To breastfeed or not to breastfeed. That is the question. Don't let the current hospital movement influence your choice!

I know I've written about this before in a previous post ... about how difficult it was when I decided not to breastfeed my fourth baby (and I don't mean the decision itself was difficult -- it was that the health care providers around me were unbelievably difficult). Well, I'm just glad that I'm not giving birth today because of the self-righteous stance that a slew of hospitals and providers around the country are taking.

What's happening is this: there's a movement involving hospitals in New York, California, Colorado, Massachusetts and Texas to stop giving out free formula samples to new moms. The thinking behind this movement is that because the American Academy of Pediatrics has determined that breastfeeding is best, then new moms should not be exposed to a 6-pack of free formula bottles because, heaven forbid, they will most assuredly become instantly swayed to give up breastfeeding. I mean, who are we as women to actually make the choice on how best to feed our babies?

And so what about the women who end up having to have an unplanned (or planned) C-section which can delay milk production by several days? Or the women who have babies that suffer from severe allergies? Or the women (like me) who choose to take an anti-depressant, that happens to be very dangerous to an infant, in order to be able to function as a mother? I'm sure there are plenty of new moms who are suddenly confronted with a change in plan and have to use formula for one reason or another, and are unprepared ... it is essential for them to have easy and free access to formula.

Whoever had the idea that mothers need to be denied something in order for them to make the "right" choice (according to the mandate of an organization) is absolutely crazy. And, not to mention, obviously a man. This isn't an Orwellian world we live in -- at least not yet. Let's protect our right to choose how we feed our babies.

Shoshana Bennett, Ph.D, author of Postpartum Depression for Dummies, joins our conversation!

I am so thrilled to have a comment on my blog from Shoshana Bennett, Former President of Postpartum Support International and Founder/Director of Postpartum Assistance for Mothers. How awesome is this!! Shoshana joins the conversation that developed from my posts on the use of anti-depressants while pregnant and/or breastfeeding. Here's what she says:

"As Anne Dunnewold expressed, the judgment needs to go. There is no one “right” way. Each mother is trying to make the best decision for the wellbeing of her baby, and whatever choice feels right for her needs to be respected and supported.

"In order to make the best choice she can for the welfare of her family, it’s also important for the mom to have solid information on the pros and cons when she make this important decision. Here are some facts which many are not aware of. Most medical professionals who have dedicated their careers to studying the safety of antidepressants in pregnancy agree that they have been focusing too heavily on one side of the issue for years. Now, instead of solely focusing on the possible unknown risk to the baby when the mom takes medicine, they are leaning much more on the KNOWN risks to the baby if the mom is NOT treated. Until a few years ago, most of the focus with respect to taking medications while pregnant was on the possibility of harming the baby. Today, since there is much more data gathered on the dangers of depression and anxiety to the developing baby, the focus has shifted to the possible harm from NOT taking medication if the pregnant woman needs it to feel like herself.

"It’s quite clear from the research in the last few years that depression and anxiety in pregnancy can chemically hurt growing babies. For instance, depression in pregnancy can cause low birth weight and preterm delivery, and anxiety may cause harm by constricting the placental blood vessels and raising cortisol. One thing is for sure that everyone agrees upon. If a woman is experiencing depression or anxiety during pregnancy, she and her whole family (big or little, born or not yet born) needs her to receive treatment. Treatment, of course, does not necessarily involve medication, it’s simply the topic of this discussion. On that note, we are learning quite a bit about effective non-pharmaceutical treatments for depression in pregnancy with no side effects except good ones!"

Shoshana S. Bennett, Ph.D. Author, Postpartum Depression For Dummies, http://drshosh.com/

Ann Dunnewold, Ph.D, author of Postpartum Survival Guide, joins our conversation!

I've had quite the response from my last two posts that hit on the emotionally-charged issue of taking anti-depressants while pregnant and/or breastfeeding. Every comment has been great and I really appreciate the personal stories and thoughts that have been shared.

I was especially thrilled to see a comment today from Ann Dunnewold! Ann is a psychologist and nationally-renowned expert on postpartum depression. Of her several books on the topic, my favorite is "Postpartum Survival Guide." Her latest book, "Even June Cleaver Would Forget the Juice Box," provides solutions to the "mommy madness" that tends to pervade our lives as we feel pressured to aspire to perfect mommyhood.

On that note, her comment is awesome:

"I am so glad you brave women are talking about these issues. We need more honesty among women that this decision is hard--and that pregnancy or postpartum is not always a glowing Hallmark card experience.

"The official professional position is that a comprehensive "risk-benefit analysis" is necessary, because there is no "Right Answer". This means weighing the possible effects on the mother and baby of either choice —medication or doing without. There are documented serious negative effects of not treating depression and anxiety during pregnancy, including low birth weight. Over the twenty years that I have worked with postpartum moms, information has changed as research and drugs continue to evolve. Responsible, caring healthcare providers are usually glad to look at the issues for any individual’s case. If not, get a second opinion.

"For the facts about meds during breastfeeding, one of the key experts is Dr. Thomas Hale, who has a website at http://neonatal.ttuhsc.edu/lact/ and is the author of a great resource, Medications and Mother's Milk. Dr. Hale is VERY reassuring, feeling most meds are safe--but he is addressing breastfeeding, not pregnancy.

