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Breastfeeding And Mental Health – Interview with Dr Wong Boh Boi

For first-time mums, breastfeeding can be a monumental yet challenging journey, with so many stories surfacing here and there. Some simply breeze into the whole experience while others, not so, and some are entirely not able to.
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By Seraphina Khoo
May 25, 2021

Take heart; you’re not alone, and if you decide to go down the breastfeeding path, don’t be shy to seek advice when things do not go smoothly. While breastfeeding is a natural process, it does not always come naturally.  A lactation consultant can be a valuable resource for first-time mums, especially as they can help navigate any possible challenges associated with breastfeeding your little one, such as getting the proper latch or dealing with sore nipples.

Aside from physical challenges, studies have shown that there’s a direct correlation between breastfeeding and maternal mental and emotional health. According to an academic review on the impact of maternal anxiety on breastfeeding outcomes, “prenatal and postpartum anxiety may impair maternal functioning and disrupt mother-infant behaviours including breastfeeding.” A good breastfeeding experience can do wonders for a mum’s well-being; however, a difficult one does otherwise. 

We asked lactation expert and well-known baby whisperer Dr Wong Boh Boi, to share her views on breastfeeding and address Dysphoric Milk Ejection Reflex (D-MER) – an uncommon condition where mums can experience a surge of negative emotions immediately before breastfeeding. With over 30 years of experience in lactation consultancy, antenatal and baby care, Dr Wong also dishes out invaluable advice on how mums can cope with the pressures of breastfeeding.

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Dr Wong Boh Boi, Lactation Expert, Baby Whisperer, and founder of Wong Boh Boi Pte Ltd, with over 30 years of experience in lactation consultancy, antenatal and baby care. Photo Credit: Wong Boh Boi Pte Ltd

1. From your personal and professional experiences, what are the advantages of breastfeeding?

Breastfeeding brings with it many benefits for both mum and baby. It can lower the risk of osteoporosis. When lactating, your body is more efficient at absorbing calcium. This means that even though your spine and hip bones may be less dense at weaning, they will eventually be denser than what they were before pregnancy, effectively lowering your risk of osteoporosis during menopause.

Breastfeeding can also enhance the bond with your baby. This is by far one of the biggest benefits of breastfeeding your baby. You get to enjoy moments of intimate bonding that cannot be experienced in any other place. As your baby breastfeeds, the two of you exchange looks, cuddles, and communicate with each other. Watching your baby grow on your breast milk is going to give you a deep feeling of fulfilment, more than you’ve ever experienced.

It is also a great way to lose weight gained during pregnancy Milk production can burn up to 500 calories a day. Therefore, you are going to have an easy time losing pregnancy weight if you are breastfeeding.

2. In your opinion, are there any disadvantages at all of breastfeeding?

The disadvantages for breastfeeding are more annoyances than anything. The main ones that get brought up include the discomfort involved with breastfeeding. When you first start breastfeeding, you may experience sore nipples. For the entirety of your breastfeeding endeavours, your breasts may feel swollen or engorged.

Similarly, you may leak milk at times which can be inconvenient or embarrassing if you are not prepared for this properly. When the baby cries, you almost immediately start producing milk. The best way to combat this would be to use an efficient breast pump so that the excess milk does not go to waste.

3. Under what circumstances would you recommend switching to formula-feeding instead of breastfeeding?

Generally, breastfeeding is regarded as the best nutrition option, but breastfeeding may not be possible for all women. For many, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical situations.

Breastfeeding can be very taxing on the body and mind. The added lack of sleep and bodily challenges of breastfeeding can increase the likelihood that of postpartum depression. If it is truly a stressor in one’s life, then I would recommend switching.

However, I would still wholly recommend breastfeeding if possible. With numerous advances in this area such as with electric breast pumps, it has never been more comfortable. My recommendation is to try to explore all options here before deciding to switch to formula.

4. What are the top 3 most common problems that mums face when they start breastfeeding?

Ensuring they are fully prepared for it, mentally and materially. This would include having all the equipment for their breastfeeding journey, such as nursing bras and a reliable, efficient breast pump. Additional problems would be dealing with having sore nipples and other possible complications like low milk supply and ensuring that baby has a good latch when breastfeeding.

5. In Singapore, do you think that there is pressure for mums to solely breastfeed their baby?

I think this pressure radiates across the globe. Mothers are seen as being sole providers for their children, especially concerning their nourishment and health. There is still a negative stigma attached to when a mother cannot breastfeed, which is a relatively common condition. Inversely it is also interesting to note that although breastfeeding is becoming more generally accepted in the public sphere, there is still a stigma attached to the act of breastfeeding.

