Realigning Expectations With Reality: A Case Study on Maternal Mental Health During a Difficult Breastfeeding Journey

Abstract

Introduction: Many mothers have the goal to breastfeed. However, more than 50% will have breastfeeding difficulty by the 3rd day of life. Mothers who are unable to meet their breastfeeding goals are at higher risk for anxiety, depression, embarrassment, and guilt. Those who stop breastfeeding need support and help resolving these feelings. This case study aims to describe one woman’s difficulty with mental health surrounding breastfeeding, her decision to bottle feed, and her successful transition back to direct breastfeeding. Main Issue: Barriers to the participant’s success with breastfeeding were pre-existing history of depression/anxiety, forceps delivery, uncontrolled perineal pain, infant physical trauma, and nipple/flow confusion. The decision to discontinue direct breastfeeding and start bottle feeding came after 2 months of anxiety, frustration, and persistence. Management: The participant followed her healthcare team’s recommendations of triple feeding, lactation support groups, pediatric chiropractic adjustments, and prescribed galactagogues. After 2 months of exhaustion and deliberation, she made the difficult decision to stop breastfeeding for nutritional benefits and switched to breastfeeding only for her infant’s pleasure and comfort. Lowered expectations allowed the dyad to heal and her son to transition to nearly exclusive breastfeeding at 4 months of life. Conclusion: Clinicians must be aware of the delicate balance between promoting breastfeeding for its nutritional value and health benefits and supporting a struggling mother with mental health needs.

Extending the concept of moral distress to parents of infants hospitalized in the NICU: A Greek qualitative study

“…A similar nding emerged from a previous study conducted recently in Greece [35]. Indeed, "mothers who are unable to meet their breastfeeding goals are at higher risk for anxiety, depression, embarrassment, and guilt" [52]. In case of high risk for a mother-to-child transmission of an infectious disease, mothers reported experiencing sadness and guilt for not breastfeeding, while they regard breastfeeding as a means of developing bonds with their infants and bene t them [53].…”

What are the needs and challenges of breastfed medically complex infants and children in the paediatric setting?

“…Triple feeding is the term used when mothers are breastfeeding, expressing, as well as feeding their child with expressed milk, infant formula or donor milk by bottle. There is little highquality research on this topic, but many clinical papers and case reports have identified triple feeding as tiring and time consuming Briere et al, 2015;Noble et al, 2018;McCue and Stulberger, 2019;Elder et al, 2022). Many of the mothers also experienced breast pathology, ranging from mastitis, delayed or absent milk ejection reflex, engorgement and blebs, to an infected nipple fissure that was hard to treat.…”