easy in my area to find furniture that fits a number of green lifestyle requirements. At least try to enjoy life, will you?
“Invest in better furniture.”
Exactly! In my experience it’s easy to find “green” furniture, and any mother who loves her family enough will prioritize the money to pay for it. Certainly it’s been no problem for me to afford.
Ellen Mary is just lazy. She claims ” I will be divesting [of my consumer-grade sofa] at my earliest convenience”, but who believes her? It’s one predictable excuse after another with these mothers who create chemical-laden homes for their families. She clearly doesn’t care about what her kids are exposed to. I’m sad for her that she puts $ before her kids’ health.
I like it, but I think it might have wooshed right over her head.
I’m sure the workers in the furniture industry appreciate your lack of support for their livelihoods.
What kind of sophisticated approaches are you talking about?
Talk therapy and medication are the standard treatments for clinical depression and anxiety.
If you are being treated with medication, you might quite reasonably feel that formula feeding is preferable to exposing your baby to the medication, even if it is generally regarded as safe. Or you might feel that the benefits of breastfeeding outweigh any potential risk. Neither approach is obviously right or wrong, given our current state of knowledge.
Therapy might aid a woman in choosing not to breastfeed, if she feels it is contributing to her depression/anxiety. A skilled, professional therapist is not automatically going to direct a woman to give up breastfeeding, especially if it is something she values and enjoys. I’m not really sure why you’re so hostile to the idea of breastfeeding contributing to depression in some women, or why you view therapists with such suspicion.
I don’t view Therapists with suspicion. I view advice regarding BF with suspicion because of the abysmal history there.
So why assume that a therapist will advise a woman who wants to BF to stop unnecessarily?
Have you considered that with BF and depression, as with all other areas of reproductive health, women’s needs, values, and experiences may vary? So it may be valuable for some women to have support in choosing not to BF if it is causing them distress or guilt, or if they would benefit substantially from medication but don’t want to take it while nursing.
And for some moms, the sheer stress of trying to BF and make appointments with or without the kid might ensure that they won’t even get to therapy.
Signed, the woman who drained her own breast abscess (yes, I do know now just how stupid that was, no, I won’t do it again) because the thought of trying to schedule a doctor’s appointment or procedure with all the feedings a newborn requires was so overwhelming I couldn’t deal with it. ‘Cause, you know, much better to risk blood poisoning or what-have-you than to hand DH the baby, stash a few bottles of formula in the fridge, point out the changing table (stocked with diapers, wipes, and so on) and say “I have a medical emergency, and need to go to the doctor to get it taken care of.”
Here’s an analogy to help you understand. Let’s say I’m planning to drive my baby around in a 10 year old Civic. You think nothing less than a new Lexus would be appropriate for transporting a new baby. I disagree, because the Civic is safe and serviceable, and provides the essentials despite what it lacks in frills. Besides, no one can look at a kindergarten class and pick out which kids arrived in an average car, and which arrived in a luxury vehicle. That answer isn’t good enough for you, so you up the ante and accuse me of being a bad mother who is too lazy, uneducated, or just plain inferior to see the wisdom of your advice. For someone who is already in an extremely vulnerable state of mind, is it possible that this type of “help”could tip the scales in the direction of depression?
I’m also wondering if the hormonal differences of a breastfeeding mom play a role in PPD. When I finally quit breastfeeding at 7 months, all the fears that I would throw my baby over a bridge stopped. I had terrible anxiety that made it impossible for me to cross a bridge with my baby on foot. We lived in a high rise in a large city and it was summertime, but I refused to open the windows. Once my husband left a window open and I locked myself in the bathroom sobbing on the floor because my baby was crying and I couldn’t go near her because of the window. I thought I was going mad, and maybe I was. I stopped breastfeeding to get help, but then all the anxiety just left and I was me again. For that reason alone, I will not attempt to breastfeed our second child at all. Not even for the colostrum. I have received countless tisk tisks for not even being “willing to try”. But at this point I feel the rest of the world can just F itself.
Postpartum OCD with intrusive thoughts is miserable. I’m sorry you had to go through that. At this point almost everyone has heard about PPD, but we are not educating women about PPOCD. So then when they have the intrusive thoughts, they think they are going crazy or that they are in danger of acting on the instrusive thoughts (they aren’t). We don’t know why some women develop it and others don’t. For some, breastfeeding plays a part, but others it doesn’t.
I think I see more PPOCD w intrusive thoughts than I do vanilla PPD. I am in the midst of reading up on it. It’s hard to treat.
ETA: the most important thing seems to be reassuring them that they don’t have pp psychosis.
Some cases are hard to treat, but a lot of them really aren’t. As you say, education about what exactly are intrusive thoughts and why they aren’t the same as PPP thoughts goes a looooong way. Knowing that the thoughts are just a brain glitch and don’t reflect deep dark desires, is a huge relief. When fear of the thoughts goes away, the thoughts can decrease in frequency just from that alone. Add to that some CBT +/- SSRI and that may be all they need.
You have just changed my life in a very positive way, and I mean that very seriously.
Thank you.
Nobody talks about this and nobody asks. I didn’t have PPD, but like others here, I had dreadful thoughts of dropping the baby, smothering the baby, baby dying in a car accident, on goes the list. Mine wasn’t so bad and resolved in time, but my sister needed meds and therapy with her second.
I know you’re a GP, fifty. I just wish more GPs talked about anxiety postpartum, and not just depression.
