Smita Hanciles, Camden Baby Feeding Service Manager, discusses infant feeding support and maternal mental health in a guest blog for the 2020 Baby Friendly Virtual Conference
Conversations matter. In particular, the conversations we have with those who do not share our opinions and viewpoints really matter. The right conversations reveal our blind spots and areas of blinkered vision.
As an Infant Feeding Lead, it is hard to move out of the echo-chamber of my like-minded tribe into what feels like enemy territory, dodging the verbal hand-grenades that come my way. In the attempt to promote, protect, support, and normalise breastfeeding, it is hard to strip away the emotions and just talk about the evidence.
But maybe that is not the right thing to do. Maybe the emotions are the key. Maybe the fact that breastfeeding, or not breastfeeding, or experiencing difficulties, can have such an impact (both positive or negative) on maternal mental health and emotional wellbeing, that this is exactly what needs to be highlighted. That this is the reason that timely, effective breastfeeding support is critical – not just because of long-term health outcomes for mother and baby, as important as these are, but because it could mitigate escalation of postnatal anxiety and depression and protect maternal and infant mental health.
Talking to colleagues in perinatal mental health services revealed how breastfeeding was often (not always) viewed as having a negative impact on mental health, and how bottle or mixed feeding was seen as protective, especially where lack of sleep was a risk factor for relapse or medication was contraindicated with breastfeeding. However, some women we were supporting spoke of how getting the right support for breastfeeding had relieved their anxiety and positively impacted their mental health or how breastfeeding had been the one thing they could do for their baby when experiencing mental ill-health and how much it had meant to them. Unfortunately, some also felt they were let down by inadequate or ineffective infant feeding support, which caused feelings of failure and anger. Many difficult and varied conversations with professionals and parents started to paint a complex picture of the interrelationship between infant feeding and mental health, which led to the development of competencies on Perinatal Mental Health for the Infant Feeding workforce.
As one mother later diagnosed with PTSD said, “I didn’t want to breastfeed because it was good for my baby, although I knew about the antibodies in breastmilk. I wanted to breastfeed because it was my way of healing myself and my baby from the traumatic birth we experienced.” This mother was also a Health Visitor.
Another part of the puzzle that is often ignored are the experiences of the healthcare professionals themselves and how these impact on the support they give to women with birth, breastfeeding and mental health. We need to build supportive structures with appropriate opportunities for debriefing and reflecting on personal experience to protect the mental health of those supporting others with theirs, and to guard against re-triggering of painful emotions and unconscious bias when providing care.