Did you struggle with postpartum anxiety? Were you assessed for postpartum depression and wonder why your anxiety was overlooked? And did anxiety affect your breastfeeding relationship?
You might be interested in a new study published in Pediatrics that has shown an association between maternal postpartum anxiety and shortened breastfeeding duration.
These findings come from a randomized controlled trial comparing traditional office visits to home nurse visits for initial well baby care visits. It involved 1,123 mothers of healthy newborns, and as part of this trial, mothers were assessed for anxiety and postpartum depression at regular intervals after the birth of their babies until 6 months. Half were first time mothers and, in keeping with the national average, one third of all the mothers birthed by cesarean.
The first interesting finding was that at the initial assessment during the hospital stay, 17% of the mothers tested positive for anxiety, and 6% tested positive for depression. There was a steep drop off in anxiety by two weeks, but mothers remained more likely to score positive for anxiety than depression at each test through six months postpartum.
At the 2-week, 2-month, and 6-month assessment, the percentage of women experiencing anxiety remained in the range of 5.8% and 7.2%. First time mothers were more likely to screen positively for anxiety, and mothers birthing by cesarean were more likely to experience both anxiety and depression.
The researchers wrote: “Postpartum state anxiety is very common during the maternity hospitalization and is far more prevalent than depression in the first days after childbirth,” researchers wrote. Despite this, they noted, mothers are more likely to be screened for depression than anxiety.
Second, the study found that testing positive for anxiety while in the hospital was associated with reduced breastfeeding duration during the first 6 months for first time moms and those delivering vaginally.
Testing positive for depression during the hospital stay was marginally associated with shortened breastfeeding duration, especially among first-time mothers and those delivering by cesarean. Note that while postpartum depression is common, it “classically does not acutely present in the first days after
childbirth,” according to the authors.
There are a few theories about how anxiety might be related to sorter breastfeeding duration. One, the authors note, is that it’s possible that high levels of anxiety might impede oxytocin, the hormone necessary for milk ejection.
Another – my own hypothesis here based on seeing many, many anxious breastfeeding women – is that maternal anxiety can center around milk supply, especially in first time mothers who are new to the task of interpreting their babies’ behavior. Anxiety of about milk supply often leads a switch to formula feeding or to supplementation, which in turn is closely associated with shortened breastfeeding duration.
It’s worth noting that the mothers in this study were largely white, married, and college educated, and so may not represent the experience of a more representative sample of American mothers. And since all the mothers in this study were breastfeeding, it doesn’t necessarily represent the experience of formula feeding mothers, either.
Yet, these findings are important. The authors write that postpartum anxiety’s “association with adverse maternal and child health outcomes makes it relevant for both maternal and pediatric health care providers who have ample opportunity to screen for state anxiety and potentially intervene, particularly among those most affected, such as first time mothers.”
(While we’re making a list, I’d love to see screening for another common experience of women after birth – Post Traumatic Stress Disorder. An estimated 9% of women meet full criteria for PTSD, and many more had symptoms, after childbirth.)
Breastfeeding – when it’s going well – has been shown to be protective against postpartum mood disorders, so this recommendation for better screening might have the power to turn a vicious cycle (anxiety/depression and no breastfeeding) into a virtuous one (well state and breastfeeding).
Image credit: Wikimedia Commons