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.
While the most obvious thing would be to let a mother's milk dry up if she does not have a baby to nurse, there is another option that might be the best one of all: continued lactation. While this may seem surprising, it definitely has benefits. Breastmilk is one of the most valuable substances on this earth and in high demand. Expressed and donated breastmilk is highly sought after by many sources, including neonatal intensive care units in hospitals for use with premature infants, and foster and adoptive parents and birth parents who cannot provide breastmilk to their new infant. MilkShare (www.milkshare.com) is a group that connects people looking for donated breastmilk with donors. This service is free for donors and asks a small fee for those looking for donated breastmilk to help support the website. There are also several milk banks across the United States that will provide storage and shipping of your breastmilk but do resell the milk to individuals who are able to afford the initial cost of purchasing it. A simple search of "donating breast milk" on the Internet will yield many milk banks for consideration. The most practical and perhaps most emotionally satisfying option would be to donate to a local family in need. You can find a local family through the MilkShare website, a local mother's group, your midwife, or even a local ob-gyn practice.
If you do decide to pump and donate your breastmilk, what kind of babies will you be helping? Many babies do not have the benefit of human milk and are put on formula even when this is the least desirable option for the family. Some babies are so sick in the hospital they cannot nurse and their mothers cannot pump milk for them due to complications with the delivery, fatigue, stress, or other external factors. For these babies, breastmilk is vitally important and could very well mean the difference between life and death. Babies born to drug-addicted mothers benefit from breastmilk that is free of the contaminants that the mother has voluntarily put into her own body. In most instances, these babies are put on formula and put into foster care. Donated breast milk is the only way these babies have a chance of receiving human milk. Mothers who have had breast cancer or breast surgery quite often cannot nurse due to their milk ducts being severed. They can use donated breastmilk in a supplemental nursing system (SNS) attached to their breast so that their babies can receive both the comfort and nutritional value from breastmilk. The same is true for mothers who adopt newborns. Even when very dedicated adoptive mothers take lactation-inducing medications, they are often unable to produce enough milk to sustain their babies and have to use formula in place of breastmilk to make sure their babies have enough calories to thrive. Some milk banks send donated breastmilk out of the country to babies in dire need. Donated milk makes a huge impact on the future of these children as well.
What about the mother donating the milk? What benefits does she receive from continued lactation after a loss? The benefits for any lactating mother are well known. The release of oxytocin during breastfeeding is a boon to any new mother, but can be especially beneficial for a woman in the grieving process. There have been numerous studies that show a correlation between oxytocin and blood pressure. When talking about a stressful situation or problem, the oxytocin contributes to lower blood pressure. A mother going through the pain of losing her child could greatly benefit from the relaxing effect oxytocin can have on her system. Also, women who lactate and ask their bodies to make milk on the same schedule as it does with a new baby could very well delay the onset of returned menstruation. This can help keep the mother from conceiving again too fast after giving birth. Many mothers who have lost a baby do not want to conceive again right away and look for a way outside of chemical birth control to prevent a pregnancy before they are ready. Lastly, the emotional benefit of knowing that your milk is going to help a baby and family in need is priceless. Just as organ donation provides closure and a positive in an otherwise negative situation, breastmilk donation provides the opportunity to give something that makes a huge impact on the life of another individual. That is something that can provide a bright spot and a sense of purpose to a mother looking for some comfort after losing her child.
Continued lactation for a mother who has lost a baby to stillbirth or early infant death may not be the right choice for everyone. Certainly there are circumstances where the mother is just trying to cope with what has happened and would not be able to pump and donate her breastmilk. However, it should be presented as an option for any woman who is going to go home with empty arms, a broken heart, and full breasts. Human milk is a precious commodity that brings health and life to so many babies and can only be made after our bodies have gone through the rigors of pregnancy and labor. The life force behind our milk is so powerful and can be incredibly healing, whether nursing your own baby or donating it to a family in desperate need. For my family, the decision to allow continued lactation was entirely positive, for me, for my son, and for my entire family. While I do not wish our experience on anyone, I do encourage those who go through something similar to consider all options and look for the positives.
Melissa Coffey resides in Albuquerque, New Mexico and spends her time with husband Jamie and their five precious children.