Breastfeeding and mental health

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Young mother breastfeeding her child - 19th century painting by Hortense Haudebourt-Lescot Hortense Haudecourt-Lescot - Young mother breastfeeding her child (Jeune mere allaitant son enfant).jpg
Young mother breastfeeding her child – 19th century painting by Hortense Haudebourt-Lescot

Breastfeeding and mental health is the relationship between postpartum breastfeeding and the mother's and child's mental health. Research indicates breastfeeding may have positive effects on the mother's and child's mental health, though there have been conflicting studies that question the correlation and causation of breastfeeding and maternal mental health. [1] [2] Possible benefits include improved mood and stress levels in the mother, lower risk of postpartum depression, enhanced social emotional development in the child, stronger mother-child bonding and more. Given the benefits of breastfeeding, the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) suggest exclusive breastfeeding for the first six months of life. [1] Despite these suggestions, estimates indicate 70% of mothers breastfeed their child after birth and 13.5% of infants in the United States are exclusively breastfed. [3] Breastfeeding promotion and support for mothers who are experiencing difficulties or early cessation in breastfeeding is considered a health priority. [1]

Contents

The exact nature of the relationship between breastfeeding and some aspects of mental health is still unclear to scientists. [1] [4] [5] The causal links are uncertain due to the variability of how breastfeeding and its effects are measured across studies. [4] [5] There are complex interactions between numerous psychological, sociocultural and biochemical factors which are not yet fully understood. [5]

Breastfeeding and mother's mental health

Benefits on mood and stress levels

Some studies indicate that breastfeeding positively influences the mother's mental and emotional wellbeing as it improves mood and stress levels, [4] [5] [6] [3] and it is referred to as a 'stress buffer' for mothers during the postpartum period. [3] However, other studies indicate that the stress of breastfeeding may have a negative impact on maternal mental health, especially when presented in an all-or-none, "Breast is best" manner. [2] The activity facilitates a calmer psychological state and decreases feelings of anxiousness, [7] negative emotions and stress. [4] This is reflected in their physiological response to breastfeeding, where the mother's cardiac vagal tone modulation enhances, and blood pressure [1] and heart rate decreases. [4] The stress-buffering effect of breastfeeding results from the hormones oxytocin and prolactin. [3] Mothers who breastfeed experience enhanced sleep duration and quality, while instances of sleep disturbances are decreased. [1] [4] The activity positively influences how mothers respond to social situations, which facilitates improved relationships and interactions. [4] Mothers who engage in breastfeeding respond less to negative facial expressions (e.g. anger) and increase their response to positive facial expressions (e.g. happiness). [4] Breastfeeding also help mothers feel confident and empowered given the knowledge that breastfeeding is beneficial to their child. [4] [5]

Postpartum depression

Postpartum depression is a mental health condition that can start during a women's pregnancy or come after the birth of her child. Statistics report that roughly 13 to 19 percent of women are affected by it. New mothers feel many negative emotions from this, depressed, hopeless, and/or worthless. It is a difficult time for those who suffer from this condition. Postpartum depression could be short-lived but it can also last up to two years after the mother gives birth. Postpartum depression has the potential to bring on more mental conditions for new mothers such as obsessive-compulsive disorder and/or anxiety. It is important for mothers and their partners to be watchful of any signs of PPD and how it affects the mother and the baby. [8]

Effects of postpartum depression on breastfeeding

Studies indicate mothers with postpartum depression breastfeed their infant with lower frequency. [3] Breastfeeding is an intimate activity with requires sustained mother-child physical contact and new mothers with symptoms of depression, including increased anxiety and tendency to avoid their child, are less likely to breastfeed their child. [3] Postpartum depressive anxiety can decrease the mother's milk production which reduces the mother's ability to breastfeed her child. [9] Mothers who take certain antidepressants to treat their depression are not recommended to breastfeed their child. [3] The ingredients in the medication may be transferred to the child through breast milk and this may have detrimental consequences on their development. A woman should consult with her doctor to understand if her specific medication might be problematic in this regard. [3] Mothers with symptoms of postpartum depression commonly report more difficulties with breastfeeding and lower levels of breastfeeding self-efficiacy. [3] Mothers with postpartum depression are more likely to have a negative perception of breastfeeding. They also initiate breastfeeding later, breastfeed less, and are more likely to cease breastfeeding early on during the postpartum period. [1] [5] [7]

