Mothering Through the Darkness

Throughout the publication process for Bottled Up, there was a lot that ended up on the cutting room floor (um, like my entire first draft). I’m incredibly grateful to my editor, Naomi Schneider, who turned what was basically a disgustingly navel-gazing account of my own breastfeeding struggle into a serious, research-heavy social commentary. But one thing I do regret is that much of my struggle with postpartum depression was removed from the final manuscript, because as years go by, I become more and more passionate about the intersection of breastfeeding and postpartum mood disorders. I think it’s easy to dismiss anecdotal evidence of women claiming that breastfeeding provoked or exacerbated their PPD or PPA, until you’re faced with the bloody, exposed guts of what this actually looks like. The more we speak out about our experiences, the more people will (hopefully) listen and consider what the pressure to breastfeed is doing to the collective mental health of mothers. MOTHERINGTHRUDARK-1

That’s a big part of why I’m bouncing up and down with excitement today, as the announcement for the next HerStories Project anthology goes public. Coming from SheWrites Press in the fall of this year, Mothering Through the Darkness: Women Open Up About the Postpartum Experience features a diverse group of incredible writers (including #ISupportYou co-founder Kim Simon and a forward by Katherine Stone, founder of Postpartum Progress) coming together to battle the stigma and silence associated with postpartum depression. I’m honored to be one of those writers, and my essay – “The Breast of Me” – details how intricately entwined my breastfeeding experience was with my postpartum depression.

As I said on the Contributor Page for the book,

“As soon as I delivered my first child, I felt a cloud pass through me, over me, erasing all happiness and hope. I remember them handing him to me, and thinking, ‘please take him somewhere safe.’ In the weeks that followed, I failed to breastfeed in every which way, and hearing him scream at the sight of me, at my incompetence, my inability to nourish him, reaffirmed what I already thought: I wasn’t fit to be a mother. This piece is about my first important lesson of motherhood: that in some circumstances, what society says is the right way to mother can sometimes be the absolute wrong way…

What I wish people understood about postpartum mental health struggles is that there is no blanket way to understand them or approach them. Sometimes it is hormonal, sometimes it is situational, sometimes it’s a combination of both. And for this reason, it is vitally important that we approach women as individuals. What will help one won’t help another. We need to do a better job of listening, and realizing the impact our media (and more importantly, social media) messaging has on vulnerable moms…

…The most important aspect of my recovery was giving up breastfeeding. It still took medication to truly resolve my depression, but I wouldn’t have been able to heal if I had kept on nursing. I needed the bodily autonomy, the lack of physical pain and dependence… I needed to be important to my son for my brain, and not my body. It may not make sense to most people, but that was what I knew I needed, and it was so hard to have nobody listen or respect that.”

 

I also want to share that HerStories Project is asking other mothers to step up and join the conversation, through a blog post link-up and social media blitz. My hope is that the FFF community – who include some of the most insightful, honest writers I know, if your FFF Friday essays are any indication – will answer this call and speak your truth. For more info, visit HerStoriesProject.com.

And no matter what, keep talking. Keep sharing. Because there’s always another mother out there, stumbling around in her own darkness, needing to know she’s not the only one to falter; needing other survivors to light her path.

 

 

Why The World is So Screwed Up About Breastfeeding Research, In Several Paragraphs & A Few Headlines

The headlines:

“Study: Breastfeeding can ward off postpartum depression” (Press TV)

“Breastfeeding mothers less likely to get postnatal depression” (The Independent)

“Breastfeeding ‘helps prevent postnatal depression’” (ITV)

“Breastfeeding could help prevent postnatal depression, says Cambridge researchers” (Cambridge News

“Breastfeeding ‘cuts depression risk’, according to study” (BBC

“Failing to breastfeed may double risk of depression in mothers: study” (Telegraph)

“Mothers who breastfeed are 50% less likely to suffer postnatal depression” (The Independent)

“Mothers who choose not to breastfeed are ‘twice as likely to get postnatal depression because they miss out on mood-boosting hormones released by the process’” (Daily Mail, UK)

“Breastfeeding Keep Mothers Happy and Reduces Postnatal Depression” (International Business Times)

“Breastfeeding moms have lower depression risk” (Health Care Professionals Network)

“Breastfeeding protects mothers from postnatal depression, study finds” (The Australian)

 

And the reality:

New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions.

