Six days after my second child was born, I laid on the floor of my tiny bedroom and wept. My mother-in-law took me in her arms, held me like I was the infant, and said, “Oh honey. You’ve got the bad hormones.”
That was 19 years ago, but it could have been yesterday.
You don’t forget that kind of desperation.
That kind of hopelessness cannot be erased. There is no amount of therapy or medication that will make you forget that in the time the world says you should be happiest, you only wanted to die.
My mother-in-law did the thing my own mother could or would not — she held me. After she picked me up and put me to bed, she stayed with us another week.
I owe her my life.
After she left us, and I was left with the overwhelming responsibility of caring for two small children, the depression put down roots. It hung over me like a heavy blanket, blocking out the air and light for almost a year, making mothering miserable and life barely tolerable.
According to the CDC, 11-20% of women who give birth will experience symptoms of postpartum depression. In the US that would equal 600,000 women a year.
This is roughly equal to the population of Portland, OR.
And this data is only for live births; when you include stillbirth, that number rises to 900,000.
This is roughly equal to the population of Austin, TX.
These CDC statistics are probably way off because they are:
Only include 17 states
Don’t consider impoverished areas separately. Studies confirm that PPD rates in these communities are closer to 25%
With this in mind, could the number of women in the US who suffer from PPD be close to one million?
What do we know about PPD?
We know it can appear at any time, from right after birth on your bedroom floor up to one year later.
We know that risk factors include the following:
previous experience of depression or anxiety
family history of depression or mental illness
stress involved in caring for a newborn and managing new life changes
having a challenging baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict
having a baby with special needs (premature birth, medical complications, illness)
first-time motherhood, very young motherhood, or older motherhood
other emotional stressors, such as the death of a loved one or family problems
financial or employment problems
isolation and lack of social support
A loss of pleasure or interest in things previously enjoyed, including sex
Eating much more or much less than usual
Anxiety — all or most of the time — or panic attacks, scary thoughts
Feeling guilty or worthless — blaming yourself
Excessive irritability, anger or agitation — mood swings
Sadness, crying uncontrollably for very long periods of time
Expresses fear of not being a good mother /
Fear of being left alone with the baby
Inability to sleep, sleeping too much, difficulty falling or staying asleep
Disinterest in the baby, family, and friends
Difficulty concentrating, remembering details, or making decisions
But there is something we know that we still aren’t talking about: how we feed our babies and how those feeding methods impact our feelings about ourselves. And how do those feelings we have about ourselves impact the risk of postpartum depression?
For many years now we’ve said with conviction, “Breast is BEST!”
You have a baby. You make milk. The baby drinks it. Everyone is healthy and happy. The end.
That all sounds great.
But what about when that doesn’t work out?
What about when your baby won’t latch?
What if they go to the NICU from some reason and end up with a bottle or delayed onset of feeding?
What about when your nipples are bleeding and it’s 2 am and the only person around is your husband who doesn’t even have boobs?
What about when your baby isn’t gaining weight quickly enough and you have to supplement?
What about when your milk supply drops because you have to supplement and don’t have the time or capability to pump?
What about when you are sick of it all and just decide to formula feed?
You might also like: Rav’s Repro: Failure To Thrive
Feeding our babies, an act that started out as a normal part of mammalian physiology and biology, has become a source of anxiety and struggle — of fear and failure.
When we can’t successfully breastfeed, we hear (either actively or passively):
Your baby will get diabetes.
Breastfed babies are smarter.
You should have done x, y, z.
Breastfed babies have a closer bond with their mothers.
Formula companies are evil (see: Nestle).
You basically suck.
Do you think this might impact a mother’s mood?
You bet it does.
It took science a little while to catch up, but they are.
There have recently been some focused studies to investigate the relationship between PPD and how you feed your baby.
In 2015, scientists set out to study this phenomenon (by phenomenon I mean “something that is pretty obvious”).
They studied four groups of women (it's important to note here that there were no transgender folks included in this study):
Mothers who had not planned to breastfeed and did not breastfeed (reference group)
Mothers who had not planned to breastfeed but did actually breastfeed
Mothers who had planned to breastfeed but did not actually breastfeed
Mothers who had planned to breastfeed and did actually breastfeed
These women were questioned during pregnancy at 18 and 32 weeks’ gestation, postnatally at eight weeks, and again at 8, 18, and 33 months
Who was at greatest risk for depression?
