FFF Friday: “We will bond no matter how she is fed…”

Earlier in the week, I shared an expert’s perspective on the emotional and mental health impact of formula feeding. Megan’s story feels like the perfect corollary to the insight offered in that post; a raw, brave account of mental illness and how this illness influenced a truly informed decision not to breastfeed. 

It is so incredibly humbling to get stories like the one below. The fact that you trust me and this space enough to share them here is not taken lightly… and while I hate that any of you even have to write these heartbreaking accounts, I can’t help but celebrate your resilience and willingness to speak your truths in the hopes of helping others feel less alone. 

So thanks, Megan. And thanks to all of you who share and read and participate – you are all amazing.

Happy Friday, fearless ones,

The FFF

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Megan’s Story

During the summer of 2014, I spent two months separated from my husband.  I took our 4 kids, packed up and went to another state to stay with my parents.  Things were pretty tough.  Traumatic would put it mildly.  But there’s a happy ending.  We both desperately wanted our marriage to succeed.  With blood, sweat and tears on both sides, we reached a really good place by the end of the summer – a fantastic place, even!  That fall, reunited both physically and emotionally, we finally made significant progress in so many areas of our lives that we had been struggling to move forward with over the decade of our marriage.  We remodeled our house (which we bought bank owned and in need of repair).  We instituted family rituals and routines that we had always wanted in place, but never quite could manage because we often couldn’t be in the same room with each other – hurt feelings make it hard to pretend that everything is fine.  But mostly, we both felt very strongly that there was another child ready to come to our family.  It was a very exciting, exhilarating time.  And a very anxious time.  Things were still so new.  We had just demolished the foundation our entire lives had been built upon for the last 11 years, and our new foundation was yet to be truly tested.  We were about to do just that – and how.

 

The day after my birthday in September, I started what would be my last menstrual cycle.  We were so thrilled!  This baby was figuratively and literally a symbol of our renewed and healing relationship.  Hope for the future of our family.  Evidence and a symbol of just how far we had come, of the new life we had brought to our union.  I was basking in the glow of being pregnant again.

 

Eventually, however, elation began to give way to a gradual sinking… At first I just thought it was exhaustion from first trimester blahs’.  But as the days began to grow shorter, and colder, we began to see that this was depression.  Depression wasn’t something foreign to me.  I had struggled with major postpartum depression with 3 of my 4 babies, with depression in-between postpartum periods as well.  I had a history of childhood sexual abuse, though, so I mostly attributed my depressive episodes with my work to resolve the effects of that abuse.  I kept figuring “once I get past this issue, I’ll be able to move on with a normal mood”.  Grieving and untangling trauma can be very difficult, and often looks like depression.  As we neared December, however, I hit a new low, even for me.  I went from being just fine and functional in the morning, to being so low that afternoon that I began thinking not just suicidal thoughts, but even thinking that my children would be better off being spared the agony of living with such a mother.  I thought to myself, “I can see how those mothers end up drowning their children in the bathtub.  I can see how that would be merciful”.  Then I wondered, as I brought up the image of the logistics in my mind, how you would drown multiple children, and what would you do with the bodies?  If you did them one at a time, they would freak at seeing the bodies of their siblings…..”  OH MY GOD!!  Did I really just think that???  Right as I thought that, the very clear phrase came into my mind “I need medication”.  That snapped me out of it, and gave me a surge of energy and forward momentum to act on a solution.

 

I reached out to my husband.  I told him he needed to come home.  I was shaken, I was ashamed, I was afraid.  What was happening?  That was NOT like me.  What was going on?  I couldn’t wrap my brain around it, but I knew that this couldn’t happen again, something had to change!  Dealing with things in psychotherapy wasn’t addressing this issue.  What else would??  Could medication really help?

 

 

Near the end of the two months I’d spent at my parents, when things began to calm down and my husband and I had a solid timeframe and plan for our reunification and going back home, my mother sat me down and had a talk with me.  That summer she was finishing up her rigorous PhD program in psychology.  She later said she was too close to the situation to be able to see it clearly for a time, but by the end of the summer, she finally had drawn a few conclusions that put the pieces together.  She read me the DSM-V definition of Bipolar I.  I was crushed.  I fit the description to a t.  I didn’t want to believe it.  Bipolar meant something was wrong with me, and I didn’t want to own that.  That was shameful.  And it meant I had a part in the separation, and I wasn’t the innocent victim.  I needed to be the innocent victim, and I needed him to be the perfect bad guy.

