Supporting the Lactation Needs of Mothers Facing Perinatal and Neonatal Loss

Background:

Breastmilk, long recognized as the optimal food for newborns, has immeasurable benefits to both mom and baby.  However, in cases of anticipated perinatal or neonatal loss, breastmilk is not usually considered in the plan of care.  As hospital-based lactation consultants, who are also practiced L&D nurses, the authors have been challenged by colleagues who are not supportive of the use of breastmilk for babies who are likely to die.  These well-intended professionals feel as they are acting in the best interest of the family.  However, in many of these cases, the use of breastmilk can be a wonderful experience for both the mother and her baby.  By creating a sense of normalcy in tumultuous times, the use of breastmilk can contribute to creating positive memories.

Overwhelming grief often accompanies the loss of a baby.  In addition, some grieving mothers experience unexpected breast changes that accompany lactogenesis II.  Addressing lactation issues immediately postpartum should be routine care, aimed to decrease discomfort and distress.  These mothers also have options regarding lactation other than suppression, such as donating their breastmilk, and should be allowed to make an informed choice.

Case:

From the authors' experiences as lactation consultants, some mothers who have experienced a neonatal loss call to  inquire about donating their breastmilk.  These mothers seek to give meaning to their loss experience and to honor their children.  Information regarding this option should be provided with knowledgeable guidance.  Not all mothers will qualify, and disappointment can be abated if counseled properly.  Mothers who have not started to pump must be educated on the commitment and possibility of stress interfering with milk production.  Ultimately, praise for offering a selfless act enhances their emotional healing, regardless of the outcome.

An example case involving a baby in the NICU describes the physical and emotional comfort of a mother giving her son drops of breastmilk, prior to his death. 

Conclusion:

In difficult loss situations, mothers still have an informed choice about the use of breastmilk.  Maternity and NICU nurses should be familiar with all options and refrain from making judgments for these families.  Lactation consultants can be supportive team members who can assist with the care of these special patients. Educating the mother who elects not to use her breastmilk should include engorgement management and the normal process of breast involution, so she does not encounter unexpected changes alone.

Keywords:

Perinatal/neonatal loss and breastmilk, lactation suppression, breastmilk donation