Breastfeeding and Mental Health: When It Helps or Hurts

Those experiences are why I want your mental health included in any conversation about feeding. The question is how feeding is working for you and your baby, including what it's costing you.

Does breastfeeding help or hurt your mental health?

It can do either, and sometimes both in the same day.

For some moms, nursing is grounding: a reason to sit down, a few quiet minutes, a closeness that feels like theirs. For others, it's where the anxiety lives: worry about how much the baby is getting, dread before the next latch, the sense that everything depends on their body cooperating.

The study I find most useful looked at what moms had planned. Cristina Borra and colleagues at the University of Seville (2015) analyzed more than 8,500 mothers in England who gave birth in the early 1990s and hadn't shown signs of depression during pregnancy. Those who planned to breastfeed and did were the least likely to screen positive for postpartum depression at eight weeks. Those who planned to breastfeed and didn't end up breastfeeding were the most likely. The link was strongest at eight weeks and weaker by eight months.

So the gap between what you hoped for and what happened seems to matter. The researchers' conclusion is one I'd underline: moms who want to breastfeed need expert support, and moms who intended to and can't need compassionate support.

Why can breastfeeding take such a toll on your mental health?

Pain. Stephanie Watkins, Alison Stuebe and colleagues at the University of North Carolina (2011) studied 2,586 U.S. moms who had breastfed. Those who reported severe breastfeeding pain on the first day or in the second week had roughly twice the odds of screening positive for depression at two months. Among moms with moderate or severe pain, getting help with breastfeeding was linked to lower odds of depression. If nursing hurts, an IBCLC (International Board Certified Lactation Consultant) or your OB is the right person for the pain itself. Tell someone how you're feeling, too, because the two are connected.

Sleep. When you're the only one who can feed the baby, every night feed is yours. A 2015 review of 31 studies by Andrea Lawson and colleagues at the University of Toronto linked poor sleep, as moms reported it, to developing postpartum depression. So who's up at night belongs in your feeding plan.

The support gap. It can feel like you get one visit from a lactation consultant in the hospital and then, at discharge, best of luck. What if the baby isn't gaining weight? What if they can't latch? What if you're told to triple feed: nurse, then give a bottle, then pump, around the clock? In a CDC study that followed 1,177 moms through their baby's first year, about 60% of those who stopped breastfeeding said they stopped earlier than they wanted to (Odom and colleagues, 2013). Stopping early was tied to concerns about lactation, the baby's weight, illness or medication, and the effort of pumping.

Feelings that arrive with the feed. Some moms feel a sudden wave of dread or sadness right as their milk lets down, and it passes within minutes. Others feel rage, or a skin-crawling urge to unlatch, while the baby is nursing. Both have names, and D-MER: Why You Feel Dread or Sadness at Let-Down explains them.

Why does feeding feel like a test of being a good mom?

How we feed our babies is tangled up with how we feel about ourselves as moms, and everyone seems to have an opinion about it.

That's where "breast is best" and "fed is best" come in. Either slogan can turn into a rule. "Breast is best" can become "I can only exclusively breastfeed, and anything else means I've failed." "Fed is best" can land as "your feelings don't matter as long as the baby eats," which is hard to hear if you're grieving that breastfeeding didn't work. Neither slogan holds everything you're carrying.

Here's how I'd say it: there is no moral hierarchy here. Breastfeeding has real benefits, and the American College of Obstetricians and Gynecologists lays them out in its 2018 guidance. That same guidance says each woman "is uniquely qualified to make an informed decision surrounding infant feeding." Your mental health is part of the information that decision needs.

Guilt tends to show up whichever way you feed. A 2021 University of Liverpool review of 20 studies, led by Leanne Jackson, found it in breastfeeding and formula-feeding mothers. It was more common among formula-feeding moms, and for breastfeeding moms it came most often from family and peers. If guilt is running the show, Postpartum Guilt: Why It's So Intense and What Helps goes deeper.

Is it OK to stop breastfeeding for your mental health?

Yes. You are allowed to choose your mental health and your overall wellness. That choice is still being a good mom.

I'm not saying the choice is easy, because it's not. Whether to keep going or stop is a personal decision, and it's yours.

Two things I want you to hear:

Mixed feelings don't mean you're making the wrong choice. You can want to stop and wish you didn't. You can feel relief and sadness on the same afternoon. A hard decision can come with more than one feeling.

