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What Every L&D Nurse Needs to Know About Lactation Management After Stillbirth
Every week, we deliver evidence-based strategies for modern perinatal bereavement care. Written by Jay CRNA, MS, specializing in obstetrical anesthesia, and Trina, a bereavement expert, both who have experienced loss.
In Today’s Issue:
🔗 The best resources I found this week
📖 Deep dive: What Every L&D Nurse Needs to Know About Lactation Management After Stillbirth
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🔗 The Best Resources I Found This Week
📢 Virtual event: Our next bereavement training event is coming up
Forget Me Not and Share Pregnancy & Infant Loss Support are partnering up for a special event with expert training, peer connection, and practical strategies designed specifically for bereavement coordinators. Register here on Forget Me Not.
💔 The Power of Donating Milk
For some parents, donating expressed milk becomes an act of healing, identity, and legacy. Real stories from bereaved parents and clinicians in this research article. Milk donation after loss
🩺 3 Pathways for Managing Lactation
Ever been in a situation where you weren't sure how to support a parent after infant loss? Dr. Katherine Carroll and colleagues outline the three evidence-based options in their influential AID Framework
📖 Deep Dive
The Missing Conversation: What Every L&D Nurse Needs to Know About Lactation Management After Stillbirth
Here's something that probably didn't get much airtime in your nursing program.
Maybe you've been there. A mom delivers her stillborn baby. You're doing everything you learned about compassionate bereavement care. The memory box. The photos. The handprints. You're checking all the boxes.
Then 48 hours later, her milk comes in.
And you realize nobody really talked about this part.
The Gap We Don't Talk About
A 2024 study found that 38% of U.S. hospitals provide NO perinatal loss training for L&D nurses. Half have no standard debriefings after a loss. (psst…This is what we’re trying to change)
But here's the thing that really caught my attention.
Research shows lactation care is one of the most overlooked aspects of bereavement care.
Think about it. In the U.S., approximately 21,000 babies are stillborn every year. That's 21,000 mothers who will experience lactation after loss. Yet most of them report receiving little to no lactation support from hospital staff.
A few quotes I found from bereaved mothers on Reddit:
"My milk came in and I had no idea it would. The nurse seemed surprised too. Nobody prepared me for this."
"The physical pain of engorgement was unbearable but the emotional pain was worse. I felt like my body was mocking me."
Here's something that surprised me.
Lactogenesis can begin as early as 16 weeks gestation.
Not just late-term losses. Early losses too.
So when you're caring for a mom who lost her baby at 18 weeks? She might lactate. And if nobody told her? That's going to be traumatic.
Dr. Carroll's framework recommends acknowledging that "milk production can occur after early or late miscarriage, stillbirth, neonatal death, or infant death".
Not just the late-term cases. All of them.
Please Enter Dr. Katherine Carroll
There's this incredible researcher at Australian National University, Dr. Katherine Carroll, who has spent years studying lactation after infant death.
She led an Australian Research Council-funded study that changed how we think about this.
And here's what she found. Most bereaved mothers aren't getting the full picture.
They're only being told about suppression.
But suppression isn't the only option.
The Three Options You Should Be Presenting
Dr. Carroll's "Lactation After Infant Death (AID) Framework" lays out three distinct management pathways:
1. suppression with cabergoline
2. Gradual expression and weaning
3. Sustained expression (with or without milk donation)
Research shows that when mothers are presented with all three options—not just suppression—they feel more empowered and less traumatized by the lactation experience.
But here's the problem.
A 2023 study found that lactation care for bereaved mothers, when provided at all, was "limited to brief encounters with the goal of lactation suppression".
Translation? We're making the decision for them.
What Mothers Are Actually Saying
I dug into some really powerful research where bereaved mothers who donated milk after loss were interviewed.
Three themes emerged:
"Fulfilling the mother role" — One mom said, "I couldn't feed my baby, but I could feed someone else's baby. It was the only mothering I could do."
"The power of being able to 'Do'" — Another shared, "Everything felt out of control. Pumping was something I could control."
"Making good from the bad" — A third mom explained, "My milk was the last gift my baby gave me. Donating it meant her life mattered."
Now listen. Not every mother will want this. And that's completely okay.
Research also shows that for many mothers, lactation after loss is "emotionally painful".
One mother described it as: "Why is my body doing this to me? After everything, why do I have to do this now?"
The point isn't that one option is better than another.
The point is mothers deserve to know all their options.
