Breastmilk, Lactation, and Infant Loss
Losing a baby to miscarriage, stillbirth, illness, or accident is devastating for parents. This grief can be compounded when dealing with the physical changes that come after birth. Many parents are worried about their milk and the physical discomfort that comes with milk production when the baby is not here to breastfeed. When drying up milk after birth, most parents find that they are comfortable after approximately one week. When a baby dies after breastfeeding is established, it can take a couple of weeks for them to no longer feel full. It is normal to be able to express droplets of milk for a week, months, or even years after weaning.
What to expect after giving birth
Colostrum production is generally established at around 16 weeks of pregnancy. Miscarriages and stillbirths after this point in pregnancy will usually result in milk production after birth. Mature milk will usually start about 30-40 hours after birth and the removal of the placenta. This milk production is based on the hormone drop after the placenta is born and will happen whether or not the breasts are stimulated or emptied in the first few days after birth. How much milk is made will vary from parent to parent. Parents who have breastfed a previous child tend to make more milk more quickly after birth. Some parents will find that they might make very little milk after birth, while others will make large amounts.
Differences between engorgement after birth and engorgement from milk supply
- IV fluids from birth may have increased the number of extra fluids in the birthing parent
- Swollen feet and ankles are often a sign of extra fluids in the body
- Breasts can also be swollen from these fluids and feel uncomfortable
- Cold packs and reverse pressure softening can relieve pain and help fluids move into the lymph system
- Check https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/ for more information
Techniques for drying up milk supply
For many parents limiting milk removal to just enough for comfort will help reduce milk supply within a few days. The less nipple stimulation and milk removal performed, the less milk will be produced.
- Hand expression of small amounts of milk to relieve pressure
- Pumping just enough to relieve pressure
- Warm bath or shower to stimulate letdown without active hand expression or pumping
- Leaning over a large bowl of warm water to stimulate letdown without active hand expression or pumping
- If you have a toddler/older child who is nursing, having them breastfeed for comfort to relieve engorgement
Other methods to manage breast milk and breast discomfort include cold, washed cabbage leaves tucked into the bra. Leaves should be switched out once they are warm and wilted.
There is no research supporting breast binding or extra pressure on breasts for reducing milk supply. A firm supportive bra and breast pads are all that is necessary. The bra can be worn day and night
There is no research supporting cold compresses reducing milk supply, but some parents find that they make the breasts feel more comfortable during the process of reducing milk supply.
Remember to drink to thirst. There is no research to support restricting fluids to lower milk supply. This is especially important when rehydrating after birth as well as crying for several hours/days/weeks.
Anti-inflammatories and pain medication can help with the pain of engorgement. Check with our healthcare provider to see if they are safe for you.
Sage tea can also help dry up your milk.
- 3/4 teaspoons dry sage leaves in 1 cup of boiled water
- Drink 3 cups per day for a maximum of 7 days
- Sage essential oil is toxic, so only use sage tea
- Consult with an herbalist to ensure sage tea is safe for you
Some medications and supplements have been shown to up manage milk supply. Pseudoephedrine single 60 mg dose has been shown to reduce milk supply by about 24%. Check with your health care provider to see if it is safe for you. Estrogen containing forms of contraception is known to reduce milk supply. Bromocriptine (Parlodel) is no longer suggested for drying up milk due to serious side effects/risks that include stroke, seizure, and death. Vitamin B6 (pyroxidine) pills have been recommended at 2 x 100 mg three times a day for the first day and then 100 mg daily. Be mindful that side effects can include nausea, vomiting, diarrhea, dark yellow colored urine. Always consult with your health care provider to make sure this is safe for you.
If breasts remain extremely full after several days post-partum, some parents find that pumping the breasts as empty as possible one time and then using all of the above comfort measures can reset the milk production and lower supply.
Blocked ducts and mastitis
Sometimes when milk is not removed from the breast, plugged ducts can develop. They feel like hardened, bruised areas on the breast. Even though the parent is trying to stop breast milk production, blocked ducts and mastitis should be treated with increased milk removal to get the milk flowing again. Once the block is resolved, or the mastitis is treated, then milk supply can be lowered again.