 

Fast forward again to that dismal and garish December.  At this point, my mother’s conversation came back to me in vivid detail.  Maybe she was right!!  A sense of relief washed over me.  This wasn’t my fault!!  I can do something about this that would actually work!  Exercise wasn’t cutting it, praying and reading my scriptures diligently wasn’t cutting it, having a close connection with my husband wasn’t cutting it, having good friends wasn’t cutting it… But if this is bipolar and not just me not “trying hard enough”, then I could see a light at the end of the tunnel.

 

So, at 20 weeks pregnant with my 5th child, I was officially diagnosed with bipolar I disorder, and began taking lamotrigine.  It pulled me out of my depression!  What elation, what relief!  Of course, I obsessively looked up and read every scientific study I could get my hands on, and I was very worried about the effects on my baby, but most studies concluded that after the 1st trimester, baby was at relatively low risk.  Then I began to notice a ramping up of anxiety.  It started gradually, but I began to notice feeling really great, and very productive, but increasingly I began heading toward fully anxious, crawling out of my skin feelings.  And then I realized, 3 weeks in a row, getting to the point where I was becoming paranoid again.  That was enough.  I went back in to my doctor and pretty much insisted he start me on lithium.  I was 32 weeks pregnant.  It helped!  I was so excited, and the case studies on lithium said that as long as baby didn’t have any troubles eliminating or getting dehydrated, that as far as they could tell, lithium didn’t have any measurable side effects.  Yes, they knew it was transferred to baby in breastmilk, but didn’t really see consistent harmful effects.  I felt comfortable with those odds.

 

Then came the day, at 37.5 weeks, when I began to wonder how the hormones of breastfeeding would impact me postpartum.  My biggest fear was having a major mood set back after birth, and for good reason.  I had a very clear history of it.  And, the medications were still helping, but I wasn’t actually feeling rock solid stable yet.  I still was having some ups and downs, just not so extreme.  All the research said that breastfeeding was protective against PPD, but nothing was said about bipolar.  So I asked my psychiatrist and my OB what their clinical experiences were.  They both said that almost universally, when moms are having postpartum mood issues, they fairly immediately improved after ceasing to breastfeed.  Clinical experience has to account for something, doesn’t it?

 

I think the biggest reason I could see their point and trust it was that not even a week before these discussions, I had about 4 hours of “warmup” labor, and it put me into a manic place, followed a few days later by a depressive place.  We increased the dosage of both my mood stabilizers, and that noticeably helped.  So when both my providers agreed with each other about stability and breastfeeding in my situation, I whole heartedly could see their point of view.  If I wasn’t even mood stable before birth, what would be the after birth chances when things really got screwy with my hormones?  It also occurred to me that my psychotic episode the summer before happened while I was still breastfeeding my one year old.  They were right.  Breastfeeding was not the option for me if my main goal was emotional stability.  I was crushed.  And peaceful.  And then obsessive about ordering just the right bottle feeding supplies.  And then crushed.  And then peaceful.  And then obsessive about looking up research to tell me that my doctors were wrong and I could actually breastfeed and I would be able to stay mood stable at the same time….

 

And then my shipment of bottles, pacifiers and all things formula feeding came in.  I could barely look at the unopened amazon box for a few hours.  I placed it on my couch where it could torment me every time I passed it.  Then I’d have a good cry, and busy myself with something to forget it.  Then I finally screwed up enough courage to open the shipping box.  Then I had a good cry, but left all the bottles and things in their original packaging – I wasn’t really going to use these, was I???  Eventually, after enough tears and grumpiness, I decided I would stop thinking about it.  I invited my older daughters to help me open them.  They were thrilled.  They wanted to touch everything, suck on everything (of course) and figure out how everything worked. Bottles and pacifiers are definitely a novelty in our home.  To this point, the only bottles I had ever owned always lived safely covered in thick dust in the cabinet above the fridge (you know, the useless one you can never get in and out of because it’s too high and you always have stuff on top of your fridge in front of it?).  Boy is this a change.  It did comfort me that the small size bottles, when I held them up and imagined feeding my baby from them, felt very close…. Like maybe I could bring baby really close to me like if I was breastfeeding.  Bottles and pacifiers safely in the dishwasher and ready to be sanitized, I needed a good cry again.

