Breastfeeding in the US: Effects of Early Experiences on Postpartum Depression

August 15, 2011

Article

Data increasingly point to the benefits of breastfeeding, both for the infant and for the mother. Now, a new study points to the relationship between postpartum depression and negative early breastfeeding experiences, just as the Centers for Disease Control and Prevention sheds light on the lack of breastfeeding support for women in hospitals.

Breastfeeding’s Impact on Postpartum Depression
Previous research has indicated a relationship between short or no breastfeeding with postpartum depression, so researchers from the Gillings School of Global Public Health and the departments of psychiatry and obstetrics and gynecology at the school of medicine at the University of North Carolina, Chapel Hill, conducted a longitudinal study evaluating the role of early breastfeeding experiences on postpartum depression.

Stephanie Watkins, lead author of the study, and colleagues leveraged data from the CDC’s longitudinal Infant Feeding and Practices Study II. The study recruited 4902 women between May 2005 and June 2007; these women were observed from their seventh month of pregnancy through their child’s first year of life. A telephone interview was conducted at the time of birth. Questionnaires were sent at approximately 3 weeks postpartum, monthly between 2 months and 7 months postpartum, and then every 7 weeks between 7 and 12 months postpartum. The 2 month questionnaire assessed maternal mood, while a neonatal questionnaire at 3 weeks assessed early breastfeeding experiences. For this analysis, the researchers included women (n = 2586) who initiated breastfeeding and completed the neonatal questionnaire.

The early breastfeeding experiences questionnaire consisted of questions to ascertain pain levels associated with breastfeeding, the woman’s overall feelings toward breastfeeding, the amount of breastfeeding support received, and time until breast milk came in after delivery. The researchers used the 10-item Edinburgh Postnatal Depression Scale; women with a score of 13 or greater were categorized as having depression.

Watkins and colleagues found that 8.6% of the women who initiated breastfeeding had postpartum depression. Further, the researchers discerned the following:

• Women with postpartum depression were more likely to participate in a postnatal WIC program and were twice as likely to have less than a high school education as compared to those women without postpartum depression.
• Women with postpartum depression were less likely to be breastfeeding at 2 months as compared to their counterparts who were not depressed (68.56% vs 74.9%, respectively).
• Women who experienced severe breastfeeding pain had a twofold increased risk for postpartum depression. Moderate pain was also associated with postpartum depression, but the increase was not statistically significant at conventional levels.
• Overall feelings toward breastfeeding were also associated with increased risk of postpartum depression at 2 months; women who reported disliking the experience were 1.42 times as likely to have postpartum depression as compared to the women who reported liking the experience.
• Women who received information about breastfeeding support groups on hospital discharge experienced a small but not significant protective effect against postpartum depression.

Although the researchers found a small but statistically significant protective effect associated with receiving breastfeeding help in the hospital among women with moderate to severe breast pain during nursing on the first day, they did not find any further association between breastfeeding support in the hospital and postpartum depression. Similarly, Watkins and colleagues did not find an association between depressive symptomology and time of milk coming in.

“Our results suggest that women with breastfeeding difficulties should be screened for postpartum depression, and women with depressive symptoms should be offered breastfeeding support,” Watkins and colleagues explained. “Screening and treatment of women with early breastfeeding difficulties may reduce the severity of postpartum depression and enable women to meet their breastfeeding goals, thereby improving health outcomes across two generations,” they added.

Hospitals Lack Appropriate Breastfeeding Support

The CDC released a report on the state of breastfeeding support in US hospitals, and their findings are somewhat alarming. The CDC’s report, Maternity Practices in Infant Nutrition and Care, found that less than 4% of US hospitals provided the full range of support a mother needs to be able to breastfeed, and only about one quarter of the hospitals support mothers and babies at discharge with the services they need, be it a follow-up visit, a phone call from hospital staff, or referrals to lactation consultants, WIC, and other important community support systems. Similarly, only 14% of hospitals have a written breastfeeding policy, and in nearly 80% of hospitals healthy breastfeeding infants are given formula when it is not medically necessary (this can inhibit opportunities for both mom and baby to learn to successfully breastfeed).

“Hospitals play a vital role in supporting a mother to be able to breastfeed,” Dr Thomas R. Frieden, CDC director, said in a press statement. “Those first few hours and days that a mom and her baby spend learning to breastfeed are critical. Hospitals need to better support breastfeeding, as this is one of the most important things a mother can do for her newborn.”

“In the United States most women want to breastfeed, and most women start,” added Dr Ursula Bauer, director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “But without hospital support many women have a hard time continuing to breastfeed, and they stop early. It is critical that hospitals take action to fully support breastfeeding mothers and babies so they can continue to breastfeed long after their hospital stay.”

More Information

Breastfeeding: Health Benefits for Mother and Baby
Breastfeeding:Medline Plus