My father passed away in August. As I waited for news about his arrangements, I felt the pangs of anxiety building. Knowing that I have a history of anxiety, I called the only doctor I’ve seen in 2 years–my obstetrician.
I explained to the receptionist what I was going through and that I knew I needed to get in with someone, a therapist, for treatment, but that I didn’t know where to start and the wait time would likely be too great to treat my immediate needs. I asked if they could they prescribe something to help. The nurse practitioner called me back that afternoon.
“Are you breastfeeding?”
“Yes. A few times a day. My daughter is 16 months old.”
“There’s only one medication we can give you.”
Currently, there is only one medication on the market specifically approved by the FDA for use in breastfeeding mothers, and it isn’t the medication with which I’m most experienced or even the best one for treating anxiety. It also isn’t the only medication that has been proven safe for breastfeeding mothers in study after study.
I was sort of crushed by the lack of options given to me by my doctor’s office. I felt like I was being told to choose between the extended breastfeeding relationship I have with my daughter and treating my anxiety with a medication I knew to be safe and effective. I was angry for other moms who might find themselves in similar situations.
I had taken another medication while breastfeeding my son and had no issues. I knew how it worked and that it worked for me. I was comfortable with the heaps of research that said it was a safe choice.
I went in the following week for a visit and asked why they wouldn’t prescribe anything else to breastfeeding mothers. Their answer was that the practice is a one doctor show and since he isn’t an expert on mental health he prefers to defer to those who are. He will triage issues like PPD and generalized anxiety, but he likes working in conjunction with a psychiatrist for treating PMADs to make sure moms are getting the best care possible.
I felt that was a fair enough answer. It didn’t help me in that moment, but I could understand their reasoning. Of course we want all moms to receive the best possible care. I walked out of the office with the name and phone number of a therapy practice in my area.
But then I thought about all the other doctors who don’t make it a habit of handing out referrals and will only prescribe one medication to breastfeeding moms, regardless as to whether or not it’s the best medication, when there are others which are also safe. I wondered how many of those doctors don’t follow up to see if the medication is even working or who tell moms they have to stop breastfeeding if they want to get better.
I thought about how frustrating it would have been if, as a new mom, the OB who delivered my son, a different doctor, hadn’t checked up on me and had refused to prescribe something different to treat my postpartum depression and anxiety. It’s one of the few times I’ve ever felt lucky in this whole experience.
Moms who decide to breastfeed and who also suffer from postpartum depression shouldn’t be made to feel that in order to treat themselves, they have to stop breastfeeding. While there are some medications and treatments which are not safe for breastfeeding mothers, there’s certainly more than one which is safe.
Dr. Hale, who wrote the actual book on medication and breastfeeding, has stated “breastfeeding should be supported fully and not interrupted by mom’s needs for medication…treatment of postpartum depression can be accomplished relatively safely in breastfeeding mothers.”
Obstetricians are on the front lines in treating postpartum depression, and given the myriad reasons people lack access to treatment from a therapist or psychiatrist, they owe it to all the moms in their care, not just the breastfeeding ones, to know current best practices for the treatment of perinatal mood and anxiety disorders.
While well-rounded care from an obstetrician and psychiatrist or therapist is certainly the best course of action, it’s time for doctors to start paying attention to the literature regarding how best to treat PMADs in moms who are breastfeeding and treat them accordingly.
Until they do, we have to be our own advocates. If the treatment isn’t working, ask for help in finding a new one.
There’s more than one way to save a mom.
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