I attended the 2019 Lactation Consultant in Private Practice Conference in Philadelphia recently for the first time. It was 3 days of great really meaty presentations that provided me with many ‘lightbulb ‘ moments.
The conference opened with a truly excellent presentation by Jabina Coleman, LSW, MSW, IBCLC. She spoke on Perinatal Mood and Anxiety Disorders (PMADs) -What Lactation Professionals Should Know. Jabina, an excellent speaker, opened saying , though we need not be psychoanalysts we are in the frontline and our Scope Of Duty means we need to acknowledge mental health of infant and mother. We need to be using our interactive counselling skills and assess how PMADs affect breastfeeding.
Jabina brought us through the various theories of PMADs, from postpartum blues to pp psychosis, giving us lists of signs and symptoms, how the mother may appear, how she may feel she is doing and how she might express herself. A mother with obsessive compulsive disorder (OCD) may realise her thoughts are ‘crazy’. A mother with postpartum psychosis does not realise this , her family members may say ‘things are very ‘off”. She talked us through how we might approach the subject… for example, with a mother who has OCD we might ask..”how do you feel about baby?”, “Are you having any scary thoughts.” She encouraged us to let mothers know that ‘thought does not equate action’.
Jabina asked us to consider the dilemma of medication for PMADs. Do we ..expose baby to medication through milk, expose baby to adverse effects of an untreated depression or have the mother take the antidepressant med and wean the mother off breastfeeding.
When a mother says ..’the thought of harming myself has occurred to me ‘ we must follow up. Jabina alerted us to the fact that screening tools such as Patient Health Questionnaire or Edinburgh Scale are not diagnosing. We might say to a mother..I am going to reach out to your health professional on your behalf. A depressed person will probably not be able to make necessary calls . By us normalising the symptoms with the mother she is more likely to seek help.
Jabina gave us all the definitions, the lists of symptoms and the statistics. However she enriched this excellent presentation by referring to her own experience of mental health issues after birth trauma when her first baby was born, describing how well she would have appeared to onlookers…’I had my new baby, my car, my partner, my apartment and my degree. But each time I went home to my baby I sat on the bed and cried.’ This image added power, understanding and humanity to her words.
The statistics of hospitalisation of mothers, suicide and infanticide are stacks of sadness and tragedy. We need to include a section about mental health in our assessment forms for consultations and normalise the subject. If mothers feel heard and we respond appropriately we can perhaps prevent tragedies and reduce lost lives.
Mairead Murphy IBCLC March 2019
Mairead received a bursary of €200 from ALCI to attend LCinPP.