Mother’s Milk, Mother’s Tears

Breastfeeding With Postpartum Depression

Share this: Tonia Olson, RN, BFA, BSN, MN, IBCLC1

Lorraine Holtslander, RN, BSN, MN, PhD2
Angela Bowen, RN, BSN, MEd, PhD2

Recent literature suggests that when breastfeeding goes well, it may protect mothers from the
deleterious effects of postpartum depression. Using a phenomenological approach, the objective
of this research was to provide insight into the lived experience of breastfeeding in mothers
with postpartum depression. Two major themes emerged from the participants’ perceptions of
breastfeeding with postpartum depression: (a) Breastfeeding in the Dark: Despite difficulties
associated with establishing and maintaining the breastfeeding relationship, breastfeeding through
depression meant bonding with baby and maintaining a semblance of control; (b) Breastfeeding
Under Wraps: Mothers perceived a lack of support to breastfeed their babies and delayed seeking
support for their symptoms of depression out of fear of being stigmatized. This study underscores
the need for heightened awareness regarding perinatal and postnatal screening for depression.
The early identification of women at risk for postpartum depression will offer healthcare
professionals the capacity to engage women and their families in a participatory manner to
work through natural challenges associated with establishing and maintaining the breastfeeding
relationship.
Keywords: breastfeeding, postpartum period, maternal-child nursing, qualitative

In 1858, Louis-Victor Marcé compiled an extensive
monograph reviewing the existing knowledge of psychiatric
disorders of women during and following pregnancy
including a description of postpartum melancholia
occurring during lactation (Trede, Baldessarini, Viguera,
& Bottéro, 2009). Marcé noted that although some
authors discouraged breastfeeding for women at high
risk for depression, others delayed the recommendation
to wean infants until depressive symptoms had subsided
(Trede et al., 2009).
by the same research team in the 1980s) showing
an association between breastfeeding and increased
depressive symptomology (Dennis & McQueen, 2009). In
fact, the review concluded that depressive symptomology
increased risk for negative infant feeding outcomes,
including breastfeeding cessation and increased
breastfeeding difficulties (Dennis & McQueen, 2009).
This finding continues to be upheld in the literature
(Nishioka et al., 2011; Watkins, Meltzer-Brody, Zolnoun,
& Stuebe, 2011).

More than 100 years later, attention is again being paid
to the interplay between infant feeding practices and
postpartum depression (PPD). However, whether or
not there is directionality in the relationship continues
to remain contentious (Bogen, Hanusa, Moses-Kolko,
& Wisner, 2010), despite growing research that touts
that breastfeeding protects against maternal depression
(Donaldson-Myles, 2011; Hamdan & Tamim, 2012;
Kendall-Tackett, Cong, & Hale, 2011). A 2009 systematic
review of the literature found only two studies (conducted
Concomitantly, it has been shown that women who
have negative early breastfeeding experiences may be at a
greater risk for PPD (Kendall-Tackett, 2007; Watkins et al.,
2011), and that early breastfeeding cessation is a risk factor
for increased depression and anxiety (Ystrom, 2012).
Notwithstanding, public and professional resistance to
breastfeeding protection, promotion, and support is often
expressed as a concern about unwelcome pressure on
mothers to breastfeed, and some healthcare professionals
will argue that if mothers are depressed, breastfeeding
poses an “unnecessary burden” (McCarter-Spaulding &
Horowitz, 2007, p. 10).

There is an abundance of research that confirms that

1. tonia.olson@usask.ca, College of Nursing, University of
Saskatchewan, 107 Wiggins Rd., Saskatoon, SK, S7N 5E5, Canada understanding the nature of maternal difficulties
2. Associate Professor, College of Nursing, University of in the context of PPD is imperative to the health of
Saskatchewan our mothers and infants. However, despite increasing

