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Breastfeeding Support Following Loss

Heidi Indahl
Winona, MN, USA
From: Leaven, Vol. 45 No. 1, 2009, pp. 10-11

Hopelessness. Despair. Grief. These emotions are not the first to come to mind when, as women and La Leche League Leaders, we consider the miracle of birth and the wonders of breastfeeding. For many women, however, this is not the case. The journey that began when they learned they were pregnant has ended with the death of the baby. This death may have come in the form of a miscarriage before the baby's first kicks were felt...or in the form of a stillbirth when the baby dies before making his entrance into the world...or in infant death shortly after a premature birth...or even weeks or months later due to an unknown cause.

According to a US-based advocacy group, First Candle, in the USA 25,000 babies are stillborn each year and another 2,000 die from Sudden Infant Death Syndrome (SIDS) related deaths. The American Pregnancy Association reports that 600,000 women suffer from a miscarriage and almost 28,000 infants die before their first birthday. As La Leche League Leaders it is easy to forget those facts when surrounded by the warmth of mothers nursing their new babies and their curious toddlers. Unfortunately, disheartening statistics do not disappear in the comfort of our La Leche League surrounding. It is likely that each of us will at some point in our journey as Leaders be confronted with the cold, harsh reality of these losses.

That confrontation happened to me in August of 2007 when my first daughter, Kenna, was stillborn at 30 weeks. For fellow Minnesota, USA Leader Rachel Schwendinger, that loss came in October of 2008 when her daughter, Felicity, was stillborn at home after a full-term pregnancy. As Leaders we knew the "breastfeeding" side of the story. We were prepared for the engorgement (physically, if not necessarily emotionally) and were both fortunate to have two-year-old nurslings who were happy to enjoy their new abundance of "mommy milk." In talking with other grieving mothers, however, we discovered that many were never told by their health care providers that their milk could come in; of those who were informed, most were not given sound information on what to do about it. One mother states:

I wasn't given any direct information on engorgement, or even my milk coming in. It almost seemed like the nurses didn't think it would come in. My loss was at 21weeks...It completely caught me off guard. It was like rubbing salt into a wound. Here I was, no baby, but with the milk to feed him.

As La Leche League Leaders, we all need to be aware of this breastfeeding scenario and be equipped with accurate information to share with mothers. The most pressing breastfeeding concern related to infant death is engorgement. Mothers may be told not to pump or express for fear they will continue to make additional milk. The Womanly Art of Breastfeeding encourages the opposite, stating that expressing several times per day and at night may be initially necessary to alleviate discomfort and prevent excess accumulation of milk in the ducts (2004 edition, pages 291-92). This method will allow the mother to decrease gradually and then eliminate her milk supply, while reducing her risk for a breast infection or plugged duct.

Instead of expressing milk, the mother may get help from an older nursing child who could assist the mother to reduce the milk supply slowly and naturally. Rachel notes that breastfeeding her son, Elijah, during the days after Felicity passed away helped her to find comfort during a difficult time, "It helped so much to have someone to nurse while I grieved the loss of my daughter. She wasn't in my arms, but my arms weren't empty when I was nursing Elijah." Rachel also noted that because Elijah was an experienced nurser, she was actually fortunate to be able to experience less engorgement than after her other births.

In the event of a previous miscarriage or stillbirth while nursing, a mother may contact La Leche League feeling the need to wean prior to becoming pregnant again. As a Leader, you may need to assure the mother with information on breastfeeding during pregnancy from The Womanly Art or The Breastfeeding Answer Book. Remember, however, that this mother is dealing not only with her concerns and fears for her unborn child, but also with her guilt and concerns over the role that breastfeeding may have had in her previous loss.

Another option available to mothers (particularly if they have an established milk supply, as in the case of an older infant's death) is to continue expressing milk and donate it to a milk bank. If a mother is interested in pursuing this option, a Leader should review the La Leche League policy on the donation of human milk found at www.llli.org/Release/milksharing.html and provide the appropriate support and information. This option allows some mothers to feel that they are continuing to care for an infant even though it is not their own.

