Can I ask a question of all our lovely BF experts/ counsellors/ etc. about BF and lithium...

[mylittlepudding]

...It's all done and dusted now for dd - she is 15 months, and was FFed, failure to thrive due to reflux, but has now grown out of that and eats and drinks pretty well. But the guilt has been HUGE and I might be stupid brave enough to do it again one day.

I was and am on lithium. I had a fantastic perinatal psychiatrist who said that the risk of a perinatal psychosis/ mania on an unopposed antidepressant was very significant (around 2/3) and that it was best for me AND baby to take the lithium and give formula.

Obviously it's too late - but I still wonder whether that was the best advice. I read the really great article put up the other day - the "mind your language" one. And I just wonder...
What advice do you give if you see people like me? Have you got people through it? Is it better to be BFed in a psychiatric unit than FFed at home? I just hope one day I might feel easy about all this, I certainly don't yet.

pudding, all this is a judgement call, as you imply, and not cut and dried at all.

toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~uu9x2o:1 is a good overview of the research, showing that a third option might have been to use lithium and breastfeed, while monitoring your baby for ill-effects.

It is not good for babies to have a severely mentally ill mother - it interferes with attachment and emotional well-being, even down into the next generation. These effects can be long-lasting. And committed breastfeeding supporter that I am, I would say that in my view I would say this is more important than breastfeeding - one of the powerful aspects of breastfeeding is that it promotes attachment and emotional well-being, after all.

Maternal mental ill health needs treatment - no doubt about it. The challenge is to treat and not interfere with breastfeeding.

I don't think you can choose between home and a unit without more info - it really depends on the support structure in each, but it's an unusual institution that replicates a loving household. A loving home is better for all the family than even the best unit, I would say.

So - there is no easy answer to your Q, except to suggest another psych. might have had a different opinion on the drug effects on the milk, but you would not know that - sounds like you had a hard time, and would have had a much harder time if you had been ill, and you made the decision you felt was right for your dd...which is all any mother can do. No regrets necessary.

pudding - what's your response to this? I hope I have not upset you in any way...would hate to have done that

To be honest, it sounds to have been the most pragmatic solution for you albeit a difficult one to accept.

Sometimes the mental health of the mother has to be the overriding concern for all involved. In my experience, I have seen some seriously ill women with puerperal psychosis and mania and it is not something which I would encourage someone at high risk to take a chance with. Lithium and breastfeeding don't mix unfortunately.

What is it that makes you sad or regretful about the decisions that were made?

tiktok - not at all, just thinking. Been a lot of thinking to be done.

It sounded quite a rollercoaster to BF and use lithium, regular blood tests for baby, etc... And none of the other mood stabilisers are much better.

I think I will get to acceptance. Am just still sad to not have had the experience, or for DD to have had the benefits. I've had a brief depressive psychosis since and I feel like I practically missed dd's first birthday and Christmas. It could have been so much worse, I guess.

I couldn't read your post, mylittlepudding, and not post. It sounds like you made a very wise decision with the information that you were given at the time.

If you did want to persue the idea of BFing another baby, maybe you could consider mixed feeding if you are worried about how much lithium is transferred to the baby through your BM. I know that you would still need to have the baby monitored and that you wouldn't get the full benefit of exclusive BFing, but you would still get some of the benefits and may feel more at peace with your decision to BF if you have a bit of a back up with FF that obviously won't contain lithium.

I personally think that you are a very selfless woman and you sound like a fantastic mummy. I wonder if you would benefit from discussing your feelings of guilt and thoughts about a future baby with your psychiatrist? It would be less pressured to discuss things now before you get pregnant again and I think that it is important that you explore the feelings you have regarding feeding.

I couldn't read your post and not post either...not a BF expert but someone who bf a ftt baby due to reflux. I didn't manage to exclusively bf, I had to top up for a period. I had all the support in the world, had an easy birth, was psychologically in a good place and it was still the hardest thing I have ever done.

The idea that you should feel guilty for having stopped due to the lithium which you NEEDED makes me really . I think you absolutely did the right thing. There is no guarantee that you would have managed to keep bfing if you had not taken the lithium, and ff in a psychiatric unit is definitely worse than ff at home. Realistically, do you really think you would have been able to bf if you had had to go into a psychiatric unit?

I really hope you can come to terms with the fact that you did what was best for everyone. Even if you do decide to do differently for a next one, that doesn't mean that that was the wrong thing to do! You sound like an incredibly loving and dedicated parent, and that is going to make a much bigger difference to your dd than the method of feeding.