Focus on Lactation and Mental Health

The Crying Curve is an evidence-based pattern of crying that begins at about 42 weeks of gestation (2 weeks of extrauterine life), peaks at 6-8 weeks of age, and sharply declines by 12-15 weeks. As many as 15 different studies have concluded that this pattern is common across infants of all cultures, gestational ages (based on a 40-week gestation), and parenting styles—and the applications are many in the early parenting world. How can parents use this pattern to help them navigate breastfeeding? How can they gather their support people, family or village to maximize positive relationships and get the support they crave? How can they utilize it to help assess their newborn and understand what is needed for their specific situation? How much crying is too much crying? Lactation consultants, postpartum doulas, and other postpartum professionals who possess this information are well positioned to help to educate parents on how to best approach their postpartum recovery period, as well as navigate the ups and downs of breastfeeding and early newborn sleep. This session will aim to explain and apply the Crying Curve in multiple ways to support and guide the newborn family.

If you have worked with mothers for more than a few weeks, you have encountered a mother with mental illness. You may not have recognized the symptoms while talking with your patient. Or, you may wonder if a certain psychiatric medication is “safe” during lactation.

Perinatal mood and anxiety disorders (PMAD) include a spectrum of common mental health disorders: depression, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, and postpartum psychosis.

These disorders often ruin enjoyment of the postpartum experience and bonding with the baby. Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression and reckless or bizarre behavior that can endanger mother and baby.

Medicating the lactating mother is a careful balancing act between the health and safety of the mother and the health and safety of the baby. But failing to medicate a mother with PMAD can lead to misery, dysfunction, poor infant outcomes and in the worst situations, injury and death.

This presentation will give an overview of the different classes of antidepressants, antianxiety medications, antipsychotics, and mood stabilizers commonly used in breastfeeding mothers. Electroconvulsive therapy and transcranial magnetic stimulation will also be discussed as non-pharmacologic treatments.

Every day, around the world, many mothers are faced with the complex task of managing the initial onset, or continuation, of their lactation following a late miscarriage, stillbirth, neonatal or infant loss. This presentation explores findings from a multi-year, multi-site Australian study conducted with bereaved families and health professionals that confirmed the limited nature and scope of lactation care currently available to bereaved families.

This presentation will provide evidence of the need and benefit of approaching lactation after infant death using a biopsychosocial care framework, so that bereaved families are able to make informed decisions from the full array of lactation management options that may be available including: suppression, sustained expression, breastmilk donation or using milk as memento. The challenges involved in providing bereaved lactation care will be acknowledged and discussed. Health professionals will be advised on what information and support bereaved families need and want, how and when this information may be best provided and who may be best placed to offer lactation care to bereaved families.