A new study, published 20th August 2014 in the journal Maternal and Child Health, has found that mothers who planned to breastfeed and who actually went on to breastfeed were significantly less likely to become depressed than mothers who had planned to, and who did not, breastfeed (1).
This study emphasises how crucial it is for mothers to know how to get support so they can continue breastfeeding as long as they want to, and how this may play a key role in helping to prevent postnatal depression. LLLGB Leaders (volunteer breastfeeding counsellors, who have undergone a training programme and been accredited by La Leche League International) are mothers who have breastfed their own babies and understand how important it is to get support if difficulties arise.
Dr Maria Iacovou, of the University of Cambridge’s Department of Sociology, in collaboration with Dr Almudena Sevilla from Queen Mary University of London and Cristina Borra from Universidad de Sevilla, Spain, conducted this study of over 10,000 mothers.
It is one of the largest studies of its kind and is also one of the few to take into account mothers’ previous mental health. It also controls for socioeconomic factors such as income and relationship status, and for other potential confounders such as how babies were delivered, and whether they were premature.
It was found that women who breastfed their babies were at significantly lower risk of postnatal depression than those who did not. The benefit increased for each week of breastfeeding up to one month. The relationship between breastfeeding and depression was most pronounced when babies were 8 weeks old, but much smaller when babies were 8 months or older. However, any longer term impact on post-natal depression could not be determined due to the small number of women in the study who were still breast feeding several months after the birth.
The research, funded by the Economic and Social Research Council, used data drawn from the Avon Longitudinal Survey of Parents and Children (ALSPAC), a study of 13,998 births in the Bristol area in the early 1990s. Maternal depression was measured using the Edinburgh Postnatal Depression Scale when babies were 8 weeks, and 8, 21 and 33 months old. Depression was also assessed at two points during pregnancy, enabling the researchers to take into account mothers’ pre-existing mental health conditions.
Around one in 12 women in the sample experienced depressive symptoms during pregnancy, while one in eight experienced depression at one or more of the four measurement points after giving birth.
Confirmation of previous studies
Several previous studies back-up the findings in this new study. In her book Depression and New Mothers, Kathleen Kendall-Tackett, PhD, IBCLC, looks at depression and breastfeeding. She reports that “rates of depression are lower in breastfeeding mothers than their non-breastfeeding counterparts”(2). She also notes that “breastfeeding is protective of maternal mental health because it reduces the stress response”.
Writing in Leaven, a publication produced by La Leche League International, August-September 2005, Kendall-Tackett, a La Leche League Leader, explains how stress and fatigue can increase risk for depression, but lowering stress can be protective. This is where breastfeeding can make a difference. Mezzacappa and Katkin (3 ) compared maternal stress levels after both breast and bottle-feeding, with 28 mothers who were doing both.
They measured stress immediately after breastfeeding, and immediately after these same mothers bottle-fed. The design of this study allowed the authors to account for pre-existing differences in mothers who chose to breastfeed rather than bottle feed since each mother was compared to herself. They found that the act of breastfeeding decreased mothers’ negative moods, and when these same women bottle-fed, bottle-feeding decreased their positive mood.
In a 2004 study published in Biological Psychology (4) Jones and colleagues found that breastfeeding protected infants from the harmful effects of maternal depression. They compared four groups of infants: infants of depressed mothers who were either breast or bottle-feeding, and infants of non-depressed mothers who were either breast or bottle-feeding. The infants of depressed bottle-feeding mothers had abnormal brain activation patterns, such as those found in previous studies. But the infants of depressed breastfeeding mothers were no different than those of non-depressed mothers.
How breastfeeding benefits and protects babies
Breastfeeding has been demonstrated to enhance psychological interactions between mothers and infants. Research has shown that mothers who breastfeed exhibit increased physiological and social responsiveness to their infants (5). Breastfed babies have been shown to be more alert and responsive (6) and more reciprocity and affection has been observed in breastfeeding dyads (7,8).
If a woman becomes depressed while breastfeeding some health care professionals consider breastfeeding a risk factor and she might be urged to stop in order to recover. This view does not take into account the research demonstrating breastfeeding’s protective effect on maternal health. Many medications for postnatal depression are compatible with breastfeeding and it should be possible to discuss with a doctor a treatment plan which is right for each individual circumstance.
Kendall-Tackett says that breastfeeding protects babies from the harmful effects of maternal depression. One apparent reason for this finding is that by simply breastfeeding, mothers were more likely to touch, stroke, and make eye contact with their babies. Another possible explanation for the beneficial effect includes the release of feel-good hormones when milk is produced. This is one more good reason for encouraging mothers to continue to breastfeed even while depressed.