In addition to providing support with the physical aspects of engorgement, La Leche League Leaders are uniquely qualified to lend a warm shoulder and an ear to a grieving mother. The listening skills and empathy we have practiced and provided to nursing mothers are desperately needed by grieving mothers. It is important, however, to be alert to signs of depression that may need a referral to another service. It would be valuable to keep a list of local resources with the Leader Log or in an area near the phone. In the United States, First Candle offers a 24-hour per day crisis hotline with both English- and Spanish-speaking counselors. They can be reached at 800-221-7437. Check also with local health care providers; they may be aware of area support groups or counselors who work with mothers.

Although this may seem far outside the expertise and scope of leadership, La Leche League is an organization dedicated to supporting the mother-child relationship. The grieving mother is missing her child and to have that child acknowledged by such a group is an exceptional comfort. If a mother has developed a relationship with a Leader during her pregnancy or prior to her child's death, she may contact a Group Leader because of their familiarity. Grieving mothers often simply wish for their child to be remembered. Remember the child's name, use it and listen, and the mother will return to La Leche League for her later needs, or refer a friend or loved one.

In November of 2007, the day before my daughter Kenna was "due" to be born, I sat with Rachel at an Area Leader event. She sat with me silently, knowing of Kenna's death, while Kathleen Kendall-Tackett gave a presentation on postpartum depression. I had to leave only once to compose myself and I was greeted in the entryway by a warm hug from our Area Communications Coordinator. When, a short time later I was called upon to do my first post-Kenna home visit and then later to lead my first meeting without the safety net of my co-Leader, the Grief Support discussion on the Community Network was quick to provide me with the reassurances that I needed. When Rachel's daughter died, another Leader was able to step up and assume responsibilities for her Group.

It is the culmination of these experiences that assures me that La Leche League Leaders are in a unique position to provide support to grieving mothers. Armed with accurate breastfeeding information and an open heart, we can support grieving mothers knowing that our fellow La Leche League Leaders will be there if our own time of need arises.

Resources

First Candle. Facts on Stillbirth. September 2006, , (12 January 2009).
American Pregnancy Association. American Pregnancy Association Statistics., (12 January 2009).
The Womanly Art of Breastfeeding, 7th Revised Edition. Schaumburg, IL: La Leche League International, 2004; 291-93.
La Leche League International. Media Release: La Leche League International Offers Guidelines on Human Milk Sharing. January 2005, , (12 January 2009).
LLLI Policies and Standing Rules Notebook. Milk Donations. LLLI, April 1994.
Mohrbacher, Nancy and Julie Stock. The Breastfeeding Answer Book. Schaumburg, IL: La Leche League International, 2003; 406-08

Postpartum Grief vs. Postpartum Depression

Kathleen Kendall-Tackett, PhD, IBCLC

Whenever a mother faces a loss of a baby, she is likely to experience profound feelings of sadness and grief. This is a perfectly normal and understandable reaction to her life circumstances. The acute phase of grief can last for months. But how can you tell if her grief is compounded with postpartum depression? We have no real guidelines for helping us tell the difference, especially when on the outside looking in. There are, however, some possible indications that a mother might need some additional support.

  • Is she so overwhelmed with sorrow that she cannot care for herself or her family?
  • Is she overwhelmed with guilt about what has happened?
  • Has she indicated that she wishes that she no longer wants to live (even by saying something like wanting to go to sleep and not wake up)?
  • Does she view her life and future as hopeless or meaningless?

While many of these emotions are part of normal grieving, they are more concerning when they last for weeks, months, or years. And if mothers have histories of depression or trauma (including previous childbearing losses), they are going to be more vulnerable to depression following loss of a baby.

Mothers with depression following loss need extra support from friends and family. They may find participating in a grief support group helpful, and mothers and their partners may benefit from short-term counseling. Journaling can be very healing (to this end, I'd recommend the book Writing to Heal by James Pennebaker). Finally, mothers may benefit from antidepressant medications. The goal of medications, in this case, are not to erase the signs of grief. Rather, they are to help mothers not feel so overwhelmed and paralyzed by their grief. If mothers are expressing their milk to donate, or are breastfeeding older babies, La Leche League Leaders can provide mothers information about medication choices that are compatible with breastfeeding.

Every mother will grieve in her own way and on her own timeline. But as we walk with mothers down this road, we can be alert to when they might need some extra care and support.

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