Option One: Pharmacological Suppression (using medication like cabergoline)
This is the pathway where a provider gives medication to stop milk from coming in. It’s often offered as the first solution after stillbirth. Many hospitals default to this, sometimes without mentioning other options. If chosen, it’s important for the care team to explain what the medication can and cannot do, possible side effects, and what to expect in the days ahead.
This approach is outlined in Dr. Katherine Carroll’s research, specifically her Lactation After Infant Death (AID) Framework. If you want details about timing, safety, or how this works for each family, please see her framework article.pmc.ncbi.nlm.nih+1
It’s not the only way—but it’s a commonly offered path. If your unit isn’t sure where to start, using her guide (linked above) is a great reference.
Option 2: Gradual Expression and Weaning
Some mothers don't want pharmacological suppression.
Maybe they have contraindications. Maybe they want a more gradual process.
Gradual expression involves expressing just enough milk to relieve pressure—but not so much that you stimulate more production.
Think of it like slowly turning down the dial.
The timeline for complete suppression? It varies. Could be days. Could be weeks.
Mothers need to know:
How to hand express effectively breastfeeding
Signs of mastitis (redness, fever, severe pain)
That some milk production may continue for weeks or months
And here's something compassionate you can offer.
Even if a mother chooses suppression, she can still keep her milk as a memento. Freeze it. Save it.
"I kept a small vial of my milk. It's the only physical thing I have from my body that connected to my baby."
Option 3: Sustained Expression and Donation
This is the option that rarely gets mentioned.
But for some mothers, it's transformative.
A 2023 study of bereaved mothers who donated milk found that the experience was "empowering and both emotionally and physically healing".
Mothers described it as:
A "healing ritual"
Giving their baby's life "meaning"
"The last gift my baby could give"
One mom explained:
"Pumping gave me a sense of purpose when I felt completely purposeless."
But here's what mothers need to know:
Milk banks have requirements:
Mothers need to maintain healthy diet, adequate hydration, avoid alcohol and certain medications.
It takes commitment:
Pumping every 2-3 hours. Sterilizing equipment. Proper storage.
Resources exist:
Organizations like Mothers' Milk Bank and New York Milk Bank have specific programs for bereaved mothers.
The Conversation They're Not Having
Here's what really gets me.
Research shows that hospital cultures often regard post-loss lactation as "valueless and best dealt with through medical suppression".
But individual healthcare professionals? They have more complex insights.
There's a disconnect.
The system says: suppress it, move on.
But the nurses caring for these mothers? You know it's more complicated than that.
One L&D nurse posted: "I had a mom who wanted to pump and donate. I had no idea how to help her. I felt so unprepared."reddit
What This Means for Your Practice
Before delivery:
Mention that lactation may occur. Not as a scary warning. Just matter-of-fact. "Your body may produce milk. We'll talk about your options if that happens."
Within 24 hours after delivery:
Have the lactation conversation. Present all three options. Ask what feels right for her.
Screen before cabergoline:
Check blood pressure. Confirm no contraindications.
Provide resources:
Have handouts ready. Milk bank contacts. Support groups.
Follow up:
Don't assume one conversation is enough. Check in at discharge. Mention it in discharge paperwork.
🔖 The Research Worth Bookmarking
If you want to dive deeper, these are the resources that really stood out:
Dr. Carroll's AID Framework — The gold standard for evidence-based lactation care after loss
British Association of Perinatal Medicine guidelines — Comprehensive clinical protocols
Star Legacy Foundation lactation page — Patient-facing resources
Breastfeeding Support article — Detailed suppression vs. expression guidance
Why This Matters
Look, I get it. Stillbirth care is already overwhelming. There's so much to remember. So many protocols.
But here's the thing.
Research shows that bereaved mothers consistently identify lactation management as a major gap in their care.
One bereaved mother on Reddit wrote:
"My nurse was amazing in every way. But when my milk came in, she looked as lost as I felt. I wish someone had prepared both of us."reddit
You already have the heart for this work. You already show up with compassion. Now you have the framework to back it up.
Because these mothers deserve comprehensive, evidence-based care.
Including the conversation about lactation.
Even when—especially when—there's no baby to feed.
👋 That’s a Wrap!
Before you go: Here are ways we can help your hospital
We offer bereavement boxes to give as gifts to those who leave the hospital after a miscarriage, stillborn, or infant death. Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:
Tools for hospitals to create a bereavement experience for families to begin their grief journey
Educating nurses with modern bereavement standards and continuing education.
Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.
These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.
Until next week,
Trina and Jay
Co-founders of Forget Me Not

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