Breastfeeding.
That word, and the process that accompanies it, can bring about immediate stress for women suffering perinatal mood disorders. It's a highly charged issue. For some of us, difficulties in being able to do it at all send us into a tailspin, and can either cause or exacerbate postpartum depression and anxiety. I thought, if breastfeeding is one of the few things a female body was meant for, why the hell can't I do it? What a defective mother I was!! For others, breastfeeding is one of the only ways suffering moms feel connected to their babies, and the idea of taking medication is terribly distressing. They'd rather continue to be ill than take meds and have to stop breastfeeding, and are nervous about the risks of continuing and passing trace amounts of meds in their milk to their babies. No matter how we try to look at it, we are filled with dread, guilt and indecision. I've been meaning to write about this topic for a long time, but then I received an essay in my email this week from Lisa Sniderman. It is very poignant, and I've decided it will be more powerful to share her confrontation of this issue than mine, with her permission, of course:
My name is Lisa, and I have a 2-year-old daughter. Unlike some mothers, PPD was far from my first experience with mental illness. I have been diagnosed with bipolar disorder since age 22, although that diagnosis took 4 years of frequent hospitalization and medical guesswork. I have a "treatment-resistant" illness; most medications simply increase my symptoms. In 1993, I finally found my miracle in a combination of doxepin and lithium. I got on with my life goals, thanked my lucky stars and never looked back — until 2005, when I was newly married and hoping to start a family.
It turns out that while my medications could be titrated during pregnancy, because of my history I really, really needed them in full dose immediately after delivery. Just when my daughter would really, really need to breastfeed. Thus commenced a frantic search for safety information about the drugs.
The outlook couldn't have been worse. Doxepin had been shown to cause respiratory distress in nursing infants whose mothers took one-third to one-eighth of the dose I needed. Meanwhile, the lactation and neonatal experts were divided on lithium; some recommended 'extreme caution' and frequent neonatal bloodwork, while others said it was completely contraindicated. Call me nuts, but I couldn't really see myself, in my vulnerable postpartum state, carefully monitoring my newborn for apnea and hepatoxicity 24/7. I don't think I ever would have slept.
As it was, I panicked right after delivery and tried to go without my meds for my baby's sake. I lasted three days before uncontrollable suicidal ideations and racing thoughts sent me to the hospital. At that point, I realized just how real my illness was, though it had been dormant for over a decade. I went back on doxepin and lithium, and added an antipsychotic for the short term. At the time, I thought I was a terrible mother for needing these medications. Worse — I thought I was a terrible mother for having the illness that these medications treated (hello, stigma!). Was bottle-feeding really a 'choice' for me? Only if I could somehow have 'chosen' instead to spend my daughter's first year either in unbearable torment or dead. The rhetoric of personal responsibility that surrounds breastfeeding, despite the very real barriers so many women still face, disturbs me in general. When it is applied to severely mentally ill mothers who need uninterrupted sleep, mood stabilizers and antipsychotics, it absolutely stops me cold.
With the passage of time, I stopped cursing God for making me one of the few women who truly cannot breastfeed. I tend to search for the larger meaning in things, and I don't think it's an accident that the two medications I need are among the only psychotropic medications unsafe for nursing. I believe this happened so that I could critically re-evaluate my identity as a mother — and begin educating myself on the cultural disease of maternal self-negation that enrobes new motherhood in impossible expectations.
I gave my daughter a mother without a breast, because I couldn't give her a breast without a mother. I know that she and I missed out on a precious experience, but we humans are extremely adaptable and many other equally precious experiences came out of my recovery from PPD, and her subsequent development into a secure and happy little girl. I learned that self-acceptance radiates out, from me to my daughter. I learned that the real joy of mothering only comes from mothering oneself first. My husband and I are trying for our second child, a decision I made only when I felt fully reconciled to the idea of not breastfeeding this one, either. The stakes are just too great. The risks of bottlefeeding are well-known; the risks of untreated maternal depression, though they can be equally or more grave, are far less imprinted on the public consciousness. I accept this; the fact that I am knowledgable about my own situation is enough for me.
The ironic thing to me is that someone seeing me mixing formula at the mall might think to herself, 'What a bad mother. She must not care about breastfeeding.' When, in fact, I am a breastfeeding advocate and would staunchly defend anyone who took flak for nursing a baby — or a pre-schooler — in public. My story is not a threat to everything we know about the wonders of breastmilk, and I'm not presenting it as such. It is because breastfeeding is so important that my decision was so difficult. The interaction between PPD and breastfeeding can be a lot more complex than 'take Zoloft — it's safe!!' There are other women, caught in the distorted thinking so common in PPD, who refuse any medication out of fear of harming their nursing babies; weaning is sometimes necessary if it is the only way a desperately ill woman will accept treatment. Many OB/GYNs, lactation consultants and psychiatrists have little appreciation for these complex issues.