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And why was I crying?  I had hope for stability.  I was making choices that would not only benefit my new baby, but all my children and my marriage too.  I was making a choice to skip the living hell that is the ups and downs of bipolar – a choice that would afford me the chance to be in the world of people, living in the moment and enjoying that living.  Bipolar depression is completely exhausting and isolating, and bipolar mania is terrifying and crazy making because you can’t trust your gut or calm down enough to take in the moment.  Why would I want that?  Wouldn’t I want the best thing for everyone I love, including myself?

 

That night, my husband held me while great sobs wracked my frame.  I didn’t want to grieve.  I didn’t want to have to grieve.  I didn’t want to need to grieve.  I wanted to just treat this as a matter of fact, and then move on.  Grieving is scary – what if I get going and can’t stop – what if it’s not actually grief but just that ugly old depression again?  I felt broken, helpless, like a failure… Why did I have to be bipolar?  Why couldn’t I be stable?  Why did I need medications?  Why weren’t they working better yet?  Where was the line between a normal emotional response and a bipolar swing?  In truth, I don’t think they can really be distinguished, after a point.  The feelings are there either way.  The options are learn to sit with it in a way that isn’t destructive, or adjust medications.  After my intense crying session, I felt better.  That was a good sign that this was grief!  But grief usually comes in waves. I woke up the next morning after nightmares about having to bottle feed next to my breastfeeding friends.  I felt so surreal, to be bottle feeding – and horrifying.  I got up, sad and even angry.  Angry that this is my situation.  Angry at myself, angry that this is just part of living and having a body.  I’m grateful for my body and the children I have been able to conceive and give birth to, and the four I was able to breastfeed, even if it was a great struggle for my mental health in every postpartum period.  I’m grateful for this baby too – this little miracle child of the seaming back together of my marriage that was hanging by a thread only just one year ago.  And I feel raw.  I don’t want one more thing put on my plate that I don’t feel I have the capacity to do and do well.  I don’t want to see anyone pregnant and brimming with excitement about breastfeeding.  I don’t want to imagine them taking their brand new baby onto their chest, and having their baby root and suckle.  I don’t want to imagine that and a hundred other images I have in my head from my own babies.  I just want to fall down face first and sob until I have no strength left to sob.   And I want to not have to sob, to be able to either breastfeed, or get over it.

 

So why is it so emotional?  Why can’t I just “get over it”?  I never realized how much of my self worth was wrapped up in my ability to breastfeed, and ultimately in my capacity for perfection.  Good mothers feed their babies, but the best mothers know that “breast is best” right?  Good mothers know that emotional stability and consistency are keys to raising well-adjusted children, but the best mothers are just born with that natural ability.  Good mothers often sacrifice and put their children first, but the best mothers never have needs of their own and can endlessly give whatever their children require without resentment or burnout.  Wow.  What a load of distorted thoughts!!!  Does any of this sound familiar to you?

 

The truth is – the best mothers recognize their limitations, and plan for them.  The best mothers accept reality, get help, surround themselves with supportive people, and don’t try to brute force themselves into good mental health through sheer force of will and determination.  The best mothers recognize that breastfeeding, while extremely biologically engineered to create bonding, is not the same as bonding.  It’s a tool.  Bonding is a choice – one that continues through the child’s entire life span, and has many stages and phases.  You can’t breastfeed your teenager back into a close relationship with you if you haven’t stayed close through his earlier childhood and tween years…..  The best mothers understand that our imperfections are gifts to ourselves and our children.  Seeing that we aren’t perfectly put together all the time lets them know that it’s okay that they aren’t perfectly put together all the time either.  It gifts us all a sense of “we’re in this together – I’m ok, you’re ok”.  Which brings the sweetest sense of safety, connection and reassurance I’ve ever known.

 

The best mothers know that when we love ourselves, warts and all, we are providing the greatest example for our children we possibly can.  An example of just showing up, being transparent, and having self-compassion and self-kindness.