Borra C, Iacovou M, Sevilla A.

Abstract

This study aimed to identify the causal effect of breastfeeding on postpartum depression (PPD), using data on mothers from a British survey, the Avon Longitudinal Study of Parents and Children. Multivariate linear and logistic regressions were performed to investigate the effects of breastfeeding on mothers’ mental health measured at 8 weeks, 8, 21 and 32 months postpartum. The estimated effect of breastfeeding on PPD differed according to whether women had planned to breastfeed their babies, and by whether they had shown signs of depression during pregnancy. For mothers who were not depressed during pregnancy, the lowest risk of PPD was found among women who had planned to breastfeed, and who had actually breastfed their babies, while the highest risk was found among women who had planned to breastfeed and had not gone on to breastfeed. We conclude that the effect of breastfeeding on maternal depression is extremely heterogeneous, being mediated both by breastfeeding intentions during pregnancy and by mothers’ mental health during pregnancy. Our results underline the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.

In other words, women who wanted to breastfeed and did = low risk of PPD. Women who wanted to breastfeed and couldn’t = high risk of PPD. The researchers stress “providing compassionate support for women who had intended to breastfeed but…found themselves unable to”.

This does not prove that breastfeeding cuts depression risk. It proves that women who had a goal and met it tend to have lower rates of depression. It does not prove that there is a biological reason that breastfeeding may be protective against depression. That may indeed be the case, but then the depression risk would have been similarly high in women who never intended to breastfeed.

Our societal confirmation bias is so damn strong, that we blatantly overlook the finding that suggests something potentially negative about breastfeeding promotion. But here’s something to ponder: while we can’t force insufficient glandular tissue to produce adequate milk, or force women to breastfeed who don’t want to, we CAN ensure that every mother gets support in her feeding journey. We CAN listen to research that suggests the pressure to breastfeed is contributing to feelings of guilt, shame, and judgment – a potent trifecta of emotions for those prone to depression – and do something about it. If we are going to take this one study as “truth”, as so many parenting-related studies are mistakenly interpreted, something good might as well come out of it.

At this point, there is a pretty clear correlation between not breastfeeding and PPD. Instead of using this as ammunition against formula use, we could be asking the tougher questions: Why are women who don’t breastfeed more depressed? If it is something biological, wouldn’t the rates of PPD have been skyrocketing in past generation where breastfeeding was rare? If we stop making breastfeeding seem like the only-best-right choice to raise a happy, healthy child, would it mitigate this risk?

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

One of my favorite quotes about research comes from the Nobel-prize winning scientist who discovered the importance of vitamin C, Albert Szent-Gyorgyi: “Research is to see what everybody else has seen, and to think what nobody else has thought.” These days, the reverse seems to be true – research is to confirm what everybody else has seen, and everybody has already thought. This needs to change, and it won’t, as long as our society and media turns even the most interesting findings into self-confirming soundbytes.

 

Vital Signs: Ignoring postpartum depression and psychosis won’t make them go away

Another horror story. Another mom. Three beautiful girls who will never have another birthday, whose last memory will be terror at the hands of the person they trusted the most.

I don’t know the details. I don’t really want to know the details. I do know that this mother reached out, told her own mom she was “feeling crazy”. I do know that she had three babies in a row, and that the youngest was 2 months. I do know that there’s a strong chance that this was the result of postpartum psychosis.

And I know that this has got to stop.

Can we protect every family, prevent every case? Of course not. But postpartum mental health is taking a backseat when it should be sitting shotgun to every maternal and child health program. That’s a start, at least. We spend so much time worrying about a woman’s breasts, while we dismiss her mind. We worry about how hormones and birth practices affect lactation, while we disregard how they affect our emotions.