Effects of breastfeeding on postpartum depression

Breastfeeding may provide protection against postpartum depression or reduce some of its symptoms, [1] [4] [5] [3] and it is suggested that the benefits of breastfeeding may outweigh the benefits of antidepressants. [1] The abstinence of breastfeeding, or decreased breastfeeding can increase the mother's likelihood developing of this mental disorder. Oxytocin and prolactin, which is released during breastfeeding, may improve the mother's mood and reduce her risk of depression. [3] Breastfeeding women have lower rates of postpartum depression in comparison to formula-feeding women. [3] Stress is one of the strongest risk factors in the development of depression, and as breastfeeding reduces stress it may decrease the risk of postpartum depression in mothers. [3] Improved sleep patterns, improvements in mother-child bonding and an increased sense of self-efficacy due to breastfeeding also reduces the risk of developing depression. [1]

Breastfeeding difficulties and postpartum depression

Breastfeeding difficulties and interruption lead to poorer maternal mood and increase the risk of developing postpartum depression. [1] [4] A 2011 study conducted by Nielson and colleagues found women who were unable to breastfeed were 2.4 times more likely to develop symptoms of depression 16 weeks after birth. [10] Reasons for being unable to breastfeed include nipple pain, child temperamental issues, lack of milk production, breast surgery and mastitis. [1] [4] [11] The lack of self-confidence or difficult experiences during breastfeeding is a common concern for mothers with postpartum depression. [4] It is suggested that mothers who experience problems during breastfeeding require immediate additional support or should be screened for any signs of depression. [1] [5] Encouragement and guidance from professionals promotes self-efficacy and help mothers feel capable and empowered. [12] As a child's temperament may affect the breastfeeding process, mothers are also encouraged to gain a deeper understanding of how infants feed during breastfeeding so potential problems can be anticipated and addressed. [13]

Nature of relationship between breastfeeding and postpartum depression

There is a clear link between breastfeeding and postpartum depression; however, the exact nature of the relationship between breastfeeding and postpartum depression is unclear to scientists. [1] [4] [5] This is due to several reasons including:

  • Complex interactions between multiple physiological, sociocultural and psychological factors that are not yet fully understood. [5]
  • Different methods adopted by scientists to study this relationship may have led to different results. [1] [5]
  • Conflicting scientific studies have indicated either that there is no link between breastfeeding and postpartum depression or that breastfeeding leads to increased risk of developing depression. [1] [4] [5]

Recent reports indicate that a reciprocal or bidirectional relationship exists between breastfeeding and postpartum depression. [5] That is, postpartum depression results in reduced breastfeeding activity and early cessation, and abstinence from breastfeeding or irregularity in practicing it increases risk of developing postpartum depression. [5]

Mechanisms of action

The relationship between breastfeeding and the mother's mental health may be due to direct causes such as the following:

Physiological mechanisms

The underlying physiological explanation of the benefits of breastfeeding on the mother's mental health is attributed to neuroendocrine processes. [1] [4] [5] Breast milk contains lactogenic hormones, oxytocin and prolactin, which contain antidepressant effects [1] and reduces anxiety. [3] Prolactin is the primary hormone responsible for milk production and its levels are proportional to breastfeeding frequency and the child's milk requirements. [3] Prolactin facilitates maternal behaviour, acts as an analgesic and decreases stress responsiveness. [15] This hormone level is higher in women who breastfeed compared to women who do not breastfeed. [3] Oxytocin decreases stress [3] [15] and promotes relaxation and nurturing behaviour. [1] [4] [5] [15] Prior to breastfeeding, oxytocin is released into the blood stream to aid in milk release. Oxytocin and prolactin are also released during nipple stimulation when the child suckles. The nerve fibres linked to the hypothalamus controls this release and the hormones are released in pulsating patterns. [3] The increased levels of these hormones during breastfeeding have a beneficial effect on the mother's mental health. [1] [4] [5] [3] When exposed to physical or psychological stress, breastfeeding mothers also have a reduced cortisol response due to decreased production of stress hormones and improvements in their sleep. [1] [4] Physical contact during this activity attenuates the cortisol response. [1] Postpartum depression and breastfeeding failure are also attributed to neuroendocrine mechanisms. [5]

Postpartum depression is also closely associated with inflammation caused by postpartum pain or sleep deprivation, which are common experiences of motherhood. Breastfeeding decreases this inflammation response which is beneficial to the mother's mental health. [1]

Breastfeeding and child's mental health

Social and emotional health and development

Breastfeeding is associated with improved social and emotional health and development of the child. [1] The breastfeeding activity induces calming and analgesic effects in the infant. During this activity, their heart and metabolic rates decrease and their sensitivity to pain is reduced. [15]

Research indicate infants who are breastfed for more than 3 or 4 months develop fewer behavioural and conduct disorders. [16] Breastfeeding may also facilitate decreased aggression and antisocial tendencies in infants; and it is suggested this effect carries on into adulthood. [4] In a longitudinal study conducted by Merjonen and colleagues (2011), it was found adults who were not breastfed during infancy demonstrated higher levels of hostility and aggression. [17] Infants who are breastfed also demonstrate more 'vigour' and intense reactions compared to bottle-fed infants. [4] [11] To signal to their parents and have their needs attended to, infants who are breastfed may display greater distress and frustration. [4]

Mechanisms of action

The calming, analgesic effect and reduced sensitivity to pain is due to several factors: [15]

  • Suckling the nipple stimulates the child's oropharynx. This focuses the child's attention on the area and reduces attention to other influences.
  • The act of suckling and intestinal adsorption of fat increases the hormone cholecystokinin, which enhances relaxation and pain relief.
  • Breast milk is sweet and this stimulates the release of opioids which decreases the infant's sensitivity to pain.
  • Physical contact stabilises blood glucose levels, body temperature and respiration rates, aids neurobehavioural self-regulation, reduces stress hormone release and blood pressure.
  • Social interaction and physical contact promotes release of oxytocin.

The reduction of antisocial behaviour and aggression is attributed to increased levels of oxytocin in the infant during breastfeeding. [4] [7] Human breastmilk contains oxytocin and this hormone is also released in the child due to physical contact and warmth during breastfeeding. [1] Increased levels of oxytocin promotes social and emotional development, [4] [7] and this facilitates lower levels of aggression and other antisocial behaviours. [4]

The act of breastfeeding may also be an indicator of the mother's maternal behaviour. The abstinence or unnecessary prolonging of breastfeeding may suggest the mother is not mentally well and this contributes to increasingly antisocial behaviour in the child. [4]

Autism spectrum disorder (ASD)

Research suggests breastfeeding may protect children from developing autism spectrum disorder (ASD), a mental disorder characterised by impaired social and communicative skills. [4] [18] Infants who are not breastfed, are breastfed later or breastfed for a short duration have a higher risk of being diagnosed with ASD. [4] [18] The exact physiological mechanism of this link is unclear [18] but this association may be due to the lack of colostrum intake from breast milk which contains essential antibodies, protein and immune cells that are necessary for typical socio-emotional development and health. [4]