 

And that’s why my bottles are currently sitting in my dishwasher sanitized and ready to be packed into my hospital bag.  That’s why I have histamines and decongestants ready to go to dry up my milk supply.  That’s why I have a list of friends and family who have agreed to help support me after birth.  That’s why I’m still taking my mood stabilizers.  That’s why I’m going to finish writing this, and then go enjoy the last precious days of being a family of only 6, before our world changes to welcome our new one.  She’s precious no matter my weaknesses, and we will bond no matter how she is fed, because I will be emotionally stable enough to enjoy her.

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Want to share your story? Email me at formulafeeders@gmail.com.

The Mental Health Benefits of Formula Feeding – a Guest Post by Anna Glezer, MD

I’m so thrilled to be able to bring you the following guest post, from Harvard-trained clinician Anna Glezer, MD.  Dr. Glezer holds joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center, and recently launched a new website, Mind Body Pregnancy.

Enjoy!

-The FFF

The Mental Health Benefits of Formula Feeding

A guest post by Anna Glezer, MD

 

In my clinic, I have spoken with many women who struggled with the decision about how to best provide nutrition for their baby. I remember Cindy, a new mom who had low milk supply postpartum and supplemented her baby’s diet with formula, who expressed feeling inadequate as a mother. I remember Sarah, a second time mom who was taking medications that led to her decision not to breastfeed and the difficult time she had making that decision for herself and her baby. I remember Anne, a woman who felt judged by her peers and even strangers in the street when she would bring a bottle out to nourish her crying child.

As a new mom, you may have heard repeatedly from various clinicians, other parents, and perhaps even random strangers about the benefits and importance of breast feeding. However, not all women are able to breast feed and this article is for you. After reviewing the reasons when formula is the right choice and the negative feelings many women experience when making it, we will discuss all the emotional benefits of choosing to formula feed your baby.

Reasons When Formula is the Right Choice

There could be a wide variety of reasons for choosing formula:

– When taking certain medications that can be harmful through the breast milk. These may include medications for conditions such as multiple sclerosis, certain types of cancer, HIV, or others. Women taking medications for mental health reasons (such as certain mood stabilizers) may choose not to breastfeed because of a lack of data at this time on safety.

– When sleep is a significant issue. For women with bipolar disorder, poor sleep is a common trigger for a mood episode. For women with severe illness, the risks of poor sleep may outweigh the benefits of breastfeeding.

– When breastfeeding causes pain to a degree beyond what is typical. This may be due to medical complications such as recurrent mastitis.

– When breast milk supply is poor (due to a multitude of underlying reasons).

– When breastfeeding is not an option due to a woman’s medical history, such as a history of breast cancer and subsequent surgery.

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The Feelings of Many Women Choosing Formula

Women who initially planned to breastfeed but for whatever reason cannot often go through several stages of feelings:

Guilt – Many women describe feeling like a failure as a mother and guilty for being unable to provide breast milk for their infant. I have had women describe this when they are supplementing with formula and when they are exclusively formula feeding, when they are using formula temporarily and when it is for months.

Anxiety – Moms describe feeling worried about their infants’ future. Am I providing my baby with the best possible start? What about my baby’s health?

Shame – While guilt is the feeling you place on yourself with responsibility, shame is what you feel when the judgement of others falls upon you. Women have told me that their parents, partners, clinicians, friends, and acquaintances have made them feel ashamed of their choosing to formula feed their infants.

Depression – Postpartum depression affects 15% of moms, and difficulty with breastfeeding is a significant risk factor.

Grief – A grieving process is not unusual after a significant loss. In this case, the loss is the expectations a mom may have had about what postpartum will be like and what breastfeeding will be like.

How to Manage These Feelings: Looking at the Emotional Benefits of Formula Feeding

Once the decision to formula feed is made (and this is often not an easy decision to make, requiring careful weighing of choices, hopefully with the support of a partner and nonjudgmental health care professional), the next step is managing all those feelings mentioned above that come with that decision.

Recognizing all the positive mental health benefits of formula feeding can help you achieve this.

