In honor of World Breastfeeding Week (even if it is almost over), I offer a post about breastfeeding, blame-the-kyriarchy style.
Perhaps you’ve been lucky enough to have missed this scenario, but I, at the intersection of those with lactating breasts and those with mental illness, have seen it far too often: a woman goes to her psychiatrist, generalist, family doctor, nurse practitioner, or psych nurse, for help with, oh, depression (postpartum or otherwise), or anxiety, or mood disorder, or sleep problem. Being a careful parent and a conscientious patient, she discloses that she is breastfeeding her child, so that she and her health care practitioner can find the healthiest, most appropriate medications for her (should they mutually decide medications are necessary).
This is when, in a sane society, her physician or nurse would nod, draw on hir vast knowledge of and experience with medications appropriate for breastfeeding, and say “No problem, that only rules out a very few classes of drugs, there are lots of things we can try still.” Or, barring that, would reach for the copy of Hale’s zie keeps handy in hir office, or would call one of the many breastfeeding-knowledgeable pharmacists zie keeps on file as references. The woman and the health care provider she employs would then work together to pick a medication most appropriate for her particular situation.
That is not what usually happens. Too often (ever would be too often), the physician, upon hearing said disclosure, automatically replies “I don’t want to give you anything until you wean/terminate breastfeeding/stop doing that.”
There is so much wrong with this situation, I hardly know where to start.
Do I start with the ignorance? How so very rarely is weaning actually necessary, in any situation, and even less often to treat most mental health issues? How the ignorance of a basic facet of women’s health is inherently misogynistic: how women are not a “special group”, lactation is not a “special case”, and we shouldn’t have to go to “specialists” to find a physician knowledgeable of the basics of care when we are engaged in a normal human biological function? To be ignorant of these things is inexcusable, and reflective of both systemic and individual misogyny, whether recognized or not.
Or do I start with the authoritarianism? With the assumption that the physician knows better — knows what they’re talking about for that matter! –, that what they “want” matters one whit in the face of a client coming to them for treatment of a specific issue, that they have the right to place ultimatums on the conditions under which their clients receive treatment? Paternalistic authoritarianism, whether coming from a man or a woman, dictating or denying the course of a woman’s treatment and what she can/’t do with her body, is always misogynistic.
Or do I simply rail against how *&^%ed up, how immoral and wrong-headed it is? How in fact damaging to a woman’s mental well-being it is to be denied her normal biological entwinement with her young, to be told she must chose between her own health and the health of her child? Do I describe the panic that ensues, the flight-or-fight reaction as her body is flooded with adrenaline, as she realizes the person across from her is not her ally but her enemy, her judge, the antagonistic gatekeeper blocking her from that which might make her well? Do I justifiably liken it to throwing gasoline on an already smoldering — or raging — firestorm of imbalanced brain chemicals?
I do think that we ought be cautious in what we expose our young to, especially when it has the potential to affect brain development, and I am the first in line to question the pervasive use of psychotropics, the first to encourage that other avenues of health and stability and sanity be pursued first, or at least simultaneously. I am the first in line to criticize the culture of “problem? pop a pill!”, the first to point out the downsides of many mental health medications — my own experiences with mood stabilizers and anti-depressants are far from flawless, and what finally made me sane was not the prescription I was handed first.
And I am jumping the line to be the first and loudest to proclaim how so many postpartum and parental mental health problems are the kyriarchy’s damn fault in the first place: how the isolation, the lack of tangible support, the dearth of family-friendly work options, the pitiful state of parental leave (in the USA at least), the antagonism toward breastfeeding in public, the burden of parenting placed solely on the “nuclear family” — and too often primarily if not exclusively on the woman within that unnatural unit –, all combine to create situations in which NOT experiencing postpartum mental health problems is more surprising than having them.
But this? This “I don’t want to give you anything until you wean”? That’s not a careful critique of the pharmacological industry, that’s not an intersectionalist examination of the role kyriarchy plays in the creation of women’s mental health issues, and it’s not a sober weighing of the balance of “greatest goods” when faced with exposing a child to an ill mother or minute quantities of probably-safe substances. No, that’s nothing more than an ignorant, authoritarian, fucked up, misogynistic ultimatum.
