Breastfeeding with Manic Depression
Gargrave, West Yorkshire, GB
From New Beginnings, Vol. 31 No. 1, 2010, pp. 18-19
First Journey: Bipolar with Babe
"Breastfeeding is easy," my mom told me when I was pregnant. After straightforward home births she had breastfed my sister and then me. I had grown up assuming that I too would breastfeed, although I never imagined breastfeeding anyone who could walk or talk. As for its being easy, I wasn't so sure as two of my friends hadn't managed it with their recent firstborns.
At La Leche League meetings I was glad to find support and watch real babies feeding. Reading The Attachment Parenting Book by William and Martha Sears changed Duncan's and my parenting path forever. The approach they described tied in with what I had observed when traveling in Malawi, Peru, and Bolivia. It appealed to my intuition, and it came as such a relief to me to read all about it in a Western context. Duncan agreed to give it a go, too.
Two years previously, one and a half weeks into my first teaching job, I had been hospitalized because of a psychotic episode. I was diagnosed with Bipolar Affective Disorder, or manic depression. Things had been somewhat precarious for me since then. I was aware that childbirth is notorious for triggering mania in people who are predisposed to it. I did some research about breastfeeding and medication, with the LLL library being a helpful starting point.
My longed-for home birth was derailed when the midwives changed shift. My dilation reversed and the new midwife pronounced "false labor," and then went home for the night. The following morning, after 30 hours of labor, I was exhausted and transferred to hospital, where I had an epidural and floated off into oblivion. By late afternoon my dear sister Sarah arrived unexpectedly. Her voice got through to me at a time when I was blocking everyone else's out. My son Chris was born within half an hour of her arrival. I was amazed: I had forgotten I was having a baby.
Chris took to breastfeeding straightaway and we had a peaceful night together snuggled up on my single hospital bed. We went home the next day and all was well at first.
Soon afterwards the dreaded postpartum mania began to set in and I got gradually more and more worked up. Five days after Chris was born I didn't sleep overnight. Duncan called my psychiatrist, who visited us at home. She recommended that I take some antipsychotic medication straightaway -- the sooner you start, the lower the dose and the shorter the duration.
"Of course, you will need to stop breastfeeding," she told me in a matter of fact way, "as some of the medication will come through to your milk." I was incensed because the risks of not breastfeeding were not being taken into account. I was convinced that the benefits of breastfeeding (for Chris's health, for our bonding, and for the calming its oxytocin and prolactin hormones would bring me) would outweigh any chemical disadvantages. I became highly distressed and pitched head first into combat.
I had my ammunition ready. I'd written a letter, backed by research, about mothers who had successfully breastfed when taking a similar drug, and by notes from a very positive conversation I'd had with the local hospital pharmacist. He'd explained how only small amounts of a drug pass into your breastmilk, and how it's cheaper for drug companies to say, "Don't take while breastfeeding" rather than do trials to prove the drugs are compatible with breastfeeding.
My psychiatrist listened and eventually agreed to support me in continuing to breastfeed, after all. Exhausted, I started the medication. Sarah and Duncan agreed to take turns monitoring me and Chris, night and day, particularly as I was planning to continue to cosleep with him and the drugs initially made me drowsy.
The next few weeks were a rocky and ravenous time for me. Mania makes me extra thirsty and hungry. This was compounded by the extra nutritional needs for milk production and the dehydrating medication. In addition, I had contracted a urinary tract infection from catheterization during labor, and my temperature shot up to 105°F several times over the first three weeks. I drank liters of water at a time and, through the night, tucked into full meals put aside for me earlier. I felt disabled by exhaustion, lack of sleep, drowsiness from medication, the "hyperness" of the manic state, and the immobility of static breastfeeding. I was extremely reliant on others to look after me.
Although a bit loopy and ranting at times, I always took good care of baby Chris. I found that, when he was taken away so that I could "catch up on sleep," I would lie there imagining every noise I could hear was that of a baby crying. We didn't try this very often.