© 2014 United States Lactation Consultant Association 9

Clinical Lactation, 2014, 5(1), http://dx.doi.org/10.1891/2158-0782.5.1.9
quantitative research focused on the interplay between
PPD and breastfeeding, qualitative research regarding
the relationship between PPD and breastfeeding is very
limited. The purpose of this study was to explore the
lived experience of breastfeeding in women suffering
from PPD.
Method
Study Design
We used a qualitative approach as inspired by the traditions
of hermeneutic phenomenology (van Manen, 1990). This
approach allowed for a description of the experience of
breastfeeding with PPD from the unique perspectives of
the women interviewed, and accommodated the notion
that data were an inevitable consequence of interpretation:
from the mothers’ memory and retelling of their
experiences to the researcher’s exploration for meaning
in their words and to the final thematic representation
of that meaning (van Manen, 1990). Ethical approval was
received from the University of Saskatchewan Behavioural
Research Ethics Board, contingent upon participants
receiving support from the program at the time of the
interviews.
Participants
The research consisted of a purposive sample of five
mothers attending a local postpartum depression support
program on a weekly basis. Eligibility criteria required either
current or previous breastfeeding experience. Women who
indicated a history of severe mental disability, or who had
been clinically diagnosed with postpartum psychosis, were
excluded from the study. Intake for the study did not occur
until the facilitators of the PPD program were confident
that a therapeutic relationship had been established with
each woman and that the relationship would not be
compromised through participation.
Data Collection
Data were generated over a 4-month period using
conversation style interviews. Conversations began with
a simple question: “Tell me about your experience of
breastfeeding with PPD, starting with when you made
the decision to breastfeed.” Prompts included the
following: “What was the breastfeeding experience like
in hospital?”; “What was the breastfeeding experience
like when you came home from the hospital?”; “When
did you begin to notice your symptoms of depression?”;
and “Do you think that breastfeeding made you feel
better or worse?” Women were offered an opportunity to
review the transcripts and thematic interpretations for
accuracy and fittingness.
10 Clinical Lactation, 5(1), 2014         Electronic version of this issue is available at http://www.clinicallactation.org/
Data Analysis
Interviews were audio recorded and transcribed
verbatim. Data were analyzed using the hermeneutic
approach as described by van Manen (1990). Transcripts
were reviewed for preliminary impressions as a whole
and then line by line (van Manen, 1990). Through
this rigorous process of immersion, the authors met
numerous times to debrief and review the interpretive
summaries. The summaries and thematic statements
were developed through a process of writing and
rewriting (van Manen, 1990). Participant quotes are
included in the presentation of results to demonstrate
fittingness of themes, and pseudonyms are used to
protect the mothers’ identities (i.e., Greta, Jane, Jessica,
Mary, and Patti).
Results
Purposive sampling yielded a small, homogeneous
group of five women: all were English speaking, well
educated, of a moderate socioeconomic status, and in
committed relationships; demographic characteristics
positively associated with breastfeeding (Thulier &
Mercer, 2009). Mothers also identified psychological
and social aspects identified with breastfeeding, such as
having the prenatal intention to breastfeed, and having
support from husbands/partners to breastfeed (Meedya,
Fahy, & Kable, 2010; Thulier & Mercer, 2009). All of
the mothers indicated previous episodes of depression
or anxiety (as young adults). However, none outwardly
acknowledged their earlier depression or anxiety as a risk
factor for PPD. Mothers reported depressive symptoms
beginning between 3 and 6 weeks postpartum, with an
outlier of 3.5 months. At the time of the interviews, four
of the five mothers were still breastfeeding their babies,
who ranged in age from 4 to 10 months. Although the
mothers’ stories of breastfeeding with PPD were varied,
the following two main themes emerged.
Breastfeeding in the Dark
This theme captures challenges in establishing
breastfeeding and maintaining breastfeeding while
depressed. All mothers reported anxiety surrounding
breastfeeding, which they described as beginning in
hospital. Mothers expressed that they did not have
enough practical help or encouragement to breastfeed
with confidence: they longed for reassurance that they