After we give birth, we are whisked off to the maternity ward. Our vital signs are monitored, but other vital signs are ignored. A mom who can’t seem to connect with her baby. Who is scared, and asking for help. Who is alone and voiceless. Her pulse may be steady, but her hands shake. Her breasts may leak colostrum, but her eyes may leak silent tears. And we ignore this.

GE-Healthcare-Dash-2500-v4-Vital-Signs-Monitor

OB/GYNs don’t see mothers until 4-6 weeks postpartum. In some cases, that will be too late.

Pediatricians see moms with their newborns several days postpartum, but they are focused on the infant. As they should be. We don’t expect a heart surgeon to be concerned with the diabetic foot of his cardiac patient’s wife.

When I see the role of lactation consultants and breastfeeding counselors growing, gaining more attention, more insurance coverage, I also see an opportunity. What if these professionals could be trained to screen for postpartum mental health issues, if they could recognize red flags and know how to refer families to the proper resources? What if they were trained to support families in their feeding journeys, with the goal being a happy, healthy family and not just a breastfeeding statistic?

With the state of our health care system, I don’t expect that an entirely new support staff can be instilled at every hospital, for the sole purpose of protecting maternal mental health. But when 1 in 7 mothers suffer from postpartum depression or anxiety, I think that constitutes just as much of a public health concern as the supposed risks of “sub-optimal breastfeeding practices” in developed countries. If we are going to focus so heavily on breastfeeding, could we at least give a little simultaneous attention to a mom’s mood while we inspect her breasts?

What happened to the Coronado family is sub-optimal. What passes as “support” for postpartum women is sub-optimal. There is no reason we can’t support breastfeeding while prioritizing maternal mental health. Both are important, but one has been systematically ignored, shoved under piles of paperwork, given lip service. We only seem to worry about postpartum depression in terms of how it affects breastfeeding “success”. There are so many things wrong with that sentence, with that mentality. It’s like worrying about prostate cancer only in terms of how it will affect sex and procreation. Biological norms are important, but support also means protecting those whose biology turns on them.

If we can only speak of maternal needs under the umbrella of lactation support, I can live with that. As long as those needs are met, I can live with that. As long as those needs are being met, maybe we can all live with that.

Survive with that.

Thrive with that.

 

 

An open letter to Chris Bingley: Your wife deserved better.

This is an open letter to Chris Bingley in honor of his wife, Joe Bingley, whom he lost to severe postpartum depression. 

Dear Chris,

I read about your beautiful wife Joe’s battle with postpartum depression, and I wanted to say… oh hell, I don’t know what to say. Because I’m afraid my anger about what happened to your wife will just feed your grief, and that is the last thing I’d ever want to do.

I write about the pressure to breastfeed, and what it is doing to women, and I hear stories every day that mirror what Joe went through. Women who suffer from a growing desperation, an inner knowledge that something isn’t right, even when everyone around them is willing it to be so; even when everyone around them is telling them it will all be okay if they just get some sleep, get some help around the house, or get over the “hump” of the baby blues.

And these women – more often than not – are seen by an array of healthcare professionals as they try to dig themselves out of this tunnel. The stories I hear have a common refrain – all they cared about was if the baby was breastfeeding. I came second. And all I heard was that breastfeeding was the most important thing a mother can do for her child and I was failing at that. This was my refrain, 5 years ago. I sang it and sang it until someone listened, until thousands of other women answered it with a song of their own. And our collective voices are rising, growing stronger by the day, shouting our song, screaming that we deserve more, that Joe deserved more, and that we will. Not. Let. This. Happen. Again.

PPD is a strange and mysterious beast; it’s not always tamed easily, and it feeds on different aspects of different people. For some, breastfeeding is a lifeline, the one thing they can do “right”. For others, it is the sandbag strapped to them as they are already sinking. But the problem is not breastfeeding. The problems is that we are so focused on breastfeeding that all of resources and energy are going to this one aspect of postnatal care – that we have forgotten that the mother’s mental and physical health should come first. I know most people will think that is a terrible thing to say – because doesn’t the baby’s physical and emotional health matter? But what they are forgetting is that a mother’s mental and physical health can afford to be a priority because there are other options to ensure the physical and emotional needs of the baby. Formula or donor milk can suffice. A father’s loving embrace, or a grandmother’s or aunt’s or uncle’s, can fulfill all needs until a mother is well. We are lucky to live in a time where moms can get well without sacrificing their babies’ well being.

