Lactation After Loss

Supporting a family after the loss of their pregnancy or the death of their baby is strengthened when healthcare professionals are knowledgeable about both the emotional and physical impacts of loss. This can be a devastating time for parents and they may feel unprepared to make decisions related to lactation. It is recommended that a healthcare provider familiar with supporting families in their breastfeeding experience be involved as early as possible during their loss experience to provide support and education.

Families have often thought about the decision to breastfeed or chest feed* long before the expected due date. When they are faced with the reality that they will not be providing breast milk for their child, it is important that healthcare providers support parents’ physical and emotional needs.

Feeding a child has meaning on many levels other than the provision of food. The grief that parents experience after the loss of a pregnancy or infant may include feelings of compounded loss for the missed opportunity to breastfeed their child. Families may wish to suppress the production of breast milk or consider donating expressed breast milk. Supporting the family’s decision with information and gentle prompts will help with both physical and emotional needs.

*Chest feeding is a term used by some individuals who feel it better reflects their experience of infant feeding versus breastfeeding. In this information sheet we use the term breastfeeding to also include chest feeding.

Lactogenesis I is the developing capacity of the breasts to secrete milk, beginning mid-pregnancy and ending at birth when lactogenesis II occurs with the beginning of copious milk production. Lactation may occur after 16 weeks of pregnancy even in situations where the pregnancy doesn’t continue. (Wambach & Riordan, 2016) The lactating parent is more likely to produce milk early if they have had previous pregnancies or breastfed in the past. Even small amounts of milk leakage that may occur during this time can be quite upsetting to parents who have experienced a loss. For these reasons, discussing lactation at the time of loss should be standard practice.

Lactogenesis II is the production and secretion of mature breast milk and begins between day two and day eight after birth (Wambach & Riordan, 2016). This phase is triggered by the delivery of the placenta. It is often described as the time when breast milk “comes in.” During this phase, the onset of breast fullness, tenderness and leaking are common. This is also when the milk-ejection reflex or “let-down” may occur, which can be spontaneous or triggered by thinking about, seeing or hearing a baby. Parents who have experienced loss may find these changes quite distressing. Providing information and support to parents about lactogenesis II is another important aspect of compassionate care.

• Skin-to-skin contact with the baby following delivery (if possible)
• Putting the baby (living or not) to breast or placing expressed colostrum on the baby’s lips is desired by some parents but seldom offered
• Collecting expressed breastmilk to save as a memento
• Teaching hand expression for breast comfort, or as part of a plan to donate breast milk

The major influence on breast milk supply is how fully and often the breasts are emptied. In lactation suppression, the goal is to allow the breasts to remain full while avoiding engorgement. A full breast will send messages to the brain telling the parent’s body that they are making too much milk and start to decrease the supply. Cold compresses and minimal expression are recommended comfort measures for suppressing lactation (Wambach & Riordan, 2016). It is important to avoid engorged breasts as engorgement can be painful, promote milk stasis and increases the risk of blocked ducts and mastitis. Pumping or hand expressing just enough milk to remain comfortable will promote a gradual reduction in supply. Advise parents to watch for a hard, reddened area on the breast, fever or flu like symptoms any of which could indicate a breast infection requiring further assessment.

If the breast milk supply has already been well established (eg. when a parent has been exclusively pumping or breastfeeding baby has died), lactating parents can be advised to gradually decrease the frequency and volume of breast milk expression. There is no exact timeline for how soon parents should expect their milk supply to stop. Consider advising parents that it can take a matter of days to no longer feel full and weeks for their milk to fully dry up. It may be helpful to share with families that limiting fluid intake doesn’t play a role in milk suppression.

Other strategies for comfort during milk suppression include:

• Wearing a firm bra with good support, but without underwire, both day and night.
• Binding breasts is no longer recommended
• Wearing nursing pads to absorb milk leakage and changing them when they become moist.
• Applying cool compresses to the breasts for 15 minutes each hour

Your role providing information and support to help families develop a lactation after loss plan is an important one. Here are other resources you may want to explore:

• Government of Ontario breastfeeding resources
• Ontariobreastfeeds.ca

• Wambach, K., Riordan, J. (2016). Breastfeeding and Human Lactation, Fifth Edition. Burlington: Jones & Bartlett Learning.