Breastfeeding and medication

Recently, I was talking to someone on Twitter about breastfeeding on (and after) antidepressants, and it hit me once again how big a role breastfeeding can play in a woman's decision whether or not to seek treatment for PPMD. For me, among other fears (such as my child being taken away from me), I was so far into the whole "Breast is best" mindset that, when the filter of PPMD was added to the mix, the idea of having to stop breastfeeding my baby was horrifying and extremely upsetting. Concern over having to stop nursing is one that I frequently hear/see brought up and it is totally understandable.

I have written a couple of blog posts in the past about why Breast is not always best (part 1 and part 2). That is not going to be my focus for this blog post. In this post, I'm just going to share what my personal experiences have been with breastfeeding and medication.

When I was admitted to the hospital with a diagnosis of Postpartum Depression, my baby was 3 months old and exclusively breastfed. I had held off on getting help but finally realized I was at a crisis point and went to the ER, where I was transferred and admitted to a psychiatric facility. Because I specifically didn't want to have to stop nursing my baby, we tried talk therapy for the first day or two, but I could hardly even open up about how I was feeling and we quickly realized that medication was necessary. They started me on Lexapro (I was soon switched to Celexa, a generic version, for Insurance reasons), Ativan, and Ambien, which are not considered "safe for breastfeeding", so I had to stop nursing. I was extremely upset, but accepted that if I wanted to get better, this was what needed to happen. My baby did fine switching over to formula and the only discomfort was on my end because I stopped nursing/pumping cold turkey (ow, ow, ow). 5 years down the road, my daughter is extremely smart and well-adjusted, and we continued to bond very nicely. Actually, I think we bonded better because I was on medication and was able to connect better (I definitely remember the connection better after starting medication).

That first admission, diagnosis, and start of medication were in July 2009. At the beginning of December 2009, I was diagnosed with hypothyroidism (my doctors had previously missed it, but that is a whole different story for another time). Pregnancy can cause hypothyroidism, and hypothyroidism can cause mental and emotional health problems. I was promptly started on a low dose of Levothyroxine, a thyroid hormone replacement medication, and started to see my symptoms lessening pretty immediately. My dosage only had to be adjusted once to get my TSH and T4 levels back to within normal limits, and that also kicked the rest of the PPMD symptoms. After 3 months of Levothyroxine, I was able to stop taking the Celexa, Ativan, and Ambien that I had been on since July, and all was well.

I have been on this same dosage of Levothyroxine for 5 1/2 years now and it has never needed adjusting. During my pregnancies, the OB monitors my thyroid levels with bloodwork once a trimester (more often if I start experiencing anything unexplained  that could be symptoms of my thyroid medication needing an adjustment), but so far everything has been fine.

In April 2011, I gave birth to our second baby. Even though we were sure the PPMD had been related to the hypothyroidism, at my midwife's recommendation, I started taking Zoloft at 38 weeks pregnant (read what the Mayo Clinic has to say about antidepressants during pregnancy) as a prophylactic measure, and weaned off of it at about 6 or 7 months postpartum. This was shortly before finding out that, much to my shock and attempts to prevent pregnancy, I had another bun in the oven.

That second baby nursed through Zoloft, Levothyroxine, and the first two trimesters of my third pregnancy. She finally weaned herself at about 13 months. I was about to force her to wean since she had started biting (yay for teething). Let me tell you, I thought getting a tooth to the boob was painful enough under normal circumstances but with pregnancy making the girls extra tender? Yeeeeeeeeah.... "ow" doesn't quite do it justice. But, at that point she was down to usually only nursing in the middle of the night and she weaned herself, so it all worked out happily for both of us.

I started on Zoloft again at about 35 weeks with my third pregnancy. The original plan was to wait until 38 weeks again but I had some symptoms of depression and anxiety that were due to situations that were going on totally unrelated to pregnancy and we thought it best to start the Zoloft a little early. Baby #3 was born in September 2012. I was able to come off the Zoloft at about 3 or 4 months postpartum that time, again with no issues. The only issues I had were when I started using the Nuva Ring and got super tired (plus some intrusive thoughts) but that all went away when I discontinued the Ring. Baby #3 was EBF until I started school fulltime when he was ~4.5 months old. At that point, I got a good double electric breast pump and started pumping so that he got exclusively breastmilk at daycare and EBF when he was with me. With my school schedule and everything else going on in life, the pumping got to be a bit too much and eventually I stopped pumping; he got formula at daycare and breastfed when I was around. He self-weaned at 9 months.

I've done a wide range of options for feeding my children. Exclusively breastfed, Formula fed, breastfed through pregnancy and a little past the first year mark, breastfed plus breastmilk in a bottle, and breastfed plus formula. I've nursed on different medications and off of them. There is no shame or failure in any of these methods that I chose to feed my children. At the end of the day, what matters the most isn't *how* I fed my babies but *that* I fed them.

