Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties

Abstract

AimsTo examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period.BackgroundDifficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of ‘breastfeeding difficulty’ is wide and includes biological, psychological and social factors.DesignA cross‐sectional self‐report survey.MethodsData were collected between December 2012 and February 2013. 217 women with an infant aged 0‐6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale.ResultsA short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score.ConclusionsUnderstanding women's specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding women's breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch.

Breastfeeding Support in the Early Postpartum: Content of Home Visits in the SILC Trial

“…Nipple pain, perceived low supply, and expressing (pumping) of breastmilk are known to negatively affect breastfeeding duration 32, 33, 34. Pain and low supply have also been linked with an increased likelihood of women experiencing symptoms of anxiety and depression 8. This study reinforced that these were important issues experienced by a significant number of women in the community, not only those seeking breastfeeding support.…”

“…A number of other researchers have also found that perceived low supply is the main reason for women reducing or ceasing breastfeeds 33, 36, as well as for expressing (pumping) breastmilk 18, 33, 36 and bottle feeding 37. Clinicians should be aware of the common misconceptions about adequacy of milk supply and actively dispel these when appropriate because breastfeeding problems have been linked to an increased risk of postnatal depression 8.…”

“…It is recognized that new mothers need to feel confident and supported in the early stages of their breastfeeding experience 4, 5, 6, 7, 8, and first‐time mothers have been found to progress from being “on shaky ground” through to gaining more information and understanding to eventually being “at ease” with breastfeeding 4. A 2012 Cochrane review of breastfeeding support identified early support for breastfeeding, including both professional and lay support, as having a positive influence on breastfeeding duration, with face‐to‐face support being the type most likely to succeed 5.…”

Psychological effects of breastfeeding on children and mothers

“…For example, Brown et al [79] found that breastfeeding cessation is correlated with high depression scores in mothers, but when examining this correlation more closely found that it was only present in mothers who stopped breastfeeding due to physical difficulty and pain when breastfeeding. Another study assessed breastfeeding complications and maternal mood at 8 weeks postpartum and found that breastfeeding problems alone, or co-morbid with physical problems, were associated with poorer maternal mood [80].…”

The resurgent influence of big formula

“…Doctors have great potential to influence behaviour, and yet training in lactation support is almost entirely absent from undergraduate or postgraduate paediatric training programmes, and attitudes can be influenced by difficult personal experiences 14. Normal neonatal behaviour (cluster feeding, frequent waking to feed) may not be understood, and breastfeeding can be hard to establish; in specific circumstances, breastfeeding is impossible.…”