But we are unlucky to live in a time where people are unwilling to see things this way.

Joe should have been helped. The professionals who she encountered should have looked at her face rather than her breasts. They should have seen she was sinking; they should have insisted that either a lifeline be thrown or a sandbag removed. There should have been protocols in place for her prenatal, delivery and postnatal care so that she was   screened for and treated for PPD. There should not have been so much pressure put on her to breastfeed; she should have been told that all that mattered was her health and happiness, and that her breastmilk or lack thereof had nothing to do with her worth as a person or as a mother.

I didn’t know Joe. I wish I’d had a chance to. I wish she could be one of the voices in our choir of healing and hope. That she could yell with us and demand better of our governments, our healthcare providers, and our society, so that no woman would be left to drown; so that no woman would ever have to sing that stupid refrain again.

Because I’m sick of the same old song. And I’m sure Joe would be, too.

Sending love from across the pond,

Suzanne Barston, aka The Fearless Formula Feeder

FFF Friday: Mental health, bottle feeding and self care

I don’t think this post needs much introduction. I specifically chose it to run this week, because it explains why I feel that the “I Support You” campaign is so integral to World Breastfeeding Week. Only by approaching each woman’s journey as an individual, personal, and valuable experience, can we hope to properly support mothers in their breastfeeding goals. 

Thank you so much, Anne Marie, for allowing me to share your story – and I hope the FFF audience will also check out her blog, “Do Not Faint”,  as she is a tremendous advocate for maternal mental health.

Happy Friday (and happy Breastfeeding Week, and “I Support You” week), fearless ones,

The FFF

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Anne-Marie’s Story: Mama’s Mental Health, Bottle Feeding, and Self-Care

Many excellent, well-informed doctors helped me take care of my mental health before, during and after my pregnancy, and I feel both grateful to them and proud that I have become such a good advocate for myself. My talent for advocacy came in particularly handy when it came to making decisions about how we would feed our baby, because I received so much conflicting advice that I once burst into tears at the idea of another doctor giving me more information. To be fair, I did a lot of planning before we even tried to get pregnant, because I depend on twice-weekly therapy, anti-anxiety meds and antidepressants in order to function as a human being. In other words, there were many people over many months with many opportunities to offer advice, information and opinions, solicited and unsolicited.

Here is a list of my decision, in chronological order, based on the advice of various “professionals” and “experts”–

  1. Exclusive breastfeeding.
  2. Exclusive bottlefeeding: formula.
  3. Exclusive bottlefeeding: donated breastmilk from a close friend.
  4. Exclusive bottlefeeding: the hospital’s donated breastmilk during our stay (lawyers refuse to allow us to bring our own, but the head nurse in postpartum recovery managed to get permission to get me access to the milk bank because the whole thing was patently absurd) followed by our friend’s donated milk when we got home.
  5. Short-term breastfeeding, followed by bottlefeeding: a team of midwives, nurses and lactation consultants meet to discuss the stupidity of the hospital’s liability fears dictating our choices about feeding our son and it occurs to someone that a few days of my colostrum might actually do more good than harm, for me, my baby and everyone’s stress levels.
  6. Breastfeeding and bottlefeeding, followed by exclusive breastfeeding, once we have established that our son and his tiny liver are doing ok with the medicine that is in my breastmilk.
  7. Breastfeeding with intermittent Dad-administered bottles of my own pumped milk or formula.

The point of it all, really, is that this combination of my milk, donated breastmilk and formula has worked really well for us. But a combination like that would never have occurred to me without all the expert help and opinions I had, and I don’t think that many mothers consider doing anything like what we have done. Shouldn’t it at least be an option? Why is it breastfeed or formula feed? And why does “bottlefeeding” always mean formula?

