Mother's Milk and Mother's Tears: Breastfeeding Experiences in Mothers with Postpartum Depression

Abstract

With an increasing amount of attention being paid to maternal mental health and the knowledge that maternal depression has the potential to adversely affect the breastfeeding relationship, the demand for appropriate breastfeeding support for mothers struggling with postpartum depression is on the rise. Using a hermeneutic phenomenological approach, the objective of this thesis research was to explore the lived experience of breastfeeding in women with postpartum depression to enhance understanding of what it means for these women to feel supported by registered nurses. After obtaining ethical and operational approval, recruitment began in September 2011 via the Saskatoon Postpartum Depression Support Program, a community wellness program offered by the Saskatoon Health Region. The researcher conducted in-depth, conversation-style interviews with five postpartum mothers. Interviews were transcribed verbatim and were analyzed according to emerging themes. The lived experience of breastfeeding with postpartum depression presented itself across interviews as overarching patterns, which are expressed by the following four themes: making the decision to breastfeed and having great expectations; learning the moves and wanting reassurance (establishing the breastfeeding relationship); breastfeeding in the dark (maintaining the breastfeeding relationship while trying to manage the symptoms of depression); keeping it under wraps and waiting it out (the issue of support). The mothers in this study valued the breastfeeding relationship when it went well; however, breastfeeding difficulties intensified symptoms of depression. Mothers who made the decision to breastfeed their infants needed ongoing support from healthcare professionals and loved ones to continue to breastfeed when faced with the debilitating symptoms of postpartum depression. This research concluded that women need increased anticipatory guidance to be prepared for the demands of motherhood. Women who are at risk for postpartum depression need appropriate treatment throughout the perinatal period and beyond. To these ends nurses must enhance their role as breastfeeding and postpartum depression educators across an extended perinatal period. Nurses should work along with other healthcare providers (midwives, social workers, physicians) to assess the effectiveness and appropriateness of prenatal classes as they are currently offered. Increased emphasis should be focused on newborn feeding and care for mother and baby postnatally in conjunction with prenatal preparation for birth itself. The issue of professional nursing support for breastfeeding must be explored from a sociopolitical context in order to determine if nurses have the cultural and institutional support they need to provide responsive care to mothers and babies. Enhanced support for breastfeeding certification among frontline staff is recommended. It is also recommended that staffing guidelines to decrease nurse-to-client ratios be implemented in order to give nurses the time needed to support mothers as they work through breastfeeding challenges (especially those mothers at risk for postpartum depression). Further, nurses need to enhance efforts to engage mothers and their families in a participatory manner so that knowledge gleaned results in responsive interventions.