  1. First, one of the main reasons breastfeeding is considered so important is that it is an essential time of bonding between mom and baby. This doesn’t change with formula! This benefit remains regardless of what the baby is drinking. The key is in how the baby feeds – in mom’s arms, in a loving, strong embrace, looking into mom’s face and seeing her love. This attachment time between mom and baby leads to healthy bonding and positive well-being for both.
  2. Second, formula feeding can help moms work on their emotional wellness by providing them with flexibility. That might mean that while the partner feeds baby, mom has the opportunity to attend an exercise class, go to a therapy appointment, or call a supportive friend. That might also mean that mom can share night-time duties with her partner or others, allowing for better sleep. Sleep is crucial for good mental health, particularly in vulnerable women.
  3. Third, by formula feeding, you might be avoiding some of the emotional costs of breast feeding. One patient of mine suffered severe mastitis from breastfeeding, complicated by a systemic infection requiring hospitalization, which led to the consequence of post-traumatic stress disorder. Others describe the pressure to breastfeed, coupled with feelings of inadequacy, as the trigger for postpartum depression. Anxiety can rise also after the transition back to work, if you are trying to pump and breastfeed while working full-time. These emotional complications – PTSD, depression, and anxiety can potentially be avoided if a woman is able to move past her and others’ expectations and accept formula feeding as a wonderful way of nourishing a baby.
  4. Fourth, formula feeding helps to promote a loving bond between baby and dad. Some fathers have said they feel left out of the relationship with young infants. This helps to foster that bond, which can also have a positive effect on the partner relationship, alleviating the sense of helplessness and jealousy that can sometimes arise.

In summary, it is essential to recognize that the decision a mother makes about breastfeeding or formula feeding is very individual and depends on her unique set of life circumstances, including physical and mental health issues. Having the support of a partner, family, other moms, or a provider will help when making this choice. Being aware of the positive mental health benefits of formula feeding might help you if you are struggling with this decision and experiencing some of those common negative feelings like guilt or anxiety.

 

About Dr. Glezer:

Dr. Anna Glezer is a Harvard-trained clinician with current joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center. She is the founder of Mind Body Pregnancy, a new online educational resource that helps women with their emotional well-being and mental health during pregnancy, delivery, and postpartum

Transformed by Postpartum Depression: A book review

“We need both medicine and mothers to create the future of maternal mental health.” – Walker Karrraa, PhD

 

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It’s no secret that I’m a survivor of postpartum depression. It’s something I talk about a lot, and it informs everything I do with FFF.  There is an obvious correlation between breastfeeding and postpartum mental health; whether this connection is positive or negative is a highly subjective, personal, individual matter. I see so many blanket statements, based on problematic data collection, and leaps of logic when it comes to this topic. No one ever stops to listen to the mothers who don’t fit their particular thesis. And while the topic of maternal mental health has slowly been gaining proper attention in both the media and research communities, as usual, the most important voices have been ignored: the voices of the mothers who have lived through PPD, and lived to tell the tale.

Thanks to Walker Karraa, PhD, these voices are now being heard. In her new book, Transformed by Postpartum Depression (Praeclarus Press, 2014) she reports on her own analysis and research as well as that of other pioneers/thought leaders in the maternal mental health field. But throughout, she allows the words of her subjects tell the story. And it’s an important story – one that not only highlights Karraa’s thesis, that PPD can be both traumatic and transformative, but also details how we are failing mothers at every turn. This is something that’s been discussed, even here on this blog, but Karraa’s delivery of the information is profoundly moving and startling because it is so specific, personal, and honest.

Using her interviews with 20 different women, all of whom survived moderate to severe PPD, Karraa examines the experience of postpartum depression. But this isn’t some clinical, cold volume that treats its subjects like research – the care and admiration Karraa has for her subjects is clear throughout the text. It’s a unique book; one that I believe will be just as helpful to moms as it is to mental health professionals and academics.

I think the FFF Friday series is powerful for many reasons, but the one that feels most vital to me is this: for every specific, personal story I share, there are hundreds of moms out there who see themselves in the words. These experiences are individual, but also collective, and sharing them helps both the writer (catharsis) and the reader (relief/camaradarie/normalization). Karraa’s book serves this purpose for the postpartum depression community. That would be enough – but she goes a step farther, pondering complex questions about how we approach the pathology of depression, and even analyzing her own reactions to her research. The result is something entirely unique, engaging, and important.

