How the pressure to breastfeed can impact mental health

Almost three-quarters of women in England start breastfeeding after giving birth, but less than half are still doing so two months later according to NHS and Public Health England data. This is less than the PHE-recommended six months.

Many women are aware of the benefits of breastfeeding, which can boost a baby's ability to fight illness and infection, reduce the risk of digestive problems and encourage bonding between the mother and baby. However, the challenging reality of nursing is often glossed over, leaving women feeling as if they have failed.

Common breastfeeding problems

There may be problems with the way the baby is latching onto the breast, a lack of milk, mastitis, pain and sore nipples. Women often struggle with the pressure to feed very regularly, as well as the lack of sleep due to nighttime feeding. As a result, lots of new mothers find themselves feeling overwhelmed, exhausted and struggling with their mental health.

"Women should never feel guilty if they are struggling to breastfeed their baby or choose not to. While evidence shows that breastfeeding in line with WHO guidance brings optimum benefits for the health of both mother and baby, it is not always possible," says Alessandra D'Angelo, quality and standards advisor for the Royal College of Midwives.

"There are many reasons why difficulties may arise, for instance, it can take longer for your milk to come in after a caesarean section than after a vaginal birth," she adds. "Some babies are born with tongue-tie which can prevent them from latching on properly - which can then lead to sore or cracked nipples or blocked ducts and mastitis. This can also impact a woman's mental well-being."

Women may choose to switch to formula milk for a variety of reasons. For example, if they need to return to work, have other caring commitments or if breastfeeding simply doesn't suit their needs. Although choosing how to feed their baby is a personal choice, many women are made to feel ashamed about their decision.

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Breastfeeding problems and maternal mental health

Research suggests the pressure to breastfeed can have a negative psychological impact on women. According to a study of more than 2,500 women, women who had a negative experience of breastfeeding were more likely to have symptoms of postpartum depression. Separate research has found that women who planned to breastfeed but were unable to have higher rates of depression.

In a Priory survey of more than 1,000 parents, eight in 10 believe breastfeeding problems fuel depression in new mums when unsuccessful or painful. The vast majority of those polled said the pressure to nurse contributed to postnatal low mood, anxiety and feelings of guilt and shame. From 'mummy bloggers' to friends and relatives, this pressure to persevere with breastfeeding -regardless of the impact on maternal mental health - can come from all directions.

"Of course, every woman wants the best for their baby and many women try to breastfeed their newborn with the best intentions to sustain it, but this isn't always possible," says D'Angelo. "We understand that this can be stressful, but women should try to not let this impact their mental health and wellbeing as there is a lot to contend with when you become a mother."

How to cope with the pressure to breastfeed

It's important to rethink how we treat pregnant women and value their choices, particularly when it comes to feeding. While the benefits of breastfeeding should be made clear and adequate support and advice provided, there should be no pressure to nurse - particularly if it is causing harm or distress to the mother.

Seek support if you want to breastfeed or formula feed

If you are worried about your baby and how they are feeding, don't hesitate to speak to your midwife, health visitor or doctor.

"It's important to seek support from your midwife or health visitor especially in the first few days or weeks if you feel you are struggling to breastfeed or have any concerns," says D'Angelo. "They can give breastfeeding mothers and their partners information and support to help manage the physical, mental, emotional, and societal challenges of breastfeeding."

Similarly, parents of babies that are formula-fed, whether exclusively or partially, should be provided with the information to enable them to do so safely. "They should be given support to encourage the bonding process," says D'Angelo. Regularly picking up your baby and engaging in skin-to-skin contact, either while feeding or not, can help you build an emotional connection with your newborn.

Speak to your doctor

If you are struggling with your mental health at any point during or after pregnancy, it is important to speak to your doctor. Your health visitor can also support you during the postnatal period too.

From counselling and therapy to medication, there are many different ways to manage and treat postnatal mental health problems - your midwife, healthcare worker or GP can help and refer you if needed. You can also self-refer for therapy on the NHS and may be bumped up the waiting list if you are pregnant or have recently given birth.

Postnatal mental health problems are common and there is no shame in asking for help. Between 10% and 20% of women have depression and anxiety in pregnancy and after birth.

Speak to trusted friends and family

It's also essential to talk to trusted friends and family about how you feel. New parenthood can be a difficult and isolating time, particularly if you are struggling with feeding. Antenatal and baby groups are a good place to chat with like-minded people who may well be feeling the same as you.