I should have known what was happening.
I was an OB/GYN physician myself. I had delivered hundreds of babies before having my own child. I had a degree in nutrition, a minor in psychology, and was fellowship trained in integrative medicine.
I had my heart set on breastfeeding. My training had told me over and over, breast is best. I knew every medical explanation as to why. My baby deserved the best, and I was committed to giving it to her.
She never latched. After an unplanned C-section with several serious complications, my milk never came in. I used every contraption the lactation consultant could find, pumped every hour in vain hope of producing drops of milk — “liquid gold,” as the nurses called it.
I had no gold, only an angry newborn who caused so much nipple trauma that I remained topless for days, unable to stand even a sheet against my breasts.
A friend donated some of her milk to me, and the feeling of another woman’s breast milk running down your bare belly at 3 a.m., trying to feed a newborn out of a tiny tube taped to your nipple, is something I would never wish on anyone. Finally, my baby was given some Similac.
She was five days old, and I already felt I had failed her. I wouldn’t feed anyone corn syrup and conventional dairy, and here she was, sucking down this poison, in my pessimistic (and clouded) view. Worry rose up to overwhelm my mind with how much I was already harming her: changing her microbiome, creating risk for SIDS, and obesity. I was heartbroken.
Normally even-tempered and optimistic, I sobbed off and on for weeks. I was plagued by intrusive thoughts of the baby being hurt, being dropped on the tile floor in our home. I developed rituals to try to keep this from becoming a reality.
Over the months that followed, I went back to work, delivered other babies, and kept trying to pump for the few milliliters of breast milk I managed to produce. I passively reflected on how another person would have been a better mother for this baby, and wondered what worth I really had on this planet since I couldn’t even feed my baby from my own body.
This all went on for far too long.
Finally, I stopped pumping, got on an antidepressant, and saw a therapist. I found out that I had been suffering from postpartum depression, postpartum anxiety, and OCD symptoms. I got better.
How could I have missed it? For God’s sake, I am an obstetrician, the expert in pregnancy and postpartum care. But, as I reflected, I realized that I had an hour, maybe two, of training on postpartum depression during my residency. I had never heard of postpartum anxiety and OCD. I had classic symptoms, but hadn’t been trained enough on the disorders to recognize them.
My birth story changed my practice as an obstetrician. Now I know that difficulty breastfeeding is one of the top risk factors for postpartum mood disorders. I see my patients trying not to cry during our postpartum visits, and I think … I see you. I know what you aren’t saying. Please let me help you.
I ask about specific symptoms and watch their eyes widen as I say what they are afraid to put words to. I lay it out, that breast isn’t always best, that the Baby Friendly hospital designations are often Mother Unfriendly, that obstetricians are poorly trained in perinatal and postpartum mood disorder diagnosis and treatment, and postpartum care and parental leave in this country are grossly inadequate.
I look at you and think, your mental health matters tremendously for the health of you and your baby, and we are going to talk about that, even if it means I run an hour late for the rest of my office day. I have developed an integrative approach to the treatment of postpartum mood disorders, and work with patients to actively manage and heal their experiences.
I see you. You can get better. It doesn’t have to feel like this.
And — as I remind my new moms — in a year all the babies are eating cake anyway.
My integrative approach to mental health for pregnancy and postpartum
– Counseling, if possible
– As much sleep as possible
– Diet high in healthy fats
– Plenty of water and tea
– Gentle walking
– Outdoor time
– Support from friends and family
– 3 g fish oil daily, at least 1500 mg of which is EPA form
– 7.5-15 mg methylfolate daily
– Consideration of Rhodiola for depression and/or 5-HTP for anxiety
– Lemon balm tea for anxiety
– Delay return to work when possible, at least until 12 weeks postpartum
– Use of formula and/or donated milk, when appropriate, to facilitate sleep and good mental health
– Relaxation breathing exercises, the 4-7-8 breath
– Guided relaxation, I like the ones on the Insight and Calm apps
Often times this approach is sufficient. However, I don’t hesitate to add on an antidepressant (SSRI) medication when indicated. Most patients, while reluctant to start the medication, come back and tell me they wish they had started it sooner, and feel it has helped shape a much more positive postpartum experience. Typically I continue it for at least 4-6 months, and wean down when clinically appropriate.
The information in this article is for informational purposes only and should not substitute for medical advice. Please contact your health care professional for evaluation and treatment if needed.
This article was originally published on