Severe mental illness (SMI) is defined as psychiatric illness that impact a person’s daily functioning, requiring ongoing mental health services. According to the authors of this week’s systematic review, approximately 2.8% of pregnant women have pre-existing severe mental illness and/or develop severe post-partum psychiatric illness. Suicide is among the leading causes of direct maternal death in the first year postpartum, along with homicide and drug overdose.
Women with SMI are also at higher risk for poorer pregnancy outcomes such as gestational diabetes, prematurity, low birth weight, growth restriction and admission to neonatal intensive care. These risks are modified by the benefits of breastfeeding.
The aims of this systematic review were to evaluate evidence for infant feeding outcomes among women with SMI, experiences of breastfeeding support among women with SMI, interventions to support infant feeding in this population, and health care provider attitudes towards infant feeding among women with SMI.
The systematic review included 18 studies, of which 11 were cohort, 2 cross-sectional, 1 case series, 1 case-control, 2 qualitative, and 1 quasi-experimental study. The 18 studies included a total of 446,393 individuals, some of whom were controls. The studies took place in the USA, UK, Australia, Greece, Norway, Israel, and the Netherlands.
Only 2 studies evaluated breastfeeding rates and found that women with SMI had lower breastfeeding rates than controls.
What else? See the question!
Jaimie Zaki, IBCLC
I have had so many mothers come to me stating that they are angry because their psychologist/psychiatrist or therapist convinced them weaning would help solve their postpartum mood disorders (often in place of getting actual lactation support!) and not only did they get worse in many cases, they then regretted stopping but felt like they were too far gone to try to attempt breastfeeding again. Some of these women had intense anxiety that got worse because they felt they’d find themselves in a natural disaster or formula shortage and be unable to feed their baby.
I fear that this study applies broadly to ALL mothers with mental health disorders, not just those with “severe mental illness”. SOOO many Mental health workers, like many others, do not have the training to be advising postpartum women on anything regarding breastfeeding even within their scope and POV of “Well remove the one thing bringing you the most stress” or whatever. It’s like they don’t understand how the hormonal shifts can often impact pre-existing mental health conditions.
Worse than that, the point regarding lack of breastfeeding support at mental health institutions is sooooo under-discussed. I believe many women who know they need to seek support postpartum are terrified to because they know they will have their breastfeeding goals undermined and under supported. What can we do to change this? How can we push for postpartum specific units that have lactation support and programs that are focused on reuniting mom and baby ASAP?
Amy Glaser
Are there resources you suggest for the pediatrician,/IBCLC to read before prenatal visit with moms’ with SMI?
Thank you
IABLE
I am going to do a case discussion on this topic Sept 17th. It is one of the free monthly Case Discussion Series webinars- https://lacted.org/shop/case202309/. We don’t have a protocol on this, and I encourage anyone/everyone to join in the case discussion to share what has helped them counsel people with a history of severe mental illness. It would be wonderful to publish an article on this.