I have recently had a number of moms come to my practice because of sudden symptoms of postpartum depression or anxiety at the time of weaning from breastfeeding. Some of these moms have chosen to wean, some are weaning because of milk supply, illness, or pain that make it impossible to continue, and some are weaning because their babies are leading the way. All of these moms have been struggling with both breastfeeding and also mood challenges that began some time between birth and their early weaning attempts. And all have had questions about whether the breastfeeding and/or the weaning were making them feel worse.
This is not a new trend in my office. As I’m sure it won’t surprise you, many women who suffer with a postpartum mood or anxiety disorder like postpartum depression are also struggling through the challenge of breastfeeding. Not all, of course, but many. There are most certainly moms who I see who hold firmly to nursing their babies because it is the one and only thing that they feel is going well. These moms feel strongly that the breastfeeding is getting them through a very difficult emotional time. But I also see a huge number of moms who feel not only plagued by anxiety or depression but also by the fact that breastfeeding is undeniably and unrelentingly difficult. And so it makes them (and me) wonder if the two are connected.
Recently, an article came out in the Journal of Women’s Health that speaks to this very question. For the purpose of my post today, I am going to attempt to explain this article in good old Plain Mama English. The article helped me to really understand the overlap between breastfeeding and postpartum depression and anxiety, and it may do the same for you.
The main premise of this article is that both mood and lactation might be triggered by the same neuroendocrine mechanisms, or the same hormonal shifts. We have always known that postpartum depression is a biochemical illness that is triggered by the immense hormonal shifts that occur shortly after birth, and that the ability to breastfeed also depends on effective hormonal activity. But is it possible that the challenges that some moms have with breastfeeding are actually caused by the very same hormonal shifts that leave her feeling sad and anxious?
Following the birth of her baby, a mom’s hormones — her estrogen, progesterone, prolactin, thyroid, and cortisol — shift dramatically as her body readjusts from pregnancy to postpartum. These very hormones also have a direct impact on both the brain chemicals that are responsible for emotional wellness and also milk production. Sometimes these hormones work together in helping both mood and lactation, and sometimes they work in conflict with the two. Let’s break it down as the article did:
Directly following birth, progesterone levels that have been increasing during pregnancy drop dramatically (up to 200 times pre-pregnancy levels) in order to initiate the start of milk production. When a baby starts to nurse, the suckling stimulates two more hormones, oxytocin and prolactin, which are necessary in let-down and the secretion of milk from a mom’s breast. But while this drop in progesterone plays an important part in the production of milk, it also may contribute to the development of a mood disorder because progesterone is required in the maintenance of brain chemistry (in other words, progesterone helps a mom feel emotionally well). So, when it drops? Milk is produced but some vulnerable moms may also become sad or anxious. (This first stage hormone shifting is known as the baby blues, but the article mentions that it used to be referred to as “Milk fever.”) When some moms become anxious or depressed due to the drops in progesterone, the initial challenges with breastfeeding (which are common for most new moms) are more difficult to tolerate because of their symptoms. These moms are simply less resilient to stress.
Estrogen levels also drop dramatically, and they remain low throughout lactation. This suggests that low levels of estrogen may be necessary for milk production to occur. But, estrogen, like progesterone, is necessary for brain chemical balance (it has a direct impact on serotonin, the “feel good hormone”) and so the same conflict might occur: low estrogen which is necessary for breast feeding may also lead some women to develop symptoms of postpartum depression and/or anxiety. Again, these moms may have a harder time working through early feeding challenges because of their symptoms.
Oxytocin is that lovely hormone that leads to feelings of pleasure, comfort, and maternal security. In fact, it has been said that oxytocin is responsible for the onset of early maternal behaviors that lead women and animals to instinctively protect their little ones. Oxytocin production also stimulates let-down in the breastfeeding mama. Some studies have suggested that moms who are depressed or anxious during pregnancy have lower levels of oxytocin. And, yup, you got it, if these moms have less oxytocin, they are also likely to have challenges with let-down and may also not feel that initial sense of connection to their babes. And so these same moms who are depressed or anxious while pregnant are likely to have additional struggles when attempting to breastfeed after their babes are born.
Prolactin levels increase in a mom’s body during pregnancy and the early postpartum period. Over time, baseline prolactin levels drop, but each time a baby suckles, prolactin levels are increased briefly in order for milk production to be stimulated. Prolactin is also thought to play a role in the emotional wellness of a new mom as both animal and human studies have found that high prolactin triggers a maternal response in caretaking of a baby (feeding, keeping safe, attentiveness). On the other spectrum, it has been found in some studies that women who have low levels of prolactin during pregnancy are prone to higher levels of anxiety. It also seems that high levels of stress can interfere with the mechanisms for prolactin release in women. So … low prolactin may lead to both anxiety and low milk supply which may lead to high stress which may lead to low prolactin and low milk supply, which may lead to high stress and anxiety which may lead to …
As many as 5% of women will develop a thyroid imbalance postpartum. And some studies have found a link between low thyroid levels and poor milk supply. Low thyroid levels (also known as hypothyroid) have also been shown to induce depressive symptoms in women. If a mama has an imbalance in her thyroid levels after birth, she may find that both her milk production and her mood are affected.
During pregnancy, a stress hormone known as cortisol increases. After childbirth, these cortisol levels typically drop, and do so even more dramatically in healthy breastfeeding moms (this contributes to the feeling of calm and wellbeing while nursing that some breast feeding moms describe). Successful milk production and let- down involve an adequate circulation of cortisol, and it seems that when cortisol levels are not balanced out appropriately, both milk production and mood can be affected: higher cortisol levels are linked to higher levels of anxiety and stress. Moms who are anxious postpartum probably have higher levels of cortisol while breast feeding which, may, interfere with milk production and also make it so that she does not experience the good feelings that are so often assumed to be connected with nursing.
So what does all this mean to you? What it means is that, if you are having difficulties postpartum – whether with depression or anxiety symptoms or with breastfeeding — it is not your fault. None of it. You are not anxious or depressed because you are not trying hard enough or because you are not doing something right. And you are also not having a hard time with breastfeeding because YOU are failing at something. Our bodies go through one heck of a rollercoaster ride after our babies are born and some women’s bodies (many, actually) are just less tolerant of this amusement park of sorts. Some of us simply don’t like rollercoasters.
~ Kate Kripke, LCSW