Perinatal Mood disorders impact 10-20% of women. As May is Mental Health Awareness month we're highlighting Academy of Breastfeeding Medicine Protocol #21 (Use of Antidepressants in Breastfeeding Mothers) & Protocol #18 (Substance use and Breastfeeding)
How can primary care providers help?
- Screen for postpartum mood disorder at routine postpartum visits and infant well child care visits.
- Use a standardized tool for screening tool like the Edinburgh Postpartum Depression Screen (EPDS)- (See below for a link with information about EPDS-US)
- Increase breastfeeding support for families with feeding difficulties, as early negative breastfeeding experiences are associated with increase postpartum depression symtpoms.
- Personalize the care and ask about breastfeeding: "Some mothers with
depression find that breastfeeding enhances bonding and improves their mood, whereas others find breastfeeding to be difficult." - Support families in choosing antidepressant medications when needed. See the protocol for more detailed discussion on meds, and for up to date information on medications and lactation see LactMed and e-lactancia
Substance use and breastfeeding support highlights:
- Recognize the frequency of non-prescribed substance use and be prepared to counsel with regards to breastfeeding. The protocol notes that "the United States (US) 2021 National Survey on Drug Use and Health (NSDUH) data found that 7.7%, 10.8%,and 9.8% of pregnant women reported past-month nonprescribed substance use, tobacco product use, and alcohol use, respectively."
- "Breastfeeding initiation timing: Individuals who discontinue nonprescribed substance use by the delivery hospitalization can be supported in breastfeeding initiation."
- "Mothers motivated to breastfeed who report recent nonprescribed
substance use and/or have positive toxicology testing at delivery should be supported in expressing milk to establish milk production." - "Perinatal breastfeeding support: Targeted perinatal breastfeeding care such as prenatal education, inpatient and postpartum lactation support, and ongoing multidisciplinary" substance use disorder(SUD) support
- See the protocol for specific recommendations on opiods,sedative hypnotics, stimulants, alcohol, cannabis, nicotine use and breastfeeding
- See the protocol for detailed discussion of compatible SUD treatments while breastfeeding (i.e.) methadone, buprenorphine, and naltrexone and noncompatbile treatments (i.e. disulfiram).
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