"The most important point in the posts here that I want to re-emphasize is that women need to stop judging each other. Society as a whole is hard enough on us, setting up perfectionist, unreachable standards for mothers. We need to keep in mind the absolute truth, for the majority of women: that we are all doing the best we can do. No woman I have ever seen in my office takes medication for fun. Women take them to function.

"We need to support, not criticize, each other's choices—and know that there as many valid choices as there are women in the world. Trust that you have made the best decision for you, given available info at this point in time. Don’t second guess or torment yourself with “what ifs” once you have decided."

Thank you so much, Ann, for taking the time to visit my blog and to share your valuable insight with us. You're the best!!!

More on meds and breastfeeding

Well, I've been e-mailing with a woman who wasn't at all happy with me after reading my previous blog on anti-depressants and breastfeeding. (She gave me permission to write about our communication on this blog.) She shared with me her experience of suffering from bipolar disorder and being on medication for it since she was a teen. When she and her husband were trying to get pregnant, she went off her meds. But by the end of her first trimester, she was having an absolutely horrible time so her doctor advised her to go back on her medication. She did so and went on to have a symptom-free, wonderful full-term pregnancy. Her baby is now nearly six months old and she's breastfeeding her baby and doing just fine. She feels very good about her decision to remain on medication and knows that she needed to do this in order to function and to be able to take care of her baby. She said she felt like she needed to defend her decision after reading my last post and make it clear that other moms shouldn't feel guilty about the decisions they make.

I absolutely agree with her. I applaud her for handling her illness so incredibly well and being so strong to know her options and then to choose the best one for her and her baby. Taking charge of our own health care is what each of us needs to do. The big stumbling block here, that I was trying to express in my previous post, is knowing our options. Often we're given information by the medical community (via pharmaceutical companies), without realizing we have other options. Or we're given just part of the information, or worse, complete misinformation.

I do feel fortunate that I didn't need to take an anti-depressant while I was pregnant, so I never faced that excruciating choice. I do know plenty of other moms who have and who felt like they wouldn't have made it through their pregnancies without medication. I totally respect and support their decision. I remain skeptical, however, about the safety of taking anti-depressants while pregnant or breastfeeding and think we need to demand more and better testing on these drugs. We shouldn't have to settle for an anti-depressant that is shown to cause birth defects, even if it is only a small percentage. We shouldn't have to settle period, but as women, that's historically what we've had to do when it comes to our health care.

I'm starting to ramble, but I guess what I really want to express here is that I think it's always good to discuss how we all need to respect each other's differences in opinion and different choices. Motherhood is tough enough as it is, but it's certainly way tougher if we don't pull together and support each other.

Just like the mom I've been e-mailing with felt attacked by my statement in my previous post that it's common sense to avoid anti-depressants during pregnancy and breastfeeding, I went through a similar experience when I made my decision not to breastfeed my fourth baby. I had really thought it out and made this decision because I knew it would be in my and my baby's (and my other children's) best interest for me to avoid postpartum depression so that I could be a functioning mother. For me, that meant not breastfeeding so that my hormones would become normalized faster and so that I could immediately go on an anti-depressant and not worry about it being in my breastmilk. It was a good decision for me, but I had a heck of a time expressing that to the nurses on the maternity wing of the hospital where I delivered. Although they didn't come right out and say it, they practically accused me of being a bad mom.

Twice a lactation consultant was sent to my hospital room to try to encourage me to breastfeed. I was given all kinds of "breast is best" cues and whenever I asked for formula for my hungry baby, it took forever for it to be delivered to my room. It was all I could do not to feel guilty for my decision, when I knew deep down, below the crashing hormones, exhaustion and pain from the C-section, that I had made the best decision for me.

These decisions are never easy, are they??

Anti-depressants and breastfeeding

There have been several new moms visiting this blog who have shared their concern about taking anti-depressants while breastfeeding. There are so many mixed messages on this out there -- doctors saying that it's perfectly fine, that moms need to take care of themselves first in order to take care of their babies; or that there is a risk, but it's so minimal to not really count. Then there are those who say that even a minimal risk is still a risk, so why risk it?

A recent study came out from the New England Journal of Medicine that concluded that women do not increase the risk of birth defects in their babies by taking anti-depressants while pregnant or breastfeeding. And yet it also stated that "drugs such as Celexa, Paxil, Prozac and Zoloft may increase the risk for certain defects, but, even then, the absolute risk is extremely small." AND it also stated that "even if a certain drug increased rates by a factor of four, the risk of having a child affected by the problem would still be less than 1 percent."

Confused??

Bottom line, and what no one seems to be talking about, is the fact that this study was funded by a few pharmaceutical companies, including GlaxoSmithKline, the manufacturer of Paxil.

Hmmmm.... what does that tell you?

In any case, when I was pregnant, I would never have entertained the thought of having even a single glass of wine, much less a drug that hasn't been completely tested in children, let alone infants. I don't know, but it seems like common sense to avoid anti-depressants while pregnant and breastfeeding.

What do you think? I'd love to hear about your own experience with or without medication.