PPD and BFing?

[Carita]

In the past week I have heard 3 stories from women who FFed and their struggle with PPD. The stories were strikingly similar.

- Starts with open-minded mom that desires to breastfeed
- 2/3 started with a vaginal birth plan (one NCB) that failed and led to C-section, and start of guilt
- Medications/complications from birth or anatomy (inverted nipple, etc,) cause initial problems
- CLCs are fully utilized in hospital, as are online chatboards
- Initial problems become extremely overwhelming, especially when arriving at home, and some light formula supplementation is used
- Guilt is magnified, forum board advice is decidedly split, and not necessarily equally - between BFing moms who insist no supplementation be used and moms who say "oh well, you tried, that's what counts, we are here for you"
- Guilt from only the BFing moms is what is heard, even though there are good intentions, and PPD worsens.

Within less than a week, mom has given up completely on BFing and has been diagnosed with PPD. The once pro-BFing mom is now weary of Lactivists who think she is a horrible mother and won't do the best for her child. (Their perception, not mine).

Three stories - eeriely similar.

What is being done to help these moms??? - I can't believe that these 3 stories were shared with me in such a short time!! Is this an under-appreciated cause for failing to BFed?

Is there any literature out there or links for help? Next time I run into this I want to be prepared. The most difficult part of all of this is that when dealing with someone with PPD, they take everything anti-FFing so personally, so any information they are given has to be crafted with the utmost of care while still gently encouraging BFing. Each of these moms felt it was an all or nothing decision to FF somehow. Like once they supplemented, they had shut the door to BFing. If a mom with PPD is so unbelievabley overwhelmed that they cannot BFed, then isn't there some way to encourage them to go 1/2 and 1/2 until they find the right medication, get control again, and then work on BFing? Obviously that is not the easiest path to a EBF relationship, but for these women, it may be the only path available.

Sorry this is a ramble, I was so impassioned to want to educate other women, I had to ask you all!

TIA!

[Lil'M]

Check out books by Kathleen Kendall Tackett. I saw her speak and she has a lot to offer on the subject.

[mamajake]

I second the recommendation of Kendall Tackett's work.

One thing that leaps out at me is how dependent these moms were on the support of cyber-mothers. At the risk of being pounced on, I think PPD is not something peers should be treating - particularly from afar. Many people who are trained professionals in depression can't treat it. I hear these stories and I feel grateful I wasn't hooked into the cyber-mommy world when I had my first son. I had most of the risk factors these moms had (gruesome birth with unexpected complications, no family support, history of depression). I already felt like I had failed birth. It would have been really horrible to have people, no matter how well-intentioned, making me feel like if I didn't do what this or that person told me to do (awash in conflicting information) that I would fail breastfeeding as well. Hey, you fail breastfeeding, then you have failed nurturing, right? So if you failed birth, and then you failed breastfeeding and nurturing, you have failing mothering - all before your baby is a month or two old. Little wondering so many new mothers have PPD.

Moms with PPD need qualified one-on-one real live support. Screen names with agenda will not cut it. I think more moms need to know how common PPD is and that you can come through it as a great mom. New moms also need insurance coverage for qualified professionals (IBCLCs post-hospital and PhD psychologists with PPD training). When moms come to forums who need real live support, the rest of us need to resist the urge to tell her to do the things we think must work. We help her most but helping her find help in her real life.

Just my .02.

[buttercupmama]

Almost identical to my story. I'm just too stubborn to put into words, so even though I was already mourning the loss of our BFing relationship, I kept going. What helped me was researching and talking to another mom with exactly the same experience I had. She had overcome it all and told me she knew I would too. If not for her and the LLL, I would have more than likely ended up with PPD. The problem is the 'professionals' suck and good, honest information is hard to find.

[Carita]

Originally Posted by buttercupmama

Almost identical to my story. I'm just too stubborn to put into words, so even though I was already mourning the loss of our BFing relationship, I kept going. What helped me was researching and talking to another mom with exactly the same experience I had. She had overcome it all and told me she knew I would too. If not for her and the LLL, I would have more than likely ended up with PPD. The problem is the 'professionals' suck and good, honest information is hard to find.

did you find someone to talk to through LLL?
I completely agree on seeking support in person, but these women don't call their CLC - they call their OB and they go online for help.

