Ep 35 - Breastfeeding and ... Postnatal Depression

[Nicole] This episode discusses postnatal depression and related conditions. It touches on trauma, including mention of childhood sexual assault and sexual trauma in the military. While there are no specific details discussed in the episode, we encourage you to take a moment to reflect before listening to this podcast.

[Music]

[Kathleen] So I wrote my first book about this back in nineteen ninety two, and I did it because I was actually having a horrible time after my first son was born, and I couldn't get any help. I mean, I told several people and they all just said, well, we don't know what to do. So I did the thing, I was trained. I was right out of grad school, and I did the thing I was trained to do, which was I started reading the research articles.

[Nicole] Welcome to Breastfeeding with ABA, a podcast brought to you by volunteers from the Australian Breastfeeding Association. Breastfeeding with ABA is podcast about breastfeeding made by parents for parents. In this episode we're going to talk about breastfeeding and postnatal depression support, with Doctor Kathleen Kendall-Tackett. This podcast records in different parts of Australia. We acknowledge the traditional owners of the lands we're recording on and the lands that you're listening on. We pay our respects to elders past, present and emerging, and to any indigenous people listening. We also acknowledge the long history of oral storytelling on this country, and of women supporting each other to learn to feed their babies. My name is Nicole Bridges, and I'm a breastfeeding counsellor and educator with the Australian Breastfeeding Association. I live and work on the lands of the Darug people and my pronouns are she and her. Kathleen, would you like to introduce yourself, please?

[Kathleen] Hi. Well, I'm Doctor Kathleen Kendall-Tackett. I am a health psychologist and I'm also an International Board Certified Lactation Consultant, and I've been at La Leche League leader actually for like thirty years, believe it or not. Boy, that kind of went quick! And my areas of interest, I'm primarily a researcher and I study effects of things like family violence, particularly looking at family violence on adult health. That's one of my kind of big areas of studies, but I also do a lot of work in the area of postpartum depression. And the breastfeeding piece was one that I never necessarily thought I was going to do. But I started doing volunteer breastfeeding counselling, and then pretty soon people were starting to ask me, "Will you talk about trauma and breastfeeding? Will you talk about depression and breastfeeding?" And I said, you know, okay, so I kind of started coming up. And what's very interesting is breastfeeding actually has a much more integral role than I think most people expect. And that's certainly true for my psychology colleagues. They honestly can't believe that breastfeeding kind of has anything to do with this stuff, but we actually find that breastfeeding can be extraordinarily helpful in times when women are struggling with depression, or if they've got traumatic incidents or, you know, experience in their background, you know, that breastfeeding actually can really help them from a physiological standpoint. And I think actually, that's one of the things to me that's very interesting about this kind of whole area, you know? So I kind of look at this in terms of psychoneuroimmunology, which is a big area of study, looking at the effects of stress on health and how like the inflammatory response system, which is part of the stress system. When it's elevated, it actually increases the risk of depression. But breastfeeding actually counters that through the work of oxytocin. And so that actually I think is just a really important message to kind of communicate to people. I just I really want them to know that. But it also means too, that like if you're struggling with things like depression and stuff like that, sometimes breastfeeding gets to be more difficult just because there could just be challenges. And it kind of can reduce your thoughts about whether you can actually fix this problem. And so there's a lot of different ways. So again like I said, I really think it's very important that we pay attention to the mental health of mothers when we're talking about, you know, sort of that postpartum period. And I wrote a book recently for mothers called Breastfeeding Doesn't Need to Suck. And it was actually focusing on the mental health aspects, you know, and really concentrating on for the mental health aspects of breastfeeding, kind of all the different ways that that's related, how breastfeeding helps, but also how mental health unfortunately can have a negative impact on breastfeeding if like things aren't addressed, if symptoms aren't addressed. So that's kind of the perspective that I'm coming from, especially talking to you today.

[Nicole] Fantastic. Well, thank you so much for joining me. I thought we just might take a little bit of a step back and perhaps ask if you could explain to us exactly what is postnatal depression.