One section that deserves national attention – like, yesterday – is Karraa’s chapter on the failure of care providers to help these women. Her interviewees report harrowing tales of begging for help, only to be cruelly dismissed, ignored, or ridiculed. Nearly all reported a complete lack of forewarning that PPD was even a possibility, in prenatal classes and OB/GYN appointments – even when they had past histories of mental illness. Lactation consultants failed to see what breastfeeding was doing to a mother’s mental health; pediatricians told mothers their suicidal thoughts were “normal”; therapists refused to help or refer to others who could. These mothers were forced to take matters into their own hands, as Karraa describes:

As I analyzed this data, images of the walking wounded came to mind – as if these women were hemorrhaging – in public – and no one noticed… To walk through daily life dying and being ignored by care providers, and invisible to support systems was crazy-making and cruel. There was almost a punitive sense of the experience of care-provider failure – an additional layer of humiliation, indignity, and negligence…women got pragmatic; if their providers were not going to fix the problem, they would do it themselves.”

Of course, this could be viewed as a silver lining, in the American, pull-yourself-up-by-the-bootstraps sort of way. But that is not what Karraa is advocating. It’s inspiring to see how these women overcame adversity, but infuriating that they had to do it alone. I hope that this book will act as the missing link – a close-up on the face of postpartum depression, a healing volume for those who have been through this particular battle, and a call to action for our society to make immediate changes in how we approach postpartum mental health.

“Where is the mother in the discussion?” An interview with Walker Karraa on maternal mental health and infant feeding

Some of you may know Walker Karraa from her comments on our Facebook community page, or from her fantastic posts on Science & Sensibility. But I doubt you’re aware of the full magnitude of her bravery and dedication to issues surrounding maternal mental health. I recently interviewed Walker for a short piece on formula feeding and postpartum adjustment, and was so blown away by her answers – I was only able to use a few of her wise words due to word count constraints, so I’m thrilled she’s agreed to let me post the interview in full here on FFF.

Walker is a doctoral candidate at Sofia University, where she is conducting a study on the transformational dimensions of postpartum depression. She was also the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth, and is a perinatal mental health contributor for Lamaze International’s Science and Sensibility, Giving Birth With Confidence, and the American College of Nurse-Midwives (ACNM) Midwives Connection. Like that wasn’t enough on her plate, Walker also served as social media manager for the Integral Leadership Review, and has her own social media consulting business, On My High Horse, and is currently working toward co-authoring a book regarding PTSD following childbirth with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA. 

I’m exhausted just reporting all of that. And did I mention she has two kids and is a breast cancer survivor? Yeah, she’s all that and a bag of reduced fat potato chips.

I hope you guys will appreciate the revolutionary nature of Walker’s discussion here – her opinions, while brilliant, probably seem uncontroversial to those who follow this blog, but they are quite “rogue” in the birth/maternal-child health community. I can’t thank her enough for being a dissenting voice and speaking up for the benefit of all women. 

FFF: Here on FFF, we see stories almost weekly which discuss how a perceived “failure” to breastfeed can lead to depression, anxiety, and self-esteem issues. Do you think the maternal mental health community has recognized how breastfeeding (or lack thereof) can affect the emotional state of new moms?

Walker Karraa

WK: I think that overall breastfeeding is very well addressed in the health psychology, and developmental psychology fields. What’s lacking is the reframe of the research to integrate more qualitative data, and methods, into the consideration of the full range of implications of breastfeeding from multiple perspectives—including the woman’s perspective.

In a 1985 Lancet article on maternal mortality, Allen Rosenfield asked the famous question, “Where is the ‘M’ in MCH (Maternal Child Health)? In the discussions of MCH, it is commonly assumed that what is good for the child is good for the mother.” (Rosenfield & Maine, 1985, p. 83). In many ways this is relevant in the discussion of breastfeeding and maternal mental health. Where is the mother in the discussion? And in what ways do we still assume what is good for the child is good for the mother? For me, this is all about reproductive rights and a deeper issue about our discomfort with women’s sovereignty over their reproductive, physical, and mental health.

The mental health community has responded to the growth in published data regarding infant health and breastfeeding. This has also been the funding stream for a large part of the last 20 years. But maternal mental health has yet to directly address a woman’s infant feeding choice as a part of her reproductive choice, rather than discrete periods of time that occur with as a continuum of events that are inextricably woven through reproductive events—none of which, taken by themselves, gives either the best data on mental health.

