Bereavement Support and Lactation After Loss

During pregnancy, your breasts change to prepare to feed your baby.

After your baby is born, hormones signal your body to begin making milk. Your body does not  know that your baby has passed away, and it will continue to make milk.

Your first milk is called colostrum. Colostrum will transition to milk at about 3 to 5 days after birth. Your breasts may become full, firm, or uncomfortable, and you may notice milk leaking.

Milk production is more common after a pregnancy loss later in pregnancy, although it can still happen earlier as well.

If you decide to stop making milk, your body will gradually make less milk when less milk is removed.

The biggest thing that affects milk production is how often and how much milk is removed from your breasts.

When milk is removed by breastfeeding, pumping, or hand expression, your body receives a signal to make more milk. When less milk is removed, your body gradually receives the signal to make less.

When stopping your milk supply, the goal is to allow your breasts to remain as full as is comfortable while avoiding painful fullness, called engorgement. You do not need to empty your breasts. Removing a small amount of milk, when you are uncomfortable is okay.

Drinking less fluid will not stop your milk supply. Continue to drink according to your thirst and your healthcare team's advice.

If you have not been breastfeeding or pumping, you may be able to stop without expressing milk. Your breasts may become full, firm, or uncomfortable for a few days as your milk supply decreases.

You do not need to empty your breasts. If you are uncomfortable, you can gently hand express or pump a small amount of milk, just until the pressure is relieved. Removing a small amount for comfort is okay and can help you feel more comfortable while your milk supply decreases.

Ice or a cold compress may help with fullness and discomfort. Apply it for about 15 minutes at a time and wrap frozen items in a clean cloth or tea towel to protect your skin. Chilled cabbage leaves may also help with breast fullness and discomfort. You can place clean, chilled cabbage leaves inside your bra and replace them when they become warm or wilted.

Advil (ibuprofen) or Tylenol (acetaminophen) may help with pain and discomfort. Talk with your healthcare team to make sure these medications are safe for you and follow the directions on the package.

Try to avoid heat, including heating pads and hot water directed at your breasts, as heat may increase swelling and discomfort. Wear a comfortable, supportive bra or top, and avoid tight bras, binding, or anything that puts strong pressure on your breasts.

As less milk is removed, your body will gradually receive the signal to make less milk. This may take several days to a few weeks.

If your breasts become very painful, you develop a red or hot area, or you have a fever, chills, or flu-like symptoms, contact your healthcare provider or the CHEO Lactation Support Team.

If you have been regularly pumping or feeding your baby, your body may have an established milk supply. Stopping suddenly can cause your breasts to become very full, firm, or uncomfortable. Gradually reducing how often you pump and how much milk you remove can help your body slowly adjust and lower your milk supply.

There is no single schedule that works for everyone. You can reduce the number of pumping sessions, shorten each session, or use a combination of both. The goal is to remove less milk over time while keeping your breasts comfortable.

For example, if you are pumping 6 times a day for 20 minutes each time, you might first reduce to 5 pumping sessions a day. You could then gradually shorten each session from 20 minutes to 15 minutes, and later to 10 minutes. As your breasts adjust, you can continue to reduce the number of sessions and the amount of milk you remove until you no longer need to pump.

Another option is to gradually reduce the number of pumping sessions:

6 times a day → 5 → 4 → 3 → 2 → 1 → stop

You can stay at each step for a few days or longer, depending on how your body feels. If your breasts become very full or uncomfortable, you can remove a small amount of milk for comfort rather than fully emptying your breasts.

There is no single schedule that works for everyone. Your lactation team can help you make a plan based on your milk supply and comfort.

Pumping to comfort means removing only enough milk to reduce pressure or discomfort.

For example, if your breasts feel very full, hard, or uncomfortable, you can hand express or pump a small amount of milk. Once the pressure has eased, stop.

You may only need to remove a few drops or teaspoons.

You are not trying to empty your breasts.

As your milk supply decreases, you should need to express or pump less often.

Cold compresses
After hand expressing or pumping, apply a cold compress for about 15 minutes.
You can repeat this as needed, including every hour if needed for comfort.
Do not place frozen items directly on your skin. Wrap them in a clean, damp cloth or tea towel first.

Pain medicine
Ibuprofen or acetaminophen may help with pain and discomfort if they are safe for you.
Talk with your healthcare team if you are unsure whether these medicines are right for you. Follow the directions on the package or those given to you by your healthcare provider.

