Lactation after loss: supporting women's decision-making following perinatal death
Offering sensitive and compassionate clinical and bereavement care following perinatal death is the innate focus of the caring healthcare professional and facilitating informed choice around the subject of lactation following loss is an integral part of this. However, evidence suggests that there may be a deficiency in the provision of lactation advice and support following loss. Contributory factors may include a lack of awareness of lactation options following bereavement amongst midwives, as well as an absence of clarity around where the responsibility for offering lactation support and advice lies. This paper presents the literature surrounding the support of women's decision-making for lactation following perinatal death, explicating the physiology of lactation in the antenatal and postnatal periods, and exploring the challenges and opportunities for the midwife when supporting grieving mothers to decide the best option for them and their family.
Perinatal death affects 5.4 out of every 1 000 births in the UK (Draper et al, 2019) and is classically defined as a stillbirth (where a baby is born in the UK with no signs of life after 24 completed weeks' gestation) or a neonatal death (where a baby is born alive but dies within 28 days of life). However, the gestation of pregnancy or timing of baby loss is not necessarily reflective of either the intensity of grief experienced by the mother (Brier, 2008) or the incidence of lactation after loss. This means that the prevalence of support requirements around lactation following loss is likely to be higher than generally perceived.
Pregnancy and baby loss have profound and enduring effects on women and their families which extend to broad aspects of their psychological and psycho-social well-being (Burden et al, 2016; Coffey, 2016; Heazell et al, 2016; Nuzum et al, 2018). Offering sensitive and compassionate clinical and bereavement care is the innate focus of the caring healthcare professional following perinatal loss and facilitating informed choice around the subject of lactation following loss is an integral part of this. However, research findings demonstrate that around a third of bereaved mothers are not advised about management of lactation (Redshaw, 2014) and lactation suppression is only discussed with half of mothers (Draper et al, 2015).
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