Austin M-P, Highet N and the Guidelines Expert Advisory Committee (2011) Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: the national depression initiative.

The 2011 Australian perinatal mental health clinical practice guidelines state that, “While estimates vary, research suggests that depression, anxiety or both are experienced by at least one in ten women during pregnancy and one in six women in the year following birth.”

1 in 10 antenatally. 1 in 6 postpartum. It’s a big deal.

Not one of the women that I have seen in my clinical role has ever told me that bottle-feeding is the healthiest or easiest thing they can do for their baby. None. Zero. Nada. Zip.

In clinical practice, often women report that one of their biggest disappointments in motherhood has been attempting to breastfeed their baby but being unable to sustain it. Unmet expectations about an ideal pregnancy/birth/parenting experience are very common amongst women who experience anxiety or depression.

We (we the health system, that is) don’t help. As one new Mum said, “I get it: I’ve been to the classes, seen the posters, read the brochures. The message is loud and clear: GOOD MOTHERS BREASTFEED. That makes me a bad mother.”

There are other insights that have come from clinical practice;

• Depression robs you of resilience and dampens your capacity for pain tolerance, so much so that a cracked nipple, mastitis, or baby that chomps can become intolerable.
• Depression robs you of the skill of being assertive, so that you don’t feel empowered to have a balanced discussion and feel like you’re being heard if the clinician/health system is relentless in reinforcing the single message that breast is best.
• Depression robs you of sleep and the luxury of feeling refreshed – if I can offload some of the demands on my time I will feel better; hopefully.
• Depression makes you feel inadequate, ineffective and stupid – that’s why I can’t breastfeed, no matter how hard I try.
• Depression and anxiety make me so negative, so prone to thinking the worst, that I just don’t feel safe breastfeeding. It doesn’t matter how good breastfeeding is, I feel as if spending time alone holding this baby is a risk that is not worth taking right now.
• Depression robs you of joy; I don’t hate my baby, but I can’t stand being around him/her as much as I have been.
• Depression robs you of power. I don’t have a voice. It is ridiculous that every time I bottle-feed the language and attitude of others makes me feel invalidated. I am making informed decisions about what works best for me/my family right now.

So, with this information in mind, how should we respond to suggestions to concentrate on the risks of not breastfeeding? Perhaps we need a tool to support our decision-making; here’s one I prepared earlier:

We (the health system, the community) need to be respectful of what happens within families – they’re a bit like icebergs sometimes, and we don’t always see what’s going-on below the surface. Obviously infant nutrition is important; infants also benefit from having parents who feel supported in making informed decisions, parents who don’t feel that they have to hide from the health system/their peers, and parents that have their emotional and mental health taken into consideration.

Breast is best, but when breast-feeding doesn’t work-out bottles (like parents) are good enough.

Paul McNamara, 29 September 2012

Short URL meta4RN.com/breat-is-best-1