We know that maternal mental health is an important part of overall perinatal health. As Certified Breastfeeding Counselors (CBC), it is important we understand maternal mental health in relation to breastfeeding. The impact of breastfeeding on mental health was recently examined by researchers at the University of Massachusetts Chan Medical School.

While CBCs do not diagnose nor treat perinatal mood and anxiety disorders (PMADs), it is important that we understand them. When we understand PMADs we can better educate and support oh0020ur clients in the prenatal period as well as during lactation.

What Are Perinatal Mood and Anxiety Disorders (PMADs)?

Perinatal Mood and Anxiety Disorders are related to mood and anxiety symptoms with onset occurring during pregnancy or up to one year postpartum. PMADs are not always fully understood though we do understand treatment options and risk factors.

Given the prevalence of PMADs within the first year, researchers wanted to see what correlations exist with breastfeeding. PMADs impact about 14 percent of birthers in their lifetime, with some populations experiencing rates as high as 50 percent.

What Did Researchers Find About Breastfeeding and Mental Health?

Researchers Megan Yuen and Olivia Hall, from the University of Massachusetts Chan Medical School, and colleagues, wanted to look at the impact of breastfeeding on mental health. Overall, they found breastfeeding was associated with improved maternal mental health outcomes.

However, they also found some circumstances related to breastfeeding were associated with an increased risk of negative mental health outcomes. Those circumstances were:

• When one experiences difficulties breastfeeding.
• When someone’s expectations for breastfeeding differ from the reality of their breastfeeding experience.

Overall, breastfeeding is linked to improved maternal mental health. This is not a surprise given the physiological process of breastfeeding which can increase oxytocin levels. Breastfeeding can help offset some of the abrupt hormonal changes following birth.

It also makes sense that those experiencing difficulties and unexpected circumstances are more likely to struggle with PMADs. Current public health campaigns encourage breastfeeding, but many people do not receive adequate education and support.

While public health campaigns are vital, as breastfeeding rates are a public health concern, it can lead to some parents feeling stressed. If you have been educated about the benefits of breastfeeding but you struggle to do so, it can be a major emotional and mental hurdle. If you expect breastfeeding to be manageable but find it to be extremely difficult, perhaps navigating a preemie or a baby who needs frequent feeds, you could be caught off guard by the demands of feeding.

How Did Researchers Find These Associations?

Yuen, Hall, and their colleagues looked at 36 studies which found clinically significant relationships between breastfeeding and mental health.

Of those 36 studies:

• 29 found that breastfeeding was associated with fewer mental health symptoms
• One found that breastfeeding was associated with increased maternal mental health symptoms

They also looked at 34 studies which found a statistically significant relationship between breastfeeding and postpartum depression. Of those, 28 studies found breastfeeding was associated with a decreased risk of postpartum depression.

Of the studies looked at, it seems the majority support breastfeeding being associated with positive mental health outcomes. However, when looking at additional variables, such as breastfeeding complications, there is an association between breastfeeding and increased risk of PMADs symptoms.

Why is Maternal Mental Health Important For CBCs?

As a CBC, your role is to provide education and support related to lactation. This may mean education and planning in the prenatal period, breastfeeding initiation, or basic troubleshooting with common feeding challenges.

When we are providing prenatal support, it is important to prepare clients for the reality of breastfeeding. We can help explain the benefits of feeding, as well as typical breastfeeding patterns, frequent feeds, etc. We can also help clients prepare a support system, share community support information, and provide family and partner education.

When we are helping clients with breastfeeding initiation and troubleshooting, again, realistic information is important. It is also vital that we provide empathetic support and validation. If clients express concern about feeding challenges and how it impacts their emotions and moods, it is important we help them understand these feelings can be typical. We should reduce stigmas around struggling and refer them to area providers with experience in PMADs.

Journal of Women’s Health Editor-in-Chief Susan G. Kornstein, MD, Executive Director of the Virginia Commonwealth University Institute for Women’s Health, Richmond, VA, said:

“To help clinicians personalize breastfeeding and mental health counseling, it is important to recognize that while breastfeeding is generally associated with improved maternal mental health, if can have negative mental health consequences if the mother experiences breastfeeding challenges or the experience does not meet her expectations.”