In fact, with the data herein which shows similar breastfeeding patterns for two months followed by an assessment of depression, which correlated with a change in breastfeeding rates and then subsequent continued changes in breastfeeding rates, we are hard-pressed to make a pressure argument. Especially when we look at this data in the context of the data that came before it.
For example, the findings that the cessation of breastfeeding results in a large increase in the risk of depression and anxiety could fit with the data nicely in that the cessation of breastfeeding may have come between months two and three to lead to this increased risk of depression at month three. The data could also fit with the narrative that depression predicts the cessation of breastfeeding, especially if earlier measures of depression existed that found depression at one or two months predicted the breastfeeding change at three months.
What it doesn’t speak to is anything to do with breastfeeding pressure.
Perhaps most importantly, the jump to “breastfeeding pressure” ignores the reality that there are tons of systemic issues that affect women’s ability to breastfeed and why so many women report not meeting their goals[7]. By trying to turn this into an issue of infant feeding choices not being respected, the authors clearly state their own political agenda as they have nothing in the research that would back up their claims. Further, making these statements then ignores that often what is being perceived as “pressure” is really a push to get women the support they need, regardless of feeding method. At the end, what we end up with if we follow this path is a society in which formula feeding is passively pushed because the support for breastfeeding isn’t there, but neither is there support for formula feeding because no one wants to seem as if they are actively pushing it. It’s a lose-lose situation.
I do believe it’s important to understand that researchers continue to examine the very convoluted relationship between breastfeeding and postpartum depression and there may be a role for breastfeeding pressure for a certain subset of women (and identifying them is important); for a larger subset, we know there are real barriers to breastfeeding which can lead to women not reaching their goals and being at higher risk of post-partum depression.
Clearly there are many, many factors that are at play here and no one study will likely be able to tell us everything.
The problem we have with this study is not that it doesn’t add to the literature in any way, but the researchers are making claims that they don’t even have data to examine, much less support. When this happens, it is a disservice to everyone. Breastfeeding is hard and women who want to breastfeed need as much support as they can get and the same goes for women who want to formula feed. What does no one any good is suggesting that the pushes in our society to support breastfeeding mothers who face a host of obstacles is doing harm without any evidence to support that. Let us hope that these misguided comments do not impede progress to helping mothers reach their feeding goals.
References
[1] Woolhouse H, James J, Gartland D, McDonald E, Brown SJ. Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: implications for primary care in a prospective cohort study of primiparous women in Australia. Women and Birth 2016; in press. [2] Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. Journal of Affective Disorders 2015; 171: 142-54. [3] Kendall-Tackett K. Birth interventions, postpartum depression, and breastfeeding. Clinical Lactation 2015; 6: 85-6. [4] Figueiredo B, Canário C, Field T. Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine 2014; 44: 927-36. [5] Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy and Childbirth 2012; 12: 36. [6] Henderson JJ, Evans SF, Straton JAY, Priest SR, Hagan R. Impact of postnatal depression on breastfeeding duration. Birth 2003; 30: 175-80. [7] http://www.cdc.gov/vitalsigns/breastfeeding2015/index.htmlOriginally published here.
Tracy Cassels, PhD is the Director of Evolutionary Parenting, a science-based, attachment-oriented resource for families on a variety of parenting issues. In addition to her online resources, she offers one-on-one support to families around the world and is regularly asked to speak on a variety of issues from sleep to tantrums at conferences and in the media. She lives in Prince Edward County, Ontario, Canada with her husband and two children.