- Comes on gradually
- May shift in location
- The parent feels little or no warmth in the area
- Pain is mild
- The parent feels generally well
- A tender spot, redness, sore lump in the breast
- Fever less than 38.4oC (101oF)
- Means the milk duct is not draining properly and pressure is building up behind the duct
- Comes on suddenly
- Discomfort is localized
- Breast is red, hot, swollen
- Pain is intense
- The parent can be feeling discomfort or pain in one or both breasts
- The parent may have a fever (38.4oC, 101oF or higher), be feeling achy, and run down
- Occasionally may also have nausea and vomiting
- Continued milk removal is best for parent
- Frequent milk expression will prevent mastitis from becoming worse and aid in its treatment
- Sudden stopping of milk removal puts the parent at risk of developing a breast abscess, a much more serious condition
- Apply wet or dry heat to the affected area – gently massaging the area while it is warm – and remove any dried milk secretions on the nipple by soaking it with plain water. The parent can soak their breasts in the bath for 10 minutes 3 times a day
- Massage the affected area gently while it is warm, working over the lump using the palm of their hand and all their fingers in a gentle but firm circular motion. Work from armpit to the nipple.
- Hand-express some milk immediately after treating the area with warmth and massage
- Express milk frequently on the affected side.
- Loosen constrictive clothing, especially her bra
- Rest, and nap if you can. Mastitis can be a sign that a parent needs to heal
- Signs of a breast infection/abscess that should be seen by a doctor:
- A cracked nipple with obvious signs of infection
- Pus and blood in the milk
- Red streaks from the site of the infection back into her breast
- Sudden and severe symptoms with no identifiable cause
- A small percentage (about 3%) of breast infections can develop into an abscess which needs immediate medical attention
- An abscess is a collection of pus which has no opening for drainage so it has to be drained by needle or surgery; the incision heals from the inside out within 2 weeks
- MSRA should be considered when dealing with mastitis and breast abscesses
Managing leaking and milk supply when out
- Have several breast pads available so you can change them frequently
- You may need to double up the pads if you are leaking a lot
- Have a change of shirt with you in case you leak through the pads
- If you feel the tingle of your letdown, cross your arms and/or put pressure on your nipples to lessen leakage
A note on fertility
- Abrupt weaning can trigger fertility very quickly
- Use birth control if you do not wish to get pregnant at this time
- Birth control that contains estrogen will help lower milk production
Milk banking and Milk donation
Some parents find comfort in donating their breast milk to other babies. They feel it helps memorialize their loss and is a tribute to their child. Donating milk allows the parent to reduce their milk supply on a more gradual basis, which can be more physically comfortable, and lessen the chance of developing plugged ducts and mastitis. Lactating and expressing milk for 3 months post-partum allows the birthing parent’s body to return to the pre-pregnancy state in a more physiologically normal way, reducing the life-long incidence of developing diabetes, heart disease, and some cancers.
- In Ontario
- This milk is processed and supplied to sick and premature babies in need in hospitals around Ontario
- Donors go through a screening process in order to donate
- Human Milk for Human Babies http://hm4hb.net/faq/
- This is an informal milk sharing network where parents donate directly to other parents in need
- The onus is on the individual parents who are receiving milk to be comfortable with their donor and to arrange whatever screening they feel comfortable with
- They can also be found on Facebook by searching for Human Milk for Human Babies
Some parents will save some of their milk in the freezer as a memento of their baby. There are also some artists who make breastmilk jewelry from small amounts of breastmilk.
Infant loss is an overwhelming time for parents. On top of the deep grief of losing a child, the hormonal changes in stopping lactation and recovering from birth can be very difficult. Seeking the emotional support of family, friends, therapists, and other support people is very important. For more information, do not hesitate in contacting GWHA by calling the clinic at 519-780-0606 for a list of local Lactation Consultants to connect within the community if further support is desired.
Authored by Tania Archbold B.Sc, IBCLC
Mother’s Nectar Lactation, Robin’s Nest Family Care