Managing Depression during Pregnancy and Lactation

by Melissa Garvey, ACNM Writer and Editor

Between shifts at the information booth and shadowing the photographer, I was lucky enough to sample a few of the great education sessions on tap at this year’s ACNM Annual Meeting. I was most looking forward to meeting fellow bloggers Mary Murry, Amie Newman, and Amy Romano, but I also managed to slip into “Psychiatric Medications in Pregnant and Breastfeeding Women: Risks and Benefits,” which was taught by Beth Conover, MS, APRN, CGC, from the Nebraska Teratology Information Service.

Beth addressed a number of psychiatric conditions and medications, and designed her presentation for health care providers. But, as a health care consumer, the information on managing depression struck me the most. Did you know that during pregnancy, symptoms of depression affect 10 – 20% of women? Here’s what I learned, which I suspect is relevant to many of my fellow midwifery care consumers out there.

According to Beth, untreated depression may increase a woman’s risk for miscarriage, pregnancy-induced high blood pressure, preterm delivery, or low birth weight. There are numerous lifestyle adjustments and therapy options that may be sufficient to keep depression at bay. However, some women require medication to treat their depression. Untreated depression during pregnancy carries risks; medication during pregnancy carries risks. In fact, just by being human, every woman has a 3% chance of having a baby born with a congenital anomaly (aka something unusual or different at birth). There are no zero-risk options.

The good news is that there are low-risk, relatively safe options proven to help women with depression cope and even thrive through their preconception, pregnancy, and postpartum experience. If you’re interested in the specific risks and benefits of a particular psychiatric medication during pregnancy and breastfeeding, Beth recommended perusing the Organization of Teratology Information Specialists’ FAQ sheets in English and Spanish (and, as always, you should consult your health care provider).

Another tip Beth gave is not to rely solely on the FDA codes that rank medications as category A, B, C, D, or X. Risk classifications are based on the best data available, which are often results from studies on animals. They don’t always accurately reflect risk status either. For example, birth control pills are in category X not because they are likely to cause serious harm to a developing fetus, but because they aren’t prescribed during pregnancy. (If a woman is pregnant, why would she need birth control?) It can also take a long time for a medication to move to the category that best reflects the current available scientific evidence.

Now it’s your turn. What sessions did you attend? Which were your favorites?

Moms Reveal Telling Facts About Breastfeeding

by Melissa Garvey, ACNM Writer and Editor

Did anyone listen to the Bravado Breastfeeding Information Council (BBIC) launch event this past Tuesday? I was pleasantly surprised by the amount of solid facts they revealed from their database of 80,000 women. In case you missed it, here’s a snapshot of what they shared:

• First generation breastfeeding moms need special support. Of first generation breastfeeding moms (women whose mothers did not breastfeed), only 40% said they received amazing support from their mothers, 30% hoped for more support, and 10% were actively discouraged in their efforts to breastfeed.
  
  
• Breastfeeding works better with three. 75% of women said their decision to breastfeed was influenced by their partner. As one woman explained, “Without his support, I would have given up in the first week.”
  
  
• Being friendly to breastfeeding moms is good business. Business owners take note: more than 85% of nursing mothers will go out of their way to visit a store or restaurant that is breastfeeding friendly.
  
  
• It’s easy to create a breastfeeding friendly workplace. More than 80% of breastfeeding mothers are committed to continue nursing when they return to work, and they say all they need is a door, a plug, a refrigerator, and a sink. Panelists shared innovative ideas worth passing along on this topic. At one company, moms are able to reserve the breastfeeding lounge via their Outlook calendar. Some companies are also including their breastfeeding policy in the maternity leave paperwork, so women have plenty of time to consider their options and plan ahead.
  

Did you listen in, too? Tell us what you learned.

(Note to women: More information about breastfeeding is available from the Journal of Midwifery & Women’s Health. Read Bringing Your Baby to Breast: Positioning and Latch and What to Expect in the Early Days of Breastfeeding.)

Breastfeeding Benefits Moms, Too

Midwives and other women’s health care experts agree that breastfeeding is a great way to give babies a healthy start to life. Now a new study shows that breastfeeding may benefit mom’s health later in life. Scheduled for publication in the May 2009 issue of Obstetrics and Gynecology, the new study shows that women who have breastfed have a lower risk of developing high blood pressure, diabetes, and heart disease during menopause.