[Kathleen] Well, postnatal depression kind of in the simplest explanation is basically depression that occurs in the first year. The postnatal or postpartum, as we say here is a little bit of a misnomer, because that kind of implies for six weeks. But one of the things that I learned, kind of as I've worked in this field and I've actually now done the fifth edition of my book Depression in New Moms. So I've had a chance to see how the literature has evolved over the years. And it's really actually kind of amazing to see. What started out as a fairly small area of study has just exploded. The last edition of my book is now in actually two volumes. We had to split it. But you know, what we really have found is, you know, people originally were kind of talking about it as being kind of a really unique condition. That's not necessarily the case. People don't necessarily think that anymore. There are unique stressors to the postpartum period. But it's really we're looking at kind of the symptoms, particularly of major depressive disorder. But it also could be postpartum anxiety. And actually now we're also seeing studies with post-traumatic stress disorder. Depression in a lot of ways is still the center of the wheel. But then you can see all these other conditions that kind of tag on. And yes, you do see studies particularly looking specifically at anxiety. But oftentimes depression is involved even if anxiety is the primary focus. So depression really seems to be a very central part of the whole spectrum of postpartum mental illness. Yeah, yeah. And how common is postnatal depression and these related conditions?

[Kathleen] Well, that's a really interesting question because I think a lot of times the numbers that people quote really underestimate it, because when you look at the general population, I'll talk, let's talk about the U.S. And, you know, the Australian stats are actually pretty similar because again, like I said, we look at studies from all over the world and they're pretty comparable in a lot of ways. But let's take the US example. Okay. So the US says the Centers for Disease Control, the most recent study, said that it was thirteen percent of mothers, new mothers had depression. And it was like at three to four months postpartum. Okay. So that sounds like okay. That sounds like right in that range when they say ten to fifteen percent, right. Okay. But here's the thing. When you start even looking just at that CDC data and you start pulling it apart, it varies a lot by ethnicity, for example, you know, and so certain groups tend to have actually higher rates. African American and American Indian in our case tend to actually have higher rates of depression. When you look at things like if they've had intimate partner violence either before or during their pregnancy, the rate bumps up to thirty three percent. You know, one of the groups that kind of popped up in this most recent edition because we've got suddenly a bunch of studies on this was mums in the military. Their rates are sky high. Sky high. It is unbelievable, even if they haven't experienced military sexual trauma, which many of them have. It's forty four percent. I mean, it's just unbelievable. You look at, say, refugees, another population that's very high at risk. Cindy-Lee Dennis in Canada did some really interesting studies, and she had enough of a population that she could distinguish between immigrants, refugees and asylum seekers. A lot of times studies group all those together. But she found actually there was a significant difference between them, with asylum seekers having the highest rates. And so again, like I said, we start kind of looking at these certain populations. You notice that the rates are much, much higher. So you can actually see thirteen percent globally. But in some ways it doesn't actually really make sense when you consider these other groups, because I think I worried that when people say that, they think, oh, it's not that big of a problem. Well, it's a huge problem in certain populations, and particularly in populations where we're worried about things like infant mortality. We want to make sure that the mother has good mental health. So breastfeeding happens because otherwise you just repeat that cycle of poverty and deprivation that happens. And so it's like it is really kind of, in my mind, very critical to kind of like make sure that we distinguish and consider these other populations that are at risk.

[Nicole] And what do you see as the primary reasons that these particular populations are at a higher risk?