My midwives talked with nurses and lactation consultants, because I had so much anxiety about feeding my baby. That wonderful team directed me to a pediatrician who specializes in breastfeeding medicine, and it is she who changed my entire outlook. The psychiatrists who warned against breastfeeding on meds meant well, but they knew about adult-sized doses and side-effects. My first clue should have been that one of them actually said, “Lots of our generation, including me, had formula, and we are all fine!” Can I get an eye roll for that line? This was hardly the evidence-based reassurance I was used to getting from the same doctor who had once handed me a whole stack of pages of medical journal articles on pregnancy and psychiatric medications. The pediatrician who helped us, an actual expert in actually feeding actual babies told me that the nursing relationship only works well if everyone is relaxed and happy. This is why she was thrilled to tell me that I could breastfeed on my medicine with safety, as far as the evidence showed, and that we could use our freezer full of precious donor milk to give us peace of mind.

She also taught me to relax about breastfeeding before I gave birth, because in her experience, a mother/infant pair can learn to breastfeed even if (heaven help us!) an infant should have a bottle or pacifier early in his life. That came in really handy when my son was born with a tongue tie that the hospital staff failed to notice. He could not, would not latch. The nurses fretted. I pumped colostrum and tried to stay calm, but it wasn’t until our breastfeeding expert clipped that tongue tie that we could nurse comfortably. In the meantime, we were happy to feed him from a syringe or a bottle, and we loved seeing his grandparents participate.

For the first three months of his life, my son had bottles of donor milk, and he breastfed, every day. I pumped for the ounces he drank to keep up my supply. By the time we ran out of donor milk, we were thrilled to see that he was showing no sign of any side effect from the medication in my milk. Unfortunately, he quickly began cluster feeding for hours right around the time I was getting used to exclusively breastfeeding. I had no time to pump for bottles; he was always nursing. After a night during which he nursed from 11 pm to 4:00 am, stopping only to switch sides or scream while his diaper was changed, I arrived at my therapist’s office in despair. I can’t manage my anxiety without sleep. Every doctor had told me that without at least a four-hours-in-a-row chunk of sleep every night, my mental health would suffer. My therapist asked about formula. I cried about how hard I had worked to feed my son only breastmilk. Then, I thought about sleeping, and bought formula immediately after leaving my therapist’s office.

I ask my husband to give our son a bottle when I’m feeling very anxious or stressed, or when I would just like a break, or when I would like to finish what I am writing. When I need to sleep or recover from a migraine, all I need to worry about is keeping myself comfortable, because I know that our son will be fine with the loved ones who care for him and feed him. Usually, I find that breastfeeding strengthens my bond with my son, that we both enjoy it and, for us, it’s extremely convenient. I also find that my anxiety and depression are much easier to manage when I have had enough sleep. My husband and I both get at least one break, every day, when we are “off-duty” and responsible for none of the parenting. When it’s my turn, that often means a bottle of formula. I am still trying to figure out why so very many people get so very upset about that. I honestly do not understand.

Mom, Dad and Baby are happier with the way our family does feedings. That short-lived experiment with “EBF” was absolutely miserable for me. It was a huge moment for me when that switch in my head flipped from “breastmilk or formula” to “do whatever it takes to be healthy and happy,” because I stopped believing that I could sacrifice my mental health for my child. All three of us suffered when I made myself a martyr.

Everything we learned about feeding babies along our rather strange journey has helped my husband and I in other areas of our relationship and family life. We check in with each other and stay creative in how we try to balance the trickier parts of this child-raising business. Sometimes, that means that one of us takes on responsibilities that may be uncomfortable so that the person who is ill or exhausted can try to get from “miserable” to “uncomfortable. A few bottles of formula have not transformed us into people who are happy all the time. But our approach to feeding our son has made us more creative problem-solvers, and that has definitely made us happier.

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If you’d like to share your story for an upcoming FFF Friday, please send it to formulafeeders@gmail.com.

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