[AislinCarys]

Here's where the trouble lies: LLL, lactivists etc. are often very quick to tell you what to do to deal with your low milk supply (feed all the time, no supplementing/no bottles, feed in the bath, eat & drink well, herbs etc), and they tend to assume you have caused your low supply by scheduling, and that you are not feeding on demand.

I am a low supply mama, who fed on demand from the beginning (really, all the time, DD never latched off!), and we got there in the end, DD is still breastfed at 10 months, we weaned from the SNS around the same time we introduced solids. But it was an extremely difficult journey.

Loneliness was one of the most difficult things to deal with, and feeling judged. I felt like I just wasn't a good enough mama among my friends, all of them breastfeeding, and buying into the myth that everyone has milk for their babies, as long as they feed on demand. No one criticized me, but I kept getting advice from these "good" mamas, most of whom had over-supply issues (which was good, as they could donate milk ). LLL was quite the same. I had a great LC, and she helped me so much. What I really needed from others was support, to feel I was doing well, to feel a part of a group, to not feel so lonely. To make it worse you get stuck between this camp and the other (the "just give her a bottle of formula, it won't hurt, you'll hurt her if you don't, some mums just don't have enough milk" crowd), both of them judging you as a bad mother for not doing what they think is ideal for baby.

The pressure is enormous from both sides (at least that's how it feels), at a time when what you really need is to concentrate on feeding and loving your baby, and you need support, not pressure. It is a situation when I think the normal response would be depression.

So if a friend of yours is struggling, tell her she's doing great, whatever she's ending up doing, and offer to cook a few meals for her/take her toddler out for the day or do a couple of loads of washing for her. Acknowledge that it is really hard, but friends are there for her, and she is doing the very best for her baby. If she isn't seeing an LC already, maybe suggest she does? Only give advice when asked, and involve her - and don't talk about exclusive breastfeeding for 6 months!

BTW, I find the "Oh well, you tried" to be awfully condescending, basically telling her she's failed, when she is working so hard to do the best for her baby in her particular situation!

I know I got through it (with or without PPD, I don't know), but I am very crunchy, and adamantly against formula, and also, extremely stubborn. Most women would have given up within a month.

[dirtgirl]

I couldn't agree more with what you say about getting real professional help Jake. I also think that we need layers of support. In my work, as well as my personal experience, I have been astonished at how resistant women can be to asking for help. Getting quality help is another issue. A postpartum doula can alleviate some of the stress of a difficult start with breastfeeding by helping out with everything else, providing companionship, and perhaps being a gauge for when professional help (LC and/or psychologist) is needed - and likely getting mom to get help sooner. Also, a pp doula can help the mom feel okay about the choices she is making if things don't go as planned. I think having a nurturer and advocate in the home setting can make a big difference in a new mother's perspective. Mother-to-mother support (LLL) has also proven to be invaluable for many women.

I also recommend Kathleen Kendall Tacket's work. I saw her speak a couple of years ago and was very excited about what she had to say about these topics. Her websites are: www.breastfeedingmadesimple.com and www.GraniteScientific.com.

[CEVmommy]

I heard a radio program recently where they were talking about an inpatient PPD program. Within the span of 10 minutes, 2 different callers who had PPD inpatient experience called and talked about how breastfeeding was really important to them, but being in this program was difficult because of several issues including that they couldn't keep their babies with them in the hospital and that the doctors were not knowledgeable about what medications were compatible with breastfeeding. Both of these moms were able to breastfeed, but felt that they did so despite their experience with the PPD inpatient program and wanted to see that these issues were better addressed for other mothers. When the head doctor on the radio program was asked to address the breastfeeding issue, his response was that mothers need to be told that it is okay to give their babies formula because the stress of worrying about breastfeeding was just adding to their troubles and that formula is just fine, etc. I really felt like he was not "hearing" these moms' concerns though. I don't know what the answer is, but that doesn't seem like it.

[AutumnAir]

Originally Posted by Carita

- Starts with open-minded mom that desires to breastfeed
- 2/3 started with a vaginal birth plan (one NCB) that failed and led to C-section, and start of guilt
- Medications/complications from birth or anatomy (inverted nipple, etc,) cause initial problems
- CLCs are fully utilized in hospital, as are online chatboards
- Initial problems become extremely overwhelming, especially when arriving at home, and some light formula supplementation is used
- Guilt is magnified, forum board advice is decidedly split, and not necessarily equally - between BFing moms who insist no supplementation be used and moms who say "oh well, you tried, that's what counts, we are here for you"
- Guilt from only the BFing moms is what is heard, even though there are good intentions, and PPD worsens.

