What happens when everything you try as a new mom doesn't improve your breastfeeding situation? Your spouse is saying stop; your heart says keep going and the baby doesn't seem to care one way or the other. You can't bear the thought of giving up, but the tears are coming more and more frequently.
This is an all too common scenario among today's mothers. I see it weekly in my practice and hear chatter about it on Facebook and Twitter. Obstetrics and Gynecology published a paper that looked at depression among women that experienced early breastfeeding difficulties. Conclusion?
Women with negative early breastfeeding experiences were more likely to have depressive symptoms at 2 months postpartum. Women with breastfeeding difficulties should be screened for depressive symptoms.
What is the role of the lactation consultant in this situation? Certainly screening for depression is important. But do we tell someone to give up?
I recently received a very sad and angry letter from a mother that had given up breastfeeding at three months due to a very low milk supply. She was upset with me that I had not given her permission to give up breastfeeding sooner. At first, I was taken back by the tone of her letter. Then I was terribly hurt and then I was angry. It took me 48 hours to process the letter. That's when it dawned of me that this really had nothing to do with me. This was a mother experiencing huge disappointment with her own body and perhaps depression. That's alright if she wants to blame me; perhaps it makes it easier for her to cope.
But I am worried about her. That's a lot of angry to have. And the part that doesn't make sense is that "You didn't give me permission to give up." When was I to give her permission? At her first visit on day four when no one knew what her milk supply would do? At her second visit on day ten when she was still so full of hope? Several attempts were made to contact her after her visits, but she didn't return the phone calls. That clued me in to the fact that she may be depressed, but you can't leave a message like that. So three months later she writes me this letter.
Now that we have this study I have more tools in my toolbox. Look at this from the study: "Women who disliked breastfeeding in the first week were more likely to experience postpartum depression at 2 months." I sensed from the beginning that this woman disliked breastfeeding. There are not many women I meet that cause me to feel this way. Now I will be more alert to this and will ask, "Do you really want to breastfeed? Do you enjoy it?"
I do not judge anyone by the choice of feeding they make for their child. There are many issues leading up to delivery that impact a woman's feeding choice and certainly once the baby arrives breastfeeding problems make it harder, if not impossible to enjoy breastfeeding or even to continue.
For those women that choose to continue breastfeeding even when they are having problems, my mantra is and always will be Diana West's mantra:
Each woman defines her own success.
One woman pumped an ounce of milk a day for her baby's first year and she was delighted. Another mother of triplets pumped 18 ounces a day until their first birthday and she was very proud of herself. Another mother stopped breastfeeding for six months and then started pumping and built her supply back to 18 ounces a day. Do I tell someone when to stop? I feel my responsibility is to support her 100% whatever decision she makes and perhaps that is where I failed this mother. Did I forget to tell her this? Was I too full of hope for this mother? I can't be a fortune teller, knowing who will and who won't make a full supply of milk. Breastfeeding does not have to be all or none. I don't want to be and shouldn't be the one to define a mother's success.
Every ounce of breastmilk you give your baby, for as many days and weeks as you can, is like money in the bank for your baby's health.
Help me think through this and learn from this letter. How can I and others that work with breastfeeding mothers be a better support to the mothers we work with? What would you have wanted me to say to you?