Lactation After Loss

By Melissa Coffey
Web Exclusive - December 19, 2008

I started my mothering journey with high hopes and misinformation about breastfeeding. Although I was able to breastfeed my first three children, it was with formula supplementation and early weaning. After my fourth child was born, I fell into the cloth diapering community through a twist of fate and found myself immediately drawn to the attachment parenting community. For the first time I was given solid information about breastfeeding that encouraged me to think outside the box and recognize the bumps in the road of my past experiences as just that: bumps. I realized that my pattern of weaning at the six-month mark could be overcome with a little diligence and understanding of what was happening with my child at this age. His disinterest wasn't a sign he was ready to wean, he was simply more interested in the world around him and easily distracted. All this information paid off as my son and I continued our nursing relationship into his second year. Little did I know what an impact this would have on me as I headed into my biggest challenge as a mother.

Shortly after my son turned two-years-old, we learned we were expecting our next baby. As my belly got bigger, my son became less interested in nursing. I assumed it was due to the changing taste of my milk and we peaceably weaned. I was very satisfied that our nursing relationship was coming to an end at the right time for both of us. Then the unthinkable happened. At my 30-week checkup, my midwife noticed I was measuring a little big. She gave me the option of having an ultrasound, but I knew if twins were discovered she would have to transfer my care to an obstetrician. This was not an option for me, so I declined. One week later, the swelling was noticeably more, and my husband and I decided to go through with the ultrasound. We did not find twins. We found that the baby I was carrying had a rare form of dwarfism called Thanatophoric dysplasia. Thanatophoric dysplasia had caused severe heart and skeletal deformities in the baby. It had also caused the baby's lungs to stop growing. No baby has ever survived this condition. In addition to presenting such abnormalities in the baby, it can cause many health problems in the mother, as the amniotic fluid continues to increase rapidly. The risks, including uterine rupture and respiratory failure, were ones I did not want to take. Going to term would most likely have resulted in a cesarean, something I was adamantly against. At the advice of my midwife and the perianatologist, we opted for induction at 32 weeks.

At the hospital, my midwife brought up a point I hadn't yet considered: what to do about my milk supply. I was far enough along that my body would not differentiate the birth of a stillborn baby or severely sick baby from a live birth and would produce milk just as it had done after my other births. She explained the different options I had including herbal supplements. Suddenly I asked her a question I would have never thought of before: Could I try to reintroduce the breast to my now-weaned son? She asked how long it had been since he weaned and said she thought it would be an excellent idea to try. I gave birth to a son who lived approximately one hour before passing away. He was born very quiet and did not cry or take a breath. Due to his deformities, he could not be put to the breast, though that was one thing I had hoped for during this birth experience. I went home with empty arms and a broken heart.

He was born early on Wednesday morning and by Friday evening I felt the familiar fullness in my breasts indicating my milk had come in. Hesitantly, I put my two-and-a-half-year-old son to my breast after asking him if he would like to "nur nur," his words for nursing. He happily climbed onto my lap and latched on as if he had never been weaned. This moment was the one that made me so thankful for the time I had invested in continuing to breastfeed past what everyone around me told me was normal. This little boy in my arms helped heal a hurt so deep that words couldn't express. We continued nursing for another several months and I attribute this to helping me get through a very difficult time in my life. While my arms did not hold a precious newborn, they were still holding a little boy who needed me almost as much as I needed him.

When a woman experiences a stillbirth, or early infant death, her body seems to betray her with engorgement, a reminder that there is no baby to nourish or comfort. While many do not understand it, this experience can be very traumatic to a woman, especially when no one has taken the time to address what will be happening with her body after her loss. Although my case was handled by many sweet and caring individuals, my midwife was the only one who brought up this topic. She understood that birth wasn't about a single event. She helped me understand the dynamics of a body that didn't understand the baby it birthed had died. Perhaps the medical community doesn't know how to address this issue eloquently and thus avoids the subject in an effort to be sensitive to the mother; however it's more likely this is yet another time where the breastfeeding relationship to birth is swept under the rug as unimportant. Every mother who is going to birth needs solid information about breastfeeding and what to expect from her body after she has given birth; this is especially true for mothers who will not have a baby to nurse. There are several options available to a woman who has a milk supply without a baby to use it. She needs to understand these options, preferably before she gives birth.

One option, probably the most frequently used, is allowing the mother's milk to dry up. This is something that naturally occurs for women who do not plan to breastfeed. It can be a painful process. Breastfeeding works on the basis of supply and demand. Because of this, it takes a relatively short time for the body to get the message that the milk is not needed. To help this process along, some midwives recommend a preparation of sage either as a tea or tincture. As with all herbs, you should consult your midwife or a certified herbalist for information about the correct preparation of this herb. Binding your breasts through wearing a tight-fitting sports bra, or wrapping your breasts in an ace bandage has been used for years by woman wanting to dry up their milk, but this practice is said to increase the risk of breast infection because of the compression on the milk ducts. Cold packs of frozen vegetables or traditional ice packs can be used to relieve the discomfort of engorgement. Heat should not be used, as this will cause letdown and send a message to the body to continue producing milk.