In Today’s Issue:

🔗 The best links I found this week
📖 Deep dive: Milk donation as part of the grieving process
🩷 Self-care moment: A Simple Practice for Emotional Renewal

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🔗 My Favorite Finds This Week

💗 Supporting Nurse Grief After Patient Loss
"Helping perinatal nurses cope with patient death" by Catherine A. Pankonien and Sandra M. Groth offers practical strategies for grief management, including debriefing sessions and healthy coping mechanisms for nurses experiencing perinatal loss. (Infant Journal)

🥛 Milk Banking Information
The Human Milk Banking Association of North America (HMBANA) offers resources for milk donation, including finding the nearest milk bank to your location. [11] (www.hmbana.org)

🌿 World Health Day 2025 Campaign: Maternal & Newborn Health
The Pan American Health Organization's campaign "Healthy beginnings, hopeful futures" aims to end preventable maternal and newborn deaths with alarming statistics showing one preventable death every 7 seconds worldwide. [15] (Paho.org)

🔬 Human Milk Research Resources
HMBANA provides connections to biorepositories for researchers interested in human milk studies, including The Human Milk Science and Biobank, The Infant Risk Center, and Mommy's Milk Human Milk Research Biorepository. [12] (hmbana.org)

📖 Deep Dive

Milk Donation as Part of the Grieving Process: Supporting Mothers Through the Nuances of Palliative Care

Today's deep dive is based on Chapter 20: "Lactation and Breastfeeding in the Context of Perinatal Palliative Care" from the Handbook of Perinatal and Neonatal Palliative Care by Diane L. Spatz and Joanna C. M. Cole.

For many mothers, lactation after loss presents both a physical challenge and a potential pathway through grief. Research shows that milk donation can provide structure, comfort, and meaning during the postpartum period when grieving the loss of an infant.[1]

Why Would a Mother Want to Donate Her Milk?

For mothers experiencing perinatal loss, milk donation can serve multiple meaningful purposes:

• Finding purpose in grief: Many mothers report that milk donation makes them feel involved with their infant's care, bonded to their child, and motivated to want to continue milk expression.[3]

• Helping other vulnerable infants: Women who donate milk in the context of perinatal palliative care find comfort in the idea of providing life-saving human milk to critically ill infants.[4]

• Honoring the child's memory: Expressing and donating breast milk can act as a way of honoring the child's life and legacy. Mothers can "memorialize their child's life by donating a bodily substance that is directly connected with the life of their child."[2]

Understanding the Mother's Experience

After a perinatal loss, healthcare staff must recognize that a mother has not just lost her child, but is also mourning the loss of how she envisioned feeding, loving, and caring for that child. The textbook highlights that "for some women, the process of donating milk can be helpful; for others, it may trigger feelings of guilt, worsen grief, or prolong the grieving process."[5]

Healthcare providers should understand that while milk donation can be healing for some mothers, it's not appropriate for everyone. The decision is deeply personal and influenced by many factors, including the mother's emotional state, support system, and cultural background.

Clinical observations show that mothers who choose to donate milk following a loss often report that this gives them a sense of purpose and connection to their baby's memory. The act of pumping and donating serves as a tangible link to the child they've lost.

Having the Milk Donation Conversation

Introducing the idea of milk donation requires sensitivity and timing. The Handbook offers these evidence-based recommendations for healthcare providers:

• Following the death of an infant, mothers are generally discharged from the hospital within 24 to 72 hours, prior to the onset of lactogenesis II, which typically occurs at 72 to 96 hours after birth.[6] This timing creates a critical window for intervention and support.

• Timing is crucial: Introduce the idea of milk donation in the postpartum period after the mother has had time to process her initial grief, not immediately after the loss.[7] The textbook doesn't specify an exact timeframe, but suggests that discussions should ideally occur before discharge, as mothers will be experiencing milk production shortly after returning home.

• Collaborative approach: Work closely with the lactation team to clearly and respectfully present milk donation as an option, not an expectation.[7]

• Begin with assessment: Start by exploring the family's knowledge about human milk, lactation, breastfeeding, and any past personal or familial experience.[8]

• Present options without pressure: When discussing milk donation, present it as one possible option among many ways to honor their baby's memory.

