PMADS includes Postpartum Depression, but it also includes mental health issues that occur during pregnancy and the anxiety that can also come postpartum.
Perinatal- Pregnancy through 1 year postpartum
Mood- depression and bipolar disorder
Anxiety- GAD, Panic, OCD, PTSD
The hard facts:
81.9% of women initiate breastfeeding nationally (76% in our sweet little state of DE).
PMADs is the number one complication of childbirth yet there is NO universal screening in most practices (here is what is recommended)
To give you a comparison, gestation diabetes and pregnancy induced hypertension combined affects less than 10% of pregnant women. We are sure to test for those, aren’t we?
Breastfeeding and PMADS:
- A woman who fails to meet her breastfeeding goals or a woman who is suffering through breastfeeding is at a higher risk for PMADs.
(perception of ) FAILURE= DEPRESSION
- A woman who has nipple pain is at a higher risk for depression.
- At least one in five women report persistent pain at two months postpartum and are at a significantly higher risk for depression.
- Women with pain in the first day, first week, and second week were more likely to be depressed at two months postpartum.
- Up to 50% of women who quit breastfeeding earlier than planned cite nipple pain the primary reason.
- A woman who is sleep deprived is at a higher risk for postpartum depression
(ie those told to breastfeeding, bottle feed and pump every two hours around the clock)
SLEEP DEPRIVATION= DEPRESSION
What this means:
- Pain is real and it matters. If a woman is having persistent nipple pain past 10 days postpartum, it should be considered abnormal and she should be referred to an IBCLC.
- It is important we understand a woman’s breastfeeding goals, then help her to reframe those goals to be more realistic. The current age of “exclusivity” fuels the unquenchable thirst for perfection so many mothers today have.
- IBCLCs have a responsibility to not throw mental health under the bus for breastfeeding. Mental health providers have a responsibility to not throw breastfeeding under the bus for mental health. Neither will yield ideal results. Rather, we should adopt modifications that protect breastfeeding and mental health.
- Everyone who cares for a breastfeeding mother should be screening her for PMADs. It is as simple as an Edinburgh Tool. In fact, mama, just go ahead and screen yourself.
Our goal as a society should not be “breastfeeding at all costs,” but rather “support through the whole process” so that every mother may find a place of resolution that leaves her mentally healthy and bonding with her baby.
In my opinion, as an IBCLC it is not my job to make sure a woman achieves her breastfeeding goals. I cannot do that anymore than a midwife or OB can make sure a woman has a vaginal birth. We can certainly play a huge role in achieving those ideals, but we are not magicians. Rather, as an IBCLC, it is my job to fight with a woman toward achieving her goals as long and she wants to and or as long as it is healthy.
It is also an IBCLC’s job to help a mother cope When she falls short of her goals. Helping her comes to terms with “what is” and heal….now that is the greatest gift in the work we do.
It is my job as an IBCLC to assess for PMADs. It is my job to coordinate support services with a psychotherapist who specializes in PMADs care and collaborates with a prescriber who is comfortable with breastfeeding mothers.
Just because breastfeeding may put a woman at a higher risk for PMADs doesn’t mean a woman shouldn’t plan to breastfeed. It doesn’t mean she should quit breastfeeding at the first sign of depression. A woman struggling with PMADS doesn’t need “permission to quit breastfeeding,” she need professional help so she can take care of herself and continue to mother her child.
A breastfeeding mother needs extra special support to feel successful, no matter whether or not she achieves her breastfeeding goals.
Stories from our local PMADs Mental Health Providers:
Moms’ PMADs Stories
Academy of Breastfeeding Medicine. (2016). AMB Protocol #26: persistent pain with breastfeeding. Retrieved from the Academic of Breastfeeding Medicine website: https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/26-persistent-pain-protocol-english.pdf
Borra, C., Iacovou, M., Sevilla, A. (2015) New evidence on breastfeeding and postpartum
depression: the importance of understanding women’s intentions. Matern Child
Health J, 19(897-907). DOI 10.1007/s10995-014-1591-z
Dias, C. C., & Figueiredo, B. (2015). Breastfeeding and depression: A systematic review
of the literature. Journal of Affective Disorders, 171, 142-154. doi:10.1016/j.jad.2014.09.022
McClellan, H.L., et al. (2012) Nipple pain during breastfeeding with or without visible trauma. Journal of Human Lactation, 28 (511). DOI: 10.1177/0890334412444464
Terres, N.M. (2017). Resources for psychiatric clinicians working with breastfeeding mothers. Journal of Psychosocial Nursing and Mental Health Services. https://doi.org/10.3928/02793695-20180329-03
Watkins, S., et al. (2011) Early breastfeeding experience and postpartum depression. Obstetric & Gynecology 118 (2). doi: 10.1097/AOG.0b013e3182260a2d