[Kathleen] Well, there's a lot of things. One of the biggest risk factors. And, you know, when I first started looking at this, so I wrote my first book about this back in nineteen ninety two, and I did it because I was actually having a horrible time after my first son was born, and I couldn't get any help. I mean, I told several people and they all just said, well, we don't know what to do. So I did the thing, I was trained, I was right out of grad school and I did the thing I was trained to do, which was I started reading the research articles. And the thing that really amazed me is it was very different than what the quote experts were talking about at the time. They were talking about estrogen and progesterone. It's the drop in that, and that's what causes it. And I'd say, well, excuse me, what about, you know, family violence. What about sexual assault? No, that doesn't have any impact on that at all. Well, now we know that, first of all, estrogen and progesterone aren't particularly related to depression. Other hormones are. The stress hormones certainly are. Oxytocin certainly is. But the drop in estrogen and progesterone for most women, that's not the problem. But what is a huge problem is violence. Violence is a gigantic problem. The other thing is lack of social support. That's huge. And especially God, we saw what happened during Covid. All the social isolation that took an absolute wrecking ball through maternal mental health. It was disastrous, those policies. I mean, I hope we learn that if there's another pandemic, that we don't do that again. And so, again, that talk about exacerbating that social isolation, we're just really not meant to be as isolated as we are, and we really are. And so I would say those are probably two of the biggest reasons. But, you know, like if you talk about like, you know, say immigrants and asylum seekers, you know, oftentimes it's the feeling of otherness. And we've seen this in other countries around the world. If you're not native to that country, you tend to have higher rates of depression. And I think it's that sense of otherness. And also too, if you've moved, you've moved away from all your normal sources of support. And oftentimes, you know, there's a there's a trauma history there, too, because the thing that spurred the immigration, even if immigration was done for a positive reason, it can still be very difficult a transition and learning the language and learning the culture and how to access things. I mean, that's daunting. That's really daunting. I actually got a little taste of that. When we were in England and I was trying to bake a birthday cake, and everything was in centigrade and metric, and I'm like, I was in. I didn't know how to do really basic things like turn on the oven, you know, what temperature should I put it in? And you know, what's half a cup? So I've gotten a little taste of that. And we had a lot of refugees that came to my church when we lived in New Hampshire. And what happened is there was an African social worker who came and he went to a lot of the little churches and he said, look, we need your help. We need your help. Help us with these folks. They need help getting assimilated. And how can you do it? And so I got kind of a second hand experience of what that is like. And so it's like these are kind of things I say those are probably the two biggest. But you know, one of the things that emerged that was really kind of a surprise was smoking. That came up as a risk factor in at least half a dozen studies. Right. And I not sure I can explain that, but it was very consistent. You know, another thing too, is kind of that whole issue of infant temperament and how much babies cry. And it's kind of like, you know, as lactation consultants, I think one of the things we want to do is, okay, if baby's crying, can we figure out what's going on? We look at it different than the psychologists. Psychologists kind of help mothers. We look at it as, okay, is that baby hungry? You know, has that baby been hurt? Maybe some chiropractic would be a good idea. I mean, so we want to kind of. I actually mentioned that to a psychologist friend of mine. She goes, oh, I hadn't actually thought about that. But even just educating about temperament would be really helpful. And also getting that mother some support because that can be really intense. So those are a lot of the kind of common stressors really kind of related to depression.

[Nicole] You talked you touched briefly on trauma. Can you just explain a little bit more about the relationship between trauma and postnatal mental health?

