(Spanish version: Preguntas frecuentes sobre la lactancia después de una pérdida)

Some bereaved mothers experience a loss postpartum after previously breastfeeding or pumping their milk multiple times a day, while other bereaved mothers lose a baby in utero or at birth before they ever had the opportunity to breastfeed their baby. Regardless of the type of loss, lactation is a reality for most bereaved mothers amid the shock, pain, and sadness over the loss of their baby. There are physiological and emotional aspects of lactation that should be addressed with the family when a baby dies.

If you or someone you know has recently experienced the loss of a little one, here are some common lactation questions and answers that might be helpful:

What should I do if I had been breastfeeding or pumping my milk multiple times a day when my baby dies?
When your baby dies, your body goes on making milk. You need to continue expressing, although you can gradually cut back on the length of time spent pumping and stretch the time between pumping so that your body gets the message to make less and eventually stop making milk. Keeping comfortable and preventing engorgement is a priority when you are still producing milk and are unable to breastfeed. You could even get plugged ducts or mastitis if milk is not removed from the breasts. Even if you decide to wean your body from making milk right away, you usually have to pump your milk to ease discomfort and prevent engorgement for at least a week or two after your baby dies. When your breasts feel full, express some milk to relieve any discomfort. If you pump just enough to relieve your discomfort during each pumping session, you will feel relief and you will begin to train your body to produce less and less milk in a comfortable way. The amount of time it takes to end milk production varies from mother to mother.

What should I do if I have a freezer full of breastmilk after my baby dies?
When your baby dies, some of the milk that you pumped may be stored in a hospital Neonatal Intensive Care Unit (NICU) freezer if you delivered at that hospital, and/or in your freezer at home. If you still have milk in a freezer at the hospital at discharge from the hospital, you can take the milk home with you, have the hospital discard the milk for you if you wish, or donate the milk to a nonprofit milk bank.

What are my options if I do not want to throw my milk away?
Some bereaved mothers do not want to discard their stored milk because it is a reminder of and a connection to their baby. One alternative to discarding milk is donating it to a nonprofit milk bank, which provides milk to the most fragile recipients. Most nonprofit milk banks screen, collect, process and distribute donated human milk to babies whose mothers cannot supply the milk to meet their own baby’s need. The majority of milk donated to nonprofit milk banks in the United States and Canada, for example, goes to NICUs for babies with gut problems, cardiac problems, and a multitude of other medical challenges that benefit from the gift of donor milk.

My baby died in-utero or at birth. Will I produce milk even if my baby did not survive?
A woman can begin to make and leak milk as early as 12 weeks gestation. Therefore, your body will most likely begin to produce milk even after your baby dies in-utero or at birth. Even if you want to try to dry up your milk right away, it is important to learn how to manage your milk supply in the days and weeks following your loss to maintain physical comfort and prevent engorgement.

If my baby dies in-utero or at birth, what should I do when I start producing milk?
The most effective way to deal with the milk your body starts making after your baby dies is to express or pump your milk to prevent engorgement. If you remove just enough milk to reduce pressure in your breasts but not enough to empty them so that they produce more milk, this will decrease your milk production over time. When your breasts feel full or uncomfortable, express a small amount of milk to relieve any discomfort. This usually takes just a few minutes. You may need to express or pump every few hours anywhere from a few days to a few weeks after the birth to maintain comfort and to prevent any physical pain from engorgement. Many mothers find a hospital-grade electric breast pump is the easiest and most effective way to pump for comfort. Others have used hand expression. When an electric pump is not available, you can use a manual breast pump or hand expression to remove your milk. You can discard the milk right away after you pump it, or you can store it in the freezer at the hospital if they will permit it while there, or in your home freezer if you are pumping at home.

Can I continue to pump my milk beyond what is necessary to maintain comfort?
You can keep expressing your milk after your baby dies. Some bereaved mothers find that expressing milk on a regular basis helps them move through the grieving process. They use pumping as a ritual to help them manage their grief and to honor their connection to their baby. If you do not own a pump, ask if the hospital can provide you with a breast pump to express your milk in the few days following to maintain physical comfort and prevent engorgement. If you are interested in expressing your milk when you return home from a hospital, ask a nurse or lactation consultant about borrowing or renting a breast pump for home use.

