Talking Breastfeeding and Mental Health with Mother-Daughter Team Amanda Wilkinson, MFA, CLS, PMH-C and Alisa Williams, RN, MSN, IBCLC

National Breastfeeding Month

By Samantha Reaves, MA, PMH-C | Postpartum Support International

Amanda Wilkinson, MFA, CLS, PMH-C, is the owner of Weeding the Garden: Peer Support & Coaching for Perinatal Mood Disorders. Her mom, Alisa Williams, RN, MSN, IBCLC, is a registered nurse, lactation consultant, educator, and owner of Momentum Lactation.

Samantha: Please share with us about your organizations, Weeding the Garden and Momentum Lactation – and how you work together.

When I stopped working for the practice full-time, I knew that I had to find a way to keep providing this critical support to mothers, and so I “put out my own shingle” and started Weeding the Garden: Peer Support & Coaching for Perinatal Mood Disorders. I offer 100% virtual peer support sessions where we can work on anything from symptom identification, resource navigation, screening, teaching coping skills, narrative processing, or referral out to a higher-level provider if needed. I am also developing a collection of in-depth resources that are instantly downloadable so that moms have 24/7 access to targeted, evidence-based support. The areas that I’m most passionate about are birth trauma, infertility trauma, and breastfeeding grief/trauma.

I still work with Momentum often, collaborating on resource identification for Alisa’s patients, sharing new research/studies that affect the perinatal population, and presenting or speaking at different professional events on the intersections of mental health and breastfeeding. I LOVE having more excuses to hang out with my mom!  

Alisa: I founded Momentum Lactation in 2017 with the goal of providing greater access to breastfeeding support in Edwardsville and the St. Louis Metro Area. I worked in a hospital setting for many years and realized that many mothers needed more support and information after they left the hospital to be successful on their breastfeeding journey, and that many were ending their journey too soon due to not having support. With decades of experience supporting and educating new mothers through various modalities, and as an expert in clinical lactation, I founded Momentum Lactation to provide the needed access and support missing in the hospital.

I collaborate with physicians, other providers in the community who care for birthing families and have built a strong referral network in the area for a variety of breastfeeding and postpartum issues and support. This has allowed me to extend my support to various other elements of perinatal health, including mental health. The research is clear that mental health and breastfeeding can go hand in hand, having a complementary or also an adversarial relationship. I recognized that moms often will not voluntarily disclose how they might be feeling on their breastmilk feeding journey, but that those feelings could be seriously impacting the mother’s wellbeing, mothering journey, and also breastfeeding success. My relationship with Amanda, as my daughter, and seeing some of the challenges she faced, created a bridge for us to be able to develop a standardized and robust plan for mental health screening of every mom seeking lactation support. We curate care plans and referral resources to get each mom quick access to further screening, medications, counseling, or peer support.

Samantha: The many ways, big and small, in which breastfeeding can affect mental health are often misunderstood. What can you share with us about this?

Amanda: From a mental health perspective, breastfeeding can be highly protective of a mother’s mental health. Studies show that breastfeeding can contribute to a significant decrease in a mother’s risk of developing postpartum depression and other perinatal mood disorders due to the reduction of cortisol (stress hormone) and the increase of oxytocin (feel-good hormone) that is stimulated by breastfeeding. In situations where mothers have known risk factors for perinatal mood disorders (like birth trauma, pre-existing mental health diagnoses, lack of support, etc.), the protective measures that breastfeeding can provide for maternal mental health may be even more critical.

However, it’s so much more nuanced than that. Breastfeeding can also become the cause of a mother’s anxiety, depression, OCD, or other mood disorders because she experiences feeding challenges and can’t access the support she needs to overcome them. Chronic physical pain from an incorrect latch or untreated mastitis, fear over whether a baby is getting enough nutrition, and shame about not being able to do something that our culture has framed as “completely natural” can all send mothers into a downward spiral with their mental health. When breastfeeding initiation is underpinned by existing anxiety, low confidence, or poor preexisting mental health management, the rate of failure is very high. The true tragedy is that this impacts the long-term health outcomes for both the mom and baby over their lifetime. These benefits are set in motion as a result of effective breastfeeding and breastfeeding continuation.

Additionally, many medical providers are uneducated about the compatibility of many mental health medications with breastfeeding. So they recommend that patients discontinue their psychiatric medications (even though there is clear evidence that many of these medications are safe while breastfeeding). Fortunately, we have amazing lactation providers like Alisa–if a mother does want to try and continue breastfeeding and overcome these kinds of challenges, that’s where she comes in!

Samantha: Alisa, tell us how you built such a strong referral network for breastfeeding and postpartum support in the Edwardsville and St. Louis Metro Area.