[Kathleen] Oh, gosh. Yeah. Trauma is a huge risk factor. And so there seems to kind of be a little bit of a difference in terms of if it's childhood trauma or if it's kind of current kind of ongoing drama, that that seems a little bit different kind of mechanism. Because the question a lot of people have asked me particularly like looking at childhood sexual abuse and Jan Coles, down in Australia, she's done some really good work on this. But one of the things that it's a question that a lot of people ask is, are women who have experienced childhood sexual abuse less likely to breastfeed? And when you look at the studies, they're all over the map. Okay. You know, some say yes, some say no. What's the thing? And what I noticed as a little trend in the literature when I was working on the core curriculum chapter, was that it seems to be if you have childhood trauma and you have symptoms from it, like as an adult, you have depression, you have PTSD, you have anxiety, then the breastfeeding stuff becomes a little more difficult. So I think the answer to that is if we can address those mental health issues, I think a lot of times breastfeeding rate gets better, but it's not a straight line. And so we did a we have an article that I've actually got in process, but we did all the analysis on our radar, and it showed that looking at women who use cannabis during pregnancy and breastfeeding. Okay. So again, huge percentage of trauma survivors like ninety one percent. I mean, it was really, really high. And about a third had been sexually assaulted as a teen or adult. I mean, so these are high numbers. And again, like I said, not unexpected. Okay. But one of the things again, that we saw was exactly that pattern. It wasn't the fact that they've experienced this that caused the breastfeeding difficult is that they had symptoms and then that caused the frequency of use. That's what we were looking at. You know, frequency of cannabis use was obviously one of the things is you want to reduce their use so that you reduce the THC exposure. But it was the same pattern. It was the same pattern. So it can actually indirectly affect women because it increases their risk of depression, anxiety, PTSD before they sometimes even get pregnant. They may have had this their whole life, you know, and so that could be actually one of the mechanisms. The other thing is it kind of can undermine self-efficacy. You know, we talk about that in terms of like, do you feel like you have the tools and ability to be able to address a problem when it comes up? And that could be very undermined if there's not a secure attachment relationship that happened in childhood. And again, that can be learned as an adult. But a lot of times we're not necessarily looking at that. So that's one of the other mechanisms. Also too there could be, you know, issues about social support. I mean, you know, there could be a number of things kind of going on. Now, if you've got ongoing violence, you know, that's a whole different thing. So it seems to kind of activate the stress system in a different way. And I think actually ongoing violence can be very detrimental not only to mental health but also whether women breastfeed. Yeah. And it's like I looked at the data and I thought, I don't think somebody who's experiencing ongoing partner violence is going to breastfeed. But I've had women come up to me and say, you know, I just left a thirty year abusive marriage. I breastfed all four of my kids and it saved me. It saved us. And so I've learned to never say never. You know, not to put my expectations, but, I mean, I think it would be very, very, very difficult. And it's the same thing. I think we've got more women coming back from combat. And oftentimes that's a group that we haven't necessarily looked at as much. But oftentimes they've experienced violence and they may have experienced military sexual trauma, which we're seeing more and more studies on. So combat violence military sexual trauma. And they're bringing sometimes PTSD or anxiety or depression or sleep problems, all these things to the situation. So those are kind of different ways. So it's like I think current violence acts in a different way than than childhood violence. But I think one of the things I want to be very clear about is that women who have experienced abuse or adversity, particularly in childhood, but even as adults, are not necessarily less likely to breastfeed. I call this the downside of trauma informed care. Sometimes we put this expectation, well, you're not going to want to do that. You don't need to do that. I've heard stories like that, and it's kind of like I think that our approach should be, what would you like to do and how can I help you do it? And it's like, yeah, I've worked with women who've had all kinds of different setups and arrangements that have worked for them. They say, well, I can't really do it at night. It just really freaks me out. It's like, okay, well, you know, focus on daytime, you know, or or oh, I hate the pump, you know? So there's different kind of strategies, you know, depending on who it who it is kind of what their experience is. And sometimes what happens too is they sometimes can't do it the first baby, but maybe the next baby, they actually feel like they've kind of healed to a point where they can do it again. Like I said, I really view this as a chance to stop that kind of cycle of violence that goes through families. And I think this actually, you know, when we help women at this stage, I think the implications of it go far beyond what we actually see, what we think we're doing. You know, it's like it's not just the breastfeeding. It's like helping that mother and baby establish a secure attachment. Kind of like the the long term implications for that. And so again, like I said, the work of actually supporting breastfeeding is actually has a lot bigger implication than I think a lot of people think and realize.

[Nicole] Absolutely. Just a little bit of a pivot. Now, is there data on dads or partners and how commonly they might experience something related to postnatal depression?

