The Elephant In the Living Room Part II: Breastefeding and Postpartum Depression

Hello.  Welcome back to another exciting episode of, “What to do when you have dropped your basket.”

What is “dropping your basket”?  I’m glad you asked.

Often, it is nothing more than being weepy and dysphoric, not enjoying things you once did.  It can also manifest as:

1.  Irritability

2.  Obsessiveness / OCD.  OCD can sometimes be just obsessiveness without compulsions,  and hand-washing and tidiness are not the only signs.  Trust me; I know.  Look for fear/concern over toxins, frequent thoughts of the baby being hurt or something being wrong with her, checking things over and over even though you just checked them, even words, phrases, or music repeating themselves in your head.  OCD can focus on numbers, textures, certain rhythms.

3.  Outbursts of anger, even episodes of violence (including punching walls, throwing things, and kicking holes in the cupboards).

4.  Anxiety, memory problems, feelings of emptiness, losing interest in things that you used to find pleasurable

There are surely more.  Some would suggest that this cornucopia of symptoms might better be called something else.  Postpartum syndrome?

In any event, clearly the usual question of “do you feel sad and not want to get out of bed in the morning” doesn’t really cut it as a diagnostic tool.

But let’s say you already know.  Let’s imagine that you’ve struggled with depression throughout your life, so you know you are more at risk for severe PPD, and you kinda know what it looks like.

What do you do?

There are many options available.  I would have to say that the top five solutions are all occupied by the words “find support.”  Whether this means help at home with children, meals, or housework, or a friend who is a good listener, or a therapist of some kind – do it.  Do it all.  Don’t keep quiet.  Now, that said – I am the quiet sort.  No one has any idea just how far down I had sunk.  In fact, I think depression feeds on itself and postpartum depression has its own unique brand of vicious cycle.  We are mothers.  We are supposed to be able to do this thing, right?  So when we can’t, we feel awful about ourselves.  This feeling awful makes everything worse.  When you believe you are an epic FAIL as a parent, why in the world would you want to advertise?

So more than just seeking out help and support for yourself, it’s important that you have the people closest to you understand what to look for.  Have them ask you how long it’s been since you showered (but please don’t ask me how long – not today).  Schedule someone to come over once a week for a standing date, no matter how little you feel like being social.  If that person knows they are there to make sure you are okay, they will be respectful of your limits.  Sleep.  Exercise.  Eat right.  You know the drill.

If these things don’t work, then what?

We are lucky to live in a time when medications for depression are so much better than they used to be.  SSRIs are excellent medications for dealing with depression, anxiety, anger and OCD.  Some are better at handling some things than others, so have this discussion with your physician.  And most are safe to varying degrees, particularly Zoloft.  For the best resource available on medication use during pregnancy, I recommend Dr. Thomas W. Hale’s book,  Medications and Mothers Milk: A Manual of Lactational Pharmacology. He discusses many of the medications used for depression and how they can affect your baby and you.  The book is often available through a local La Leche League group lending library (LLLLLL??), and there are discussion forums on his website.  Be forewarned, however, that consumer questions are not accepted and many of the forums essentially tell you to read the book.

If the first line of antidepressants don’t work for you, what should you do?

If breastfeeding is well established and your baby is a little older, there are more options.  But what if you have tried some of the stronger medications, and it looks like your only option is to wean and break out the big guns or continue to struggle?  How do you make that choice?

My baby is twenty months old.  I nursed my last child to the age of three.  I really never expected to do that, but somehow you just get caught up in things.  He had emotional and behavioral issues which made parenting him extremely difficult, and breastfeeding was my ace in the hole.  I admit it – I’m lazy.  I wanted an easy way to get this child to sleep at the end of my grueling days, and nursing was like slipping him a mickey.  His eyes would even roll back in his head as he went on the nod.  Now my little Beckett is pretty addicted to it, too.  And he is my last baby.  Once I wean him, I will never share that bond with another one, which is sort of depression-inducing on its own, for me.

So I find myself weighing the seriousness of my depression with my knowledge that I might have to sever the breastfeeding relationship.  It’s a sucky place to be.  And the worst part of it is, it’s a selfish position.  My mental health being stable is so much more of an influence over my almost-two-year-old than a few more months of breastfeeding.  But I don’t want to feel I sacrificed that relationship for nothing, since trying a new medication is always a crap shoot.

I also struggle with the issue of judgment, both from myself and others.  There has been so much talk over the last couple of weeks about breastfeeding in public and working. There’s The Case Against Breastfeeding by Hanna Rosin, and an excellent rebuttal by PhD in Parenting.  Then there are posts about when to give up and even about nursing another woman’s child.  It seems not too many of us can straddle that middle ground all that well.  Or maybe it just doesn’t make good blog.