However, scientists have emphasised the need to avoid assigning a causal role to breastfeeding in the development of ASD in infants. [4] [18] There is a possibility that children who are later diagnosed with ASD already possess behavioural traits which prevent regular breastfeeding activities. [4] [18] Children with ASD have reduced joint control, [4] decreased social interaction or lack of cooperativeness; [18] and this can lead to irregular breastfeeding patterns. [4] [18] The existence of research which do not show a relationship between breastfeeding and the development of ASD is also noted. [4] [18] For example, Husk and Keim (2015) conducted a large-scale survey with parents of 2 to 5 year old infants and found no significant correlation between ASD development and presence/absence of breastfeeding or length of breastfeeding duration. [19] More studies are required to improve the understanding of breastfeeding and its link with ASD, and the underlying physiological mechanisms. [4] [18]

Breastfeeding and mother-child bonding

The mother and child's bond enhances during breastfeeding. 1942 btm13095.jpeg
The mother and child's bond enhances during breastfeeding.

Breastfeeding enhances the emotional and social bond between the mother and child, [1] [4] [5] [11] [15] and this attachment is important for their mental health. [20] This bond increases the mother's and child's abilities to control their emotions, reduce the stress response and encourages healthy social development in the child. [20] Physical contact during breastfeeding increases levels of oxytocin in the mother and child, which improves the mother-child bond. Breastfed infants become more dependent on their mothers and develop a deep social and emotional connection. [21] Likewise, breastfeeding facilitates mothers' emotional connection with their child and thus mothers generally display more warmth and sensitivity. [11]

Compared to non-breastfeeding mother-child pairs, in breastfeeding mother-child pairs:

Brain imaging research indicates breastfeeding mothers who listen to their infant crying demonstrate greater activity in limbic regions of the brain. This suggests the mother's enhanced emotional, empathetic and sensitive response to their child, which supports mother-infant bonding. [4]

Studies which do not demonstrate a significant relationship between breastfeeding and mother-infant bonding exist. [4] For example, Britton and colleagues (2006) did not find a significant association between breastfeeding and mother-infant bonding but found that mothers displaying more sensitivity were more likely to breastfeed than bottlefeed. [22] This suggests that the mother's sensitivity may have a more direct effect on mother-child bonding as more sensitive mothers are more likely to breastfeed and display greater emotional sensitivity. [4]

See also

Related Research Articles

<span class="mw-page-title-main">Infant formula</span> Manufactured food designed for feeding infants

Infant formula, also called baby formula, simply formula, baby milk or infant milk, is an ultra-processed food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid. The U.S. Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk".

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

<span class="mw-page-title-main">Breast milk</span> Milk produced by the mammary glands in the breast of a human female

Breast milk or mother's milk is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates and variable minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, whilst also contributing to healthy development of the immune system and gut microbiome.

<span class="mw-page-title-main">Maternal bond</span> Relationship between mother and child

A maternal bond is the relationship between a mother and her child. While typically associated with pregnancy and childbirth, a maternal bond may also develop in cases where the child is unrelated, such as an adoption.

<span class="mw-page-title-main">Lactational amenorrhea</span> Post-partum infertility due to breast feeding

Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding.

Human bonding is the process of development of a close interpersonal relationship between two or more people. It most commonly takes place between family members or friends, but can also develop among groups, such as sporting teams and whenever people spend time together. Bonding is a mutual, interactive process, and is different from simple liking. It is the process of nurturing social connection.

<span class="mw-page-title-main">History and culture of breastfeeding</span>

The history and culture of breastfeeding traces changing social, medical and legal attitudes to breastfeeding, the act of feeding a child breast milk directly from breast to mouth. Breastfeeding may be performed by the infant's mother or by a surrogate, typically called a wet nurse.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

<span class="mw-page-title-main">Lactation</span> Release of milk from the mammary glands

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all female creatures is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.

<span class="mw-page-title-main">Breastfeeding promotion</span> Activities and policies to promote health through breastfeeding

Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.

<span class="mw-page-title-main">Extended breastfeeding</span> Defined as after age 12–24 months

In Western countries extended breastfeeding usually means breastfeeding after the age of 12 to 24 months, depending on the culture.