[Kathleen] Oh, absolutely. Absolutely. And actually that's one of the things that's been really interesting is looking at the relationship with partners in breastfeeding. Because again, you know, we've seen that in study after study, that partner support is really the key. Now, I have known women who had totally unsupportive partners and defied them and did it anyway. But that's, I think, not the common experience. And so having a partner. But Covid actually did teach us some things about this, which I think was really interesting. And what they actually found is there was this one group of studies and it was uh, looking at father's relationship and breastfeeding. And what they found is, like, the different types of support made a difference. So if they actually gave expressive support or, you know, like they they really empathised with the mother and her goals and what she wanted to do. If they did that first, then all the other stuff was helpful. Yeah. If they didn't do that, it actually decreased duration and exclusivity because it felt like coercion or it felt like unreal expectations. You know, it's like nobody was listening. Whether she wanted to continue doing this or how she was feeling about it. So it really does kind of make a difference. It kind of goes back to there's always questions on the IBCLC exam about what's the first thing you would do? And the first thing is support the mother. But here's another study that was I think really interesting. It was done in the UK and they kind of they didn't assign these groups, but they naturally kind of grouped. They have four hundred and thirty two families in this study. So the first group actually had high support. So they had support from the mother, you know, or the mother's family, the partner and the healthcare providers. And two months later, ninety eight percent of them were still breastfeeding. Okay, really big number. The next group, they considered family support. And so it was the grandmother and the dad. Okay. Supporting the mother. Okay. Now, people thought that their numbers would be actually higher than the group that was considered low support, which was partner only. But what was interesting is with the family support with mother and grandmother. The father and the grandmother also took turns feeding the baby. And so their numbers went down to thirteen percent two months. It shows you that's not actually supportive. And that's when things people always suggest in terms of mental health, it's like, no, it would be better if we take care of all the other stuff. So she could do that. And also don't isolate her. So she's sitting there thinking, I'm never going to get my life back. This is all horrible from now on. Okay. But the one that was actually just the partner support. Forty eight percent of them were still breastfeeding because the mum fed the baby. The dad didn't. But we can involve partners. You know, a lot of times partners feel like they're just out of it. And then people will say, oh, you can change the diapers. Now that's absurd. They can actually after mum feeds the baby, they can actually take the baby for a walk. They can do skin to skin. They can do babywearing. They can do infant massage. I mean, all of these things can be really helpful. And it's a great way for partners, dads to connect with babies, that doesn't involve feeding. Because that's a big I think, pressure. People say, well, you know, I need to do feeding so I can bond. No, there's lots of other ways you can bond. But the big thing is let's support what the mum is doing and how she's doing it.

[Nicole] Great response and great suggestion. Someone once said to me that one of the important things that a dad can do is actually show the baby that they're loved without food. So don't all of the other things to support and nurture that baby.

[Kathleen] And that's the thing, you know, when it really comes down to it, the most important thing is responsive care. You know, that's the biggest thing because when that's the thing that actually predicts secure attachment and secure attachment predicts everything else, all the resilience factors, even in the face of poverty and things like that, it's really important. Yeah.

[Nicole] So we've talked about postnatal depression, but what do we know more broadly about breastfeeding and mental health. And what does the research say about that.