One of my biggest fears was of being re-admitted to a psychiatric ward, as being parted from my baby son was my ultimate nightmare. I was so grateful for the home care provided by my immediate family.
It was a few weeks before Duncan's return to the shared bed, once my sleep patterns and mind had settled down. I came off the medication after a month and we had help at home for six weeks in all: Duncan's sister Heather and then, when Sarah left, our friend Susan helped.
Sarah hadn't planned to come at all, but ended up staying for a month. Her boyfriend, of one week standing, John, came along to support her. They spent many hours in the kitchen preparing meals for me, constantly amazed by my appetite. "It was a blessing in disguise," they said afterwards as their love blossomed and two years later Chris's cousin Ella was born. I had an overactive let-down for the first three months: Chris was half-choked by my jetting milk at the start of most feeds. I found that feeding lying down, and often, seemed to help things; long car journeys certainly hindered them. I took to wearing patterned tops to help disguise my milk leaks.
When Chris was three months old I started using a ring sling. This settled him at the start of feeds, it freed up one of my arms and I found I could even feed him in it while walking along. Breastfeeding became a way of life for us. I occasionally got mastitis, usually when I was trying to do too much.
LLL meetings were a lifeline for talking to like-minded mothers and the League Family Camps in the summer were fantastic for this, too.
Second Journey: Tandem Feeding
Thankfully when Annie was born, things were different. We engaged independent midwives who would stay with me throughout the labor and we invited my mom along as a birthing partner. We hired a birthing pool and I listened to some antenatal hypnosis CDs. I had been inspired by the positive birth stories in Ina May's Guide to Childbirth. Duncan and I made a far more comprehensive plan for the likely ensuing postnatal mania.
Continuing to breastfeed Chris seemed an attractive way both of maintaining our bond and reducing sibling rivalry or rejection. Hilary Flower's Adventures in Tandem Nursing gave me insight and encouragement.
The home birth was a very healing experience. Annie was born underwater and caught by my mom. I wasn't surprised to have a baby in my arms, and she took to breastfeeding straightaway. Most wondrous of all, I didn't get manic this time. I'm convinced that the natural labor helped here, without artificial pain relief confusing my body's chemistry; I'd read about this in Michel Odent's The Scientification of Love.
Chris was delighted with the copious milk supply; it had been scanty throughout my pregnancy. With his willing suckling help, engorgement and overactive let-down were not problems this time. Once again I was glad of a high level of family support -- this time it was my mom who stayed and helped for a month.
Annie and I shared a bedroom for the first few months, with Chris and Duncan cosleeping in another room. We then changed to sharing a room, all of us together, in what became known as the "teletubby bedroom."
Simultaneous tandem feeding became a daily feature of our four-in-a-bed morning starts. Chris and Annie learned that they had a side each and swapping sides simultaneously became one of their first games. At times I found it a skin-crawling experience, eased by taking my mind elsewhere. I could cope with it best when chatting to Duncan. Reading aloud proved to be a good distraction for me, too.
Breastfeeding has suited Annie perfectly. She is a high need child, who has almost always slept in my arms or in contact with my body. She resisted both pram and car seat for her first year: she couldn't bear the separation. Another era is beginning for me. I feel so grateful to my family, the aforementioned authors who have inspired me, and to LLL Wharfedale Leaders, Gwyneth, Ruth, Barbara, and Suzanne, who have greatly encouraged me. Thank you all.
Annie continues to nurse to sleep and to have feeds throughout the night. I'm relishing the special bond while it lasts. I've managed to continue to stay out of hospital and have been largely medication-free. Chris is almost weaned from his remaining morning feeds: there is hardly any milk there and the stories I tell him are more compelling.
Adapted from a story in LLLGB's Breastfeeding Matters.
Flower, H. Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond. Schaumburg, IL: La Leche League International, 2003.
Gaskin, I. M. Ina May's Guide to Childbirth. New York: Bantam, 2003.
Odent, M. The Scientification of Love, second edition. Free Association Books, 2001.
Sears, W. & M. The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby. Little Brown and Company, 2001.