August is National Breastfeeding Month, a time when advocates of breastfeeding focus their efforts on awareness, education, and support for breastfeeding mothers. Education, awareness, and support regarding this issue is extremely important, given how many people struggle with nursing and how few structural supports there are in place for it. Women are told constantly during pregnancy that “breast is best,” are bombarded with information about its benefits, and are advised that the American Academy of Pediatrics recommends that breastmilk be the sole source of nutrition for the infant until at least six months of age. But when the baby comes, there is often little practical support available to most moms to actually achieve their breastfeeding goals. Certainly, there are qualified professionals such as lactation consultants holding the IBCLC designation, however while insurance coverage is improving, these services are largely paid out of pocket. The same can be said for postpartum doula services. The cost is a barrier for many, many families (this can be said for psychotherapy as well, but that’s for another post!). Breastfeeding support groups can sometimes be helpful, but that is dependent on who is running them and their philosophy. Next, while new mothers are learning how to feed their babies, many times they need to go back to work very soon after giving birth, sometimes as early as six weeks and very often after 3 months. There are laws protecting nursing mothers in the workplace that require that there be a private space other than a bathroom for them to pump, a break to do so, and storage space for the breastmilk, but often on the ground, these rules are being followed on paper but do not actually make pumping possible. Maybe the pumping room takes a lot of time to walk to and from.Maybe there is nowhere to sit near an outlet. Maybe the additional breaks needed cause the pumping person’s workload to pile up. Not to mention that some people find pumping extremely difficult. All this to say, advocacy, awareness, education, and support are needed on many levels.
If breastfeeding is a struggle, there can be intense feelings of inadequacy. Mothers fear that they will not be able to bond with their baby, that there is something wrong with them as mothers, or even as women, if they cannot do it. They may feel quite isolated, especially if they are not pumping or supplementing with formula, and sleep can be severely impacted. On the other hand, if breastfeeding is going well or eventually “clicks,” it can be a source of deep joy. The release of oxytocin (the “feel good” or “cuddle” hormone) triggered by the infant’s suckle can be very calming. There can be mixed emotions; “I love nursing, but I wish I could get away for more than two hours to do something I need to do,” “This is really hard, painful, and draining, but I really want to be able to do this.”
And what about those who are suffering from a postpartum mood or anxiety disorder? Well, its complicated! Some research shows that breastfeeding, when it goes well, can be protective against pmad’s, as it provides that boost of oxytocin, and can also give the mother a feeling of accomplishment and competence at a time when she may not be feeling either of those things very much. And, we also know that when breastfeeding isn’t going well, it can exacerbate or be a source of negative emotions. Sleep is also critically important in the managements of a pmad, and breastfeeding most definitely impacts sleep! Finally, many folks are concerned about the utilization of medication while nursing. There is plenty of evidence that many anti-depressant and anti-anxiety medications are compatible with breastfeeding, but it is very important to find a provider who is skilled in prescribing during the reproductive period of life.
Here is my personal take. Fed is best. I support breastfeeding, pumping, formula feeding, and any combination of the above. The most important thing is that Mom can take care of herself, and that the baby is fed. Sometimes, that means making changes to plans that may have been precious and a part of how a woman envisioned herself mothering. This involves loss, and that loss must be acknowledged. Sometimes, making sure Mom is doing well and baby is fed means working with the right professionals (IBCLC, psychiatrist, etc) to make sure that conditions for nursing are optimal. Every family’s situation is different and the solution is not one size fits all. The current cultural climate around mothering in general and nursing in particular is pretty prescriptive, and it can be hard to live in this climate while doing things your own way. Mothers today face so much judgment for all of their choices, whatever those choices are. I see my role in the bigger picture of all of this as being to help dismantle the culture of mom-shaming, one therapy session at a time. So, come on in, talk to me about whats going on, and if you want, feed your baby however is best for you while we sort it all out!