My experiences and feelings may not be yours. I can not say what is right or wrong for you and your family, aside from telling you that taking care of yourself is absolutely right, and that anyone who looks down on or tries to shame you for how you feed your children is 100% wrong. What I can tell you is that you are a good mother no matter what method (or combination of methods) you choose to feed your baby[ies]. In order to take care of others, we have to take care of ourselves first and practice radical self respect. Self-care is vital to not only our own well-being but the well-being of our babies and our families.

Whatever your choice, make it and don't let anyone get you down. If they want to say that they don't approve or agree or whatever, you feel free to send them on over to me and I'll gladly have a friendly chat with them.

Breast is not always best, part 2.

Note: I'd like to refer everyone to a post I wrote a couple of months ago about the fact that there are antidepressants you can take while breastfeeding.


In a previous post, I wrote about why Breast is not alwaysbest. Today, I’d like to discuss a specific facet of that.

Usually, people who espouse the idea that Breast Is Always Best will acknowledge that “Of course this doesn’t extend to women with legitimate medical issues”. Here’s the problem that I often see: these people will either not truly acknowledge PostPartum Depression as a legitimate medical problem, or the women with PPD will not realize that they fall inside this criteria and will still succumb to the guilt of “If I get help and have to stop nursing my baby because of medications, I am not doing what is best for my baby”, thus either prolonging the time they go without treatment or, if they do seek treatment, adding unnecessary guilt which may make it even harder to deal with the PPD. Also, when women give a reason other than a “legitimate medical problem”, they are dismissed and scorned as “selfish”. What those doing the dismissing too often fail to take into consideration is that the new mother may in fact have something like PPD going on below the surface that they either don’t realize or don’t want to talk about it.

Even if there is no medical problem, again, if they just do not want to nurse, they should not be made to feel guilty for that. As I stated in my previous post, a woman who breastfeeds due to pressure and guilt, despite not wanting to for her own reasons, may end up suffering negative repercussions such as difficulty bonding, depression, and a host of other problems.

We need to get away from this idea that the only acceptable reason to not breastfeed is to have a “legitimate medical problem”. We need to realize that using this terminology and pushing this mindset may cause those very problems. Who are we to decide what constitutes a “legitimate” reason to make a particular non-life threatening choice?

Of all the issues that we could be devoting our time and energy to, we choose to spend it on judging women for why they choose to feed their child a certain way? As I’ve said before, by all means, let’s educate people about the benefits that breastfeeding can give to both mother and and baby; benefits such as passing along to the baby the mother’s immunities, reducing the mother’s risk of cancer, assisting the mother with weight-loss, the fact that breastmilk contains/helps the baby develop pro-biotics and pre-biotics, and many other positive benefits and side-effects . But please, let’s do so in a manner that makes the mother feel empowered to make an educated choice as to what she feels is best for her and her baby and family, rather than feeling judged for making her choice, a manner that does not add to the stigma, myths, and problems that women with PPD (and their families) already face.

Breast is NOT always best

Note: I'd like to refer everyone to a post I wrote a couple of months ago about the fact that there ARE antidepressants you can take while breastfeeding.


In today’s society, there is a HUGE push towards promoting breastfeeding for babies. The phrase/idea that “Breast is always best” gets thrown around a lot. We say things like “Women who don’t breastfeed are selfish” or “If she cared about her baby, she would breastfeed” or “When I have a patient who chooses not to breastfeed, I walk out of the room muttering ‘Selfish bitch’ under my breath and I hope her uterus falls out”. And yes, I have heard/seen ALL of these things said, the latter was actually by a nurse/lactation educator who was “venting” on a Facebook group). All of these phrases are tossed about in the interests of promoting the health of the new mothers and babies, we are passionate about their health, but we don’t really think about the effect that our passion and our well-intentioned phrases/attitudes and militant campaigns can have on the health of those we say we care about. The saying “The road to hell is paved with good intentions” applies all too well.

Now, before I go any farther, let me say that I am a HUGE supporter of breastfeeding. I breastfed my first until she was three months old and only stopped because I had to go on antidepressants to treat my PostPartum Depression. I had every intention before that of nursing her as long as she wanted to. I breastfed my second until she weaned herself at 13 months old; that was through the first and most of the second trimester of my current (third) pregnancy. She weaned HERSELF. Now granted, I was just about ready to start weaning her because nursing a child with teeth who used my poor breast as her teething ring was decidedly uncomfortable (especially since they were more tender than normal thanks to pregnancy) and because nursing plus pregnancy was taking a toll on me. But, she ended up weaning herself without any action on my part and I don’t regret one second of letting her nurse for that long and/or through that much of my pregnancy. When I was planning on going back to work (before the Army moved us away from my job), I had planned on pumping. I nurse in public, with or without a cover (and yes, I am still discreet and modest if I am nursing without a cover; you’re probably going to see more boob/cleavange/skin in a Victoria’s Secret ad, at the pool or beach, or even just glancing at someone in anything other than a turtleneck than when I nurse). I don’t think women should feel like they have to go to the restaurant bathroom to breastfeed (how about you take your dinner in there to eat first before suggesting I make my baby eat in a public restroom). I fully believe that there are health benefits to both mother and baby that can only be obtained through nursing/pumping, and that those benefits still occur when nursing beyond the first year. I wish that more pediatricians would truly support mothers who breastfeed instead of being so quick to throw formula samples at them and tell them they need to supplement with formula (no, not all doctors do this, but I personally have known doctors who did, and women whose doctors did this, and it sabotaged their nursing efforts).