I began writing this thinking I would have some resolution at the end.  And I hate to leave anyone without solving the problem, least of all myself.  But no one really knows all that much.  In the end, it’s about weighing the pros and cons and making an informed choice, much like anything else having to do with parenting.  Seek out people who have been through it.  Keep talking and asking questions.  Even if it’s too late for us to have real answers, maybe our daughters will.

Tomorrow on Blogher:  why I’m such a know-it-all when it comes to depression.




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7 Responses to “The Elephant In the Living Room Part II: Breastefeding and Postpartum Depression”

  1. thanks so much for sharing all this jennifer. you’re very courageous. i’m looking forward to tomorrow’s installment.

    having been on both sides of parenting and depression (i.e. parenting with depression and parenting without depression), i would say that at the very very very top of my personal list of what-makes-marta-a-good-parent is Not Being Depressed. i didn’t struggle too much with depression while i was breastfeeding, and my nursing relationship was enormously important to both me and my son (he’s adopted, i induced lactation, and we nursed for 3.5 years), so i can’t say what i would have done then if faced with weaning/medication or not-weaning/depression. but in retrospect, knowing now what i do about myself, parenting and depression, i would certainly wean, if that were the only option to get myself well. depression is so incredibly debilitating to me as a parent.

  2. To your particular situation my response is that maybe it’s time for you to stop being a food source and begin being able to care for your children in other ways that perhaps this medication will allow.
    I nursed my two eldest until they were each almost three and Willoughby is 17 months and still very much into his nursey-baby, but we are coming to the end of that road. And it will be sad to close up shop at the milking shed, but our relationship (and yours too) will only grow in other ways.
    It’s not as if with weaning a pathway to give and receive love is closed off. Rather, it’s an opportunity to develop new ways of being together, new ways of showing love.
    It’s a trite old saying, but it really is true. When a plane goes down, the instructions are to first put the oxygen mask on yourself, then your kids. Sometimes, putting the children first necessitates putting one parent or the other at the top of the list. And it sounds like you need some time up there.
    Lovingly,
    Jennifer.

  3. apologies for my punctuation…

  4. Totally agree about the medication being a crap shoot. The choices aren’t as simple as A. breastfeed and suffer or B. wean, medicate, and be happy. I don’t know the numbers for PPD, but among the general population with Major Depressive Disorder, the majority of patients do NOT respond in a significant way to SSRIs. There is a very good chance that you could take the medication and still feel lousy.

    For the symptoms I had, antidepressants alone would not have been the suggested treatment. I was miserable, but I can’t say I regret not getting help if help meant a prescription for an antipsychotic. Breastfeeding was a life-saver for me. I wasn’t nursing out of some kind of martyr complex. It was simply one of the only positive things I had going for me. Give that up in exchange for a medication that may not help and may also cause intolerable side effects? I’m not sure I see how that would have made me a better parent.

    Anyway, sorry for the rant. I’m really looking forward to hearing the rest of your story.

  5. Your reference at the end of your post to the issue of judgement resonated with me. We are all so so desperate to be Good Mothers and good people! it traps us so. I am thinking that, we judge others because we are so desperate to be perfect ourselves.

    I can’t help with the breastfeeding-v-drugs question but I did like your post and I think you set out the issues very clearly

  6. […] to barelyknittogether for the links in her post that stumbled me onto this storm in a […]

  7. I just found your blog off of a link from a link and wanted to say hi and nice to meet you. 🙂 As someone who has nursed her 4 kids between 14 months and 3+ years, I really think this is one of those issues where you must listen to your own heart and know that whatever you do is the right choice for you and your little one if it feels right to YOU.

    I was pressured by my doctor to stop nursing my second child at 22 months because I was diagnosed with Chronic Fatigue Syndrome and she thought nursing was too hard on my body. I listened, stopped nursing, got my period back after literally years without it (I went from nursing to pregnancy to nursing to pregnancy without resuming it the first time). I got socked with months of the worst PMS of my life, regretted my decision to stop, felt just as weak, and had a sad toddler. For me, it was absolutely the wrong decision, because it wasn’t what I had really wanted to do.

    With my third child, I was feeling touched out and depressed and at 3 he was still wanting to nurse. I couldn’t shake my depression and was starting to resent nursing, and knew that it wasn’t a positive thing any more. I gently weaned him and went on antidepressants, and that time I did feel that it absolutely was the right decision.

    Then came baby 4. I have daily migraines and my neurologist has told me to stop nursing so we can try some more meds to try to get them under control. None of the meds the first times ever helped, and I’m not going to stop something that is still a good thing to my little guy (22 months) and me, based on a remote possibility. I don’t love migraines, but I’ve managed with them this long and I don’t have a lot of faith in meds after this many failures. This time I can wait it out.

    You’ve already given your little one so many benefits (physical and emotional) from nursing. If YOU feel it’s time for you to stop, it’ll be okay. If not, it’s okay too. You’re the only expert on what you should do. Whatever you decide with be the right answer as long as it’s YOURS. 🙂

    Sorry to jabber on so much! I do that! LOL I enjoyed your blog!

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