You might not realize it, but breastfeeding often comes with both mental-health benefits and challenges. These range from elevated levels of a calming hormone to reduced hours of sleep.

While you are focused on taking care of your baby, it’s easy to ignore or put aside your own needs. But depression and breastfeeding are not mutually exclusive, and it’s important to be in tune with and prioritize your mental health throughout your breastfeeding journey.

Mental-health benefits of breastfeeding

There are many protective physical benefits to breastfeeding for a parent. And much of it pertains to how hormones affect the body. For example, breastfeeding promotes the release of oxytocin, the “love hormone,” which helps with bonding and reduces stress by balancing levels of cortisol, known as a stress-oriented hormone. (Elevated levels of cortisol are often associated with postpartum mood disorders and sleep disruptions¹,².)

The oxytocin released while breastfeeding also helps make sleeping—when possible—easier, deeper, and more rejuvenating. This is important because lactating parents are more likely to wake frequently to feed the baby.

“Oxytocin calms the nervous system, and it's in opposition to cortisol,” says Emily Varnam, a midwife assistant and birth-and-postpartum doula.

The effect that sleep has on parents’ mental health cannot be underestimated. Even when you and your little one are down to one nighttime feeding session, breastfeeding can have a positive impact on your mental health by helping you sleep more soundly.

Mental-health challenges of breastfeeding

There’s nothing about breastfeeding itself that puts your mental health at risk; instead, it’s more about the experiences and circumstances surrounding it that can impact your state of mind. Put plainly, the psychological impacts of breastfeeding can heavily weigh on your mental health.

You may feel a high level of emotional and social expectations around breastfeeding. Many parents feel that they should know how to breastfeed without instruction, that it should come naturally and effortlessly, and that it should be a blissful experience free of challenges, pain, or confusion—all with a bountiful supply of milk. That’s how breastfeeding is often portrayed in popular culture and social media, at least.

The reality is that breastfeeding can have challenges, and it does not always “come naturally.” Breastfeeding can certainly be wonderful. However, it might also come with challenges that impact your frame of mind, including:

• feeling unsure of what you are doing

• not knowing how much milk your baby is getting
• becoming overstimulated, or “touched out”
• needing to return to work and/or needing to be away from your baby for extended periods of time—and pumping to maintain your supply
• attempting to troubleshoot lactation-oriented issues such as sore nipples, mastitis, engorged breasts, or low milk supply
• feeling “tied down” (and lacking enough social or intellectual stimulation)
• not being able to breastfeed, for any number of reasons
• needing to stop breastfeeding, for any number of reasons
• wanting to stop (or give up on) breastfeeding while also feeling external pressure to continue or “just keep trying”

Regardless of what your breastfeeding targets may be, there are things that might impact your ability to breastfeed comfortably or for a sustained period that you simply cannot control. Breast physiology can impact milk supply; issues such as insufficient glandular tissue (mammary hypoplasia), an infant tongue tie, or a past history of sexual abuse can also complicate feeding efforts. For any number of reasons, you might need to modify aspects of how you breastfeed in order to continue—or stop breastfeeding altogether well before you planned to do so.

The environment in which you’re nursing can also impact your journey. If you don’t have much logistical or educational support, breastfeeding can be more difficult. Complicating it all, you might feel guilt, sadness, or shame, if you can’t breastfeed—or if you choose to stop, even if you are able to.

Ultimately, please remember that any reason you want or need to stop breastfeeding is a valid one.

How pre-existing mental-health conditions can impact breastfeeding

If you’ve struggled with mental-health issues in the past, it’s recommended that you let your providers know. They can help you get extra support to ensure that you are taking care of yourself while meeting your breastfeeding targets.

You might need support to cope with any or all of the following challenges:

• not getting enough sleep
• not receiving enough lactation support
• having difficulty with basic self-care, such as eating, sleeping, or personal hygiene
• encountering challenges with taking care of the baby
• having limited resources to pay for medications or therapy
• feeling that breastfeeding is triggering a re-emergence of past challenges or even traumatic experiences

If you do not have sufficient targeted support with both initiating and sustaining breastfeeding, you have an increased risk of earlier than planned (or desired) cessation of breastfeeding. Earlier cessations, in turn, can contribute to the development of perinatal mood disorders³.