were “doing it right” and that their babies were “latched
on properly.” Mothers had the impression that nurses in
the hospital “had too much to do” or were “just going
through the motions” to help with breastfeeding. They
perceived that nurses expected them to know what they
were doing, and they believed that nurses viewed them
as difficult or “ridiculous” if they asked for help. Greta,
a first-time mom, describes the disparaging comments
from a nurse that left her questioning her very capacity
to mother:
Breastfeeding was really important to me. . . . One
nurse made me feel like absolute crap. . . . She was just
basically telling me that I was not doing the right thing
for my son, by not supplementing. . . . Questions just
kept running through my head until I was like, “Oh my
God, what do I do? Am I a terrible mother already? Am
I starving my baby?”
Mothers admitted that it was difficult to recognize when
their symptoms of depression began; however, four out
of five mothers believed that their symptoms started
between 3 and 6 weeks postpartum. Symptoms included
sleep disturbances, extreme fatigue, and irritability. Two
mothers reported uncontrollable anxiety.
When asked about the breastfeeding experience at that
time, mothers referred to breastfeeding as an opportunity
to bond with baby and most perceived breastfeeding as
helpful as they navigated their depression.
Mary: “The way they reach up and touch your face while
you are feeding them. . . . It is just a nice thing that you
have with the baby.”
Patti added: “It was like the only time I held her.
I really did feel that it was the only time I got to bond
with her.”
Greta and Mary believed that stopping breastfeeding
would make them feel worse.
Greta: “I think that it made me feel better because it was
the one thing that I was successful at, as a mom.”
Even Jessica, who had prenatally decided to feed her
baby breast milk and artificial baby milk, commented:
“You love it [breastfeeding] . . . but I liked the bond
when I was rested and when he wasn’t crying.”
Jessica expressed that her difficulties with breastfeeding
made her feel overwhelmed; however, she admitted
that her PPD manifested weeks after discontinuing
breastfeeding.
Despite the description of breastfeeding with PPD as a
significant source of connection between mother and
baby, breastfeeding was also perceived to be problematic
when babies did not feed according to mothers’
expectations of “normal.” There was an underlying
sentiment that one must “breastfeed the right way” and
“by the book.” For example, we can hear the intensity
with which Mary held to the breastfeeding relationship,
despite feeling pressured to accustom her baby to a
bottle:
I left the house and left a bottle with my husband. . . .
Because I heard that they can even smell you; that it can
be distracting and they won’t take the bottle. He told me
that she took the whole thing and really didn’t put up a
fuss. I drove home so fast; I was crying the whole drive
home. I walked in the door and I was like, “Just give her
to me!” I sat down and breastfed her right after she had
this bottle. And he was like, “What’s the matter?” And
I said, “She doesn’t need me anymore and now anybody
can do my job. She doesn’t even need me!”
Jane alluded to breastfeeding the “proper” way as she
discussed her plan to start introducing solid foods
at 6 months. Overwhelmed with depression, the
breastfeeding relationship envisioned prenatally left
Jane feeling besieged as her baby refused solid foods and
would accept nothing but her milk: “I felt resentful that
I had to nurse him. . . . I didn’t even want him anymore.
I think that a lot of it was that he wasn’t taking solids.
He wasn’t doing that natural weaning process that
they talk about.” Patti explained that trying to manage
the symptoms of depression and care for two children
was too demanding to enjoy exclusive breastfeeding.
Discouraged by baby’s need to eat every 3 hours, she
described how she hoped to deal with the challenges of
sleep deprivation and feeding:
They say that formula takes longer to digest . . . so maybe
she can sleep a bit longer; maybe I can get a few more
hours of sleep. . . . I’m getting resentful towards this kid
because I feel that this is all that I do, is just feed her all
of the time.
Breastfeeding Under Wraps
This theme addresses the isolation mothers felt as they
kept their feelings of depression hidden, and as they
perceived a lack of support to breastfeed from loved
ones and society in general. Breastfeeding with PPD
manifested itself as a period of waiting for the challenges
of breastfeeding and the feelings of depression to pass,
with minimal expectation for support.
Mothers made frequent reference to feelings of isolation