Breastfeeding is a feminist issue. This post isn’t about telling women what they should/n’t do, it isn’t about being a “breastfeeding zealot”, and it isn’t even a defense of medication during lactation (there are benefits and risks, and each woman — in consultation with knowledgeable health care providers — must weigh them for herself). It’s about saying that the way we talk about breastfeeding, drugs, and mental health needs to change. It’s about saying that this kind of comment is downright dangerous, because it discourages women from breastfeeding, it discourages women from getting help for their illnesses, and it supports the kyriarchy through misogyny — and thus damages all women, lactating or not.
I am lucky that I haven’t needed to go on medication during pregnancy, or while the Boychick is nursing. I have done many things, worked very hard, to achieve this, but I also know that I am, at the end, simply lucky. Maybe you were too. Or maybe you were another kind of lucky, and got a health care worker who helped you rather than hindered you. But too many women are slapped with this, too many women are lied too, too many women don’t have the knowledge or the spoons to counter this misogyny. And as long as any woman encounters this attitude, we all have a need — and a duty — to counter it.
Arwyn
In my bathroom hangs a plaque with a picture of a yin yang and the word BALANCE. I can never get it to hang straight. This probably says something deep and meaningful about my life.
…the first to encourage that other avenues of health and stability and sanity be pursued first, or at least simultaneously.
this was an important distinction my psychiatrist made to me when i first starting seeing him. meds are often the the quickest fix available, but they are not necessarily the most effective or complete. so you have to weigh your costs and benefits. in my situation, it made sense to start taking medication right away, so that at minimum, i would be able to function in everyday tasks without wanting to hide under the covers. it takes time and persistence to explore one’s particular mental illness, and figure out how to address it, and meds are no substitute for good psychotherapy, diet, and other more holistic treatments. but they are the fastest-acting.
i am with you in your outrage here. it took an immense amount of courage and willpower for me to just get out from under the covers and see a doctor. the last thing i would have wanted would have been for the doctor to say i could only be prescribed medication on the condition that [anything]. i never would have come back. and right then, it was vital that i did come back.
i have never had biological children, and even i know that it’s not all that easy just to “quit” breastfeeding, even if you wanted to, and moreover, as you say, why on earth should that be a doctor’s first recommendation? sure, there is a reason why doctors have that MD. they have knowledge and experience that qualifies them for that title (or should, anyway). but a good psychiatrist will work within the confines of a patient’s situation (including, but certainly not limited to, breastfeeding), not demand that the patient change his or her situation before treatment is given.
I wanted to pitch in my two cents on this topic. Doctors do not have the pharmaceutical training that your pharmacist does. If your doctor doesn’t have the knowledge that is required to help you try your neighborhood pharmacist. Mine is wonderful, they can often recommend cheaper and/or over the counter remedies that your doctor will never have heard of. A doctor usually has only one or two classes in their entire schooling of drugs and the rest is supplied by pharmaceutical companies. Your neighborhood pharmacist is an untapped resource that many people ignore becuase the chains have made them seem distand, clinical and unfriendly. Try going to one of the smaller places and have a real discussion with them about your troubles, it can’t hurt to try and it might really help.
I hope this helps some of the frustrated people out there.
Bev: I agree that pharmacists can be a great resource for medication advice in general, but I’m really surprised by something else you said – that doctors only have one or two classes in drugs in their time at medical school. If you’re getting follow-ups from this, could you give me your source for that? I had regular lectures in pharmacology over the course of a year, covering all kinds of subjects, and, while I know obviously I only went to one medical school and they’ll all have different timetables, I would be absolutely astonished if *any* medical schools (let alone the majority) gave so little teaching on such a crucial subject. It would be like a medical school that didn’t teach anatomy or physiology. Of course, maybe I’m wrong – fire ahead and astonish me.
The rush to wean babies before prescribing medications particularly concerns me because a sudden weaning can do a number on a woman’s hormones, as well as lead to mastitis and other physical problems. Surely the very LAST thing that a mom needs when she’s battling mental health issues is yet another problem.
It also concerns because, certainly, the small or completely non-existent risks associated with a breastfeeding mother taking medication are still much smaller than the risks of not breastfeeding. A switch to formula isn’t healthier for the infant, and denying the nursing pair something that is probably of great comfort to both of them at a very difficult time is emotionally damaging.
I am so with you on this one, Arwyn. So with you.