OMG. I just learnt something new. I was passing all the PPD questionnaires at the time, but looking back my mental health was not good. I had awful thoughts come to me – especially while bathing the baby on my own – but I didn’t feel I was ever going to do anything so I never acted on it. I also really struggled to sleep due to my fear of SIDS (would wake regularly at night and stare at the baby’s chest to make sure she was breathing).
The PPD questionnaire had something on it to do with “enjoying my usual activities” – I thoroughly enjoyed the tasks I usually had to do without the baby – it was caring for the baby that was a miserable mess of anxiety for me. I did say something similar to the Children’s Health Nurse but I think she just registered “stressed out new mum” and decided I didn’t have any issues because I’d passed the questionnaire.
The SIDS thing hung on me for a long time. When my kid was well past the danger age, my friend had a baby. She put him down for a nap and I just sat there watching him while everyone else socialized. She finally came over and said, “Anjel, he will still breathe if you look away. Come have some cookies.”
I’d like to give you a big high five or fist bump or hug – which ever you prefer. You are making the best choice for you and your baby and deserve credit for being smart, loving and pro-active.
I think you raise a valid point. I’ve also felt much more like myself (not just mentally, but physically as well) since stopping breastfeeding. Like you, I struggled with increased anxiety after my little guy…much of which faded after he weaned.
(I also developed heart palpitations while breastfeeding that went along w/ the anxiety. Scared the crap out of me. Given that, I’m really not sure I’ll try breastfeeding if we have a second.)
This is me. I get a little depressed postpartum, so PPD doesn’t feel like the right answer. I do have major anxiety though, and I am frequently certain I’m going to drop the baby, or fall on him, or something much more awful. I wish I could just tell my imagination to shut up and leave me alone.
Anxiety was worse than actual depression symptoms for me. Medication and a helpful GP who was willing to listen sorted me out though.
Oddly, my anxiety was focussed on my son, who was a toddler, rather than the baby. I was sure he would be kidnapped from nursery or hit by a car or something. I didn’t really worry overmuch about the baby.
And the anxiety can be on Dad’s part. My Demodocus was so anxious, he had to get counseling.
That is a good point. Research is starting to show the effects on the father and they can suffer too. I am glad he was willing to get he help that he needed.
F themselves for sure. Anyone who would want you to chance that again is evil.
Whoa.
WHOA.
Ummm, even after 9 months or so at the Skeptical OB, I didn’t realize that other moms had those kind of thoughts, too. *looks sheepish* Except with me, it was the worry that I’d put DD in the oven and set it to the “clean” function–you know, where it gets so hot that it automatically locks for three hours after you press the button? I could go into the kitchen, but I spent the whole time panicking that I’d somehow do the above scenario. It does sound insane. But it happened.
Next time I get pregnant, one of the first conversations with my OB will be about whether I can preemptively start some sort of antidepressants/anti-anxiety meds in the hospital postpartum. Period. Re your last line: ditto. And good on you for figuring out what works best for both you and baby and doing it.
I didn’t know either. I didn’t know until my sister shared that she had similar dark thoughts after both of her children were born.
Damn. Reading that made the hairs stand on the back of my neck. I’m so glad that the oven one didn’t cross my mind at the time. My fear of heights was exactly like that. I’m sure that if the oven had ever crossed my mind, I would have had the same thing.
The intrusive thoughts were particularly troubling to me because while we covered some depression/anxiety in my birthing class, I rather tuned it out thinking that such things could never happen to me. I would surely be in the 90% who would be just fine. I’ve never had trouble before or after that situation with depression or anxiety. Or for OCD behavior, unless you consider someone who likes to keep a relatively tidy house. Okay, so maybe there were a few OCD tendencies. Like I can’t go to sleep until all the dishes are washed, dried, and put away, and I can’t leave my bedroom in the morning until the bed is made. Both my husband and I are like this and under normal circumstances, we are just tidy and organized. Even during pregnancy I didn’t have anxiety or panic attacks. It wasn’t until after the birth that the thoughts came on and they didn’t go away until I stopped breastfeeding.
My own mother was my worst enemy. Part hippy and part evangelical and a member of the LLL, she never missed a moment to remind me that mine and my brother’s lips NEVER once touched a bottle, that we self-weaned and yada yada. She’s been so SAD that my daughter was ‘pushed’ away from her mother before she was ready.
Mine’s the locking front load washing machines at the laundromat. Not that we even go to the laundromat, since we have regular machines at home. But still.
I am also afraid of falling while holding him. I can hear the bad sounds in my head, and I just know if I look I’ll see what’s left of him. It’s never come close to having happened, and I’m super careful. But still.
I’ve had those intrusive thoughts too! Not quite to that extent, but still, I can sympathise.
I have fallen while holding my eldest and had that split-second of knowing that I was going to fall, the only choice I had was which way I fell. It was a no-brainer despite the bad thought, I went backwards and wrapped myself around bub so she was cushioned.
I had intrusive hallucinative thoughts about accidentally dropping my baby over the banister and down the stairs, or hitting her against the doorjamb so hard that it would smash her skull open. Multiple times a day. But I had similar intrusive thoughts during other periods of my life (intrusive thoughts of self- or other-harm is a part of OCD) so I recognized them for what they were and just obsessively checked my grip and her position in my arms instead of never leaving my bedroom. But if you’ve never experienced that? Frightening as hell. It would make you feel like a monster.