What can I do if my breasts are engorged after my baby dies?
Here are some things you can try if you are experiencing discomfort or engorgement:

• Cold compresses: Use cold compresses on the breasts for 20 minutes to ease discomfort and swelling.

• Green cabbage leaves: Remove the stems from large green cabbage leaves and use them as breast pads. Chill or freeze the cabbage leaves and then place them in your bra. Change them when they wilt. Try this for 20 minutes three or four times per day.

• Warm showers: This helps some of the milk run out of the breasts, which helps to relieve discomfort.

• Consider analgesics: Talk to your doctor or other health provider about whether an over-the-counter or prescription medication would be appropriate and of help to you.

• Express milk: When pumping or hand expressing, remove just enough milk to relieve discomfort — usually about 2 to 3 minutes of expression — until your breasts are more comfortable.

• Wear a bra: A comfortable, supportive bra helps carry the weight of heavy breasts. By containing the breasts during the night with a looser bra, many mothers experience less leaking and less discomfort. Underwire bras should be used with caution as they can contribute to plugged ducts and sore areas.

If I want to donate to a milk bank, where do I store my milk?
You can store your pumped milk in the freezer until you are ready to donate it. If you own a deep freezer, ideally store it there as milk can be stored longer there. If not, a refrigerator-based freezer will also work just fine. It is helpful to label a separate breastmilk storage bag with the date of each pumped session and your name. [1]

Early in your collection, be sure to contact your area nonprofit milk bank for instructions and to begin the screening process. ¹ Besides being considered as a breastmilk donor to benefit other babies, some nonprofit milk banks may also allow you to donate your milk to research.Donating to research —typically to a local university — helps further breastfeeding science and is a nice option if for any reason your health or medication history does not make you eligible for donation to other babies.

What if I want to stop my milk production instead of continuing it?
The process of drying up milk is different for every bereaved mother. The frequency in which you need to pump and the duration of the process will depend on the amount of milk you are producing, how often you pumped prior to the loss of your baby, and the length of time that has passed since the birth of your baby. A general guideline for drying up milk is to pump to comfort — shortening the length of time you pump, and going longer between pumping sessions (Neifert, 2009). [2] For example, if you have been pumping about every three hours (eight times a day) for 20 minutes at a time, go longer between pumping, maybe four hours, and pump for 15 minutes. After a few pumping sessions, try going a little longer and reduce the number of times you pump. If you are very uncomfortable, adjust your schedule to maybe pump every four hours, but for 12 instead of 15 minutes. As your milk supply diminishes, you can lengthen the time between pumps and spend less time expressing.

The most effective way to gradually diminish your milk production without excessive discomfort is to remove just enough milk to reduce pressure in your breasts, but not enough to empty them so that they produce more milk. Your milk supply will usually go down fairly quickly if you gradually reduce the number of times you pump over a short period of time in the week or two following the loss of your baby (Neifert, 2009). [2]

A hospital-grade electric breast pump is probably the easiest way to dry up your breastmilk. When an electric pump is not available, you can use a manual breast pump or hand expression to remove your milk.

A few words of advice, for family and friends of the bereaved mother:
Determining how to respond to milk production after losing a little one is a very personal and often difficult decision to make for a bereaved mother. The weight of grief, in addition to possibly planning a memorial service, is already a lot to bear. So it is important to just be available to support and comfort her. Allow her time to arrive at her own personal decision as to whether to cease or continue milk production, while showing her you are there for her, no matter what she decides.

 

This article was adapted, with permission, from pages 13, 19-21, and 30, of the book: Lactation Support for the Bereaved Mother: A Toolkit – Information for Healthcare Providers, by Jessica Welborn. Copyright 2012. The book is published by the Human Milk Banking Association of North America.

 

Additional References:

1. 2018 Guidelines for Establishment and Operation of a Donor Human Milk Bank. 10^th Edition, 2018.

2. Neifert, M. Great Expectations: The Essential Guide to Breastfeeding. NY: Sterling Publishers. 2009.