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.
Page last edited Sun Oct 14 09:32:06 UTC 2007.