Now that we have established that I am very much pro-breastfeeding, let’s establish something else: breast is not always best.

Let that sink in for a second. Breast. Is. Not. Always. Best.

The goal of the “Breast is best” movement is supposed to be promoting the health and well-being of both mother and baby, but what too many breastfeeding advocates who espouse this mindset and embrace this saying fail to take into account is that the health and well-being of mom and babe includes more than just physical health, it also includes mental and emotional health, both of which can be influenced by the decisions a new mother makes (or feels pressured to make) regarding or revolving round breastfeeding.

“Breast is always best” can - and often does – cause a new mother to feel that if she feeds her baby formula instead of breast-milk, she is doing wrong by them. It can cause a huge amount of guilt and a great deal of pressure to continue breastfeeding her baby, no matter what. This can cause her to feel that she cannot (and/or should not) seek help for PPD. It can also cause a huge amount of unnecessary guilt if she does get treatment and has to stop nursing her baby. It did in me.

One of the reasons why I put off seeking help for my PPD more actively until the night it got to a crisis point was because I felt that if I got help, I would surely be put on medication that would mean I had to stop nursing, and I couldn’t do that because breast is best. Once I did get help, I ended up having to take Lexapro and, sure enough, I had to stop nursing my daughter because the medication was not something that was safe for her to get through my breast-milk. I can’t even describe how much guilt I felt over this. I already felt a lot of guilt and felt like a failure just over having PPD and being hospitalized in the first place. I felt that it made me less of a woman and that I was not the mother I should have been, that if I were a better woman and better mother I would have been able to “shake it off”. The additional guilt I felt over having to give my baby a food source that was “sub-par” and was clearly less than the best for her made it that much harder to deal with the emotional and mental turmoil I was already fighting.

What I have come to realize since then is that what is truly best for my baby is for me to be in good health and for me to take care of myself, and that most certainly includes doing what I need to do to take care of my mental health. If a new mom has PPD, it’s not in anyone’s best interests for her to ignore it and continue breastfeeding at the detriment of her mental health all in the name of “breast is best”. It can actually have long-term negative effects on her, her baby, and her whole family if she forces herself to continue breastfeeding at the expense of seeking treatment for a legitimate medical issue.

This does not just extend to women who are struggling with a PostPartum Mood Disorder. Some women, for whatever reasons of their own, don’t want to breastfeed or don’t feel comfortable breastfeeding. And you know what? That’s okay. As with everything else surrounding non-life threatening parenting decisions, as long as they are making a well-informed and educated decision, that’s perfectly acceptable. What is NOT acceptable is to try to bully, badger, and guilt them into breastfeeding anyways. Here’s the deal: if a woman breastfeeds despite a strong desire not to, it CAN cause trouble bonding and cause her to feel resentment towards her baby and herself. As with a mother who breastfeeds at the expense of seeking medical treatment for a PPMD, this can cause lasting negative effects for her, her baby, and her entire family.

I understand that those who push so hard for breastfeeding are for the most part (I won’t speak for everyone) just trying to make sure that new moms and their babies are taken care of and educated. I commend that, I really do. But we as a breastfeeding community have got to realize that our militant efforts are doing the exact opposite of what we are trying for, we are hurting fragile women and children. Being militant is getting us nowhere good, it is only giving us a reputation for being stubborn (in a bad way), obnoxious, and putting down those who choose/feel differently than we do. We talk long and loud about how judgmental people are of us when we choose to breastfeed in public, and then we turn around and do the same thing in judging women who choose not to breastfeed at all.

The choice of how to best care for and feed our babies belongs to each of us and it is a deeply personal decision. We need to respect that and respect that there are women who, for whatever reason of their own, are going to choose to give their babies formula. We need to realize how much unnecessary guilt we are piling on these women and STOP IT. The last thing a mother with PostPartum Depression needs on top of all the negative emotions and thoughts she’s having because of her PPD is to also feel guilty about switching her child to formula. It can do irreparable damage to her to feel this way. I don’t know any breastfeeding advocates who intentionally set out to make women like me feel bad but the sad truth is that it does.

So please, the next time you’re about to start off about how “Breast is always best” and “Women who don’t breastfeed are selfish”, don’t. If your goal is education, educate (gently). Talk about the studies and facts showing the health benefits to both a nursing mother and her baby, but leave the platitudes and catch-phrases where they belong: unspoken. And don’t just be careful with your words, make sure your demeanor and attitude are also non-judgmental.

Breast is not always best. What is always best is for a mother to feel empowered, able, and confident in making decisions that she feels will best take care of her, her baby, and her family. What is always best is for a baby to be fed, nurtured, loved, and cared for. And you know what? Sometimes, that’s going to mean choosing formula over breast-milk.