Craniosacral therapy and lactation support can be really supportive for babies after exposure to antidepressants or other medication during pregnancy. I know this is a sensitive issue and hope I have given it the respect and care it deserves.
Studies show that thirty percent of babies who are exposed to antidepressants during pregnancy experience side effects after birth. This is known as discontinuation syndrome*. Symptoms may resolve within 3-5 days but can last up to one month and breastfeeding issues may potentially last longer. These babies are often monitored over the first 48 hrs in hospital, but as an IBCLC and BCST in private practice, I do see babies in the community who may still be struggling with this. They may not feed well, struggling to transfer milk and/or are excessively sleepy, or not sleeping well due to agitation. Parents may not be aware of the underlying cause. Knowing what symptoms to look out for and what things can help, means parents can better understand and support their baby, though I do understand this awareness may bring up difficult feelings.
It is not clear why some babies are affected, and others aren’t and it’s also hard to predict the severity of symptoms. Signs and symptoms may be mild, moderate or severe.
Possible effects:
- Excessive sleepiness
- Yawning, stuffy nose, sneezing
- Sleep disturbances
- Weak cry
- Jitteriness / tremors
- Poor feeding – weak suck, insufficient milk transfer, poor suck/swallow/breathe coordination
- Persistent or abnormal crying
- Diarrhoea or vomiting
- Breathing difficulties – especially when feeding
- Low blood sugar
- Low weight gain
- Irritability or restlessness
- Fever or difficulty regulating temperature
- Seizures
- High or low muscle tone
Research on long term effects and use during breastfeeding is limited. Breastfeeding babies continue to be exposed to the medication but at a much lower dose than during pregnancy, and it is thought to reduce the severity of symptoms, so breastfeeding is encouraged.
Around one in seven Australians take antidepressants daily. Selective serotonin reuptake inhibitors (SSRIs)s are a class of antidepressants, examples include Fluoxetine, Sertraline and Citalopram. Serotonin norepinephrine reuptake inhibitors (SNRIs) are also used during pregnancy with similar effects on prenatally exposed babies. When women go on to have babies, a decision is often made with a doctor to either stop, cut down or continue the medication. A risk-benefit analysis is undertaken – the risk to the pregnant woman and her baby of discontinuing the antidepressants vs the risk of medication exposure on the infant. Infants born to mothers with untreated depression are at higher risk for adverse neonatal outcomes including impaired bonding. Many women do stop taking them during pregnancy but others need to continue taking them. Antidepressants prescriptions during pregnancy are issued to 5-15% of women. There are non-pharmacological measures to be explored in individual circumstances e.g. talk therapy and other alternative/complimentary therapies like EMDR and craniosacral therapy, though cost is often a barrier. Financial support is lacking, within the health care system, for therapies that aim to address the root cause of mental health problems (e.g. early childhood/ developmental trauma) and these therapies take time to create shifts. Often in times of crisis, medication is necessary to function in daily life (dealing vs healing), though for true healing, underlying issues do need to be explored at some point.
Pregnancy and new motherhood is a vulnerable time for women. Approximately 15–20 per cent of women in Australia are affected by perinatal depression or anxiety. The changes that occur around pregnancy, birth and new motherhood can be a recipe for worsening mental health. Pregnant women do not have continuity of care with a midwife and therefore miss out on the opportunity for deeply supportive maternity care. Births are highly medicalised with up to 45% of women experiencing birth trauma! Traumatic births increase the risk of anxiety and depression and for some women can lead to PTSD (if not recognised and appropriately supported). Add to that, new mothers are sent home with poor breastfeeding support, partners work long hours with minimal paternity leave and grandparents/family may not live nearby. The recent COVID pandemic has also had a negative impact on mental health. All these factors can exacerbate mental health issues. There is poor support in general and a growing sense of social isolation in this period of life. This is a significant public health issue that is getting worse and will be difficult to change without a complete reorganising of our systems and the way we live.
My focus as an IBCLC and BCST is to support breastfeeding and to support the baby’s experience. As an ex-mental health nurse, I offer a non-judgemental approach, I understand the context and background of mental health. Mothers must not blame themselves. Having an awareness of the issue and therefore validating the baby’s experience while seeking appropriate support can make a huge difference. We know some adults can have a difficult time stopping antidepressant medication and we must hold in our consciousness the same degree of empathy and care that we offer to adults. These babies require sensitive care. Supportive measures include:
- Closeness – skin to skin, baby wearing
- Reduce stimulation – minimise noise (eg. TV/radio off), low lighting, limit visitors etc
- Calming environment – swaying, humming, talking to baby softly, gentle handling
- Craniosacral therapy can be helpful for these babies – the earlier the better. The gentle touch calms the nervous system and supports the baby’s healing process.
- Professional support for breastfeeding issues – if babies are not gaining enough weight because they are not sucking well then mothers will need support to maintain their milk supply until baby’s feeding improves. An individualised assessment by an IBCLC is recommended.
Mothers must be kind to themselves and know that looking after mental health is paramount in the perinatal period. Decisions around medication are made to provide baby with a stable caregiver which cannot be underestimated. If you feel your baby may have signs of discontinuation syndrome, then seek out an IBCLC in your area or a CST who works with babies – the therapy is super gentle and babies can be treated in the first week of life.
To work with me, get in touch for lactation or craniosacral support. Zoom appts are available for those not in Perth.
*Discontinuation syndrome (neonatal abstinence syndrome) occurs with other medications/drugs/alcohol used during pregnancy though this article has a specific focus on antidepressants.