If you said #3, you should be a scientist.
If you tried to breastfeed but weren't successful, you might be thinking something like, “GROUP THREE. THANKS CAPTAIN OBVIOUS.” Because you already know this feeling — you didn’t need a man with a PhD to tell you how painful it was when you had to say, “I just can’t do this.”
I want to share with you something from a friend of mine, Erica. Erica was not successful in her attempt to breastfeed her first baby and I think what she had to say about this experience captures that feeling of wanting to do everything right, but feeling like you’re failing.
The whole thing felt like shit. I was a 24 year old first time mom who had no experience with children. I am an only child and I was the youngest in my family. I never babysat. Kids were nice but I didn't even change an infant’s diaper until I had my own son.
I wanted so much to do what was best for him and I knew in my heart breastfeeding would be. Even when I was in the hospital having him, they fed him formula without my consent. No one wanted to listen to me. When I saw three different lactation consultants they were very dismissive and unhelpful.
One out and out told me maybe my body just wasn't 'suited' for breastfeeding.
Eleven years ago there [weren't] beautiful photos of black women breastfeeding. I had no kind of representation, and no one who seemed to give a damn if I did or not. We muddled through, but I ended up supplementing with formula because I felt goaded into it and I started to believe the woman who [said] maybe this wasn't for me.
I literally think my milk got really scarce from heartbreak.
Erica isn’t specifically addressing postpartum depression. But can you imagine if on top of this feeling of failing of not being “suited” for breastfeeding, the most basic of responsibilities of motherhood, she was already depressed? Or if she had a pile of other risk factors layered on top of this heartbreak?
And Erica is just one of many women who were willing to share their story with us.
From my friend Jennifer of Plus Size Birth, who struggled to get her premature baby to gain weight:
We were told we had to start supplementing with formula. As a new parent, still reeling from guilt of starving my son, I was devastated, but willing to do anything to see a strong weight gain.
From another friend, Boots:
I was bound and bent that I would be a successful breast feeder with my first son. Lasted all of a month. Mixed with my PPD and anxiety issues I was like a paranoid zombie most of the time. I even one night in the middle of all of ours sleeping tried to get hubby to take the baby back to his crib, I was sitting there nursing an imaginary baby. Hubby tried to get me to realize the baby was asleep in his crib. When I finally came to, I sat and bawled my eyes out for 10 mins. It was then that we decided hubby should take nights, and we should give bottle feeding a go. I was so close to cracking it wasn't funny.
My son would only ever take 3 ounces at a time, and as we found out later was on the autism spectrum so I am sure that contributed to my feeling of uselessness. I was terrified of him, and at the same time wanted to love him. Hubby and I used to fight over who he loved more... I think I was a bit beyond ppd, almost into the psychosis level.
And from Amber:
My oldest was a 30 week preemie. I had been planning a birth center delivery but ended up in the hospital with an emergency c-section. She was taken to another hospital with a higher level NICU but I wasn't moved. I went 4 days without seeing her. My only job was to pump milk....and I couldn't do it.
I would get 2-3 cc's in an hour with a hospital grade pump. It was awful. The only thing I had left from my "birth plan" was to breastfeed...and my body wouldn't cooperate. After I was released and able to hold her I believed things would get easier. Sadly that wasn't the case.
I drove myself crazy pumping constantly and getting maybe 2-3 oz in an entire day. I dutifully brought the milk into the NICU every morning to be added to her feeding tube. It was killing me but I felt I had no choice. I needed to feel like I was doing SOMETHING. I took all the herbs and Canadian black market Domperidone.
I smelled of pancake syrup. I was in pain. I was stressed. I was depressed, and yet I couldn't let it go.
We spent 5 weeks like this then she came home. I was certain things would get better once she was nursing instead of me pumping. I even bought the SNS system to supplement while she nursed. I bought all the nipple shields. I had thrush. It was awful.
I should've stopped.
Ultimately biology finally got in a groove when she was about 6 weeks corrected. That means she was actually 16 weeks old. I spent almost 4 months beating myself up and driving us both crazy. In the end it worked out (and lasted almost 2 years) but I do not recommend any of this nonsense. It wasn't healthy for me or my relationship as a mother or spouse. I just couldn't let my last "ideal" go.