Within less than a week, mom has given up completely on BFing and has been diagnosed with PPD. The once pro-BFing mom is now weary of Lactivists who think she is a horrible mother and won't do the best for her child. (Their perception, not mine).

This was all me except, crucially, the final bit - I somehow managed to continue and now have a wonderful BFing relationship. And I didn't suffer from PPD though I was at a much higher risk. I think the reason I didn't was because I was lucky enough to be able to overcome a lot of huge difficulties in the first few months. (I do suffer from PTSD from the birth and after-math, but that's another story).

I too, had the all or nothing mentality. I think that's a key to this problem. Moms who suffer from PPD are usually struggling big-time with guilt. I suffered a huge amount of guilt; first for putting my DD through a horribly traumatic birth, when I'd worked so hard to make sure we would have a gentle respectful birth. Then for the fact that the hospital nurses separated us for ages, gave her vax and formula without my permission, etc. etc. I very nearly threw in the towel in the first week too (and having been there, at rock bottom, I could never fault a mom who's given up - it's just incredibly difficult sometimes).

Things that helped me:
- Being incredibly stubborn. I'd sworn to everyone that I would BF, before DD was born, and there was no way I was going to prove all the nay-sayers wrong if I could help it (childish, I know )
- My mom, who Bfed me, flew over to help me in that first week and kept telling me that I was doing the best thing for DD by continuing
- Realising that BFing is not an all-or-nothing thing (very difficult to realise though..) Basically, once I'd read A LOT of research, I realised that yes, it was bad that DD had gotten some formula, it wasn't at all what I'd wanted, but giving in and not giving her any more breastmilk would be far, far worse for her. [I think I had to work hard to overcome the feeling that because she'd had some formula the whole thing was ruined and it just didn't matter any more if I switched altogether]
-Kellymom and MDC (I don't frequent any other boards, and I wasn't posting asking for advice at the time). I lurked and read about moms nursing their older babies/toddlers and kept reinforcing that image in my mind as where I wanted to be in a year or two.
- A LLL leader my mom put me in contact with, who talked to me on Skype (I'm living abroad in a country with no LLL) and really encouraged me to keep trying. She was fantastic and not at all judgmental about the fact that DD had gotten some formula. She praised me to the skies and really did all she could to build my self-esteem and confidence in myself, my body and my baby.

What didn't help me
- Horrible hospital staff who seemed to be intent on making sure our BFing relationship was ruined before we left the hospital.
- Badly mis-informed and totally unsupportive doctors who refused to prescribe me any other antibiotics for raging mastitis other than the one that was 'officially' approved for nursing mothers and that didn't work on me at all.
-So-called 'lactation consultants' who did nothing to help me with some serious issues, and did their best to undermine my confidence in myself.
- Everybody, even well-meaning people, who felt they needed to 'give me permission' to give up and FF. (You know - the kindly dad/FP/friend who says "Well, you've really tried hard. You know there's nothing wrong with formula if you need it." When I heard those kind of words I knew that that person wasn't prepared to support me 100%)


It's a really difficult area though, because there are some moms who really do need the 'permission' to FF. They need to hear that they've done all they could etc. But I really believe that a LOT of moms would do better with more encouragement (even to BF/FF in combination) and practical help.

[I've lost count of the number of people who saw my mastitis engorged, red swollen breast with the huge infected sore covering most of the nipple, that meant I couldn't BF DD directly from that side for over 2 months - due to lack of proper medication when really needed. They all told me that it was okay to FF, but not one of them helped in any way to fix the problem, or even get around it. I needed some practical help along with the encouragement.]

If I were in the situation of trying to help/support/encourage a mom in a similar situation I would:
- Share my story, or find similar stories of overcoming difficulties on-line or IRL to share with her.
- Praise her efforts to the highest degree. Trying to establish a BFing relationship while struggling with a major depressive episode is far from easy.
- Do the best I could to ensure that she had properly supportive people in her life, from her OB and LC to her DP and family. (Maybe give them information about supporting a BFing mom if I thought they needed it).
- Try to gently let her know that BFing is not an all-or-nothing thing. The more BM a baby gets the better, so whatever she can manage is just fantastic. (And that it is possible to gradually wean off supplements later if she really does need to use them now)
- Try to provide her with as much practical support and help as possible; from dropping off a couple of frozen meals, to offering to go with her to LC appointments.. Anything I could do that I thought would help.