I don’t have a lot to add to this but I wanted to say thank you for posting about this issue. I’m seven months into my first pregnancy at 22 and I was diagnosed with bipolar disorder at 15. I’ve been struggling with it since then (although, that’s not to say I wasn’t struggling with it before the diagnoses) and have gone through a lot of different therapists, counselors, doctors and advice but in the last seven months what I’ve heard the most is, “We can’t help you if you choose to breast feed.” This has been the scariest experience of my life as I’ve dealt with my fears about losing control and becoming suicidal, the risk I would pose to myself and my child and dealing with an “invisible” problem that my family, particularly the father’s family, doesn’t know how to address. (The baby’s father’s family hasn’t really seen me off medication before and has never had to deal too closely with my varying emotional states but because of living circumstances they’ve had it thrust upon them rather suddenly, which I wish hadn’t been necessary.) I don’t want the choice of breast feeding to be taken away from me but I want to be a responsible mother and part of that is dealing with my own problems. I hope that I can find a professional who will be able to help me but in the meantime I’m going to keep this post close to my heart.
Sybil,
I so, so hope you can find a sane team of health professionals to help you. There is simply no excuse for being given the choice between breastfeeding and being medicated. There are mood stabilizers, anti-depressants, anti-anxiety meds, and even (I believe) anti-psychotics that are compatible with breastfeeding — of course we can’t know whether they’ll work for you ahead of time, but there is so much out there worth trying. Get your hands on a copy of Hale’s (try La Leche League, or your local breastfeeding support group, lactation consultants, lactation clinics, etc), or try contacting Dr Jack Newman (I hear he’s wonderful at replying to his emails with very helpful information); whatever it takes to get the information you need to work with your providers. Don’t take no for an answer.
If there is anything more I can do to help, please don’t hesitate to let me know.
After being off my medication throughout the pregnancy, I realized that, at three months postpartum, I needed to go back onto the medication which I have been on since I was 18 (12 years!). Other things work too, but the medication is like the baseline to build on and I was becoming more and more low functioning and miserable without it. My regular doctor wasn’t in and it had gotten semi-urgent so I saw a substitute. Such a big mistake. He was terrible in so many ways, but told me, “Oh, breastfeeding is only important in the first two weeks. So I assume you will switch to formula. We don’t know what the medication could do to your baby, so we should err on the side of caution.” I was, of course, SPEECHLESS. There were so many terrible things about that statement, it is hardly even comprehendable how a medically trained professional who is supposed to SPECIALIZE in mental illness and who is a DOCTOR could say so many wrong things at once. Of course, I ignored him and now I am taking a low dosage of my medication, feeling better, and, of course, still breastfeeding my five month old who I will breastfeed for at least another seven months if not nineteen months depending on how it goes
Thanks for your great blog, as always.
Oh mercy, mercy, I’ve been there.
It absolutely amazes me how otherwise thoroughly competent providers can suddenly turn into authoritarian dimwits once a woman has HcG in her bloodstream. Not just general practitioners, but psychiatric specialists as well. Amazing.
I was told pre-pregnancy that “If you need to use formula, it’s no big deal.” Maybe to you it’s not, but to me? Huge deal, peeps.
I was also in the interesting position of being on lithium (a truly toxic drug) when I conceived. I spontaneously decided to flush it all down the toilet a week later (we did have a fetal echocardiogram for peace of mind at 20 weeks — my girl was fine).
However, for the first *six months* of my pregnancy, I had no meds management, whatsoever (this after going off some pretty heavy duty prescriptions). This was not for lack of trying, let me tell you. I fought for that entire six months to get supervision from someone who would respect my birth choices. Nearly every person I spoke with (including the staff of a psych clinic widely respected as the best in our area for pregnant moms/those with PPD!) refused to prescribe for me unless I did a hospital birth with an OB. Apparently, “psychiatric history” equalled “super high risk pregnancy” in their minds, even though I already had a working relationship with licensed midwives who were MORE than happy to collaborate on care.
Guess what? By the end of those six months, I had gone from proud of myself and doing well to seriously depressed again. Thankfully, I found a psychiatric nurse practitioner who was not an idiot, who thought breastfeeding rocked, and was honest with me about the fact that there *is* a small chance of withdrawal symptoms in infants. She was sensible enough to concede, however, that the risks of me not being medicated were far greater than those of the medication, and I went on some low-dose SSRIs until my daughter was about 8 months old, and it was all good. (My daughter also went on to nurse for another year-plus after that, and has had no issues whatsoever. We used to joke that she was so mellow because of the Zoloft, but it’s just her temperament.)
