North Dakota Nurse - April 2021

April, May, June 2021 The North Dakota Nurse Page 13
Breastfeeding and Postpartum Depression
Appraised by:
Olivia Dietrich SN, Shayla Heger SN, Elisa Johnson SN, Sierra Peters SN,
and Shanae Wentz SN (NDSU School of Nursing at Sanford Bismarck)
Allison Sadowsky MSN, RN Assistant Professor of Practice (Faculty)
Clinical Question:
In postpartum women, what is the effect of breastfeeding on
postpartum depression compared with not breastfeeding?
Sources of Evidence:
Brown, A., Rance, J., & Bennett, P. (2016). Understanding the relationship
between breastfeeding and postnatal depression: the role of pain and
physical difficulties. Journal of Advanced Nursing (John Wiley & Sons, Inc.),
72(2), 273–282.
Borra, C., Iacovou, M., & Sevilla, A. (2015). New Evidence on Breastfeeding
and Postpartum Depression: The Importance of Understanding Women’s
Intentions. Maternal & Child Health Journal, 19(4), 897–907.
Farías-Antúnez, S., Santos, I. S., Matijasevich, A., & Barros, A. J. (2020). Maternal
mood symptoms in pregnancy and postpartum depression: Association
with exclusive breastfeeding in a population-based birth cohort. Social
Psychiatry and Psychiatric Epidemiology, 55(5), 635-643. doi:10.1007/s00127-
019-01827-2
Haga, S. M., Lisøy, C., Drozd, F., Valla, L., & Slinning, K. (2018). A population-based
study of the relationship between perinatal depressive symptoms and
breastfeeding: a cross-lagged panel study. Archives of Women’s Mental
Health, 21(2), 235–242.
Hahn-Holbrook, J., Haselton, M., Dunkel Schetter, C., & Glynn, L. (2013).
Does breastfeeding offer protection against maternal depressive
symptomatology? Archives of Women’s Mental Health, 16(5), 411–422
Synthesis of Evidence:
To answer our PICO question, we searched for high quality research
articles that studied the effects of breastfeeding on postpartum
depression. We selected five articles to review as evidence in this report:
a cross-sectional self-report survey, correlational study, two quantitative
longitudinal studies, a cohort study, and a cross-lagged panel study. Our
main findings from these articles will be summarized below.
Brown, Rance and Bennet (2016) was a cross-sectional self-report
survey correlation study done to examine the relationship between
specific reasons for stopping breastfeeding and depressive symptoms
in the postnatal period. The study was done on 217 of 502 mothers in
South West Wales, UK who had initiated breastfeeding at birth, but
were no longer breastfeeding at the time of the survey. The survey
examined many reasons for stopping breastfeeding. The mothers also
used the Edinburgh postnatal depression scale. The findings showed that
breastfeeding duration and multiple reasons for stopping breastfeeding
were associated with a high depression score. There was a strong
negative correlation with longer breastfeeding durations and lower EPDS
scores. There was also a significant negative correlation seen between
age of stopping breastfeeding and reports of physical difficulty, pain,
lack of support, embarrassment, and pressure from others to stop.
However in regression analysis only the specific reasons of stopping
breastfeeding for physical difficulty and pain remained predictive of
depression score.
Borra, Iacovou, and Sevilla (2013) conducted a longitudinal
quantitative study. The study was conducted to examine the effects
of breastfeeding on postpartum depression (PPD) using data from
the Avon Longitudinal Study of Parents and Children. Mothers were
recruited into the survey by doctors, at the point when the pregnancy
was first reported. This study included 14,541 pregnancies which resulted
in 14,676 known fetuses, 14,062 live births, and 13,988 babies surviving to
one year. They assessed mother’s intentions on breastfeeding along with
depression screenings at 18 and 32 weeks' gestation and postnatally at 8
months, 18 months, and 33 months. The results of the study conclude that
in mothers that were not depressed during pregnancy and planned on
breastfeeding and went on to do so, the risk of postpartum depression
was decreased. However, if mothers were not able to breastfeed as
planned, the risks of PPD increased.
Farías-Antúnez, Santos, Matijasevich, and Barros (2020) conducted
a cohort study that aimed to evaluate the association between mood
symptoms during pregnancy and exclusive breastfeeding at three
months, as well as the association between exclusive breastfeeding at
three months and maternal depression at 12 months. The study included
4231 mothers with babies born in 2004 who were choosing to breastfeed
or not breastfeed. The mothers filled out questionnaires with information
about their demographics, socioeconomic status, and obstetric history.
Additionally, they had mothers complete the Edinburgh Postnatal
Depression Scale (EPDS) which is a questionnaire that assessed the
intensity of mother’s depressive symptoms in the preceding seven days
which was filled out at 12 months. The results found that mothers who
exclusively breastfed until three months had a 19% decrease in the risk of
depression at 12 months postpartum, compared to those that stopped
exclusively breastfeeding before three months postpartum.
Haga et al (2018) is a cross-lagged panel study based on a Norwegian
population based prospective study. This study was conducted to test
the relationship between depressive symptoms and breastfeeding over
time, from pregnancy throughout the first year postpartum. There were
1,396 pregnant women who participated in this study. These women
were receiving prenatal and/or postpartum care at nine well-baby
clinics in different Norwegian municipalities. The main finding from this
study was that breastfeeding did not have an influence on postpartum
depressive symptoms Thus, more research is needed to determine what
influences postpartum depressive symptoms.
Hahn-Holbrook et. al. (2013) conducted a longitudinal quantitative
study to explore the relationship between breastfeeding and
depression. 205 pregnant/postpartum women participated in this
study. They assessed depressive symptomatology using the Center
for Epidemiological Studies Depression Scale five times during their
pregnancy and at 3, 6, 12, and 24 months after birth using the Edinburgh
Postnatal Depression Scale. The study found that women who breastfeed
more frequently at three months postpartum showed less symptoms of
depression than women who breastfeed less frequently at three months.
Conclusions:
Of the five articles reviewed, four of them found that breastfeeding
does reduce postpartum depression. However, the article from Haga et.
al (2018) found that there is no correlation between breastfeeding and
postpartum depression, but suggested that further research is needed.
All of the articles support breastfeeding as the preferred method of
feeding as there are many benefits to both mom and baby.
Implications for Nursing Practice:
As nurses we always try to promote breastfeeding because we know
that it is best for the baby and also benefits the mom. Knowing that there
is an increased risk for depression when mothers stop breastfeeding,
we need to assess and encourage mothers to continue and help in
times of difficulties. Specific support needs to be directed towards
helping mothers experiencing pain and/or physical difficulties. By
providing education on outside support groups, lactation consultants,
and breastfeeding experts, it encourages prolonged breastfeeding
experience. Outcomes can differ depending on the mother's mental
health status before, during, and after pregnancy. Research also
suggests that the duration and frequency of breastfeeding can affect
the outcomes of postpartum depression.