AAP Voices Blog

As both a pediatrician and a lactation consultant, I've witnessed countless new mothers struggle with the challenges of breastfeeding. Over the years, I've come to understand the complex interplay between breastfeeding and maternal mental health, particularly when it comes to postpartum depression and anxiety.

I vividly remember a patient who was highly motivated to breastfeed exclusively and was observed to do very well with breastfeeding during the hospital stay but returned for the baby’s first visit looking exhausted and entirely on the verge of tears. While her newborn was thriving, she shared her struggles with breastfeeding and overwhelming feelings of inadequacy.

"I should be able to do this," she said, her voice barely above a whisper. "Why is it so hard?"

This mother's experience highlighted a critical gap in our support for new mothers. 
Postpartum depression and anxiety impact 10-15% of new mothers and can have a profound impact on breastfeeding initiation and continuation. Yet, 50% of those issues often go undiagnosed and untreated due to the reluctance of the mothers to express their feelings, given the misconception of the stigma surrounding the condition.

“By addressing the intersection of breastfeeding and maternal mental health, we can better support new mothers in their journeys”

As pediatricians, we're uniquely positioned to bridge this gap. Here's what we can do: 

• Screen early and often - Incorporate mental health screenings, such as the Edinburgh Postnatal Depression Scale, into routine newborn visits. The scale is a widely used screening tool that can help identify mothers at risk of postpartum depression. Don't wait for mothers to bring up their struggles – many won't.
• Educate and normalize - Discuss the potential challenges of breastfeeding and the prevalence of postpartum mood disorders during newborn visits. Normalizing these experiences can reduce stigma and encourage mothers to seek help early.
• Create a supportive environment - It is crucial to ensure your practice is a judgment-free zone. Train staff to recognize signs of PPD and provide resources for support. This will make mothers feel safe and comfortable sharing their struggles.
• Collaborate across specialties - Develop relationships with mental health professionals specializing in perinatal mental health and lactation consultants specializing in breastfeeding education and assistance. Be prepared to make prompt referrals when needed.
• Advocate - Push for policies that support extended postpartum care, including mental health services and integrated lactation support. 

In the case of the struggling mother I mentioned, gently inquiring about her mental health made all the difference. By providing immediate lactation support and connecting her with a mental health professional, we were able to address both her breastfeeding challenges and her emotional well-being. 

By addressing the intersection of breastfeeding and maternal mental health, we can better support new mothers in their journeys. Let's commit to creating a more holistic, empathetic approach to maternal-child care. This very special dyad of mother & newborn deserves nothing less.