FFF: What do you feel needs to change in order for new mothers to be better supported in terms of mental health in general?

WK: I think one of the first calls to action must be for maternal care providers to get support in knowing that perinatal mood and anxiety disorders are common and create the conditions for morbidity and mortality for mother and children. This is starting to happen, but still very slow. I think new models of medical care such as Dr. Michael C Lu’s life course model, which places the woman at the center of care, not the doctor. And, she is treated across the lifespan, not merely when she is pregnant. This facilitates better reproductive health in preconception and interconception, and uses a reproductive life plan for women and families from an early age. At puberty, to have a conversation with medical, nutritional, mental health providers as to planning one’s reproduction (girls and boys) would be ideal.

FFF: Many women struggle with the decision of whether to treat postpartum or prenatal depression/anxiety with psycho-pharmaceuticals, especially when they are breastfeeding. Why is there such mixed information and messaging about what drugs are safe, and what the relative risks are (ie, breastfeeding without meds vs breastfeeding on meds vs formula feeding and taking the meds)?

WK: Not having good information is a barrier to care for everyone involved. The OB/GYN or midwife, the social worker, the woman, her partner and family—when we don’t have good information, we cannot make informed choices. And for women in poverty, the risk is twofold. Specifically regarding breastfeeding, but also education across the board regarding psychopharmacology, pregnancy, and lactation. With organizations such as OTIS (Organization of Teratology Information Specialists) and Motherisk, there really is no excuse for not having current evidence-based data regarding risk and benefit of untreated depression and anxiety, as well as risks and benefits of medications used to treat them.

Byatt et al. (2012) did a wonderful grounded theory study regarding community mental health provider reluctance to providing psycho-pharmacotherapy. 28 obstetric care providers (nurses, OB/Gyns, etc.) shared how they perceive community mental health practitioners as obstacles to psychopharmacology for perinatal women. The participants felt community mental health providers “99% of the time” discontinued a patients’ medication, and put women at risk of relapse. Secondly, Byatt et al., (2012) reported that participants perceived a lack of collaboration and communication between community mental health care providers and OB/Gyn providers, and that pharmacists also “further impede or delay depression treatment by not filling needed psychotropic prescriptions, often exacerbating women’s mental health symptoms” (p. 3).

FFF: Why do you think so many women express grief, guilt, and feelings of failure around the subject of infant feeding?

WK: Because that is their experience! And I attribute all of it to social constructs that are completely ingrained in medical, social, and mental health systems that have been made for and by men. The intentions of those men is not necessarily nefarious, and not really the point. It is that the constructs we have to measure ourselves (abilities and weaknesses) are made by men. We tell women from the get-go that they need us to be good mothers. They need our insight, knowledge, treatment, book, video, technique, services, product to be taught how to mother. This is so ironic, because so many of the birth movements have evolved from a call to empower women. But to empower, we have just made more systems of knowledge that mimic the ones we refute. That is not very popular to say, but it is true. The messages still given to women is that if they “know” something analytically, they are devoid of femininity, and if they “know” something inter-subjectively, they are devoid of ration.

Shame is a powerful force for women. And at no time in her life is a woman more susceptible to shame than early motherhood. If they are lucky enough to find a safe space to share their feelings without judgment, such as your blog, they are given the gift of voice. They can speak their truths.

FFF: Any tips for a mom who is having a tough time reconciling her use of formula?

WK: You know, when I was a doula, I had clients ask me to go buy formula for them so they wouldn’t be seen in public. When I was diagnosed with breast cancer shortly after the birth of my second, I underwent two mastectomies before she had turned one. I learned that my body parts have nothing to do with my inherent ability to love her. My breasts were gone—off of my body, one in one hospital and another at a hospital down the road. I fed, nurtured, attached with, loved, and parented without them…and still do! So my advice is to write down on a piece of paper: My breasts have nothing to do with my love for my child. And keep it where you can see it. Memorize it, know it.

Good versus “Evil”: How ignorance can bring out the best in the breastfeeding/formula debate

Question: If a misguided, extremist tree falls in the forest, does it make a sound?


Answer: Yes, if the tree is talking about the breastfeeding and/or formula feeding debate.