in their roles as the “primary caregiver.” They commented
that although they had received support from their
families in the early postpartum, they needed ongoing
support to breastfeed, particularly when they were
© 2014 United States Lactation Consultant Association 11
feeling deprived of sleep. For example, they appreciated
when husbands woke up in the night to help with diaper
changing or soothing, but they were disappointed if this
kind of help wasn’t offered without asking for it (and
they rarely asked for it).
Even though mothers felt pressure as the “primary
caregiver,” they were often reluctant to accept help from
family members to care for the baby: either because they
didn’t feel listened to regarding matters of feeding or
because they “held on to” feeding the baby as a semblance
of control. For example, Jane recalled that the first time
she left her baby with grandparents, the baby refused her
pumped milk from a bottle. Jane flew home in a flurry
of tears and frustration when she found out that baby
had not eaten for several hours. She was angry that her
parents hadn’t called her sooner. At the time of her
interview, Jane’s baby was 9 months old and she spoke
of feeling trapped in her home: “I just want to get out of
the house, leave the boys behind . . . but I can’t because I
have to feed this kid!” But when asked if she breastfed in
public, Jane expressed the negative sentiment shared by
all mothers that they didn’t feel supported:
I don’t think society supports that. When he was about
3 weeks old, he was crying in the doctor’s office, so I fed
him. Like, I even had him covered, and a guy beside me
said, “Must you?” And it was just like, are you kidding
me? Yes, I must! . . . So you are in this fight between
I want to do the best I can . . . but at the same time,
I don’t have the support that I need.
Greta voiced that challenges with breastfeeding were
like “bumps in the road” and she believed that stopping
breastfeeding would make her feel worse. She said,
[Breastfeeding] was the one thing that I could control . . .
I think that it made me feel better because it was the one
thing that I was successful at, as a mom, because my birth
went so shitty, and everything just kind of spiraled down
and my mood and everything . . .
Mary also described her need to feel in control of feeding
her baby while depressed:
I lean on [breastfeeding] a lot. It is my thing with her
that no one can take away. . . . And I am the only one to
feed her solids. I don’t like other people doing it. I don’t
even like the suggestion of other people doing it.
Most mothers kept their feelings of depression “hidden”
and delayed seeking support. When she did reach
out to family, Patti referred to her depression as being
“poo-pooed.” Mothers generally believed they should be
12 Clinical Lactation, 5(1), 2014         Electronic version of this issue is available at http://www.clinicallactation.org/
able to handle their predicament on their own. Greta
commented,
I was feeling like really sad and just really isolated and
really stuck! . . . I just thought . . . “How am I going to take
care of this baby? And I am feeling so crappy!” I found it to
be really hard just to reach out and admit that I was feeling
the way that I was. I don’t know why I was so worried
about being stigmatized, but I was. I just didn’t want that
label of being a person with postpartum depression.
Jessica told about how her mother reacted to her feelings
of anxiety:
[Mom] was mad at me. . . . She was like, “Why are
you so stressed out? Why are you acting like this? You
live this comfortable life; [your husband] works his butt
off to give you everything that you want. . . . Just shake
it off! What the hell? You’re scaring me. Quit talking
stupid!” And she was getting mad at me because she
didn’t understand because she has never gone through it.
And I was feeling even worse and like freaked out.
Discussion
Mothers in this study had experienced either depressive
symptoms or anxiety previous to the onset of PPD, and
therefore were at a significantly increased risk of PPD
(Robertson, Grace, Wallington, & Stewart, 2004). Thus,
this study underscores the need for heightened awareness
regarding perinatal and postnatal screening for depression
among healthcare professionals (Bowen, Bowen, Butt,
Rahman, & Muhajarine, 2012; Robertson et al., 2004).
By identifying women at risk for PPD, therapies to offset
depression can be discussed proactively, and conversations
to explore mothers’ breastfeeding intentions may be used
to provide important prenatal teaching regarding natural
breastfeeding challenges and symptoms of depression.
Anticipatory guidance of this sort may also help to offset
the stigma associated with PPD. These suggestions correlate