Comfortable clothing
Wear a comfortable, supportive bra or top that does not feel tight.
Avoid tightly wrapping or binding your breasts. Very tight bras, tops, or underwire that presses into the breast can contribute to blocked areas and inflammation.

Wear what feels most comfortable for you.

What to avoid

• Avoid heat and deep massage
• Avoid heat on your breasts while your milk supply is decreasing, as it may increase swelling.
• Avoid deep or firm breast massage. If you need to hand express, use gentle touch.

There are medications that may reduce or stop milk production for some people.

These medications are not right for everyone. Talk with your healthcare provider about whether medication is an option for you and about the possible benefits and risks.

Do not take medication to stop your milk supply without first speaking with your healthcare provider.

There is no exact timeline.

For some parents, milk production decreases over several days. For others, it may take several weeks.
You may continue to notice a few drops of milk after you have stopped pumping. This is normal and does not mean you need to start pumping again.

If you have questions or concerns about your milk supply, please contact the CHEO Lactation Support Team.

As your milk supply decreases, watch for signs of breast inflammation or infection, called mastitis.

Contact your healthcare provider if you have:

• A hard area that is getting worse
• A red, hot, or painful area on your breast
• Increasing breast pain
• Fever or chills
• Flu-like feelings
• Feeling generally unwell

If you think you may have an infection, contact your healthcare provider, local breastfeeding clinic, public health program, or the CHEO Lactation Support Team while you are in hospital.

You do not need to wait until your symptoms are severe to ask for help.

Some parents choose to continue expressing milk for a short time or longer.

For some, expressing milk can be a meaningful way to stay connected to their baby. Others may want to express milk so they can donate it or create a keepsake.

If you want to maintain your milk supply, regular milk removal is needed. Your lactation consultant can help you create a pumping plan that meets your goals.

You can change your mind at any time.

Some parents choose to save a small amount of milk as a keepsake in memory of their baby.

Milk can be used to make jewelry, artwork, ornaments, or other special items. Some families may also choose to safely store frozen milk at home as a memory.

If this is something you are interested in, the CHEO Lactation Support Team can help direct you to local or Canadian vendors who provide milk keepsake services.

Before sending your milk to a vendor, ask:

• How much milk do you need?
• How should the milk be collected and stored?
• How should the milk be sent?
• How long will the keepsake take?
• What happens to milk that is not used?
• What are the costs?

Please speak with your lactation team before sending milk to a vendor. We can help you understand how to safely collect and store a small amount of milk.

There is no need to decide right away.

Some parents choose to donate their milk in memory of their baby.

For some families, donating milk can be a meaningful way to honour their baby. Donated human milk can help premature or medically fragile babies when their own mother's milk is not available or is in short supply.
Milk banks have a screening process for donors. Donated milk is tested and pasteurized before it is given to babies.

If you are interested in donating, your lactation team can help you learn about the process.

Ontario

Rogers Hixon Ontario Human Milk Bank: The Rogers Hixon Ontario Human Milk Bank is based in Toronto and accepts donations from across Ontario. 

• Rogers Hixon Ontario Human Milk Bank, Bereaved Parents
• Alberta and Western Canada
• NorthernStar Mothers Milk Bank
• NorthernStar is a charitable milk bank based in Calgary.
• NorthernStar Mothers Milk Bank

Quebec

Héma-Québec: Héma-Québec operates the public human milk bank in Quebec for Quebec doners and patients.

• Héma-Québec, Human Milk Donation

Please contact the milk bank before donating. They will explain whether you are eligible and how to safely collect, store, and send your milk.

There are several ways to approach your milk after a loss.

• Stop making milk: You may choose to reduce and stop your milk supply when you feel ready.
• Continue expressing: You may choose to express milk for a short time or longer.
• Create a keepsake: You may choose to save a small amount of milk as a memory of your baby.
• Donate your milk: You may choose to donate your milk to help other babies.
• Change your mind: Your choice can change over time.

There is no timeline you need to follow.

You do not have to go through this part of your journey alone.

It can be difficult to talk about your loss and your milk supply with new healthcare providers. The CHEO Lactation Support Team can continue to support you during your lactation journey while you are receiving care at CHEO.

We can support you whether you want to:

• Reduce or stop your milk supply
• Continue expressing milk
• Donate your milk
• Create a keepsake
• Manage fullness, leaking, or discomfort
• Talk through your options
• Change your plan