Is it really ground breaking news when a study shows that telling new mothers they are failures increases the risk of depression? Actually, it’s not, but considering the way that a new study on breastfeeding was reported, you’d be forgiven for thinking that it was.
The study is New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions published in the open access Maternal Child Health Journal.
According to the BBC, the study showed:
Breastfeeding can halve the risk of post-natal depression, according to a large study of 14,000 new mothers.
However, there is a large increase in the risk of depression in women planning to breastfeed who are then unable to do so.
The study, published in the journal Maternal and Child Health, called for more support for women unable to breastfeed…
That’s not precisely what the study showed. The study actually found that breastfeeding had “heterogeneous effects by mental health during pregnancy and breastfeeding intention.”
Specifically:
…[T]he effect of breastfeeding on maternal depression symptoms was found to be highly heterogeneous and, crucially, mediated by breastfeeding intentions during pregnancy. Our most important finding relates to the majority of mothers who were not depressed during pregnancy, and who planned to breastfeed their babies. For these mothers, breastfeeding as planned decreased the risks of PPD, while not being able to breastfeed as planned increased the risks.
An additional critical finding was:
For the majority of mothers who did not show symptoms of depression before birth, breastfeeding … increased the risk of PPD among mothers who had not intended to breastfeed. (my emphasis)
It’s not clear to me that this study has anything to do with breastfeeding at all. In fact, it seems to me that this is really a study of the impact societal pressure on new mother’s mental health. The authors appear to have ignored their own finding that breastfeeding increased the risk of postpartum depression among women who were breastfeeding despite their previously indicated desire to bottle-feed.
That suggests that the critical variable here is NOT breastfeeding, but rather new mothers’ self assessment.
The authors conclude:
These findings have implications for the way in which new mothers are supported; they suggest that the provision of expert breastfeeding support may, in addition to increasing breastfeeding rates and durations, have the additional benefit of improving mental health outcomes among new mothers. At the same time, it is clear that where mothers had intended to breastfeed, not being able to breastfeed may have deleterious consequences on their risk of PPD, and that providing specialised support to new mothers who had intended to breastfeed, but who for some reason find themselves unable to breastfeed, may also constitute a desirable health policy objective.
Here’s another interpretation that is far more likely given the actual evidence:
Breastfeeding has no impact one way or the other on maternal mental health, but pressure to breastfeed has a dramatic effect on maternal mental health. When women could not meet their own needs, either because they could not breastfeed when they wanted to do so or because they successfully breastfed despite not wanting to do so, their risk of postpartum depression doubled.
When we juxtapose the harmful effects of pressure to breastfeed on maternal mental health against the trivial benefits of breastfeeding in industrialized societies, an entirely different conclusion is warranted:
The findings of this study have implications for the way in which new mothers are supported. They suggest that breastfeeding itself has no beneficial effect on women’s mental health, and that the pressure to breastfeed generated by lactation consultants, lactivists and public health authorities is actually harmful. Not every woman can breastfeed successfully, and not every woman who could breastfeed successfully wants to do so. Making breastfeeding the “holy grail” of new motherhood, leads to an increased risk of postpartum depression among those who cannot breastfeed successfully (presumably due to feelings of failure) and among those who do not want to breastfeed (presumably due to feelings of frustration).
To me, the conclusion is pretty obvious: when it comes to new mothers and breastfeeding, we don’t need to provide more support, we need to BACK OFF!
