by Cynthia Billiar, BSN, RN, IBCLC, RLC, ANLC, CD(DONA), ICBD, ICCE, SpBCPE
Whether an infant loss is perinatal, neonatal, or that of an older infant/child, it is personal and unique to every mother. Loss of an infant includes emotional and physical manifestation for each mother. She not only is grieving the loss of her child but also the dream she had 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 how the mother felt 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 in regards to 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. In the past, medications given to suppress lactation were common. 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 put the mother at risk for mastitis, (Moore & Catlin, 2003). The physical pain from engorged breasts could 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. When breastfeeding or pumping is stopped abruptly it can lead to severe engorgement, pain, and 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 she 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. Some suggestions on how she might do that would be to decrease the amount of pumping in twenty-four hours by one pumping each 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). Some of these different recommendations for lactation suppression could take a few weeks before the mother can comfortably stop expressing milk completely. It is normal for mothers to be able 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 mothers with lactation suppression and comfort would be:
- Stand in a warm shower and let the water run over the breasts; this can stimulate milk leakage thereby decreasing fullness.
- Sit in a warm bath and lean into the water allowing the breasts to dangle in the water; this will also stimulate milk leakage.
- Apply ice packs or a bag of frozen peas to engorged breasts for five to fifteen minutes at a time to reduce swelling and pain.
- Ibuprofen or acetaminophen can also help decrease pain and discomfort.
- Do not restrict fluids and instruct the mother to drink when she is thirsty.
- Do cut back on salt intake as salt causes the body to retain fluids.
- 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.
- 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 they 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 https://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). Offering lactation support for mothers with a loss is an area I feel has been overlooked. We need to respect the mother’s right to choose how she would like to handle this delicate situation. There are so many decisions that have 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 from this blog, along with the contact information of a lactation care provider, 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. Please do not forget those mothers that have given the gift of life and have chosen 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 https://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