> There is a
> >1984 study that showed decreased incidence of postpartum depression in
> >mothers who breastfed.  I wonder if this proves her point that mothers that
> >cannot or choose not to breastfeed are likely to encounter more post partum
> >depression from the guilt that ensues.
>
...yet another reason to encourage / promote breastfeeding, no?

My feelings are that the guilt issue has little relevence in the
prenatal period, when they are still able to commit to breastfeeding. In
the case of a woman who did not breastfeed a previous child and is
attending prenatal classes, I would invite her to discuss the reasons
(perhaps privately, perhaps in class -- depends on the group,
individual, etc.) and to support her ability to breastfeed this time. I
would be explicit about the fact that she did not have enough
information and support to breastfeed the first time, but that *all* her
children will now benefit from her decision to breastfeed this child.

In the case of mothers not breastfeeding (for whatever reason) after
attending prenatal classes, giving them support and empathy is
important. Again, you can be explicit about the fact that they didn't
have the support they needed to breastfeed (recognizing that outside
support was available does not mean an individual mother had the inner
resources to access / accept / integrate it).

I am one of those people who believes that focussing on mistakes does
not contribute to change, trust, rapport, etc. Now, focussing (with
empathy and a true attempt for understanding) why these decisions were
made and how they affect our lives and how we can minimize their impact
-- that can help. And I don't see how that can be done without giving
lots of accurate information and lots of warm support. In the case of a
mother having difficulties breastfeeding, unrealistic expectations can
sometimes be avoided by sharing normal newborn behaviour with prenatal
clients. "It might seem that all you are doing is breastfeeding in the
early weeks, but frequent feeding is important because..." "We can't
promise you that your breastfeeding relationship will be problem-free,
but we can tell you that challenges to breastfeeding can be overcome.
Sometimes it just takes some fine-tuning; sometimes it requires more
help and you can get that..."

In fact, that can also work with health care providers -- start with the
assumption that they want to decrease rates of post-partum depression;
say that you share their interest in doing so; suggest that helping
mothers to breastfeed and giving them the support and information they
need is a good way of contributing to their emotional well-being. You
can also offer to give them the support and information they need to
help these mothers have a good experience.

Jo-Anne Elder-Gomes, IBCLC (last year, and keeping this year's
candidates in my thoughts tomorrow)
<<<<<hugs>>>>>

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