Lactation following bereavement: how can midwives support women to make informed choices?

Abstract

Perinatal loss, defined as the death of a baby within the neonatal period, stillbirth or late miscarriage (determined for the purpose of this paper as 20 weeks’ gestation), has been identified by multiple agencies and organisations as a focus for increased parental support. However, the lactation needs of mothers are broadly overlooked, which can lead to engorgement, mastitis and psychological harm. The most commonly offered option of pharmacological suppression is controversial due to a lack of efficacy, and concerns about physiological effects (Cole 2012). Women may already have stored frozen expressed breast milk (EBM) within the neonatal intensive care unit (NICU), or be discharged home before their milk comes in several days later. In our experience, information and guidance for bereaved mothers about lactation and EBM are often lacking.For preterm neonates, the use of human milk for nutrition has been demonstrated to have significant health benefits compared to artificial formula (Quigley & McGuire 2014). Incidence of infection-related events, such as urinary tract infections, necrotising enterocolitis and sepsis can be reduced, and lengths of stay in the NICU are shortened when human milk is used (Maffei & Schanler 2017). While mother’s-own-milk (MOM) is the optimal form of human milk, the use of donor human milk can act as a bridge whilst a mother establishes her milk production, or in instances where MOM cannot be used. Milk banking has been carried out in the United Kingdom (UK) for over 80 years, based on the voluntary donation of milk from women screened according to national guidelines (NICE 2010). Current research describes a diverse population of milk donors in the UK, for whom key motivators to donate were the encouragement of health professionals alongside the sense of altruism gained from the experience (Thomaz et al 2008). For bereaved parents, with appropriate support, milk donation may aid the grieving process, but previously the evidence had not been examined in a systematic manner. Expressed milk belongs to the mother and its fate after infant loss is her decision. However, bereaved mothers are often overlooked as potential milk donors (Carroll et al 2014). This study aimed to search the literature and examine local practice in order to explore the experience of bereaved mothers; in particular regarding the subject of milk donation following perinatal loss, in order to guide training and inform recommendations for future practice.