[Kathleen] Well, you know, this is the thing that surprises a lot of people is that exclusive breastfeeding actually protects maternal mental health. And this is something, you know, when I talk to mental health providers, I actually kind of hammer on because they think that, oh yeah, it's going to be a burden to mothers. It's going to be hard. Well, you can breastfeed if you insist, but you should have somebody else feed the baby. And it's like when you really look at the studies. Study after study after study has found the exact same thing. Okay. And it's like the best evidence is when we look at prospective studies. And so we determine, okay everybody's not depressed at time one, and then we follow them, and then we see the breastfeeding mothers are less depressed than the formula feeding mothers. And we have about five of those studies now. Prospective studies are harder to do, as you can imagine. So we don't have as many, but we have lots and lots of other cross-sectional studies that have found exactly the same thing. And when you look at sleep. Sleep, there's like two variables that are really important with depression, it's minutes to get to sleep and the total self-reported time that they sleep. Okay, so self-report actually turned out to be a better predictor of depression than if they used like an actigraph or something like that. So that was good news for us because that's the data that we had. We had self-report data, but that was by Dørheim in Norway. That was a really nice study showing that. But those are the two variables that come up over and over and over again. Breastfeeding influences those. It shortens the time to get to sleep and it actually increases the total amount. And it's crazy because the babies wake up more and the mums wake up more and yet they're getting more total sleep time. But that's only for exclusive. As soon as we start supplementing, that protection goes down. And I kind of wish that weren't true. I wish I could say any, you know, but for this, in terms of mental health, there seems to be a threshold that you have to do a certain number of times a day in order to kind of get that effect. And we can actually understand that effect, because remember, I told you, you know, the thing that underlies depression and all kinds of other mental health issues is that activated inflammatory response system. Okay, so it's an activation of the stress system. Oxytocin counters that they work kind of like a toggle, you know. So it's kind of like when an oxytocin is up stress is down. But it goes the other way. And you can see this in labor. Somebody, you know, they're going along fine. And all of a sudden they get stressed out. Somebody comes into the room or something becomes very painful. Labor stops. Right. Because the stress system has overridden the oxytocin system. Okay. But what happens, especially with mums that when they suckle at the breast, that seems to be where they get the biggest bolus of oxytocin. Okay. And it actually hits two different receptors in the brain. And it's like a flood of it. You know, you get some of that skin to skin, but you don't get the huge effect that you have from actually suckling at the breast. And so if you do that multiple times a day, that seems to create a threshold. And this doesn't necessarily mean that these mums won't be depressed. People say, oh yeah. Are you saying breastfeeding mums are never depressed? I'm not saying that. I'm absolutely not saying that because, well, first of all, my own experience and also all the hundreds of mums I've talked to over the years. Yeah, there's plenty of depressed breastfeeding mums. But what it does do is it makes the symptoms less severe. Yeah. And what I heard from so many mums that used to call me because the La Leche League international hotline I found out was giving out my home telephone number to call and that they were depressed. But, I mean, I heard the same story over and over again. They said I was, you know, just diagnosed with postpartum depression. They told me I have to wean and this is the only thing that is working. Yeah, they're not considering what the mum's feelings are. They just have this idea that it's stressful. But the crazy thing is, it actually helps. And sometimes the advice that mental health workers actually exacerbate symptoms. Now, that's not saying if breastfeeding is a problem. Now that's a different thing because again, what system is that gonna activate? If it's painful it's going to activate that stress system, you know. So you're probably not going to get this nice oxytocin. So those mothers are at higher risk. So again one of the reasons why we have to jump on breastfeeding problems promptly, you know, drives me crazy when I talk to a mum and she says, oh yeah, you know, I've been having nipple pain for three weeks. And they told me it should get better soon. Yeah. And she's she's just bearing with it and not getting. Yeah. And it's kind of like, you know, most of the time, sometimes it takes a little time to figure out, you know, that. But sometimes it's just a matter of little scoot, you know, A little adjustment here and there.

[Nicole] One of the reasons that a lot of women are told they need to wean is because of medications and breastfeeding. Can you talk a little bit about that?

[Kathleen] Oh, yeah. There was a good study that was done out of out of Britain. It was the ALSPAC study, the Avon Longitudinal Study of Parents and Children. And, you know, the huge data set. And they've actually had a lot of different studies from that. But what they actually found in that study was that if women intended to breastfeed and weren't able to, they were at higher risk for depression. And so, again, you know, if mental health providers come along and undermine breastfeeding, and they do it by saying, oh yeah, don't feed at night. Have your partner feed the baby. That is actually because as soon as you become non-exclusive, you don't get the protection. Now you still get all the other benefits of breastfeeding every time the babies at the breast. But in terms of the mental health effects, there seems to be this kind of threshold. And that's actually kind of where I think I'd love to see mental health providers work more closely with lactation to kind of really help the mum fulfill her goals. And so it's like if she intended to breastfeed. And so, you know, what a lot of people at the time that that study came out interpreted that as we're putting too much pressure on mothers to breastfeed. I said, you know, there's another way to look at that. We're not supporting mothers. Why are so many mothers wanting to do this and not able to? That's really the question we should be asking.

[Nicole] Absolutely. And how does postnatal mental health impact on bonding between mother and baby? And how does breastfeeding play a part in this?

