by Cynthia Billiar, BSN, RN, IBCLC, RLC, ANLC, CD(DONA), ICBD, ICCE, SpBCPE
(This blog was published in its original form at https://icea.org/lactation-after-infant-loss/)
An infant loss, whether perinatal, neonatal, or that of an older infant/child, is always personal and unique to each mother.
Emotional and Physical Impact of Infant Loss
Loss of an infant includes both emotional and physical manifestation for each mother. She not only is grieving the loss of her child, but also her dream of feeding, loving, and caring for her child. Parents are faced with many decisions after the loss of their infant, such as funeral planning, whether to have an autopsy and all the details that goes along with each decision. Many times, providers overlook the normal postpartum changes that the mother’s body will be going through.
Melissa Cole explains in her article, Lactation after Perinatal, Neonatal, or Infant Loss, that many grieving mothers have expressed their strong feelings about the lack of lactation support following the loss of their infant (Cole, 2012). Cole explained that the milk a mother produces after the loss of her infant has been referred to by some as “white tears.”
In the past, the focus was on lactation suppression and did not consider a mother’s feelings about it. Mothers have a choice of whether to suppress lactation or not. Keep in mind that a mother is most likely to lactate after the 18th week of pregnancy and it is possible as early as 12 weeks. Educating the mother on what to expect regarding lactation and then offering some options will allow her to grieve in her own unique way. It is important to include those mothers that have chosen to place their babies for adoption in this education as well.
Risks of Lactation Suppression
In the past it was common to give medications given to suppress lactation. In the 1990’s it was discovered that the medications that were given “to dry up milk” had health risks and were taken off the market for milk suppression. Abrupt cessation of breastfeeding or pumping can be very painful and leaves the mother at risk for mastitis, (Moore & Catlin, 2003). The physical pain from engorged breasts can potentially aggravate the emotional pain the mother is feeling from the loss of her baby. The sudden drop of the hormones related to lactation may also add to the feelings of depression. It is important for the mother to be gentle with herself and receive physical and emotional support and comfort. If the mother’s choice is to suppress lactation, it is important to teach her how to do this safely.
Engorgement and Lactation
When breastfeeding or pumping is abruptly stopped it can cause severe engorgement, pain, and a high risk for mastitis. Although engorgement does play a role in suppressing lactation, painful engorgement is not required and can be avoided, (Moore & Catlin, 2003). If the mother has been pump-dependent or has lost an older breastfeeding infant, she needs to be provided with a breast pump or taught hand expression promptly; delay will create additional pain. Mothers may feel more comfortable wearing a fitted bra for support, but it is not necessary. It is not recommended for the mother to bind her breasts. This technique is outdated and can lead to increased pain, blocked ducts, and mastitis. If the mother had been pumping or breastfeeding every three hours and has a full supply, she should taper off gradually.
Tapering Off Pumping
Some suggestions on how a mother can taper off slowly would be to decrease the amount of pumping in twenty-four hours by one pumping per day until she is no longer pumping at all. Another option would be to start out pumping every four hours then decrease to every six, then every eight, then every twelve and so on. She may also consider decreasing the amount of milk she is removing. If she has been pumping six ounces each session, she could stop pumping when she has removed four ounces, then three, then two, and so on until she is comfortable not pumping. She wants to follow a schedule such as on day one she will pump for five minutes every four to five hours, on day two, pump every six hours for three to five minutes and days three to seven, pump only when feeling full and just enough to relieve discomfort, (Moore & Catlin, 2003).
Recommendations for Lactation Suppression
Some of these lactation suppression recommendations could take a few weeks before the mother can comfortably stop expressing milk completely. It is normal for mothers to express a few drops of milk or have a little leaking for weeks or even months after they have stopped expressing milk. Other recommendations that can help make mothers with lactation suppression more comfortable would be:
- Standing in a warm shower and letting the water run over the breasts; this can stimulate milk leakage thereby decreasing fullness.
- Sitting in a warm bath and leaning into the water allowing the breasts to dangle in the water; this will also stimulate milk leakage.
- Applying ice packs or a bag of frozen peas to engorged breasts for five to fifteen minutes at a time to reduce swelling and pain.
- Taking ibuprofen or acetaminophen can also help decrease pain and discomfort.
- A mother should drink when she is thirsty and should not restrict fluids.
- Do cut back on salt intake as salt causes the body to retain fluids.
- She can drink a cup of sage or peppermint tea every six hours. Sage and peppermint tea can be found at health food stores. Steep one teaspoon in one cup of hot water for fifteen minutes, add some honey or milk to the tea to taste. Three to four milliliters of sage tincture every six hours can also be used. Tincture is absorbed in the mucous membranes much more readily and can be somewhat more efficient at decreasing milk production.
- Taking two hundred milligrams of vitamin B6 daily for five days is thought to help decrease engorgement.
- Mothers may consult with their provider about other methods such as taking an antihistamine, acupuncture, therapeutic ultrasound, or massage, (Parkes et al., 2016)
It is very important that the mother is instructed to call her provider if she notices any signs of breast infection. Signs and symptoms to report would be sudden onset of flu like symptoms, fever, chills, body aches, and a hot red painful hard area on the breast.
Some mothers find comfort in helping other babies and choose to continue to pump and donate their milk to a milk bank. Milk banks provide breastmilk for sick or premature babies whose mothers are unable to provide milk for them. They can also donate any milk that had been previously pumped and frozen. For more information about milk banks, or to find one near you, visit the website for the Human Milk Banking Association of North America (HMBANA) at http://www.hmbana.org/, (Smith).
Mothers might want to keep some of their milk as a keepsake. There are DIY keepsakes that can be made with breastmilk, and there are several companies that make beautiful jewelry from it, (Parkes et al., 2016).
I feel an area that has been overlooked is offering lactation support for mothers with a loss. This is a delicate situation and we need to respect the mother’s right to choose how she would like to handle it. There are so many decisions to be made when there is a loss that most mothers have no idea what they will be facing when it comes to their breasts. Creating a handout with some of the suggestions discussed above, along with a lactation care provider’ contact information, could be very helpful. In these situations, the mother may not remember a word you said, but she will remember you gave her a handout and it could be very helpful.
We also should not forget those mothers that have given the gift of life and chose to give their babies for adoption. No matter when the loss occurs, all these mothers need lactation support. Be the one that makes a difference in these mothers’ lives and give them the lactation support they need. Just one lactation visit could be all it takes to help these mothers understand their options, be more comfortable and equipped to manage lactation suppression.
Cole, M. (2012). Lactation after perinatal, neonatal, or infant loss. Clinical Lactation, 3(3), 94-99.
Moore, D. B., & Catlin, A. (2003). Lactation suppression: forgotten aspect of care for the mother of a dying child. Pediatric Nursing, 29(5). Retrieved from www.umamanita.es/wp-content/uploads/2015/05/Lactation-supression-ingles.pdf
Parkes, K., Ricci, E., Harrison, G., Ives-Baine, L., Limbo, R., Porter, S., & Taylor, K. K. (2016). Lactation after perinatal loss requires education and specialized care. Retrieved from http://www.plida.org/wp-content/uploads/2012/01/PLIDA_PositionStatement_LactationIssuesFollowingLoss
Smith, A. (). Lactation suppression. Retrieved from https://www.breastfeeding basics.com/articles/lactation-suppression