Wednesday, April 20, 2011

Breastfeeding, Mental health and Medication

I was perusing science-based parenting blogs this morning, and came across a blog focused on postpartum depression. As someone who has suffered PPD after each of my pregnancies, this was very interesting to me, and I was even more interested to see a couple of recent posts on balancing breastfeeding with the treatment of PPD. The initial one is here, and there is also a follow-up post here.

My psychologist finally figured out this last summer what was at the root of my struggles with depression and anger -- untreated ADD. Taking stimulant medication significantly improved my quality of life and my ability to function as a mom. It was very difficult to adjust to being off the medication during pregnancy, and I have been looking forward to getting a chance to take it again. However, the medication I was taking, an amphetamine derivative, is contraindicated during breastfeeding. It tends to concentrate in breast milk and would result in a nursling, especially a young one, getting far too much of the medication. It might be possible for me to take an alternative methylphenidate based medication, such as Ritalin, since the amount secreted in breast milk is far lower than with the amphetamines, but there is not good information on whether or not this would actually affect a young nursling or not. I do plan to discuss this option with my ARNP, but I am not sure that I am comfortable exposing a nursling to even low doses of stimulants. Finding accurate information to aid in the decision is difficult, as so much of the affects of medication while breastfeeding are unknown. Even experts disagree. Some who are strong advocates of breastfeeding view the benefits as outweighing the risks of nearly any medication, with only a few rare exceptions, while others view the possible risks of many medications as being potentially more significant than the risk of not receiving breastmilk. For many medications, there is little to no good research on milk transfer rates or possible affects on baby.

I could avoid the whole issue by remaining off the medication for a year or so to enable breastfeeding, but that would affect my ability to mother not only the baby but all my children, as well as affecting my adequacy as a homeschooling teacher. Would we all survive? Yes, we've done it before and we're doing it now, but now I know how much different things were when I was on a medication that got to the root of the problems I was having. Providing external structure through meal plans and a pre-planned easy to use curriculum will likely help, but it will likely all be much more of a struggle than I would have it I were taking a medication that I know works.

At this point, I don't even know which way I'm leaning. Still thinking through all my options, and trying to figure out what will be best for the whole family.

4 comments:

  1. That's a really rough choice to make. Have you considered breast feeding for just a few months and pumping and storing milk up, then weaning to the stored breast milk? Is that even doable?

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  2. That would be possible, but the extra pumping may be too much stress on top of nursing. I'd need to a get a good pump. I don't know how much extra work that'd take. . .but it is something to consider.

    I am definitely going to start out nursing the baby, for a few weeks at least, but I am torn about how long to continue and try to make do with my meds. They make a really big difference.

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  3. That is SO difficult, Becky. It is so different for every mother; each person has different choices to struggle with and it's exceptionally hard when you are trying to balance everyone's needs alongside something you are committed to. It sounds like this is not a decision you can make ahead of time, you may have to feel-it-out as you go. Since you are planning on breastfeeding for a little while, maybe you could try the other medication to see if it helps. I also think the pumping is a great idea - but don't pressure yourself. I think you would be surprised how much you could pump if you just got a one-handed manual pump and expressed on one side while nursing the other. One thing that IS well documented is the risk formula-feeding poses to the long-term health of an infant. Each day counts and your baby will have the best possible start in life with a few weeks of breastfeeding - that is longer than most mothers in America nurse their infants! You are just one person, Becky, and a great mother. Take it one day at a time and you will make the way that works best for your family. i'm proud of you for considering your own health alongside that of your children because they *both* matter!

    ReplyDelete
  4. That is SO difficult, Becky. It is so different for every mother; each person has different choices to struggle with and it's exceptionally hard when you are trying to balance everyone's needs alongside something you are committed to. It sounds like this is not a decision you can make ahead of time, you may have to feel-it-out as you go. Since you are planning on breastfeeding for a little while, maybe you could try the other medication to see if it helps. I also think the pumping is a great idea - but don't pressure yourself. I think you would be surprised how much you could pump if you just got a one-handed manual pump and expressed on one side while nursing the other. One thing that IS well documented is the risk formula-feeding poses to the long-term health of an infant. Each day counts and your baby will have the best possible start in life with a few weeks of breastfeeding - that is longer than most mothers in America nurse their infants! You are just one person, Becky, and a great mother. Take it one day at a time and you will make the way that works best for your family. i'm proud of you for considering your own health alongside that of your children because they *both* matter!

    ReplyDelete

What do you think? Let me know.