Happy ending, sure, but it took months of hell (I went and sat in an ER once, and said “I’m not leaving until you give me an outpatient appointment” — never got one). Physician attitudes towards natural birth are bad enough, but attitudes towards pregnant patients with mood disorders? Draconian.
Thank you for this post. At BestforBabes we call doctors like this one of the “booby traps” that keep women from succeeding at beastfeeding. We are working hard to put pressure on the barriers to bfdng, not moms! It would also be great if moms who really can not nurse while taking a certain med had the option of screened, donated, pasteurized human milk.
Yes, yes, yes. I <3 you Arwyn! Will you come throw a copy of Hale's at my doctor for me? Or come with me while I do it?
Yes, yes, yes! I <3 you, Arwyn!
Partly I blame the CYA culture in medicine, especially where infants are concerned. Doctors get worried that if something goes wrong, they’ll be sued for a lifetime of care for a damaged child. It certainly requires a *relationship* with a trusted professional, whether that is a family doctor, a midwife, a psychiatrist, a pharmacist, a nurse-practitioner, or other. Someone who knows and gets your desires and beliefs and needs, and is willing to work with you. Such a relationship takes time to build, something that is not well compensated in our current medical culture, and which time may not be available in a crisis.
Oh my freaking God! You have NO IDEA how timely this post is for me. I have been racking my bloody brain trying to figure out what to write my entrance essay on for my application for Masters in Psychiatric Social Work and HERE IT IS! I thought I was going to have to focus on Addictions and work with herion addicts shooting smack into new veins in their swollen bellies. I’m way too sensitive for that. I’d go home and cry every night But THIS! This I can DO! My background is in mental health and breastfeeding education. I’m passionate about both but haven’t been able to think of a way to marry the two. I KNEW I was having a mental block! I couldn’t get past the fact that working with pregnant/breastfeeding women with schizophrenia was too small a niche to get hired anywhere, but DUH! There are a lot of other mental illnesses. I can use my no fear of standing up to/working respectfully with psychiatrists to ensure that breastfeeding moms get proper treatment by informed health care workers. I can keep tabs on ALL mental health clients so I know who’s pregnant or a new mom and Bob’s my uncle! Jeepers! THANK YOU for unblocking my I’m-a-mother-so -I-can’t-think-straight-sometimes brain.
Equally egregious is doctors deciding a breastfeeding mother needs medication, but instead of bothering to look up what’s safe, they prescribe something that can’t be taken while breastfeeding and then don’t bother telling her until after she’s bought them. Or leaving it to the pharmacist and the product insert to let her know.
I am SO glad I found a family practice doc who had breastfed her own baby to take care of me and Isaac, and that my depression is fairly simple to treat!
What burns me the most is doctors and pharmacists who practice CYA medicine instead of just looking it up! Granted not many of them have Hale’s book, but it’s a RARE health care professional who doesn’t have internet access (heck, most of them have an Iphone or other gizmo in their pocket!) and the NIH’s lact med database is availabkle FREE and ONLINE, and the National Institutes of Health ought to be a respected enough source for even the most conservative of doctor’s! (If you want to look up your meds yourself, I find that I have better luck with the generic/chemical name than the drug name, bupropion for wellbutrin, acetaminophin for tylenol, etc) the link is http://toxnet.nlm.nih.gov/
I’m happy to say that I’ve had nothing but a good experience with both my psychiatrist and my pediatrician when it comes to medication while nursing. I am 45 years old with an 8 month old (my 4th child). I guess I’m one of the lucky few.
[...] The misogyny of denying milk-making moms mental-health medication [...]
[...] I eventually got stable — mostly through my own hard work — and found someone to oversee my weaning off the medications. In the end, I was able to go through pregnancy and breastfeeding without any of the drugs the doctor who had betrayed me said he would deny me. But if I had needed pharmaceutical assistance — or, to be more honest, if I had admitted I needed more help than I had — I had no one to turn to. I would have had to start anew, and overcome the aversion I learned on that day years before, try to learn to trust again while struggling with postpartum neurology and new life with a neonate. And all because of an off-hand assertion by a psychiatrist ignorant of normal physiology and human development, of the risks of formula and the damage of denying a woman’s right to breastfeed. [...]