From my sweet friend, Marybeth, who I have watched struggle for the last two years. Marybeth has an important perspective about wishing she’d “failed sooner.”
Izah was born, precipitously in the back of our car (on the way to my local midwifery birthing center). I hemorrhaged and was in the hospital and felt like my whole peaceful birth plan slipped out the window.
I guess I was clinging to breastfeeding as the last thing I could get right. Then he had horrendous tongue tie that left my nipples shredded, and I was in the hospital several times for mastitis on IV abx, and he had awful reflux + my extreme let down, so whenever he DID nurse, he projectile vomited it right back up, even after we had his tongue tie lasered.
It was so awful and I was so exhausted and stressed out.
I wish I had just quit after the first bout of mastitis and switched to formula, but since I nursed my first until they were almost 6, I had this idea that I was failing my 2nd if I gave up. Now he's 2 and I'm still getting mastitis frequently that won't resolve with regular antibiotics, and weaning now is stressful for him.
I've had two years of poor health while my baby turned into a toddler...I would rather have my two years back and have felt well through them, than to have nursed because of guilt.
From Lauren, who gave her baby formula via SNS while still in the hospital:
It was really hard at first and I was having a hard time being ok that my body had failed me yet again. Couldn't get pregnant without IVF, c-section and then a difficult time breastfeeding, but things always work out if you are willing to roll with things.
Our feelings about our bodies “failing” us in more ways than just nursing only compound matters.
From my friend, LJ, who had an unexpected (and rare) "failing" situation (and who I was lucky enough to give some of my milk to):
I had Reynauds Phenomenon. It felt like glass was in my nipples every time I nursed or pumped. Through my severe anxiety and depression I found moms who supported me by donating breastmilk. 16 moms fed my son for 2 years.
I'd like to share Suzie Barston's site, The Fearless Formula Feeder, in its entirety.
Suzie has written about her journey in such a thoughtful and beautiful way, I won't even try to summarize it. She advocates for women and babies, tirelessly.
From my dear dear friend (and Ravishly writer) Carrie Saum (of Our Stable Table), whose sweet baby boy had a stroke shortly after birth:
The stroke rendered the left side of my baby’s body weak and slow to react. We did all of the home therapies the hospital showed us. I tried to latch him to my breast but he was unable to form a seal with his mouth because of the muscle weakness.
I was relieved. Deeply, shamefully relieved. Because every time I held him to my body, I felt the terror of his near-death shoot through my body like ice water. Holding him to my bare breast sent me into a silent, self-loathing panic and all I saw was his tiny body turning blue.
So, I pumped. Every three hours around the clock.
When he had recovered enough muscle tone to nurse, he looked at me with fear in his eyes and screamed. He was terrified, too.
I passed him to my husband and pumped.
I accepted this breastfeeding failure. And the inadequacy began chipping away at my soul.
Finally, from Ravishly's Managing Editor, Erin:
In the past two years, I've been pregnant six times and given birth to one baby, a baby who came early, spent four weeks in the NICU, and has been labeled 'Failure to thrive.' I feel like I've been up against my body's failures for two years. And just when I think we've turned a corner, I feel like I've failed again. And I know that's not factual, but that doesn't make it any less painful.
Erin is not just a woman I work with, she is a woman I love. I saw her sitting in the NICU every day, pumping constantly around the clock, giving literally everything she had to her child. My heart breaks to think that she'd ever consider herself a "failure." I want to wrap her in my arms and tell her that she has done, and continues to do, everything she can for her son.
And that makes her a success.
Care providers need to do better.
We need to screen more and talk more and evaluate more. We need to be assessing moms’ feelings about feeding methods.
But even more importantly, we need to do better as humans.
We need to remember that “fed is best.”
We need to leave space and grace for a variety of experiences, perspectives, emotions. We need to know that the way we frame infant feeding can impact mothers, for better or worse. And we need to recognize that when we impact a mother’s feelings about herself, we impact her baby — and when we impact her baby, we impact our future.
We need to acknowledge that, no matter how we feed our babies, we love them. We are all doing our best; our best might not be breast, and that’s ok.