<span class="mw-page-title-main">Parental brain</span>

Parental experience, as well as changing hormone levels during pregnancy and postpartum, cause changes in the parental brain. Displaying maternal sensitivity towards infant cues, processing those cues and being motivated to engage socially with her infant and attend to the infant's needs in any context could be described as mothering behavior and is regulated by many systems in the maternal brain. Research has shown that hormones such as oxytocin, prolactin, estradiol and progesterone are essential for the onset and the maintenance of maternal behavior in rats, and other mammals as well. Mothering behavior has also been classified within the basic drives.

Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.

Oxytocin Treatment for Postpartum Depression Oxytocin (OT) has potential to be a treatment for Postpartum Depression (PPD)[1]. Oxytocin is released when a mother cares for her child, making the interaction pleasurable[2]. Mothers that report high levels of infant-mother bonding and demonstrate responsive and sensitive parenting generally show increased levels of OT and brain reward center activation during play sessions[1]. According to Slattery and Neumann, the oxytocin system of mothers experiencing PPD may have altered activity[3]. These mothers have trouble bonding with their infants when they are born[1]. An experiment found that mothers, who have low attachment ratings to adults and their infants, also have lower levels of OT when caring for their children[3]. It is thought that women experiencing PPD may benefit from intranasal OT because this treatment would help the mother feel happier and assist her in bonding with the child [1]. Another experiment shows that administering OT to a mother sheep increases the amount of care that she gives to offspring [2]. Further experimentation needs to be done in order to determine the effectiveness of OT as a treatment for Postpartum Depression[3].

Antenatal depression, also known as prenatal or perinatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% of pregnant women are affected by this condition. Any form of prenatal stress felt by the mother can have negative effects on various aspects of fetal development, which can cause harm to the mother and child. Even after birth, a child born from a depressed or stressed mother feels the affects. The child is less active and can also experience emotional distress. Antenatal depression can be caused by the stress and worry that pregnancy can bring, but at a more severe level. Other triggers include unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations.

Endocrinology of parenting has been the subject of considerable study with focus both on human females and males and on females and males of other mammalian species. Parenting as an adaptive problem in mammals involves specific endocrine signals that were naturally selected to respond to infant cues and environmental inputs. Infants across species produce a number of cues to inform caregivers of their needs. These include visual cues, like facial characteristics, or in some species smiling, auditory cues, such as vocalizations, olfactory cues, and tactile stimulation. A commonly mentioned hormone in parenting is oxytocin, however many other hormones relay key information that results in variations in behavior. These include estrogen, progesterone, prolactin, cortisol, and testosterone. While hormones are not necessary for the expression of maternal behavior, they may influence it.

The postpartum physiological changes are those expected changes that occur in the woman's body after childbirth, in the postpartum period. These changes mark the beginning of the return of pre-pregnancy physiology and of breastfeeding. Most of the time these postnatal changes are normal and can be managed with medication and comfort measures, but in a few situations complications may develop. Postpartum physiological changes may be different for women delivering by cesarean section. Other postpartum changes, may indicate developing complications such as, postpartum bleeding, engorged breasts, postpartum infections.

Changing hormone levels during pregnancy and postpartum as well as parental experience cause changes in the parental brain. Both the father and mother undergo distinct biological changes as they transition to parents, but the changes that occur in the paternal brain are not as well studied. Similar to the changes that occur in the maternal brain, the same areas of the brain are activated in the father, and hormonal changes occur in the paternal brain to ensure display of parenting behavior. In only 5% of mammalian species, including humans, the father plays a significant role in caring for his young. Paternal caregiving has independently evolved multiple times in mammals, and can appear in some species under captivity.

<span class="mw-page-title-main">Delayed onset of lactation</span>

Delayed onset of lactation (DOL) describes the absence of copious milk secretion (onset of lactation) within the first 72 hours following childbirth. It affects around 20–40% of lactating women, the prevalence differs among distinct populations.

<span class="mw-page-title-main">Establishment of breastfeeding</span>

Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organisation(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.

References

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