6. Do you think there’s a direct correlation between successful breastfeeding and a mum’s mental & emotional health?

There can be an excessive drop in mothers’ dopamine levels during breastfeeding, which may lead to a wide range of symptoms such as anxiety, anger, and self-loathing. Breastfeeding does not damage a mother’s mental health, and in fact, it usually has positive effects on it. However, a negative aspect of breastfeeding would be the physical discomfort from it, such as back pain from awkward positioning of the baby or bruising and soreness of nipples from a shallow latching. Similarly, mothers may also get Carpal Tunnel syndrome due to strained wrists from when they are not holding their babies with the right technique.

There are times when a mother’s negative experience snowballs and worsens their future breastfeeding experiences, which can lead to anxiety where they dread their next feeding. A mother in pain or being tense can affect her milk supply and breastfeeding process, where her baby can also sense her mood and may react negatively towards it. Mothers should never forget that their confidence plays a significant factor in successful breastfeeding.

7. What about breastfeeding and postpartum depression (PPD)? Is there a connection?

8. What are your thoughts about Dysphoric Milk Ejection Reflex (D-MER)? There has been little research on this, but there are cases of mums who face the full brunt of it.

Dysphoric Milk Ejection Reflex (D-MER) is a condition where negative emotions or feelings may come suddenly. This occurs to some women before their milk is released during breastfeeding, and it typically continues for not more than a few minutes. The negative feelings are brief, and range in severity from wistfulness to self-loathing, and may appear to have a physiological cause. It usually disappears fairly quickly but can also linger for a few days.

A woman should be mentally prepared before deciding to breastfeed and should never be pressured into doing so. Having support from all around, including family, friends, and in professional lives, is very important. Having partners attend classes on learning about breastfeeding, and its processes can also be very effective.

9. How would you advise mums experiencing D-MER and are having a tough time balancing their emotions and mental state when breastfeeding?

Mothers experiencing mild to moderate cases of D-MER should adopt lifestyle changes and are definitely encouraged to seek advice and support from their doctor if it escalates. It also helps to have an awareness of D-MER to better cope with the symptoms. It has been said that distractions (such as eating or having a nice, warm beverage) while breastfeeding helps. It would also be good to avoid factors that can worsen its symptoms, such as caffeine, stress, dehydration or a lack of sleep. If the case of D-MER is particularly severe, I would encourage mothers to discuss with their doctors on the use of specific herbal supplements or medication.

10. Should breastmilk be supplemented with formula milk especially for mums facing mental and emotional stresses like postpartum depression and/or D-MER?

It should be understood that D-MER is physiological and not psychological – meaning it is your body’s physical response to a chemical change in the brain rather than a condition that affects your mental health. It would be best to continue breastfeeding as D-MER does not last forever – as most of the time, it resolves in days or weeks. Even if it persists for longer than that, it will dissipate once you stop nursing.

11. What is your best advice on how to reduce or cope with breastfeeding stress?

Breastfeeding is more successful when family members are involved. Research has shown that partners are the biggest influencers of breastfeeding success.[1] Partners can support by comforting, feeding and checking up on the baby, especially at night. Partners can also give massages, offer hot drinks and offer to run errands. Some simple offloading of tasks and planning for visits can help to impact a mother’s mood, which also improves the breastfeeding experience. They can also learn about crucial breastfeeding items like the breast pump and be involved in cleaning and readying these items for the next feeding. A partner needs to be tactful and a cheerleader to mother.

At the same time, family and friends have an important role in providing much needed emotional support. Along with family members, friends can provide tremendous support by simply listening. New mums may not always be looking for advice because what they need is someone who can listen to what it is like to be a mother.

The breastfeeding journey is never easy, especially for new mothers. I would recommend finding ways to keep oneself calm, such as practising mindfulness or meditation, as being stressed directly affects milk production.

Ensuring that you have a good quality electric breast pump is also important as it can help to draw milk more effectively by acting like a baby suckling directly on a mother’s breast. Mums should also consult a lactation expert if they require advice or support as they go through their breastfeeding journey. It is important to try to solve any issues early and at the start of the journey with a certified IBCLC. One can also consider joining breastfeeding support groups to chat with other breastfeeding mums.

12. Are there safe medications that can be prescribed to reduce such stress?

There are medications with less harmful side effects that doctors can prescribe. However, most doctors would prefer counselling over medication to treat such stress. In severe cases, doctors may refer their patients to psychologists for treatment instead.