A woman’s breasts start making colostrum during pregnancy. The timing of this varies from woman to woman. This article provides information on ‘lactation after loss’ and assists women to understand how they can manage and respond to the experience of making milk following a miscarriage, stillbirth, neonatal or older infant death. Not all women will experience lactation after miscarriage or stillbirth. Some women may experience a sensation of fullness of the breasts, while others will produce and leak milk. However your body responds, it is helpful if you, and those around you, understand how to manage the physical and emotional challenges that this can bring.
Women can experience a variety of emotions in response to their lactation after loss. Each woman and her family may want to manage their lactation differently. There are a variety of ways to manage this including:
i) Lactation suppression (stopping your milk supply)
ii) Sustained expressing
iii) Donation of your breastmilk (where available).
iv) Memory making using breastmilk.
This article will provide you with an overview of these options. The booklet linked to at the end of this article will go into these options in greater detail.
Although this article and the booklet focus on lactation after infant death, there may be other situations where a mother lactates after a loss, such as giving a baby up for adoption, being a surrogate mother or in the case of a child being removed by child protection authorities. In addition to these losses, there are many other reasons why you may want or need to suppress lactation such as:
- You want or need to wean quickly for personal, work or medical reasons. Helpful resources about breastfeeding and medications can be found here.
- You thought you had finished breastfeeding, but woke a few days later with very full breasts
i) Lactation suppression
If your breasts are firmly supported and you don't express milk more than needed for comfort, your milk supply will gradually decrease. Some mothers want to stop their milk from coming in or dry up their milk as quickly as possible.
- Wear a firm bra both day and night to support your breasts and keep you comfortable.
- Use breast pads to soak up any leaking milk. Change them as they become wet.
- Relieve pain and swelling by putting cold/gel packs in your bra, or use cold compresses after a shower or bath.
- Cold cabbage leaves worn inside the bra can also be soothing. Wash and dry the leaves before use and cut out any large, bumpy veins. Keep them in the fridge as they need to be cold. Change the leaves every 2 hours or when they become limp. Continue using the leaves until the breasts stop feeling overfull.
- Handle your breasts very gently as they can bruise easily.
- Whenever your breasts feel too full, express a little milk. Express only enough to make you comfortable.
- Mild painkiller medications may help relieve pain. Your doctor will be able to advise you about this.
- Drink when you are thirsty. Cutting down fluids will not help reduce your milk supply.
- For the first few days you may be uncomfortable lying in bed because your breasts are so full. Try lying on your back or on one side with an extra pillow supporting your breasts. If you like to lie on your front, place a pillow under your hips and stomach to ease the pressure on your breasts. Place a soft towel or cloth nappy across your breasts to soak up any leaking milk.
- There are some prescribed drugs that have been used to suppress lactation. Talk over the pros and cons of using lactation suppression drugs with your doctor before making a decision about whether they are necessary in your case.
Most mothers will be able to suppress their lactation by limiting the volume of milk removed, wearing a firm bra, using cold packs or cabbage leaves and medication for pain and inflammation if required.
Things to watch for and what to do
At times, you may experience milk leaking from your breasts during the lactation suppression process. Here are some tips to help with leaking breasts:
- Use breast pads. Avoid any breast pads that hold moisture against the skin. Make sure your bra is roomy enough to hold whatever sort of pad you choose without putting pressure on your breasts. If you wear your bra to bed, take care that it doesn’t dig in when you are lying down as this may lead to blocked milk ducts.
- Stop the flow when necessary. If your milk starts to leak out strongly (ie your milk ‘lets down’) you can stop the overflow by pressing firmly on your nipple with your hand or forearm for several seconds.
Engorgement (painful, overfull breasts)
If your breasts become engorged and the ideas given above do not ease your discomfort, it may help to express all the milk in the breasts, just once, with an electric breast pump. This can relieve the pressure and from then on, you may be able to prevent it building up to that point again.
Wear a firm bra and express only for comfort.
Blocked ducts and mastitis
When breasts are left very full, there is a risk that one or more of the ducts that carry milk to the nipple will become blocked. A lump forms and the breast begins to feel sore. Sometimes there is a red patch on the skin or the breast may feel hot. If the blockage remains, milk can be forced out of the duct and into the breast tissue, which becomes inflamed. You may get the shivers and aches and feel like you are getting the ‘flu’. This is called mastitis and can come on very quickly. See your doctor if you get the flu-like symptoms or if you cannot clear a blockage within a few days. If this happens, you will need to express more milk than usual to clear the blockage. If mastitis is not treated, a breast abscess may develop. Fortunately, these are now quite rare.
