In professional practice, it is very possible that you will accompany the bereaved lactation of mothers who have lost their baby during pregnancy or childbirth. In this post, we explain how to do this.

After the placenta is delivered, lactogenesis II is set in motion, regardless of the birth outcome and the gestational weeks of pregnancy. Many mothers and families are unfamiliar with this, which can be unexpected for many during a complex emotional time.

Mothers and families need to have all the information at their disposal so they can decide what their path is to manage the mature breastmilk coming in in case of fetal or neonatal death.

What are the options for managing breastmilk in case of a pregnancy or baby loss?

Even in early pregnancy losses, sometimes as early as 12-15 weeks of pregnancy, women experience the mature breastmilk coming in. Therefore, it is good that the patient takes some time and considers what she wants to do with her breastmilk:

• Suppression through medication: administration of prolactin inhibitors (cabergoline or bromocriptine). Their efficacy is moderate during the first postpartum hours (before 48 hours). Still, it is important to inform the woman that she may experience the mature milk coming in and explain to her physiological inhibition of lactation. Once lactogenesis II and lactopoiesis are established, it is not effective.
• Physiologic suppression: As the woman experiences mature milk coming in, it is recommended to remove some breastmilk by hand or pump to relieve breast tension, apply cold to the area, and administer anti-inflammatory medications if needed. As the swelling decreases, the number of breastmilk removals and/or the amount of expressed breastmilk is gradually decreased to reduce the milk supply until it is no longer needed.
• Human milk donation, for public or private milk banks. This is an option that some mothers may prefer, feeling that the milk that was for their son or daughter will feed other babies who also need it. More and more milk banks are now accepting colostrum and milk from mothers of deceased babies. Donating breast milk, either to a milk bank or another mother: private donation is also an option to consider.
• Expressing breast milk and storing it until needed: When a woman doesn’t quite know what to do with her breast milk yet, she can store it. Expressing it and freezing it is a perfectly valid option. Surely, in some days, she will know what to do. If she finally wants to inhibit lactation, she can always opt for the physiological method.

When a mother has the information, she can decide what to do, and sometimes, such a decision can be postponed for a few days.

Not recommended measures when breastfeeding through baby loss

Mothers still often receive outdated advice that can be harmful. These include bandaging the breasts or restricting water intake, wearing tight bras, or not expressing breast milk, which is also often recommended.
Not only does this advice fail to prevent mature milk from coming in, but it can also cause pain and can even be the cause of major health problems.

Rituals in breastfeeding after pregnancy or baby loss

Rituals can help the grieving process. Here are some ideas that have been proposed:

• Expressing breastmilk and storing it for as long as desired (it’s important to explain how to store it when frozen)
• Breastmilk can be expressed and thrown away
• Expressing breastmilk and having a piece of breastmilk jewelry made.
• Express breastmilk and pour it into the soil, a tree, or a plant.
• The woman can do whatever she wants with her breastmilk, there is no right or wrong thing to do with it.

No rush

It is not urgent to know what she wants to do about lactation and her breast milk after a pregnancy or baby loss. Maybe the idea also evolves during the first few days. It is fundamental to give women in this situation a space where they can talk about their experience and provide information without judgment but with support.

 

References

Padro, A. (2020b). Somos la leche: Dudas, consejos y falsos mitos sobre la lactancia (Grijalbo)