New Jersey recently became the first state in the U.S. to mandate screening of all new mothers for postpartum mood disorders. Other states are proposing similar laws, and there is federal legislation in the works to make screening mandatory across the U.S. That’s the good news. While I applaud these efforts, I am concerned that breastfeeding may become a causality if the breastfeeding community is not proactive. Experts in the postpartum depression field seldom consider breastfeeding a factor in the postpartum equation. If they do consider it, breastfeeding is, at best, tsolerated (“Well, if mothers insist.”). More concerning is when postpartum experts specifically name breastfeeding as a risk factor for depression--or a cause.
Fortunately, there is much we can do to counteract this inaccurate information. But we must first understand the issues. Here are some concerns I have noted and approaches we can take.
Let Your Colleagues Know that Breastfeeding Protects Maternal Mental Health. Many colleagues in the postpartum depression field view breastfeeding as a mother versus baby issue. They see themselves as speaking on behalf of mothers, while we advocate for babies. Breastfeeding, they argue, is good for the baby. But when a mother’s mental health is at stake, those needs are secondary to her recovery.
We can specifically address this view by presenting an affirmative defense of breastfeeding. Yes, breastfeeding is related to profound health effects for both mother and baby. But it is so much more. Breastfeeding, with its stress-lowering effects, actually protects maternal mental health. Further, many mothers, when forced to wean, grieve the loss of breastfeeding. So forced weaning can also, arguably, add to their depression.
This is not to say that breastfeeding mothers never get depressed. They certainly do. But we can counter by noting that breastfeeding lowers risk and is worth preserving whenever possible. We can also acknowledge that breastfeeding problems can cause depression and need to be addressed promptly. Indeed, skilled lactation support can be part of an overall program to prevent depression.
Address Misconceptions about Medications and Breastfeeding. I’ve attended two postpartum depression conferences in the past six months. At both, I heard several presenters make the alarming assertion that “all medications get into breast milk.” The tacit message was that breastfeeding is just not worth the risk it poses. This assertion fails to take into account the collective wisdom of the lactation community. Yes, medications can get into breast milk, but in what amounts? Do medications that expose the baby to less than 1% of the maternal dose pose the same risk as medications that expose the baby to 20%? Of course not! Even with high exposure levels, the risks of not breastfeeding may be higher. As the breastfeeding community, we are often left out of treatment decisions for the mother. But we have expertise to share and must work to let our colleagues know how we can help.
Educate Colleagues about Treatment Recommendations that Will Lead to Breastfeeding Failure. Two weeks ago, a nurse in a medium-sized Midwestern hospital enthusiastically told me about a local OB who prescribes estriol patches right after birth for women at risk for depression. While I appreciate this physician’s proactive approach, his actual treatment protocol is concerning. Not only do estriol patches have highly questionable efficacy (with effects that disappear when tested in placebo trials), they also have a known deleterious effect on breastfeeding.
Another concerning recommendation I’ve heard multiple times is to tell mothers not to breastfeed at night. That may be necessary in some specific cases. For example, I worked with a mother with bipolar disorder whose illness is triggered by sleep deprivation. As a blanket recommendation, however, it would likely lead to premature weaning.
Even something as generally positive as home visiting can potentially have a negative impact on breastfeeding if home visitors give mothers inaccurate breastfeeding advice. We can provide education for home visitors and make ourselves available for referrals. By teaming up with our colleagues, we can help them devise prevention and treatment plans that will include impact on breastfeeding.
A Final Caution. Less than a month ago, I met a young woman who was organizing a postpartum depression task force for her metropolitan county. The breastfeeding community—I was distressed to learn—was deliberately excluded. The reason was simple. As a new mother, she experienced severe postpartum depression and needed to be hospitalized. She felt that a breastfeeding advocate harangued her at a very vulnerable time, as she sat in the psychiatric emergency room. Unfortunately, this is a relatively common perception of breastfeeding advocates in the postpartum depression field.
When I hear stories like this, I agree that the breastfeeding advocate’s approach was wrong and tell them I am truly sorry they had such a difficult experience. It goes without saying that we must always be respectful of women’s decisions about breastfeeding—even when we disagree. Then I tell them about the other side of the story; women I’ve spoken with from all over the country who are told to wean and who tearfully tell me that breastfeeding is the only part of their postpartum experience that is going well. Sadly, I know that for every one woman who calls me, there are 20 who don’t. And, they may grieve the loss of breastfeeding for years.
It is for these women that we must speak. We have valuable information to share and can be powerful allies in the fight against postpartum depression. It’s time for us to get involved and be a voice for depressed women who are breastfeeding. They need the benefit of what you know!

Resources
The New Hampshire Breastfeeding Task Force has developed a breastfeeding-friendly curriculum on postpartum depression for health care providers. This is available free of charge at www.NHBreastfeedingTaskForce.org.
Kathleen Kendall-Tackett is a health psychologist, La Leche League leader, chair of the New Hampshire Breastfeeding Task Force, and member of the La Leche League International Board of Directors. She is the author or editor of 12 books, including The Hidden Feelings of Motherhood.