Linnea Dunne investigates the often neglected phenomenon of post-weaning depression…
TW: Suicide
“It hit me like a wall. Uncontrollable crying, felt like the baby blues finally arrived seven months later.” Most of us have heard about the baby blues this Kildare mother of two references. Increasingly, we hear about postnatal depression and anxiety too. But post-weaning depression? Not so much.
[restrict]Yet it seems to be one of those things many mothers nod to each other in recognition of – not quite a rite of passage, but a ‘me too’ of sorts. For some, it merely registers as a momentary dip, with weepiness and perhaps some irritability, while for others, it’s a wild cocktail of guilt and sadness mixed with raw rage and a feeling of being completely out of control. Some report feeling so uncontrollably angry that it frightens them, as though they’re possessed.
And it is a thing, even if more research is needed on the particulars of causations and correlations. That those with a pre-pregnancy history of anxiety and depression are more prone to post-weaning depression seems clear, and mothers who stop breastfeeding early appear more likely to be affected. But in the majority of cases, thankfully, post-weaning depression is short-lived, which might be one of the reasons why we don’t hear much about it. The early months, even years, of motherhood are not exactly filled with the kind of time and space required for careful reflection. I certainly didn’t have the sort of self-awareness when I was in the throes of sleep-deprivation, weaning-induced mastitis and baby-led weaning food preparation to clock that the mood rollercoaster I was on might in fact be about more than just all of the above.
Of course, it can be hard to know what’s what at the best of times when you’ve recently given birth. The hormonal adjustments after housing a baby for 40-odd weeks are significant whether you’re breastfeeding or not. “There are lots of hormonal changes after birth, with women who are breastfeeding having different hormonal patterns to those who are not,” says Professor Amy Brown, Director of the centre for Lactation, Infant Feeding and Transition (LIFT) at Swansea University and author of a number of books on the subject. “Oestrogen tends to be low in all women after birth but remains low when women are exclusively breastfeeding. Progesterone levels are low after birth and remain low until a woman has her first period after birth.” Because women don’t tend to get their periods back while they are exclusively breastfeeding, this also means that they have more steady levels of oxytocin and progesterone – and as a result, less erratic mood influence.
Calming effect
But it’s not just the steadiness of the hormone levels that helps – it’s the calming effect of the hormones themselves too. “There are two main hormones related to milk production and feeding – oxytocin and prolactin. Both hormones are higher in breastfeeding women and are associated with feelings of calm and relaxation, and are thought to play an important role in bonding. There is some evidence that prolactin can even help a woman get back to sleep quicker at night. Taken together, that would help improve mood,” Prof. Brown explains, adding that there is some emerging evidence that breastfeeding helps protect mothers from inflammation. “We know that when we get stressed, our bodies can become inflamed. Being stressed can mean feeling overwhelmed, having little sleep, feeling lonely – all common experiences of motherhood. Inflammation is thought to increase the risk of depression, and research has shown that breastfeeding women have lower levels of inflammation than women who are not breastfeeding.”
So what happens when we stop, then? “From a hormonal perspective, your body starts to move back towards your pre-pregnancy state. This means that a woman’s menstrual cycle may be starting again if it hasn’t already, and her levels of oxytocin and prolactin will drop. This means she could lose the beneficial effects those hormones are bringing.” Or, as one study on oxytocin suggests, giving up breastfeeding can for some feel a bit like coming off antidepressants.
All hormonal things considered, it makes a lot of sense. So what’s the causational uncertainty? Simply put, breastfeeding is a highly emotionally charged experience for many women, so it’s hardly surprising that some will be faced with difficult emotions when it ends. “I breastfed all three of my babies, and I always found myself down when that journey came to an end,” one mother tells me. “But after my third baby, I was very ill, borderline sepsis. I was determined to continue to feed. I remember being strapped up to IVs in A&E and weeping to feed my baby. I was extremely low; I felt our feeding journey came to such an abrupt end. It seriously affected my mental health – suicidal thoughts and feelings of worthlessness and failure.”
Loss and dismissal
Based on her research, Prof. Brown suggests that the loss – or ‘distress’, as she calls it – has two dimensions. “First, the loss of being able to breastfeed their baby and everything that meant to them, and second, the reaction that society and many people have to that,” she explains. “Women are often told that it doesn’t matter, that they are silly for reacting in any negative way and that they have breastfed for long enough. It’s the feeling of being dismissed and not listened to that hurts – akin to being told after a traumatic birth that at least your baby is healthy. Of course that matters, but how a woman feels matters too.”
Similarly, the lack of accessible, timely breastfeeding support can compound the experience of feeling let down and unheard, as another mother recalls: “I found not being supported to continue breastfeed when it all went wrong really hard. It was extremely stressful. We managed to continue to combination feed, but a lot of stress could have been avoided had we got real support at three weeks in hospital. It was awful.”
For some, there’s a huge amount of guilt involved with weaning, and some experience a sense of loss of that immediate, intimate role as primary carer for their child. “Going back to work and stopping breastfeeding at the same time, I felt like what do I even have to offer now?” one mother recalls. “Breastfeeding can mean so much to women,” says Prof. Brown. “It can be an important part of mothering their baby from a religious or cultural perspective. When that has gone, it’s normal to feel a whole host of different things, even if you have breastfed for a long time and your experience was positive. It’s about a new stage for you and your baby, and that’s a big thing. Sadly, not everyone supports the mother in recognising that, which then makes her feel worse.”
Feeling like a failure
To complicate things further, conversations about infant feeding can be additionally tricky to navigate as a result of different women’s personal feelings of guilt, failure and grief, and indeed the many myths floating around about the pros and cons of various ways of feeding, as well as the fact that no one seems to be able to broach the subject without getting a stream of unsolicited advice. “People tend to take discussions around infant feeding personally and can sometimes see a woman expressing grief at stopping breastfeeding as a criticism of their own infant feeding decisions. It’s not – it’s simply a woman saying that breastfeeding matters to her, but the problem is that so many women have had really difficult infant feeding experiences, whether that’s a lack of support for breastfeeding or formula feeding, and such conversations bring up all sorts of memories and feelings,” Prof. Brown reflects, adding that it makes some people very uncomfortable when women talk about the realities of mothering in anything other than positive terms.
When it comes to managing the purely emotional side of post-weaning depression, she thinks that honesty and acceptance can go a long way. “It’s important to give yourself time and permission to recognise how you feel and process those emotions. Society and lots of people in it will tell you that it doesn’t matter, but if it matters to you, it matters. Even if you’ve had a long breastfeeding journey, you can still feel a whole mix of emotions at the end of it – and those can be exacerbated if you are having to stop before you are ready,” she says. “I think we need to normalise talking about this and reaching out for that support if we need it. Talk to people who will understand – whether that’s friends or family who have breastfed, a health professional or, if you’d prefer, a breastfeeding counsellor or lactation consultant. They are trained to support you stopping breastfeeding as much as they are continuing.”
If, however, the roller coaster continues for you for more than a few weeks and in ways worse than what feels like normal PMS to you, it’s wise to go to your GP and ask for help. Post-natal anxiety and depression are very common, with an estimated 10-20% of new mothers suffering from a mental disorder of some sort, so getting the right diagnosis and support can make a world of difference.
For support with all the ups and downs of new motherhood and breastfeeding, contact your local Cuidiú group or La Leche League, or join an online community like Mum Tribe Ireland.
[/restrict]
