When a woman is in the throes of making breastfeeding work, she is often running on adrenaline. She has a mission, a purpose. Without thinking, she does the work every three hours. Three hours later she does it again. Three hours later, again.
There are emotional meltdowns and outbursts, but they often don’t last too long. After all, she has a job to do. A goal to achieve. A baby to feed.
When a woman is tits-deep in the work of keeping her baby alive with the milk she is making with her body, she often shoves her feelings into a little box. The feelings of pregnancy, of birth, of her relationship with her partner—they go into the box. The feelings of disappointment, resentment, inadequacy—into the box.
Suppressing feelings is a form of survival. When the priority is keeping another little human alive, you do what it takes to keep your head above water.
Because of this, it is difficult to refer a mom who is showing signs of PMADs to a mental health provider in the midst of the work of breastfeeding. I am sure to keep close tabs on her mental health as we progress week to week, but I know there is no space to process all the feelings. Not quite yet.
For a woman showing early signs of PMADS, however, I prioritize the key components necessary to keep her safe and to protect her mental health:
- Sleep (protected 4 hour minimum)
- Hydration and nutrition
- Healthy boundaries with toxic social media or people
- Connection: to provider and support group
- Safety contract (thoughts of harming self or others)
However, the box will eventually open. I have noticed this tends to happen when breastfeeding starts to work. Nipples are healed, baby is latching and gaining weight, and then… feelings emerge. Sometimes they trickle out little by little, but more often they erupt like molten lava, shooting straight up into the air and covering everyone within a mile radius.
The problem is that if there isn’t an opening in the therapy practice for three weeks, the situation can quickly devolve into a mental health crisis.
For moms who have failed the Edinburgh Tool or who have risk factors for PMADs, I have started to try to predict when a mother’s breastfeeding relationship will resolve so that I can coordinate the start of mental health care with the completion of lactation care. Rather than graduating a mother from care and sending her off into the world alone, I instead shepherd her along to the next set of open arms to guide her in her mothering journey.