Dr Maria Iacovou says “Breastfeeding has well-established benefits to babies, in terms of their physical health and cognitive development; our study shows that it also benefits the mental health of mothers.”
When a mother stops breastfeeding before she planned to
The Study also found that mothers who planned to breastfeed, but who did not go on to breastfeed, were over twice as likely to become depressed as mothers who had not planned to, and who did not, breastfeed.
According to Department of Health statistics three-quarters of mothers initiated breastfeeding in 2012/13; by the time of the 6-8 week check, only 47% of babies were being breastfed. This is one of the lowest rates of breastfeeding in Europe.
While breastfeeding is very effective in lowering stress, breastfeeding difficulties can increase both stress and depression. In a sample of 41 breastfeeding mothers, depression, stress, severity of breastfeeding problems, and fatigue were moderately correlated with each other. These measures were taken at three days, and three, six, and nine weeks postpartum (9).
It is vitally important that women who want to breastfeed get the support they need. Dr Iacovou believes that health authorities should not only be encouraging women to breastfeed, but should also provide a level of support that will help mothers who want to breastfeed succeed.
LLLGB concurs with her comments that “Lots of mothers and babies take to breastfeeding pretty easily. But for many others, it doesn’t come naturally at all; for these mothers, having someone with the training, the skills, and perhaps most importantly the time to help them get it right, can make all the difference.”
Mothers who experience a lot of stress and severe fatigue may be more likely to develop depression. One study recruited 38 healthy new mothers who had uncomplicated births in the first day postpartum (10) . The authors found that fatigue at day seven predicted depression at day 28. Indeed, fatigue on day seven accounted for 21 percent of the variance in depressive symptoms. Similarly, a study of 465 postpartum women also found that sleep problems at one month postpartum predicted depression at four months (11).
Dr Iacovou says that social or psychological factors such as feelings of “failing as a mother” were also contributing. She added “However good the level of support that’s provided, there will be some mothers who wanted to breastfeed and who don’t manage to. It’s clear that these mothers need a great deal of understanding and support; there is currently hardly any skilled specialist help for these mothers, and this is something else that health providers should be thinking about.”
Dr Iacovou says “In fact, the effects on mothers’ mental health that we report in this study are also likely to have an impact on babies, since maternal depression has previously been shown to have negative effects on many aspects of children’s development.”
Being aware of factors which may lead to depression will hopefully enable women to get the support they need before things escalate and to protect the breastfeeding relationship between a mother and her baby.
LLLGB Leaders offer telephone counselling, group meetings, leaflets, and email support but, most of all, they are a listening ear when things are not going well with breastfeeding. They can offer accurate information so that women can decide what feels right for them and their baby. LLLGB groups offer local support, our official LLLGB because Breastfeeding Matters Facebook page offers more mother-to-mother support.
Depression and New Mothers Kathleen A Kendall-Tackett, Routledge, 2009
Non-Pharmacologic Treatments for Depression in New Mothers Kathleen A Kendall-Tackett, Hale Pub. Jun 2008
Kathleen Kendall-Tackett’s website is found at UppityScienceChick.com
1. Borra, C., Iacovou, M. and Sevilla, A. “New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions”. Maternal and Child Health Journal: 20 Aug 2014
2. Dennis and McQueen, 2009
3. Mezzacappa, E.S. and Katkin, E.S. Breastfeeding is associated with reduced perceived stress and negative mood in mothers. Health Psychol 2002; 21:187-93
4. Jones, N.A., McFall, B.A. and Diego, M.A. Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: The mediating role of infant temperament. Biol Psychol 2004; 67(1-2):103-24.
5. Wiesenfeld, A. R., C. Zander Malatesta, P. B. Whitman et al. Psychophysiological response of breast- and bottle-feeding mothers to their infants’ signals. Psychophysiology 1985; 22:79-86.
6. Worobey, J. Feeding method and motor activity in 3-month-old human infants. Perceptual and Motor Skills 1998; 86:883-95
7. Bernal, J., and M. Richards. The effects of bottle and breastfeeding on infant development. Journal of Psychosomatic Research 1970; 14:247-52
8. Dunn, J., and M. Richards. Observations on the developing relationship between mother and baby in the neonatal period. In Studies in Mother-Infant Interaction, ed. R. Schaffer. New York: Academic Press, 1977
9. Wambach 1998).
10. Bozoky and Corwin 2002
11. Chaudron et al. 2001.