to those put forth by McCarter-Spaulding and Horowitz
(2007) in their larger descriptive study exploring infant
feeding patterns in women with PPD, which concluded
that it is important to consider mothers’ breastfeeding
intentions in conjunction with PPD treatment.
It is acknowledged that for mothers in this study, the
experience of breastfeeding with PPD was expressed
not unlike that reported in the literature for mothers
without PPD. For example, mothers voiced anxiety
and self-doubt, and a perceived lack of support for
breastfeeding from nurses as they attempted to establish
the breastfeeding relationship in hospital (Mantha,
Davies, Moyer, & Crowe, 2008; Redshaw & Henderson,
2012). The critical need for improved breastfeeding
support interventions is not a new recommendation
(Britton, McCormick, Renfrew, Wade, & King, 2007;
Schmied, Beake, Sheehan, McCourt, & Dykes, 2011).
However, in the light of the most recent research to
propose that positive breastfeeding experiences help
protect against maternal depression (Donaldson-Myles,
2011; Groër & Davis, 2006; Groër, Davis, & Hemphill,
2002; Hamdan & Tamim, 2012; Kendall-Tackett et al.,
2011), whereas breastfeeding difficulties may increase
the risk of depression (Kendall-Tackett, 2007; Watkins
et al., 2011), appropriate and timely interventions are
critical. For example, emerging research in the field of
psychoneuroimmunology proposes that inflammation
is involved in the pathogenesis of depression, and
that breastfeeding mitigates stress by modulating
inflammatory responses common in the last trimester
of pregnancy through to postpartum (Groër & Davis,
2006; Groër et al., 2002; Kendall-Tackett, 2007). Kendall-
Tackett (2007), in her review of this theory, suggests that
because maternal stress and breastfeeding difficulties,
such as nipple pain, both potentiate inflammation, goals
for the prevention and treatment of PPD should be
focused on reducing stress and breastfeeding difficulties.
Frontline hospital staff must improve efforts to provide
practical breastfeeding education to decrease breastfeeding
difficulties and to allay mothers’ anxiety surrounding
establishing breastfeeding in the early postpartum. Nurses,
in particular, need to have (and to take) the time to provide
ongoing encouragement and reassurance as mother/infant
dyads learn the moves of breastfeeding; something the
mothers in this study felt they lacked. An example would be
encouraging practices like extended periods of skin-to-skin
contact as important not only to latching the baby to the
breast but also to maternal infant attachment (Bergerman
& Bergerman, 2013; Feldman, Eidelman, Sirota, &
Weller, 2002). The mothers’ voices in this study further
the assertion that healthcare providers must find evidence-
informed ways to support the breastfeeding relationship.
Although the experience of breastfeeding with PPD
manifested itself as a significant source of connection
between mother and baby, and as a semblance of control
while dealing with the tumultuous nature of depression,
breastfeeding was also a source of frustration when babies’
need to eat conflicted with mothers’ need to take time for
themselves or when babies did not eat according to “normal”
expected behavior. Other challenges included not having
help with nighttime feedings and a lack of sleep, feeling
the need to wean baby from the breast, and feeling isolated
because breastfeeding in public was not well received.
Yet despite these reported challenges and the barraging effect
of PPD, mothers in this study followed through with their
prenatal infant feeding plans. For four of the five women, this
meant continuing to breastfeed, and these women expressed
emotional benefit and feelings of increased maternal/infant
attachment as conferred by the breastfeeding experience.
When breastfeeding was perceived to be going well, mothers
felt empowered and emotionally connected to their babies:
they viewed breastfeeding as a glimmer of hope.
This study confirms earlier research evaluating the
relationship between breastfeeding and postpartum
depression: it is possible, and it may be emotionally
beneficial for women to breastfeed in the context of
depression (Kendall-Tackett et al., 2011; McCarter-
Spaulding & Horowitz, 2007). However, the mothers in
this study wanted and would have most likely benefitted
from ongoing support from healthcare professionals both
for natural challenges associated with breastfeeding and
for their depressive symptomology. Our study supports
the conclusion of Watkins et al. (2011): “Women with
breastfeeding difficulties should be screened for postpartum
depression, and women with depressive symptoms should
be offered breastfeeding support” (p. 220).
