On postpartum depression: my impression after working with birthing and
breastfeeding women for many years is that responses to hormonal states are
varied and at times idiosyncratic.  Women's responses to menopause are
another example.  Some women experience mood swings during menopause; others
find that without the hormonal ups and downs of the menstrual cycle, moods
are much more even.

Although in theory prolactin and oxytocin have a calming effect, and this may
be true for most women, there may be a minority for whom other factors, such
as the low estrogen, may have a stronger effect.  So, I don't think the fact
that one is true for most women negates experiences which may be different
for others.

I remember vividly, in my early days as a LLL Leader, giving phone support to
a woman who desperately wanted to breastfeed, yet ended up reluctantly
weaning at 6 months.  The fact that she held out that long was amazing.  She
had extreme insomnia, only sleeping one or two hours a night.  She had never
had insomnia in her life, had no psychiatric history, loved motherhood and
breastfeeding. She felt, understandably, that she was "on the edge" all the
time with such an extreme lack of sleep, was afraid she might harm herself or
her baby, just because of being so physically exhausted all the time. At the
time, I tried to assure her that the breastfeeding could not be the cause,
because of all we knew about prolactin and it's relaxing effect, right?
Everyone else she was in contact with, including her doctor, reassured her of
the same thing.  Yet when she very sadly decided to do a gradual weaning, she
reported that the night after she had totally weaned she had her first good
night's sleep.  I talked a lot to this woman and truly do not believe she had
any ambivalence about breastfeeding.  I feel sure this was an idiosyncratic,
physiological reaction and a form of postpartum depression.  I wish I had
known what I know now.  I would have tried to plug her in with a
breastfeeding-friendly therapist/psychiatrist who could have most likely
prescribed  a medication compatible with breastfeeding and the breastfeeding
could have been preserved.  But I'm not sure I could have found one at that
time.  I think as more women breastfeed and as we learn more, there are more
and more individual responses that don't fit the general rules.
Miriam Levitt RN, IBCLC

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