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Lactation After Baby Loss
- Eliza
- Mar 23
- 4 min read
Updated: Apr 7
By Eliza Strauss
Bereavement Midwife & Bereavement Counsellor
Founder of The Perinatal Loss Centre
Founder My Pebble Urn
There is limited information and research around lactation after loss and amid a mother's distress and grief, it is unlikely it will be sought out. As Midwives & Doctors supporting bereaved mothers, we need to be aware of the options that are available so we can best advise bereaved mothers appropriately.
When can lactation occur?
Lactation (breast milk 'coming in') after perinatal loss can occur following a late miscarriage (from 16 weeks gestation), stillbirth or a neonatal death. Breast symptoms in any of these scenarios can come as a surprise to the bereaved mother and can add to the grief and distress when there is no longer a baby to parent. For many mothers it is a cruel reminder that their body has continued to do what it was destined to do (make breast milk) but there is no baby to feed.
This can be exacerbated by a lack of preparation and discussions around lactation following the loss within the maternity setting where the loss occurred.
The conversations we need to have
Engaging in discussions with bereaved mothers following a late miscarriage, stillbirth or neonatal death, is challenging but necessary. It is challenging for both the mother and the Midwife who may have limited knowledge around what happens to a mother’s milk supply following a perinatal loss. The midwife may therefore lack the confidence to initiate a conversation and advise a mother with regards to lactation after loss.
Assumptions
In my experience as a Bereavement Midwife, there is sometimes an assumption by health professionals that a bereaved mother will want to suppress lactation to stop her milk ‘coming in’ and there is also the assumption that she would want nothing to do with her milk following the death of her baby. Consequently, the default position taken is a medical approach whereby medication is routinely offered with little discussion around what other options may be possible.
As a practitioner, be mindful that ...
• lactation can occur after the 18th week of pregnancy and may be even earlier in some cases.
• there may be practitioner bias around thinking ‘what is best’.
• advice regarding lactation after loss is usually ad-hoc, not best-practice or not offered.
• breast milk can be highly symbolic and a product of motherhood. There will be varied responses and meaning attached to breast milk.
• some choose to not suppress lactation and let nature take its course as part of the grieving process.
• some mothers will want to suppress their lactation as soon as possible.
• some mothers gain comfort in knowing their body made milk with the intention of feeding their baby and offering sustenance. This may offer further connection to the baby and enhance their identity as ‘mother’.
• some bereaved mothers will want to attach meaning around their loss and may gain comfort in expressing, storing or donating their breast milk.
• some choose to suppress lactation with medication.
• warn that some leakage of milk can still occur despite medication being taken and can last days or 1-2 weeks.
Letting nature take its course
If a bereaved mother chooses to let nature take its course and not suppress lactation, please consider the following:
Warn mother regarding onset of breast discomfort:
WHEN: let her know when symptoms will appear – usually within 1-3 days of birth
WHAT: let her know what she may feel – a feeling of fullness, leakage of milk, sore breasts, lumps, redness
HOW: let her know how long symptoms will last – this depends on whether lactation was established or not at the time of the loss
Offer comfort measures
Offer information
It is important to provide both verbal and written information around lactation after loss and it should be provided at any point in the loss trajectory. It is vital that written information or links to information be given to a bereaved mother at the time of discharge as often verbal information is not retained.
Memory Making
It is important to remember that for some bereaved mothers, breast milk may be part of memory making and keeping their baby’s memory alive. It can provide comfort to them and form part of their grief ‘story’ which may help them integrate the loss into their life.
Donation
For this cohort of mothers who donate their breast milk, there may be an altruistic intention – their baby died but they want to help other babies or another mother who may not be able to breastfeed.
• milk donors need to have their blood screened before they can donate their milk in Australia (www.milkbank.com.au).
• milk sharing - some mothers may choose to donate breastmilk privately via social media accounts.
Mementoes
Some choose to make or buy mementoes with their stored breast milk e.g., milk or a lock of hair jewellery or honouring their baby by burying some breast milk with baby or pouring some milk over a special plant/bush that they have planted.
Closing
The death of a baby through miscarriage, stillbirth or newborn death is one of the most challenging aspects of midwifery. Lactation after the death of a baby occurs for many thousands of women and sadly it will come as a surprise if discussions have not occurred around the possibility of breast discomfort and milk leakage. Through gentle and sensitive conversations at the appropriate point at the time of the loss, we must offer options so that a mother is aware of the possibilities around what could happen with her breastmilk. She is then able to make an informed choice about what is best for her following the death of her baby.
For information on comfort measures, please visit:
For Midwives & Doctors and for information on perinatal loss training:
References:
Carroll K, Noble-Carr D, Sweeney L, Waldby C. The "Lactation After Infant Death (AID) Framework": A Guide for Online Health Information Provision About Lactation After Stillbirth and Infant Death. J Hum Lact. 2020 Aug;36(3):480-491. doi: 10.1177/0890334420926946. Epub 2020 May 19. PMID: 32427507; PMCID: PMC7411512.
Noble-Carr, D., Carroll, K., & Waldby, C. (2021). Mapping Hospital-Based Lactation Care Provided to Bereaved Mothers: A Basis for Quality Improvement, Breastfeeding Medicine, 16(10), 779-789.
Noble-Carr, D., Carroll, K., Copland, S., & Waldby, C. (2022) “It was a shared duty”: Bereaved fathers’ perspectives, experiences and practices in relation to their partner’s lactation after infant death. Breastfeeding Review, March 2022.v
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