[Kathleen] Well, you know, it obviously can impact bonding because things like depression, which has been studied a lot, actually can impact the way mothers interact with their babies. And so like one thing to kind of look up on YouTube is something called the still face mother studies. Oftentimes if women are depressed they have kind of flat affect. And so the babies are doing all these cute things to engage, you know, and try to kind of like get some response. And if you get this sort of flat affect, a lot of times it's very stressful for babies. So it definitely can influence, however, only one study. I mean, I actually have literally two big books looking at this issue with all the studies about the effects of maternal mental illness on children all going all the way up to adult children. Okay. And they're significant. But, you know, I only found one study that looked at breastfeeding. Only one. Okay. And it found that if women breastfed, even though they were depressed, it protected the babies. Because why? Because you can't totally disengage. You might do less than you normally would do, but it's enough to protect that baby. And so again, this can be a really important strategy while mothers get better. I had a mum one time. She was from New York City and she was a peer counsellor. She was Puerto Rican and she worked Puerto Rican mums. And she said, oh, you know, my mothers, they think if they're depressed, it's going to go in the milk. And so I said, here, let me show you a study. You know, and I pulled it out and showed her. And she goes, oh, I'm going to tell mothers that because it's that interaction they can't disengage. They're going to be still looking, touching. They may not do it as much as they would normally do, but it was enough to be protective. Okay. And you didn't see the negative effects. But in the study, the depressed mothers who were not breastfeeding the babies did have the negative effects. At three months they looked at EEGs, electroencephalogram, and they were showing the pattern of depressed adults. So it was basically a measure of depression in babies. And you see that sometimes too. I've picked up babies when I've gone to see mums and the babies gaze avert and stuff, because that's what they're experiencing that, you know, and it's kind of like, okay, so let's see, how can we get that mum and baby back together, you know, especially after sometimes a difficult birth. And again, part of the thing, I think all of us who work with new mums and babies need to kind of do is, how can we get those two back together, how can we help them find each other? And so even if mums are not breastfeeding, we can think of some other things that babywearing is one of the things that really promotes attachment, because again, it's that responsivity and responsive care that makes a big difference. There was a really nice study done way back in nineteen ninety. Randomised trial women at high risk for child abuse. Okay. None of them were breastfeeding okay. Half were assigned to baby bucket and half were assigned to a soft carrier. Three months. Mothers in the soft carrier group more responsive. By twelve to eighteen months. Those babies were more likely to have a secure attachment. It shows you that breastfeeding does support that secure attachment, but it's not the only way to get there, which I think is really important when you have mums who like it didn't work out for whatever reason, you know, it's like, okay, how can we steer them toward the bigger picture, which is we're going to help you establish a secure attachment. So yes, this part didn't work out, but yes, it's not all lost. In fact, you know, I say, if the secure attachment is not the consolation prize, it's the prize.  

[Nicole] Yeah, yeah, yeah, there's always another way. So what role does social support, for example, coming along to a mums and parents group like the ones that the Australian Breastfeeding Association run. What kind of role do they play in postnatal mental health?

[Kathleen] I think they play a huge role. I think not being by yourself and being with, you know, sort of other like minded mothers and of like minded families, I think actually can be really helpful. Like, you meet other people who are kind of in the same role, or you find out somebody else is struggling with this and you think, okay, it's not just me. Oh thank God. Yeah. So I think they can actually be very helpful. I think in some situations they can be not helpful if they get kind of into competition and stuff like that. But I think that's where leadership of the group kind of comes in. And so sometimes I've talked to people kind of across the country who have tried to have postpartum depression groups, and those tend to not be very well attended. Well, there's kind of say, well, I'm not I'm really not really depressed enough to go to that or I don't want to be around other depressed people. But it is really helpful if you can talk about the stresses. And that's a great way to not only kind of educate, but then have this other group of mothers who are kind of going through this. And a lot of times, you know, lifelong friendships form at this time. It's a time when people actually really are kind of open to making new relationships and stuff. And so, yeah, I think, you know, support groups can be really very important.

[Nicole] Absolutely. And we know from the research that successful breastfeeding is usually most successful when we have a combination of peer support and support from health professionals as well. Right.

[Kathleen] Well, remember that group, you know, the high support group. I mean they had everybody in there.