Even if you don’t have an established history of mental-health issues, it’s good to be aware of factors that are associated with or can contribute to postpartum mental-health challenges:

• not getting enough sleep
• getting inconsistent nutrition or hydration
• being socially isolated
• having difficulties breastfeeding (and a lack of support to work through it)
• enduring stressful recent events, such as pregnancy complications, illness, or job loss
• caring for a baby with health problems or other special needs
• caring for multiples (i.e. twins or triplets) and feeling overwhelmed
• caring for a baby after an unplanned or unwanted pregnancy
• encountering problems in your relationship with your spouse or significant other
• having a generally weak support system
• struggling with financial problems
• having a history of bipolar disorder or depression, either during pregnancy or at other times
• having family members who have been diagnosed with depression or other mood disorders

Varnam says she tends to check in more often with postpartum patients who have a history of mental-health issues or any of these risk factors.

“A big part of this is making sure that if they have existing treatment, that it is safe for breastfeeding, so there are no disruptions,” she says. “And if they don’t, to make sure they have simple steps to activate a plan, if needed.”

Unexpected mental health struggles while breastfeeding

If you experience a sense of dread, shame, anxiety, sadness, anger, or other negative emotions when you begin to breastfeed, you may be dealing with something called dysphoric milk ejection reflex, or D-MER. It’s a physiological response to a milk letdown that causes negative emotions to surface. It’s a bit puzzling as to exactly how and why it happens.

“The causes are not completely understood. It’s thought to be a result of the interaction among the breastfeeding hormones oxytocin, prolactin, and dopamine,” says Chris Raines, a perinatal psychiatric nurse practitioner.

The response can last a few minutes or up to about 10, and it typically disappears on its own. If you are having D-MER episodes, talk to your provider.

It’s important to remember that you’re not a bad parent for having this response to breastfeeding, Raines says. What you’re experiencing is uncontrollable. Becoming aware of it, and accepting it as a temporary state that occurs when breastfeeding, will help you cope with it.

Listen to one mom detail her experience with D-MER.

Mental-health implications of complications in pregnancy and childbirth

Challenges in pregnancy and childbirth can have a lasting impact—one that you can’t always foresee. If you’ve delivered your baby, and everyone is healthy, you might think that you’re out of the woods.

“Many people have heightened anxiety from being on high alert for a long time that doesn’t go away. That anxiety can spill into a breastfeeding relationship,” Varnam says. “Because there’s so much to figure out—and ways it can go wrong—people can get hyperfocused on it.”

Some parents also intently focus on lactation, something they have a sense of control over, “when other things are going wrong—for example, if you are pumping while your baby is in the NICU,” she says.

This kind of experience is the result of trauma: It doesn’t necessarily indicate or correspond with a standalone perinatal mood or anxiety disorder (PMAD) or pre-existing mental-health issue, Varnam says.

One example is how pregnant women cope with hyperemesis gravidarum (HG), a prolonged state of nausea and vomiting that begins during pregnancy and ends when you deliver. HG can lead to an expectant mother’s anxiety and hypervigilance about nutrition.

This mental-health issue can spill over into the postpartum period, even if the nausea itself does not. Depending on the duration and severity of HG while pregnant, it can take months to recover from, Varnam says, and can potentially lead to disordered eating, which in turn could potentially impact one’s ability to breastfeed.

Gestational diabetes, which is treated in part by closely monitoring the sugars consumed during pregnancy, can lead to a similar hyperfocus on nutrition. And other traumatic experiences, such as previous pregnancy loss or infertility, can also leave a negative impact on your mental health and complicate your breastfeeding relationship.

Balancing mental health and breastfeeding

You might find that you need to alter your feeding plans to accommodate your mental health. This may mean reducing the number of breastfeeding sessions per day, supplementing breastfed milk with pumped milk, donor milk, or formula. It may even mean stopping breastfeeding altogether. All feeding options and plans should be discussed, and it is never appropriate to put the health and well being of the baby solely on your shoulders.

Sleep is vital to mental health and recovery. In some cases, the feeding schedule required to maintain your milk supply may impede your recovery and ability to regulate your nervous system.

Another thing that can impact your nervous system: all the light touches you receive all day (and night!) from your baby. When you’re feeding your baby multiple times a day, you can become overstimulated. This can contribute to being what occupational therapist Larissa Geleris calls being “touched out.”