Estimated reading time: 8 minutes
Kathleen Kendall-Tackett, PhD, IBCLC, FAPA
Photo: Scheyer Vandleta Tyrell and Ahja by Robert Zuill
New research shows how breastfeeding lowers mothers’ risk of depression, helps them get more sleep, and overcome past adversity.
Each year, hundreds of thousands of mothers worldwide become depressed after giving birth. Professionals are more aware of the existence of depression as an illness than they ever have been, and that’s been a positive change. Unfortunately, the number of women with depression does seem to be on the increase. The estimated figures used to say that 10% to 20% of all new mothers had depression. The more recent range suggests it’s between 15% to 25%. This can partly be explained by an increase in surveillance, resulting in professionals identifying more cases. But it also could be that more mothers are getting depressed. When you consider the isolation, lack of support, history of abuse or other trauma, and, particularly in the U.S., the need for mothers to return to work almost immediately following the birth, the increase in depression rates is hardly surprising.
In 1994, as a new La Leche League Leader, I wrote an article for LLLI on postpartum depression. My first book, Postpartum Depression: A Comprehensive Approach for Nurses, had come out the year before, and I thought that it might be helpful for other LLL Leaders to know how best to meet the needs of mothers who were depressed.
That article opened the floodgates. Suddenly, I was getting calls from across the U.S. from mothers who had called the La Leche League hotline. Diagnosed with postpartum depression, they had been told to wean immediately. Yet so many of them told me, “Breastfeeding is the only thing that is going well for me.” I was determined to find some answers for them. So began the work that has occupied so much of my time over the past 20 years.
A brief history of postpartum depression and breastfeeding
Fortunately, there has been a major shift with regard to depression and breastfeeding. When I first started my work, breastfeeding was not even on the table for the postpartum depression team. Practitioners told mothers they did not need to be “supermom,” that formula was fine, that they needed the sleep, that it was important for them to heal, and, in order to do that, they needed to wean. I still hear some of that, but it is less common.
The first sign of the shift was that breastfeeding was accommodated. It wasn’t preferred, but if a mother insisted on breastfeeding, practitioners (mostly) were willing to work with her. This was definitely better. But mainly, such an approach focused on which medications mothers could take while breastfeeding. That was important to know. I still remember what it was like to work with a mother before that type of information became available. I think we owe a debt of gratitude to clinical pharmacologist Tom Hale, PhD, for his pioneering work. Dr. Hale has performed extensive research on the effects of medication in mothers’ milk. His website features a professional and mothers’ forum for looking up and asking for information about medications and mothers’ milk.
Breastfeeding does not deplete mothers, nor does it cause depression.
But what about the mother who does not want to take antidepressants? There are many mothers who do not want to take medications and their reluctance to do so led to the next major change in the PPD field: complementary and alternative treatments for depression. The good news is that there are many of these. The alternatives include exercise, bright light therapy, omega-3 fatty acids, and St. John’s wort. Psychotherapy alone is also quite effective.
The important thing to keep in mind is that mothers have a lot of choices. I feel concerned when mothers are offered only antidepressants without any follow-up. Patients have high rates of non-compliance with antidepressants (in one study, only 28% were still taking them at three months). If mothers do not take their medication, for whatever reason, and are still depressed, then their depression is not being treated. It is far better for health professionals to talk with mothers to find out what they want to do before prescribing medication. The more options mothers have, the more likely they are to find one (or a combination) that works for them. There is still some resistance to these treatments, with practitioners being skeptical that they can work for “serious depression.” But there is good evidence that supports their use. For more detail, read the articles I’ve highlighted on UppityScienceChick.com.
All these changes have been good. And they have helped many mothers. But with those changes breastfeeding remained something that was accommodated. It was not considered to be something that actually protected a mother’s mental health and was important to her recovery. And that is where the new research comes in.
Breastfeeding’s role in protecting mothers’ mental health
Research over the past decade has shown that breastfeeding and depression intersect in some interesting and surprising ways. All of this work has shown something that makes sense. Breastfeeding does not deplete mothers, nor does it cause depression.
Breastfeeding problems certainly can do both of these things—all the more reason why women need good support and accurate information. But it does not make sense for something so critical to the survival of our species to be harmful for mothers. And it is not.
Breastfeeding and stress
One of the initial areas of research was in examining the role of breastfeeding in turning off the stress response. Of particular importance was breastfeeding’s role in lessening mothers’ levels of inflammation (which is part of the stress response). The molecules that cause inflammation can lead to depression. When inflammation levels are high, people are more likely to get depressed. When inflammation levels are lower, the risk of depression goes down. The great thing is that breastfeeding is specifically anti-inflammatory. This is one way that breastfeeding protects women’s health throughout their lives. It lowers their risk of depression. It also lowers their risk of diseases such as heart disease and diabetes. To read more about this, click here.
When you consider the isolation, lack of support, history of abuse or other trauma, and, particularly in the U.S., the need for mothers to return to work almost immediately following the birth, the increase in depression rates is hardly surprising.