• Honor autonomy: Allow families to make fully informed decisions about their lactation and breastfeeding experiences in preparation for the loss.[8]

Healthcare providers should emphasize that there is no "right" approach - some mothers may find comfort in milk donation while others may prefer to suppress lactation. The goal is to provide information, support, and respect for whatever path the mother chooses.

Supporting Mothers Who Choose to Donate

For women who choose milk donation as part of their palliative care plan, healthcare providers can take several important steps:

1. Ensure pump access at home before discharge

2. Provide detailed instructions on pump use and milk storage

3. Connect them with milk bank resources and shipping information

4. Offer emotional support through regular follow-up calls

5. Acknowledge that milk donation can create meaning after their child's death

Research demonstrates that facilitating milk donation in the context of perinatal palliative care requires both emotional support and practical assistance with accessing breast pumps and navigating milk bank documentation processes.[9]

L&D nurses have a unique opportunity to create a safe space where mothers can make informed decisions about lactation following loss. By approaching these conversations with sensitivity and evidence-based information, nurses help families find meaning in their grief journey.

🩷 Self-care moment

Reflective Debrief: A Simple Practice for Emotional Renewal

Caring for families through pregnancy loss is deeply meaningful—and emotionally taxing. Evidence shows that intentionally processing these experiences helps prevent burnout and builds resilience

A 3-Step Reflective Debrief Practice:

1. Pause and Breathe:
   After supporting a family, find a quiet space—even for just two minutes. Take several deep, slow breaths to center yourself.

2. Reflect and Name:
   Silently acknowledge what you experienced. Ask yourself:

   • What emotions surfaced for me?

   • What did I do well?

   • What do I need right now?
     Naming your feelings (grief, pride, sadness, hope) without judgment helps you process and release them

3. Connect and Reset:
   If possible, share a brief thought or feeling with a trusted colleague or jot down a quick note in a private journal.
   End with a grounding gesture—stretch, step outside, or simply place a hand over your heart.

This brief debrief ritual supports emotional well-being, encourages self-compassion, and helps you remain present for the next family in need

“Grief loses some of its sting and hope rises when suffering is voiced and brought into the open.” — [Infant Journal]

👎 I didn’t learn anything new

👍 Good information

💯 Very valuable

📝 Citations

[1] Cole JC, Schwarz J, Farmer MC, et al. Facilitating milk donation in the context of perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2018;47:564-570. doi:10.1016/j.jogn.2017.11.002

[2] Welborn J. The experience of expressing donating breast milk following a perinatal loss. J Hum Lact. 2012;28:506-510. doi:10.1177/0890334412455459

[3] Barbas-Stein L, Spatz DL. Human milk oral care: making meaning of pumping for mothers with infants with congenital diaphragmatic hernia. J Obstet Gynecol Neonatal Nurs. 2014;43:439-445. doi:10.1111/1552-6909.12468

[4] Limbo R, Wool C. Handbook of perinatal and neonatal palliative care: A guide for nurses, physicians, and other health professionals. New York: Springer Publishing; 2020.

[5] Ibid., 335.

[6] Cole JC, Moldenhauer J, Jones T, et al. A proposed model for perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2017;46:904-911. doi:10.1016/j.jogn.2017.01.014

[7] Limbo R, Wool C. Handbook of perinatal and neonatal palliative care: A guide for nurses, physicians, and other health professionals. New York: Springer Publishing; 2020, 335.

[8] Ibid., 334.

[9] Cole JC, Schwarz J, Farmer MC, et al. Facilitating milk donation in the context of perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2018;47:564-570. doi:10.1016/j.jogn.2017.11.002

[10] Center for Fetal Diagnosis and Treatment (CFDT) Perinatal Palliative Care and Bereavement Program, Children's Hospital of Philadelphia.

[11] The Human Milk Banking Association of North America (HMBANA).

[12] Carroll K, Lenne B, McEgan K, et al. Breast milk donation after neonatal death in Australia: a report. Int Breastfeed J. 2014;9:1-9. doi:10.1186/s13006-014-0023-4

[13] Spatz DL. Ten steps for promoting and protecting breastfeeding in vulnerable populations. J Perinat Neonatal Nurs. 2004;18:412-423. doi:10.1097/00005237-200410000-00009