ELACTA Conference 2024

Perinatal depression, encompassing both prenatal and postpartum depression, significantly impacts both the mother and the infant, including their breastfeeding relationship. There are a lot of challenges, but timely detection or support in avoiding it altogether is so important. For some, it can be associated with stigma and shame. 

Definition and Prevalence:

· Perinatal depression includes depression during pregnancy (prenatal depression) and after childbirth (postpartum depression).

· Perinatal depression affects 15-40% of women

· It goes undiagnosed in 50% of cases

· It is the most common medical issue post-partum 

· Only 20% report it to their care givers. 

· 25% of cases last up to 12 months’ plus 

· It is associated with a higher risk of preterm birth, small for gestational age, stillbirth, low birth weight. 

· Higher risk of suicide and infanticide

· There is a higher risk 

· Negative infant outcomes-poor sleepers.

Symptoms:

· Symptoms can range from mild to severe and include, fatigue, irritability, changes in sleep and appetite and feelings of guilt or worthlessness and significant distress.

· Very often with the addition of anxiety. Sadness. Low energy. Multiple persistent physical symptoms with no clear cause. 

· It affects all levels of functioning - Emotional, cognitive, behavioural, physical

· A systematic review saw a very common theme, which was the guilt and anger the mother feels at not being able to take care of baby or feel love for the baby.

Impact on Breastfeeding:

· Emotional and Physical Strain: Mothers with perinatal depression may struggle with the physical and emotional demands of breastfeeding.

· Lack of Confidence: Depressed mothers often lack confidence in their ability to breastfeed, which can lead to early cessation.

· Anxiety and Fatigue: Increased anxiety and fatigue can interfere with establishing and maintaining a breastfeeding routine.

· Bonding Issues: Difficulty bonding with the infant can hinder the breastfeeding relationship.

· Shorter breastfeeding duration

· Lack of breastfeeding confidence

· Lower oxytocin 

· Increased risk of mastitis

Breastfeeding Rates:

Exclusive breastfeeding is associated with a reduced risk for ppd however studies have shown that women with perinatal depression are less likely to initiate breastfeeding and more likely to stop breastfeeding earlier than those without depression.

Benefits of Breastfeeding for Mothers with Perinatal Depression:

Despite the challenges, breastfeeding can have positive effects for mothers experiencing perinatal depression:

· Oxytocin Release: Breastfeeding stimulates the release of oxytocin, which can improve mood and reduce stress.

· Physical Contact: The skin-to-skin contact during breastfeeding can enhance bonding between mother and infant, potentially alleviating depressive symptoms.

· Emotional Satisfaction: Successful breastfeeding can boost maternal confidence and provide emotional satisfaction.

Support, Interventions and Treatment:

· Lactation Support: Access to lactation consultants and breastfeeding support groups can help mothers overcome breastfeeding challenges.

· Mental Health Services: Counselling, support groups, and appropriate medication can manage depressive symptoms, making breastfeeding more feasible.

· Physcotherapy with social support, perhaps the addition of medication suitable for bf- centreline

Complementary approach’s

· Physical activity

· Bright light therapy

· Omega-3 fatty acids

· Healthy microbiome/psychobiotics

· Skin to skin and breastfeeding - oxytocin 

· Educating mothers about the benefits and techniques of breastfeeding can empower them to persevere despite depression.

Multidisciplinary Approach:

Healthcare Providers: Coordination between obstetricians, paediatricians, mental health professionals, and lactation consultants is crucial.

Family Support: Encouraging family members to provide practical and emotional support can also make a significant difference.  

Addressing perinatal depression is essential for the health and well-being of both mother and baby. While perinatal depression can pose significant challenges to breastfeeding, with adequate support and intervention, many mothers can successfully breastfeed, benefiting both their own mental health and their baby's development.

Is it just ‘baby blues’ which is transient and self-limited (approx. days 5-10) with symptoms that lift around week one or two and there is no functional impairment. Use of the Edinburgh score or The Whooley questions 

Parents need-

·   Validation

·   Understanding

·   Antenatal care with focus on mental health

·   Focus on mum and baby

·   Taking symptoms seriously

·   Not rushing appointments

·   Breastfeeding support

What are our superpowers as IBCLC’s?

·   Support Support Support 

·  Observation of signs and symptoms-screening (not diagnosing)

·  Referral to the correct hcp

·  It is also recommended to screen fathers/partners

·  Understand the important link we are in supporting families

·  Manage expectations

·  Screening-connecting-educating 

Complied by: Fiona Rea IBCLC

Dated: 25th May 2024. 

Fiona did receive a bursary from ALCI for this report. ALCI Council would like to thank Fiona for her report.

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