With a view to respecting mothers’ breastfeeding intentions,
healthcare providers need to fully understand the interplay
between depression and breastfeeding and to enhance
their role as breastfeeding advocates across an extended
perinatal period. Continuing to assess the effectiveness of
prenatal teaching regarding the inclusion of adequate and
consistent information regarding both PPD and natural
breastfeeding challenges may be an important first step.
Limitations
First, the study sample size was restricted as per ethical
approval stipulations, which required that only women
who were seeking ongoing support of the local PPD
program could be interviewed. Although the transferability
of the findings is necessarily limited by the small sample
size, it should also be considered that the hermeneutic
approach minimizes the implications of sample size by
seeking rich descriptive data in its pursuit to express the
lived experience. Every effort was made to achieve data
saturation within the small sample size and to honor the
mothers’ voices in the retelling of their experience.
Conclusion
The benefits of breastfeeding to babies, mothers, and
society are well established, as are the deleterious effects
of maternal depression. However, more can be done
to nurture the breastfeeding relationship particularly if
© 2014 United States Lactation Consultant Association 13
a mother is at risk for depression including screening
mothers in pregnancy for PPD, preparing mothers and
families for expected breastfeeding challenges, bolstering
breastfeeding supports in hospital, and working to
bring breastfeeding back as the cultural norm in our
communities. It is hoped that such efforts may offset
the challenges faced by the mother at risk for PPD such
that she may fulfill her breastfeeding intentions without
feelings of increased anxiety, isolation, and stigmatization.
References
Bergman, J., & Bergman, N. (2013). Whose choice? Advocating
birthing practices according to baby’s biological needs.
Journal of Perinatal Education, 22(1), 8–13. http://dx.doi
.org/10.1891/1058-1243.22.1.8
Bogen, D. L., Hanusa, B. H., Moses-Kolko, E., & Wisner, K. L. (2010).
Are maternal depression or symptom severity associated with
breastfeeding intention or outcomes? The Journal of Clinical Psychiatry,
71(8), 1069–1078. http://dx.doi.org/10.4088/JCP.09m05383blu
Bowen, A., Bowen, R., Butt, P., Rahman, K., & Muhajarine, N.
(2012). Patterns of depression and treatment in pregnant and
postpartum women. Canadian Journal of Psychiatry, 57(3), 161–167.
Britton, C., McCormick, F. M., Renfrew, M. J., Wade, A., & King,
S. E. (2007). Support for breastfeeding mothers. Cochrane
Database of Systematic Reviews, 1(1). http://dx.doi.org
/10.1002/14651858.CD001141.pub3
Dennis, C. L., & McQueen, K. (2009). The relationship between
infant-feeding outcomes and postpartum depression: A
qualitative systematic review. Pediatrics, 123(4), e736–e751.
http://dx.doi.org/10.1542/peds.2008-1629
Donaldson-Myles, F. (2011). Postnatal depression and infant feeding: A
review of the evidence. British Journal of Midwifery, 19(10), 619–624.
Feldman, R., Eidelman, A. I., Sirota, L., & Weller, A. (2002).
Comparison of skin-to-skin (kangaroo) and traditional care:
Parenting outcomes and preterm infant development. Pediatrics,
110(1), 16–26. http://dx.doi.org/10.1542/peds.110.1.16
Groër, M. W., & Davis, M. W. (2006). Cytokines, infections, stress,
and dysphoric moods in breastfeeders and formula feeders.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35(5),
599–607. http://dx.doi.org/10.1111/j.1552-6909.2006.00083.x
Groër, M. W., Davis, M. W., & Hemphill, J. (2002). Postpartum stress:
Current concepts and the possible protective role of breastfeeding.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 31(4), 411–417.
http://dx.doi.org/10.1111/j.1552-6909.2002.tb00063.x
Hamdan, A., & Tamim, H. (2012). The relationship between
postpartum depression and breastfeeding. The International
Journal of Psychiatry in Medicine, 43(3), 243–259. http://dx.doi
.org/10.2190/PM.43.3.d
Kendall-Tackett, K. (2007). A new paradigm for depression in
new mothers: The central role of inflammation and how
breastfeeding and anti-inflammatory treatments protect
maternal mental health. International Breastfeeding Journal, 2(6),
1746–4358. http://dx.doi.org/10.1186/1746-4358-2-6
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect
of feeding method on sleep duration, maternal well-being, and
14 Clinical Lactation, 5(1), 2014         Electronic version of this issue is available at http://www.clinicallactation.org/
postpartum depression. Clinical Lactation, 2(2), 22–26. http://
dx.doi.org/10.1891/215805311807011593
Mantha, S., Davies, B., Moyer, A., & Crowe, K. (2008). Providing