[Carita]

i think just hearing stories of others who are going through this is crucial too - and I will bookmark this link to let other women read your testamonials. And thank you AutumnAir!

[mamajake]

Originally Posted by CEVmommy

I heard a radio program recently where they were talking about an inpatient PPD program. Within the span of 10 minutes, 2 different callers who had PPD inpatient experience called and talked about how breastfeeding was really important to them, but being in this program was difficult because of several issues including that they couldn't keep their babies with them in the hospital and that the doctors were not knowledgeable about what medications were compatible with breastfeeding. Both of these moms were able to breastfeed, but felt that they did so despite their experience with the PPD inpatient program and wanted to see that these issues were better addressed for other mothers. When the head doctor on the radio program was asked to address the breastfeeding issue, his response was that mothers need to be told that it is okay to give their babies formula because the stress of worrying about breastfeeding was just adding to their troubles and that formula is just fine, etc. I really felt like he was not "hearing" these moms' concerns though. I don't know what the answer is, but that doesn't seem like it.

The lack of in-patient programs in the US that allow babies is a HUGE problem. I read a memoir long ago (wish I could remember what it was called) about a women in the UK with PPD requiring in-patient treatment and it went without saying that her baby would be with her in hospital. She was on a ward of women whose babies were with them. In 2000 I went on a full-out search (contacted lots of prominent trauma docs) to find an in-patient program that would allow women to bring their babies and there were none. Not a single one in the US. I would love to hear if anyone knows if one exists now. I would think that separation from your infant could be a significant disincentive to getting the help you might need.

[songbh]

That is really discouraging, mamajake. I think this demonstrates how much the healthcare system and the broader culture really need a total paradigm shift, not just piecemeal programs or laws. Babies need their mothers; mothers need their babies; breastfeeding matters and deserves support and protection, not just lip-service "promotion."

[spughy]

I just want to say that sometimes PPD can be CAUSED by BF'ing problems, even if you have all the support in the world. I had a difficult but vaginal birth with DD but had massive hemmorhaging after and a bit of retained placenta. The hemmorhage wasn't quite bad enough for a transfusion but I was very anemic for a couple months after - and not surprisingly, my milk didn't "come in". I had SO much help - good help - I had a doula who was a LLL leader and my midwives referred me to a fantastic MD who is also an IBCLC. She prescribed domperidone, I had a hospital-grade pump, and I did EVERYTHING I could do get the bf'ing working. I did, after about 3 months, manage to establish a good milk supply (and mastitis ) but the horror of having to feed my child some formula - plus all the wacky hormonal stuff from the retained placenta and anemia and all that - I was a basket case for over a year.

Honestly, I think the only thing that would have helped is if I'd had a less "formula is for bad moms" attitude from the beginning... but then maybe I wouldn't have tried so hard to bf? Sometimes, the whole thing just kinda sucks. I think the best thing to stress, as a PP noted, is that breastfeeding need not be an all-or-nothing proposition. The other thing that I think would help is better education beforehand that breastfeeding is NOT instinctive, is NOT necessarily easy, CAN DEFINITELY be affected by your birth experience, and YOU MAY NEED HELP. LOTS OF IT. At the risk of scaring people off it entirely, I really think women need to know that going in. I didn't. I thought - based on my mother's experience - that you just smucked the kid on the boob and away you go. It wasn't until I hit problems that I thought to research them, and by that point I was a sniveling ball of goo and was quickly overwhelmed by too much information.

So, to sum up - an ounce of prevention, a pound of cure. Failing that, compassion, good help but not so much it's overwhelming, a decent lactation consultant, and medical staff who know what's what with the boobage.

[SuzyLee]

I didn't read all the replies, but I will tell you that when I see posts like that on message boards (I am on another board that is way less educated about BF'ing so I try to give advice sometimes) I tend to respond that if they really want to exclusively BF, they need to call a LLL leader of IBCLC, and not depend on internet advice. But that if they are ok with BF'ing part time, during the day, whatever, to do that and give formula and stop stressing.