Experts from Murdoch Childrens Research Institute (MCRI) are calling for more awareness and support for new mothers experiencing depression and breastfeeding difficulties after new research showed a link between the two.
Study lead author Dr Hannah Woolhouse found women who reported depressive symptoms three months after the birth of their child had significantly lower rates of breastfeeding when their baby was six-months-old.
The study of 1507 Australian women found almost 95% initiated breastfeeding (including expressed breastmilk) but by three months postpartum about a quarter of these had stopped and by six months 40% were no longer breastfeeding.
Women who reported depressive symptoms at three months had significantly lower rates of breastfeeding at six months postpartum compared to women without depressive symptoms (49% versus 61%), the research found.
Dr Woolhouse said the challenges of breastfeeding could sometimes be an emotional rollercoaster, although it was too difficult to say conclusively whether these difficulties contributed to depression or whether mental health problems influenced a mother’s decision to stop breastfeeding.
“Women’s decisions around infant-feeding are influenced by a range of psycho-social factors and early postnatal depressive symptoms appear to be a significant part of this picture, as either a cause or consequence of decisions to cease breastfeeding,” Dr Woolhouse said.
Women’s decisions to wean before their babies before six-months-old are a complex interplay of physical, psychosocial and socioeconomic influences, she said. An intention to breastfeed and breastfeeding challenges after birth can influence the initiation and duration of breastfeeding. Other research has indicated the most common reasons women stop breastfeeding before six months include nipple pain, low milk supply and latching difficulties.
Socio-demographic characteristics which are consistently associated with shorter breastfeeding duration include: young maternal age; single relationship status; lower levels of maternal education; socio-economic disadvantage; being a smoker; and inadequate levels of social and/or professional support.
Dr Woolhouse said her study showed the differences in rates of breastfeeding between women who reported depressive symptoms and those who did not, start to emerge around three months postpartum.
“At three months, these two groups start to differ in the number who are breastfeeding,” Dr Woolhouse said. “We found significantly lower rates of breastfeeding at four, five and six months postpartum in women who had depressive symptoms at three months.
“It is very difficult to determine whether the depressive symptoms or the breastfeeding difficulties came first,” she said. “What we can say conclusively, based on our research, is that there is a strong and robust association between maternal depression at three months postpartum and the duration of breastfeeding over the first six months.
“The associations between these two postnatal experiences have important clinical implications. Doctors supporting women in the postnatal period will benefit from an awareness that depression may be a contributing factor to breastfeeding difficulties and that breastfeeding difficulties may contribute to or exacerbate maternal distress.
“The early identification and treatment of maternal depressive symptoms may have the added benefit of improving breastfeeding duration rates. Likewise, appropriate and compassionate support for women experiencing breastfeeding difficulties may have the added benefit of reducing maternal depression.”
The study, published in Women and Birth on Wednesday, also found the social context of women’s lives remains a vital factor in breastfeeding duration. As shown in previous studies, young mothers and those with lower levels of education are significantly less likely to be breastfeeding at six months postpartum.
“Healthcare professionals can assist women by considering the wider psychosocial context of women’s lives when supporting them in their infant-feeding choices,” said Dr Woolhouse.
The World Health Organisation recommends babies are breastfed exclusively to around six months of age, with the gradual introduction of appropriate solids and continued breastfeeding up to two years of age. While the rates of breastfeeding initiation are generally very high in developed countries, this decreases rapidly over the ensuing weeks and months. In Australia, population based studies suggest that around 90% of women initiate breastfeeding, compared to 80% in the United Kingdom and 75% in the United States. But by six months postpartum the rate of ‘any’ breastfeeding has dropped to around 50% in Australia, a third of women in the UK and about half in the US.
(Source: Murdoch Children’s Research Hospital)