Breastfeeding and postpartum depression are two aspects of motherhood that have received increasing attention in recent years.
From the adidas campaign featuring a nursing model through to Adele and other celebrities discussing their experience of postpartum depression, the physical and mental realities of motherhood are more visible than ever before.
While many mothers may experience difficulties with both breastfeeding and their mental health after giving birth, few may be aware that the two might be linked.
Jerilee Claydon is a psychotherapist and parenting educator and despite her wealth of experience and expertise, she was shocked at the impact that stopping breastfeeding had on her mental health.
Claydon explains: "For the first six to eight weeks [after I stopped] I had this awful sense of loss, as though something had died, as it was a completely different relationship [with my baby]. Even I wasn’t prepared for the loss of how our relationship was going to change."
Zainab Yate speaks of a sense of grief which gave way to low mood after she stopped breastfeeding her second child. "I was teary and I thought, Oh I must have my period, but I wasn’t due. If my husband asked me a question, I burst into tears. It sounds ridiculous, honestly; I wanted to talk about it and I wanted to grieve, but at the time I didn’t know what was going on. I felt like things were not in the right place and it was a very emotional time. It all made sense afterwards, but at the time it was very difficult."
With hindsight, both women think that hormonal changes contributed to their feelings, along with some quite complex emotions about breastfeeding. "I had experienced quite bad nursing aversion throughout my breastfeeding journey and I had a lot of bad emotion," Yate explains. "I thought at the time it was because I had felt guilty about pushing them to wean. And I thought it was because I couldn’t process the emotions, but I don’t think I made a link to oxytocin until about two years later."
Oxytocin and another hormone, prolactin, play a significant role in breastfeeding and it is the drop in production of both of these once breastfeeding stops that could be to blame for the postpartum depression, anxiety or low mood that some mothers subsequently experience.
Thirteen percent of women worldwide experience postpartum mental health issues and it is thought that the drastic change in hormone levels after giving birth is a contributing factor. When the placenta detaches from the uterus, it sets off a cascade of hormonal changes which lead to lactation. Prolactin is released, which regulates the production of breastmilk and is also known to help new mums sleep – essential when you need to get some rest before the next night feed. Oxytocin, meanwhile, is responsible for the letdown reflex, which allows milk to be ejected from the nipple. Once a mother stops breastfeeding, both these hormones will drop off, as they are simply no longer needed.
Claydon believes a significant hormonal change led to her altered mood: "You get a drop in the oxytocin and the prolactin, that stopped quite dramatically for me I found, which means I wasn’t sleeping as the prolactin helps you get to sleep."
Women should get better advice about stopping breastfeeding, says Claydon. They should make sure they wean slowly and drop just one feed a week to make sure any change isn’t too sudden – but many aren’t aware of this.
A Norwegian study of over 40,000 breastfeeding women found that stopping breastfeeding could increase the risk of anxiety and depression, with women who were already susceptible to these conditions more affected.
Dr Trudi Seneviratne, a consultant adult and perinatal psychiatrist who works on a mother and baby unit, says that despite the wealth of anecdotal evidence, more research needs to be done. "Yes, there are hormonal changes that happen that are related to the oxytocin and prolactin being released, yes it can affect mood, but there has to be so much more research that needs to be done to make any more definitive statements about that," she explains.
Pressure, motherhood and guilt
Dr Seneviratne suggests that pressure to breastfeed also has a significant impact on many women’s experiences after having a baby.
She tells us: "Honestly, I just spent the whole morning looking after some mums on the mother and baby unit, and I reckon for a good four out of five of them, the reason why they are severely depressed is they were told to breastfeed and they couldn’t and they have just wrapped themselves in guilt and they are now just really, really poorly."
To counter this, she says, women should be given much more choice over whether or not to breastfeed or continue breastfeeding. She points out that some women are actually relieved when they stop breastfeeding.
Dr Seneviratne is backed up on this by another study, which shows that the impact of a woman’s breastfeeding journey on her mental health correlates with her intention to breastfeed or otherwise. Women should be given information about getting enough rest and support prenatally, she says. "It is not empowering the woman if it is given postnatally. It is almost too late at that point."
Niquita Cole, who experienced postpartum depression after the birth of her first child, who she struggled to breastfeed, says the words of one midwife left a lasting impression. "Just before I gave birth, we attended an antenatal class where the midwife called formula 'evil' and akin to poison. It wasn’t good for our children. How on earth, as a new mother, are you meant to get over those words?" she asks.
Saskia Read also thinks that pressure to breastfeed contributed to her postpartum depression, which was picked up by her health visitor. "The stress of not being able to do breastfeeding properly made it difficult to connect with my daughter and I felt incredibly guilty about it."
This pressure, combined with a new mother's complex emotions around her postpartum body and breasts, or perceptions of womanhood, can trigger poor mental health.
Making it all better
Read thinks that having "more honest conversations" prenatally could help women be more aware of the difficulties they might experience and be better prepared to deal with them.
"Easier access to support from professionals after I went home would have been so helpful too, as I had to travel an hour to go to a once-a-week NHS breastfeeding clinic," she says.
Cole concurs: "Breastfeeding is super important, and if you can and want to, you should do it. But your mental health is far more important."