Alisa: It happened in a variety of ways. I created a Parent Resources page on my website to house resources that may be difficult for moms to find on their own. I wanted them to be comprehensive for the mothering journey, and be easily accessible to both parents and professionals. I started with national resources that were virtually available, like the PSI website and provider directory. Then on a grass roots level, I scoured community business and contacted providers to gain insight into the types of services provided, and then connected with them to understand better how they could serve moms and how available they were. I also talked to my patients, some of whom were perinatal mental health providers, and some of whom were seeing providers they found extremely compassionate and effective. The one area that was lacking was local peer support. That is where Amanda jumped in, got her certifications courtesy of Momentum, and started groups and virtual support.

Eventually, I hosted events like Build Your Village and Holding Mothers, inviting all types of providers, including prescribers, counselors, doulas, OBs, pediatricians, pelvic floor therapists, PTs, OTs, etc. These events were two-fold, to educate and update providers on perinatal mental health, and to ask them to join our network of parent resources. The response was incredible and the resource network was born! 

Samantha: Amanda, you earned your certification in perinatal mental health and are now a peer support specialist, offering coaching for new parents. Share with us what the process was like starting out as a PMH-C, affiliated professional. 

Amanda: I’ll let you in on my big secret–it’s called flying by the seat of your pants! The PMH-C certification program was incredibly comprehensive, and I truly felt confident in my ability to support people through their perinatal mental health challenges when I finished. However, the tricky thing about the Affiliated Professional track is that the assumption is that you will be providing support via another organization or provider–like an IOP program, a community-based organization, or a private practice like what I was doing at Momentum. When I stopped working at Momentum full-time, I had no clue how, or even if I should, strike out on my own as a solo Peer Support Specialist. 

Thankfully, I have an amazing network of maternal mental health professionals and clinicians, and I turned to them for advice and guidance on the role of peer support in the therapeutic spectrum. They helped shape my understanding of how I could support new families myself, and what the scope of that support could be. I am grateful that we work very collaboratively in my local area (thanks to my mom’s amazing skill at cultivating relationships!) and so I finally felt confident to go out on my own and provide peer support and coaching independently, leaning on my own lived experiences with maternal mental health, infertility, and birth trauma as the root of my ability to connect with and support others. 

The more I work with clients, the more my confidence grows! But I do think that many people in my position have major “imposter syndrome” when it comes to the PMH-C because we hold the same credentials as a physician, psychiatrist, and therapist–people who are much higher-level providers. But I would encourage everyone (including myself, haha) that the differentiator of peer support is that LIVED EXPERIENCE. There is something so incredibly valuable in the ability to look a mother in the eye who has experienced a massive antepartum hemorrhage and say, “Me too.” To be able to say “I know how you feel,” and mean it. That releases moms from the emotional burden of having to educate their providers about what happened to them. 

Samantha: We know that unsolicited advice is far too common in pregnancy and new parenthood – but assuming a new mom were to ask, what is the one golden piece of advice you would share?

Amanda: I think I would tell moms to come up with a postpartum care plan for THEMSELVES to help support them through the fourth trimester. There are so many things you can do proactively to set yourself up for support after baby comes–but so many of the pre-birth preparations are about the baby (baby showers, setting up the nursery, etc.). Some super helpful things might be: Setting up your home environment for easy baby care, like creating a rolling diaper cart that you can easily take into every room with you and has things like diapering supplies, nipple cream, snacks, an extra phone charger, etc.! Something else that I think is helpful if you have a history of mental health challenges is to proactively schedule a postpartum virtual visit with your therapist. That way, you know that you already have a resource on deck to check in on your mental health in those first weeks at home, rather than trying to set something up when you’re sleep-deprived and already struggling. 

Alisa: Breastfeeding is one of the things that you can do to bond with your baby, provide their nutrition, and ensure their health for years to come. It takes a willingness to try, time, and giving of your body and space in the beginning. It will challenge you, amaze you, calm you, humble you, and empower you at points along the way. The first eight weeks are the toughest, and it gets easier from there. One of the keys to a smooth transition is support. Family, “breast-friends”, coworkers, child care, and lactation consultants!  

Samantha: Any closing thoughts?

Alisa: Ditto. And, being with Amanda as she has become a mother and navigated her own mothering journey, has taught me many things that make my work with other mothers more legitimate and sensitive. Birth has changed so much in the past 30 years, and working with someone so closely who is experiencing it in the moment has allowed me to gain so many therapeutic and compassionate insights and has informed the care I now provide.

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Explore More PSI Resources:   

Perinatal Mental Health: Signs, Symptoms, and Treatment 

Certification in Perinatal Mental Health 

Breast- and Body-Feeding Resources