responsive nursing care: To new mothers with high and
low confidence. The American Journal of Maternal/Child
Nursing, 33(5), 307–314. http://dx.doi.org/10.1097/01.
NMC.0000334899.14592.32
McCarter-Spaulding, D., & Horowitz, J. A. (2007). How does
postpartum depression affect breastfeeding? The American Journal
of Maternal/Child Nursing, 32(1), 10–17.
Meedya, S., Fahy, K., & Kable, A. (2010). Factors that positively
influence breastfeeding duration to 6 months: A literature
review. Women and Birth, 23(4), 135–145. http://dx.doi.org
/10.1016/j.wombi.2010.02.002
Nishioka, E., Haruna, M., Ota, E., Matsuzaki, M., Murayama, R.,
Yoshimura, K., & Murashima, S. (2011). A prospective study
of the relationship between breastfeeding and postpartum
depressive symptoms appearing at 1–5 months after delivery.
Journal of Affective Disorders, 133(3), 553–559. http://dx.doi.org
/10.1016/j.jad.2011.04.027
Redshaw, M., & Henderson, J. (2012). Learning the hard way:
expectations and experiences of infant feeding support. Birth,
39(1), 21–29. http://dx.doi.org/10.1111/j.1523-536X.2011.00509.x
Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004).
Antenatal risk factors for postpartum depression: A synthesis
of recent literature. General Hospital Psychiatry, 26(4), 289–295.
http://dx.doi.org/10.1016/j.genhosppsych.2004.02.006
Schmied, V., Beake, S., Sheehan, A., McCourt, C., & Dykes, F.
(2011). Women’s perceptions and experiences of breastfeeding
support: A metasynthesis. Birth, 38(1), 49–60. http://dx.doi.org
/10.1111/j.1523-536X.2010.00446.x
Thulier, D., & Mercer, J. (2009). Variables associated with
breastfeeding duration. Journal of Obstetric, Gynecologic, &
Neonatal Nursing, 38(3), 259–268. http://dx.doi.org/10.1111
/j.1552-6909.2009.01021.x
Trede, K., Baldessarini, R. J., Viguera, A. C., & Bottéro, A. (2009).
Treatise on insanity in pregnant, postpartum, and lactating
women (1858) by Louis-Victor Marce: A commentary. Harvard
Review of Psychiatry, 17(2), 157–165. http://dx.doi.org/10.1080
/10673220902891802
van Manen, M. (1990). Researching lived experience: Human science for an
action sensitive pedagogy. London, Canada: University of Western
Ontario. (Reprinted from Albany, NY: State University of New York)
Watkins, S., Meltzer-Brody, S., Zolnoun, D., & Stuebe, A. (2011).
Early breastfeeding experiences and postpartum depression.
Obstetrics & Gynecology, 118(2, Pt. 1), 214–221. http://dx.doi.org
/10.1097/AOG.0b013e3182260a2d
Ystrom, E. (2012). Breastfeeding cessation and symptoms of anxiety
and depression: A longitudinal cohort study. BMC Pregnancy and
Childbirth, 12(1), 36. http://dx.doi.org/10.1186/1471-2393-12-36
Acknowledgments: The authors declare no potential conflicts of interest
with respect to the research, authorship, and/or publication of this article.
Funding for this study was received from the Canadian Institutes of Health
Research, the Canadian Association of Perinatal and Women’s Health
Nurses, and the University of Saskatchewan. Heartfelt thanks goes out to
the women and facilitators of the Postpartum Depression Support Program,
Saskatoon Health Region.
As a registered nurse, Tonia Olson has dedicated her career to
obstetrical nursing. She acquired a master’s degree in nursing in 2012,
and holds active status as an International Board Certified Lactation
Consultant. Tonia works as a maternal child nurse with the Saskatoon
Health Region’s Healthy & Home Program, an early maternity
visiting program. As part of her work, she also facilitates both the
Postpartum Depression Support Group and the Breastfeeding Café,
a drop-in support program for new mothers and babies.

Lorraine Holtslander is an associate professor in the College of

Nursing at the University of Saskatchewan in Saskatoon, Canada.
She teaches family nursing to undergraduate nursing students and
qualitative research methods at the graduate level. Her research and
teaching interests are mainly in care of the family, the family caregiver,
and promoting quality end-of-life care. Lorraine maintains a clinical
practice in the community as a home care nurse.

Angela Bowen has extensive clinical, educator, and administrator

experience in obstetrics and mental health. Her research focus,
maternal mental health, brings these areas together. She has been
successful as principal investigator on several CIHR-funded projects.
She was awarded a Saskatchewan Health Research Foundation New
Investigator Establishment Award to evaluate the Maternal Mental
Health Program that she spearheaded in Saskatoon. She received
a Founders Award from the Saskatchewan Prevention Institute in
recognition of her efforts to improve the lives of mothers and their
children.

© 2014 United States Lactation Consultant Association 15