I am sharing this in the hope that some other mom out there reads my story and knows that if it comes to the point of treatment vs. breastfeeding, which thankfully isn't often the case, she can find the courage to be a mother without a breast, rather than no mother at all."
Take Lisa's words to heart. Your child needs a healthy mother. Some of you will be able to alleviate perinatal mood disorder symptoms with psychotherapy alone. Others will continue to breastfeed while on medication, because you and your doctor decide the risks for your particular medication are relatively low based on research. Still others will stop, because it is easier for them or because certain medications prohibit breastfeeding. It doesn't matter. Your child needs you more than anything.
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As another bipolar mother-thank you. I didn't know what was wrong as I was only diagnosed well after birth, but I couldn't breastfeed either since sleep deprivation sends me. I advocate strongly for other mothers, but there's always that little bit that wishes.
Thank you for your story Lisa. It means a great deal to see and hear it. I'm glad you finally found something that works. I'd have Lithium's babies if I could. 🙂
Even this mom, who was able to breastfeed, ended up with the same thoughts and feelings. My milk just didn't come in enough to provide. And, though the doctors said I could be on medication and feed my daughter, it just didn't feel safe. The feelings of inadequacy and failure were so heavy and my heart sunk to the depressed level in my mind. Thank you for sharing your story Lisa. It is so important that we educate our friends and community in order to lose the stigma and help others who are suffering. God bless you.
Thank you so much for posting this. I developed a panic disorder after my first child. I had to make a choice between literally sleeping less than an hour a night or disontinuing breastfeeding so that I could take the medication I needed. Eventually I made the heartbreaking decision to stop breastfeeding. I now KNOW this was the right thing to do. My daughter is a happy, healthy toddler who had a loving mother PRESENT for her when she needed nurturing the most.
Thank you Katherine for sharing Lisa's story with us. Thank you Lisa for your very insightful and touching story. You mentioned the "maternal self-negation that enrobes new motherhood in impossible expectations," which is an issue discussed (along with breastfeeding or not breastfeeding) often at the PPD Support Group that I lead in Fairfax, VA. As a parent of teenagers, I have seen maternal self-negation be present in moms of toddlers, elementary school children, and adolescents – not just in the new motherhood stage. I encourage the moms who attend our groups to not compare themselves to other moms. I encourage them to listen to their own voices and to believe in themselves. I encourage them to understand that what works for them and for their own family, might be different from what works for say, me and my family. There is no one "perfect" way, but many healthy, perfectly good ways to be a mom. Thank you for your beautiful story and best wishes to you and your family. Your daughter will benefit from your wisdom.
Another great editorial on the topic – by Karen Kleiman can be found here….(i actually think Lisa's story is posted below this one too) http://postpartumstress.com/pages/breast_best.htm…
I hope that Lisa reads this – If I ever see you at the mall, "mixing formula," I will NOT think that you are bad mother. I promise.
The fears surrounding risk/benefit ratio are very widespread and well-researched. This is a common problem for providers and moms.
For this reason, interest is being focused on non-pharmalogic approaches to prevention and treatment of perinatal mood disorders. Although this type of treatment works best for mild to severe reactions, there are practitioners out there who are very familiar with treatment modalities for severe cases. And there are those who specialize in prevention.
A list of practitioners can be found at http://www.wellpostpartum.com, a new blog on complementary care for maternal mental health.
What a poignant and powerful story! Thanks so much for sharing. I've blogged quite a bit about my decision not to breastfeed my fourth baby as a result of my horrible bout of PPD when my third baby was born. I chose not to breastfeed simply because I wanted to get my hormones balanced again as quickly as possible as part of my strategy to prevent another PPD experience. Plus I wanted to take an anti-depressant and even though some doctors contend that Prozac is "safe," it's never actually formally been tested in newborns. (What mother would allow their newborn to be given Prozac as part of a study??)
Because of my decision not to breastfeed, I was treated with such disrespect by the maternity nurses at the hospital where I delivered. They totally treated me as if I were a failure of a mom and kept sending a lactation specialist to my room. Whenever my newborn was hungry and I needed formula, the nurses were slow to bring it to my room and still asked me if I'd change my mind and try to breastfeed. It was horribly stressful, on top of everything, not to mention recovering from a C-section.
I still try to speak out on this issue, but it's hard because I'm often drowned out by the "breast is best" crowd. Whether it's formula or breastmilk, whatever works for you and your baby is the best.
Thanks again for posting Lisa's story!
Warmly,
Kristin http://ppdsurvivor.blogspot.com