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Breastfeeding after the Loss of a Multiple

Junelle Hanrahan
Vancouver, Washington, USA
From: LEAVEN, Vol. 36 No. 5, October-November 2000, p. 102

We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time

With the rise in multiple pregnancies comes an increase in multiple birth losses. Loss in a twin or higher multiple pregnancy can occur before, during, or after the birth with varied circumstances surrounding the loss. In a multiple birth situation with survivors, there may be one, two, or more babies who are actually surviving twins, triplets, quads, or higher. LLL Leaders and breastfeeding counselors need to be aware of this special circumstance and the unique role it plays in a mother's situation. Not only is the family dealing with the loss of a baby, but the mother is simultaneously establishing emotional bonds and a breastfeeding relationship with the surviving infant(s). Mothers who are grieving while lactating may be at risk of premature weaning. Preserving the breastfeeding relationship avoids another loss for the family.

A Leader who encounters this situation needs to be empathetic to the grieving mother, while assisting her in the practical aspects of breastfeeding one or more babies. Lactating for one baby while grieving the loss of another is emotionally complicated at best. It is easy for the mother to lose her confidence in her ability to breastfeed - to adequately nourish her surviving infant(s) at the breast since she may blame herself for the loss of the other infant. You can empower the mother through listening carefully to her spoken and unspoken messages, sharing information, and making appropriate suggestions.

Counseling tips:

  • Avoid only focusing on the living baby; acknowledge the baby who died and refer to him or her by name if possible.
  • Become familiar with the stages of grief: shock/denial, anger/rage, bargaining, depression, awareness of reality of the situation, reestablishment of emotional ties, guilt, acceptance rather than resignation, feeling the presence of the loved one, and incorporating the loss.
  • Offer family referrals to appropriate professionals, counselors and bereavement support groups. (Note: CLIMB, Center for Loss in a Multiple Birth, Inc. PO Box 913 7, Anchorage, AK 99517 USA. Phone: (907) 222-5321 Website: http://www.climb-support.org/) [address corrected for web]

Special circumstances

There are many circumstances surrounding a loss of a multiple. Possibilities include pre-term birth, delivery by cesarean, NICU care, and hospitalization of mother or infant(s).

Infant conditions

As a result of the multiple birth, the surviving twin may have medical problems. There may be "disruptive structural defects" in the surviving twin such as gastrointestinal defects, atresia (absence or closure) of the bowel, and central nervous system defects. Other, more common, possible infant conditions include prematurity, small for gestational age, dysfunctional suckle, jaundice, anemia, respiratory distress, or sepsis (infection).

Maternal considerations

With the loss of a twin after delivery there may be oversupply concerns. The mother may need to watch for engorgement, plugged ducts, and mastitis. A mother who has weaned prematurely or who did not initiate breastfeeding after birth may request help in relactating. It is quite possible the mother may be prescribed medications for depression. Often mothers are advised to stop breastfeeding when they are given antidepressants. You may be able to offer information to the pediatrician and/or neonatologist responsible for the baby's care regarding which medications are considered compatible with breastfeeding. Contact your local Professional Liaison Leader for the latest information about medications.

Grief can present itself in a variety of ways. One symptom is loss of appetite. While most mothers can produce adequate milk supplies even when malnourished, some women may find that their milk production is affected by unintentional dietary restrictions. Inadequate caloric intake also contributes to fatigue. Giving mothers practical suggestions that may whet her appetite is helpful.

Parents who have experienced a loss of a multiple may find they rely on the qualities of human milk to cure illness or other conditions in the surviving twin. In such a scenario, you can acknowledge the value of the mother's milk. At the same time, help the parents recognize that their baby may need more than human milk can offer.

The physical response of empty arms that a mother might feel with the loss of a baby can also be experienced while breastfeeding when arms ache to hold and breastfeed two babies simultaneously. Seeing another mother breastfeeding twins may be painful. Even after overcoming obstacles to breastfeeding, a mother may feel unable to bear breastfeeding only one baby, resulting in weaning.

The grieving mother may be particularly vulnerable and doubt her ability to produce milk. The loss of a multiple is a stressful event for the family and low milk production can occur after a mother has experienced significant stress. It is possible a mother may perceive the loss of milk in one breast, corresponding perhaps to the side the deceased twin occupied in utero. Some mothers of surviving twins may feel unable to breastfeed bilaterally and prefer unilateral breastfeeding.

Summary

The La Leche League Leader or lactation consultant has a unique role when helping the mother who is grieving while lactating. A mother who has experienced a loss in a multiple birth may have a variety of special circumstances with which she must cope. You can help the mother sort out her feelings while you share information to help empower and build confidence in her ability to nurture her surviving baby or babies.

References:

Landy, H. and Weingold, A. Management of a multiple gestation complicated by an antepartum fetal demise. Obstet Gynecol Surv. 1989 Mar; 44(3):171-6.

Riordan, J. and Auerbach, K. Breastfeeding and Human Lactation. Jones & Bartlett, Boston, MA. 2000, p.664.

Ruvalcaba RHA. Stress-induced cessation of lactation. West J Med 146:228-30,1987.

Resources:

Herforth, Diane. Counseling Grieving Families. Lactation Consultant Series. Unit 12. Schaumburg, IL. La Leche League International.

Schweibert. P. and Kirk, P. When Hello Means Good- bye. Portland, OR: Perinatal Loss. 1985.

Limbo, R. and Wheeler, S. When A Baby Dies: A Handbook For Healing and Helping. La Crosse, Wisconsin: RTS Bereavement Services. 1995.

This article was adapted from an article called "Grieving While Lactating," which originally appeared in Clinical Issues in Lactation, Center For Lactation Education, a division of Breastfeeding Support Consultants Vol. 4 No.1 Nov. 1999 and is used here with permission.

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