Breastfeeding and sleep
The next line of research is regarding new mothers and sleep. I thought for many years that breastfeeding mothers got less sleep. Just the opposite proved to be true; breastfeeding mothers get more sleep. It turned out that the biggest effects were for the exclusively breastfeeding mothers. This research indicates that there is something physiologically different about exclusive breastfeeding than mixed-feeding. We never want to discourage a mother who is mixed-feeding. Mothers do what they can. And their babies are reaping the benefits. But mothers who are mixed-feeding may be sleeping less and getting less of the stress-reducing effects of exclusive breastfeeding.
Do Breastfeeding Mothers Get More Sleep?
Below are some of the findings from our study of 6,410 new mothers. What is interesting in these data is that there were clear differences between exclusive breastfeeding and mixed- and formula-feeding mothers, but there was no significant difference between mixed- and formula-feeding on any of the variables we looked at. This is of concern because when faced with a tired new mother, often the first thing friends, family, and often professionals will advise is supplementing. Our data, and data from other studies, indicate that mothers who follow this advice will likely get less sleep, not more.
In this figure, we see that exclusively breastfeeding mothers sleep more overall, even though they wake more often. Although it appears to be only 20 minutes or so more, that appears to be enough to make a difference on their reports of how much energy they have, their sense of wellbeing, and their rates of depression. Click here to read the full article.
Breastfeeding and overcoming previous sexual assault
To me some of the most exciting data are on breastfeeding’s effects for women who have survived sexual assault. Some assume that women who have had these kinds of experiences will not want to breastfeed. However, two smaller previous studies found that women who had histories of child sexual abuse were more likely to say they wanted to breastfeed and to initiate breastfeeding. This is not to say that it is always easy for these women. But we would be wrong to make assumptions about what women want to do without asking them.
Breastfeeding’s Healing Impact on Sexual Assault Trauma
In our data, we looked at the impact of rape, the most serious kind of contact sexual abuse. About 13% of the women in our sample reported that they had been raped (994 women). Women with a history of sexual assault had a rate of exclusive breastfeeding that was identical to the non-assaulted women: 78% for both groups.
Not surprisingly, sexual assault had a pervasive negative effect across all the sleep and depression variables we looked at. But here’s the exciting part; when we added breastfeeding into the analyses, we found that exclusive breastfeeding actually lessened the effect of previous sexual assault! I almost couldn’t believe it when I first saw the data. Take a look.
The bottom line is the combination of mixed- and formula-feeding mothers. (We combined these because we found no significant difference in a previous set of analyses.) The top line represents the exclusively breastfeeding mothers. Clearly, the exclusively breastfeeding mothers with a history of sexual assault did sleep somewhat less than the non-assaulted mothers. But see how much less it would be if they weren’t exclusively breastfeeding.
We found a similar pattern with depression: still at increased risk, but so much less than if they were mixed- or formula-feeding.
I also thought this finding on anger and irritability was interesting. The exclusively breastfeeding mothers were pretty much “chill” (i.e., low levels of anger/irritability). This was not true for mixed- or formula-feeding mothers.
Why would breastfeeding do this? I think the answer can be found in understanding breastfeeding’s role in turning down the stress response. Researcher Maureen Groer is the one who has documented this effect. Trauma survivors often have a stress response that is overly reactive and responsive to stress. The slightest stressor can set it off. Breastfeeding seems to counter that effect.
Why Breastfeeding is Important for Trauma Survivors
I love this message. Our bodies know that we don’t have our babies in a perfect world; that bad things happen to mothers. But breastfeeding allows mothers essentially to have a “do-over,” that they can parent differently than maybe they were parented. That’s an incredibly hopeful bit of information to share with mothers. (Click here to read the full article.)
Does this mean that there is no benefit for a mixed-feeding mother? No, not at all. Clearly, breastfeeding is good no matter how much she is able to do. She benefits and her baby does too. We just need to recognize that mixed-feeding mothers may not be getting all the stress-reduction benefits they would if they were exclusively breastfeeding and support them accordingly.
Our bodies know that we don’t have our babies in a perfect world; that bad things happen to mothers. But breastfeeding allows mothers essentially to have a “do-over,”
What can we conclude from all of these recent findings? I think it’s this: breastfeeding makes a difference, and it’s not all about the milk! When a mother is depressed, if she is breastfeeding, she needs support. Some people, usually well meaning, will probably be telling her to wean. If a mother indicates that she wants to continue breastfeeding, we can help her a lot by telling her that is a great thing for her to do.
Dr. Kathleen Kendall-Tackett is a health psychologist and an International Board Certified Lactation Consultant and has been a La Leche League Leader for 19 years. She is the owner and editor-in-chief of Praeclarus Press, a small publisher specializing in women’s health, and is the author or editor of 24 books including the Science of Mother-Infant Sleep. Praeclarus has recently published a new book Perfect Mothers Get Depressed.