For those of you who don’t live in the forest, the tree in question – a sprawling, giant redwood of ignorance – was planted by one Darcia Narvaez, PhD. Narvaez wrote a series of articles for her blog on Psychology Today, so aptly titled “Moral Landscapes”, on the importance of breastfeeding; each one was more offensive and misleading than the last, culminating in her piece de resistance, Is Pushing Formula Evil?” (Spoiler alert: she thinks it is.)


This most recent article included such oldies but goodies as:


Formula is a starvation diet. It gives kids the equivalent of bread and water right when they are growing the most…”


and


Formula is the first junk food. Do we want our kids to be healthy? Then we know they should not have foods that are out of balance with nature. So we don’t want to give them formula. We don’t want them to get used to the same flavor day after day (unlike breastmilk). We would be setting them up for eating disorders…”


Plus, if you order now, you’ll receive hits like:


99% of moms with full-term infants can breastfeed successfully. It is ignorant doctors, nurses, family members and the push of pharmaceutical companies that make it seem untrue…”


and


“This is a moral issue because of how much damage is being done to children, society and our future by not breastfeeding…”


And those greatest hits were from the edited version of the article, altered after Narvaez received numerous comments from therapists, lactation consultants, and mothers, some harmed, and all offended, by her words.


I could go through every one of Narvaez’s bullet points and explain why they are 95% horse poop, but I’m not sure that would get me anywhere; we’ve pretty much covered all of them in past posts (just check out the tags at the bottom if you want to hear what I have to say about her claim that formula is linked to lower intelligenceor that “99% of moms with full-term infants can breastfeed successfully. It is ignorant doctors, nurses, family members and the push of pharmaceutical companies that make it seem untrue”ironic, as the stress this writer is causing with her foreboding article could harm supply) Plus, it would legitimize her in a way that I’m not interested in being responsible for. She is so far from rational in her facts and presentation that I wasn’t even offended by her post.


In fact, I kind of liked it.


Here’s why: within hours of this drivel being posted, women were coming out of the woodwork to school Narvaez on the realities of infant feeding. Therapists finally spoke up about the link between postpartum depression and the pressure to breastfeed (Narvaez tried to pacify these folks by adding a warning at the beginning of her post:
NOTE TO MOMS: Don’t read this if you are feeling vulnerable, guilty or overstressed”. Yep. Really. I don’t know whether to laugh, cry, or demand a retraction from Psychology Today); lactation consultants, even if they were nowhere close to my end of the breast-bottle-right-to-choose spectrum, told her that her approach was wrong and damaging. Sure, there was the requisite “formula feeders are sociopaths” type of fare in the comments section (mostly from Narvaez herself, who- I kid you not – blamed the selfishness of the Baby Boomer generation on formula), but overall, the sisterhood was stronger than I’ve seen in a long time.


Over on the FFF Facebook page, there was discussion about how for any “hot” topic, the extremists get all the attention, and moderate voices are seldom heard. There’s a silver lining to this unfortunate truth: Sometimes, it takes deafening zealotry to provoke the quiet, moderate voices to speak up a little louder.


I truly believe that it will be these voices who can put an end to this ridiculous “battle” and start making some real strides in improving the lives and health of women and babies. Voices like the postpartum therapist who worries that the obsession with perfection will exacerbate women already rendered vulnerable by the monster of PPD, or the PPD survivor who urges that breastfeeding is a matter of personal preference. Or the feminist activist who manages to promote breastfeeding and choice simultaneously. Or the breastfeeding mom who understands the concept of correlation versus causation, and can cherish both her belief in/love for breastfeeding and her belief in/love for using evidence-based science for prescriptive claims. Or the mother who was once riddled with guilt, caught up in the whirlwind of caring for a micropreemie, and who now has the strength and confidence to stand up for her choices and show the world how breast is best is not so black and white.


So, I applaud you, Darcia Narvaez. You’ve managed to bring lactivist and formula feeding advocate together in mutual disgust for your approach to breastfeeding promotion. You’ve made us take a step back, and reaffirmed the need for a dose of common sense, for a middle ground, for sensitivity and reason.


I applaud you. But that doesn’t mean I don’t hope someone cuts your aforementioned poorly-written tree down to make toilet paper.


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