Guilt about stopping doesn't mean you should keep going. It probably means you care about your baby. Guilt tells you something matters to you. It can't tell you which choice is right.

A few questions that can help you think it through:

• What is feeding giving me right now, and what is it costing me?
• If I picture the next month going exactly like this one, what do I feel?
• Am I deciding from what I value, or from what I'm afraid people will think?
• Is there an in-between I haven't let myself consider?

If you do stop, grief can show up even when you chose it, and Breastfeeding Grief: Why Weaning Feels Like a Loss talks about that. If your mood drops in the days or weeks after you stop, read Post-Weaning Depression: Why It Happens and What Helps. How and when to wean are questions for an IBCLC and your pediatrician.

What does a flexible feeding plan look like?

At a Postpartum Support International conference, I heard a lactation expert put it simply: breastfeeding care is mental health care. I couldn't agree more. The talk was about flexibility. Rigidity sounds like "breast is best, so exclusive breastfeeding is the only acceptable way to feed my baby." Flexibility sounds like "what would make feeding work for this baby and for me, right now?" That could mean pumping so someone else can give a bottle. It could mean supplementing with formula. And the plan can change again next month.

The mechanics belong with the right people. An IBCLC can help with latch, pain, supply, and adding pumping or formula. Your pediatrician follows your baby's weight and growth. If you're thinking about medication for depression or anxiety and wondering how it fits with breastfeeding, that's a conversation for your prescriber. My part is the thinking and feeling side: the rules you've set for yourself, the fear underneath them, and what this is costing you. Who Does What in Postpartum Care? lays out the whole team.

When should you talk to someone about breastfeeding and your mental health?

Feeding struggles and mood struggles can travel together; in the pain study above, the researchers concluded that moms with breastfeeding difficulties should be screened for depression.

I'd want you to reach out if:

• you've felt low, anxious, or empty most of the day, nearly every day, for two weeks or more
• you dread every feed, and the dread follows you through the rest of the day
• worry about feeding, how much the baby is getting, or your supply fills your thoughts even when someone else has the baby
• you feel like a failure as a mom, or worthless, most days
• you can't sleep even when you finally get the chance
• you're having scary thoughts you can't shake

If you're thinking about suicide or need crisis support, call or text 988. Call 911 if you or your baby is in immediate danger. The same goes for thoughts of not wanting to be alive, or that your baby would be better off without you. If it isn't an emergency but you'd like support today, call or text the National Maternal Mental Health Hotline at 1-833-852-6262 (free, 24/7), or the Postpartum Support International HelpLine at 1-800-944-4773 (it isn't a crisis line).

You don't have to settle the feeding question before you ask for help, and you don't have to be in crisis. Talking it through with someone who has no stake in how you feed your baby can make the decision feel less like a verdict on you.

If you'd like that, you can book a free 15-minute consultation. I see moms in person in Austin and online across Texas and in 40+ PSYPACT states.

Your wellbeing belongs in this decision, including when your feelings about it are complicated.

Sources

• Borra C, Iacovou M, Sevilla A. New evidence on breastfeeding and postpartum depression: The importance of understanding women's intentions. Maternal and Child Health Journal, 2015.
• Watkins S, Meltzer-Brody S, Zolnoun D, Stuebe A. Early breastfeeding experiences and postpartum depression. Obstetrics & Gynecology, 2011.
• Lawson A, Murphy KE, Sloan E, Uleryk E, Dalfen A. The relationship between sleep and postpartum mental disorders: A systematic review. Journal of Affective Disorders, 2015.
• Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics, 2013.
• American College of Obstetricians and Gynecologists. Optimizing Support for Breastfeeding as Part of Obstetric Practice. Committee Opinion No. 756, 2018 (reaffirmed 2020).
• Jackson L, De Pascalis L, Harrold J, Fallon V. Guilt, shame, and postpartum infant feeding outcomes: A systematic review. Maternal & Child Nutrition, 2021.
• National Institute of Mental Health. Perinatal Depression. NIH Publication No. 23-MH-8116, revised 2023.
• 988 Suicide & Crisis Lifeline. What to Expect.
• Postpartum Support International. Perinatal Mental Health: Signs, Symptoms and Treatment and Get Help.