To treat blocked ducts and mastitis:
- Apply warmth to the breast for up to a few minutes. Then express your milk.
- Express every few hours to keep the breast as empty as possible. When the mastitis has passed, you can go back to reducing your milk supply.
- While expressing, massage your breast gently.
- If you can hand express, a good place is under the shower or in a deep warm bath with your breast supported by the water.
- Between expressing sessions, use well-wrapped cold packs (a face washer cooled in the freezer, a frozen nappy wet with water or a first-aid cold pack) to reduce swelling and relieve pain. Cold cabbage leaves can also help in this situation.
- Consult your doctor straight away if you have a fever, feel unwell, or if you cannot clear a blocked duct within a few days.
- Anti-inflammatory medication may also help (speak with your doctor of pharmacist about this or call one of the numbers on our Breastfeeding and prescription medications article).
How long before the milk goes away?
This depends on a few things. These include:
- How old your baby was and how much milk you were making, or your stage of pregnancy if you had not yet given birth.
- How much milk is taken from the breast through expressing, let-downs and leaking.
- How much your nipples are touched, such as in lovemaking.
- Another pregnancy.
- Some mothers find it takes weeks for their milk to go away completely. Others find that it takes days. You may notice milk stains on your bra or that you leak during or after a shower. You may even feel the let-down months or even years after losing your baby. Every mother will have a slightly different experience.
ii) Sustained expressing
Some mothers may not want to suppress their milk production after the loss of their baby. These mothers may appreciate the time expressing gives them to connect with and grieve for their baby. Mothers may want to continue to express their milk for days, weeks or even months. You can express as often each day as you like for as long as it suits you. The lactational amenorrhea method is an accepted and effective method of family planning and is a factor which may be relevant for some mothers to consider when expressing. Avoiding significant and sudden changes to your expressing regime can help reduce the risk of your breasts becoming engorged and blocked ducts.
When you decide to wean from expressing, doing so gradually (eg by dropping one expressing session every few days or so) can help your breasts adjust more comfortably. For tips of expressing and storing breastmilk, see Expressing and storing breastmilk.
iii) Donation of breastmilk after loss
The milk produced by mothers can be kept, or used as a memento. Some mothers may wonder if the breastmilk they express can be used to help another baby. Many mothers have found that this is beneficial as the ability to help other babies has assisted with their grieving.
This option may not be available to all mothers. There are only a few human milk banks in Australia. Milk donors need to be screened by having blood tests before they can donate their milk. If you would like to know more about this, contact the milk bank in your state or territory, or ask your doctor or the hospital staff if there is one in your state which might accept your milk.
iv) Memory-making using breastmilk
There may be stores of your frozen milk at home or in the hospital. If you have frozen breastmilk stored in the hospital, you can approach the hospital staff to make decisions about what to do with these frozen stores of milk such as to discard it, keep it as a memento or donate it (if possible).
Some women have used their breastmilk in an activity or item to help create a memory. For example defrosting it and pouring it on a special plant in the garden, using it to make breastmilk jewellery, burying some milk with the baby, using breastmilk as a symbol in the funeral service, donating it. You do not have to make these decisions quickly. You can keep your milk in a freezer and take it with you if you move house.
One step at a time
It can take a long time to recover from the death of a baby. There will be times when you feel you have made some headway, only to fall back into the deep sadness of it all. You may find it hard to get to sleep or you may wake often. This is quite normal.
This is the time to be kind to yourself. Talking with others who have also have lost a baby may give you support and some comfort. Details of support groups are listed below.
Further information can be found in the ABA booklet Breastfeeding: lactation suppression.
There are also a number of organisations that may be of some help to you at this difficult time. These vary from state to state. Look in your local telephone book or on the internet for the following:
SANDS (Stillbirth and Neonatal Death Support) (phone 1300 072 637)
Red Nose (phone 1300 308 307)
Angel Baby Foundation (phone 1300 283 238)
Cradle Inc NT)
These organisations may have comprehensive libraries with a wide variety of useful books and other literature for further reading.
© Australian Breastfeeding Association January 2020