[Nicole] Absolutely. And finally, what advice would you give to anyone listening who might be experiencing postnatal depression?

[Kathleen] Well, one of the things I would suggest is if you think you might have symptoms, I would suggest looking online and looking for a questionnaire called the Patient Health Questionnaire four. That's the one I actually like the best. And it lists a two item screen for depression and a two item screen for anxiety. And so those are kind of give you an idea of kind of where you're at. And then you can kind of decide, okay, what are you going to be your options here. How would you like to approach this. because people immediately think medication, you know that that's the way to treat it. But we have so many other treatments, and we've got a lot of mothers who actually do not want to be on medication. Okay. So medication is absolutely a way to go. And so in that case, you know, go in and have a frank conversation with your provider, say, look, you know, I found this I'm feeling this. I'd like to do, you know, and, you know, things like Zoloft, Lexapro, those are the ones that we tend to prescribe because they tend to be kind of the lowest impact on breastfeeding babies. Medication doesn't necessarily transfer, but maybe you don't want to do that. Maybe you want to try something else. Okay. So we know exercise works. Acupuncture works. Making sure you're not vitamin D deficient. And we found even mothers in sunny Perth, Australia actually vitamin D deficient because everybody's trying to protect against melanoma, which obviously is very important. But then we've kind of had this other thing where a lot of people now are vitamin D deficient and that actually and, you know, you can look at things like omega three fatty acids, particularly EPA and DHA. Those are important. So kind of bringing along these supports. And so if somebody wants to kind of go the alternative route, this is what I would recommend that you keep track of where you are. Okay. And you have somebody else a trusted person to maybe your provider. It could be your partner, it could be your friend, but that you check in with them in a few weeks or in a, say, a month and see how you're doing. And if your symptoms aren't improving, you might need to do something else. Okay. But exercise, you know, three to five times a week for forty five minutes with the baby on a sling, go down and take a walk. That kind of thing has actually been proven to be as effective as antidepressants. You know, people kind of don't realize that. They think, oh, you have to have medication for serious depression. No. Not necessarily. Acupuncture is even treated major depression quite successfully. So we have a lot of options. But I would say if you're going to try to kind of not go the medication route, I would say let's keep track of where you are, see how you're doing, and if there's no improvement, think, okay, what can we add? If it were kind of me and I was going to try to do the alternative stuff. I do probably exercise vitamin D, omega three fatty acids and probably some social support. Those would be the things I would kind of recommend. And again, monitor symptoms, check in, make sure you're getting better because within a month you should be starting to feel better. And if you're not okay then we can think about okay, what's plan B? But those that that would be if I were going to go the non-med route, that would be the way I'd go. Right.

[Nicole] Well, that's some wonderful and practical advice. Thank you so much for chatting with me today, Kathleen. It's been absolutely enlightening, and I'm sure all the mums and parents out there will value this information greatly.

[Kathleen] Thank you very much for having me. And actually I would like to mention I have a an article that you can get for free called A New Paradigm for Depression in New Mothers. It's actually published in Australia at the International Breastfeeding Journal. And so you can go if you're interested in kind of understanding, like kind of that inflammation relationship. It was published a few years ago. We actually actually, believe it or not even know more now, but that kind of gives a baseline for kind of understanding. But also too, I would actually recommend if you want to go to my Kathleen Kendall-tackett website, I actually have some handouts and things talking about things like exercise and omega three and stuff. So to kind of give you some more specific guidance and you're welcome to send me an email. I'm not super fast, but I actually do try to respond to all my emails.

[Nicole] Thank you so much. For more information and links, please check the episode notes for breastfeeding information or to access live chat with a qualified volunteer, visit. Breastfeeding. You can speak to a breastfeeding counsellor on the National Breastfeeding Helpline on one eight hundred. Mum to mum or one eight hundred six hundred eighty six two hundred sixty eight. The Australian Breastfeeding Association receives funding from the Australian Government. Please rate, review and subscribe to breastfeeding with ABA. Thank you for supporting the Australian Breastfeeding Association. 

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