My son, Beckett, was born when I was 23 weeks and 5 days pregnant. After a short but fierce fight, he died due to his extreme prematurity. I left the hospital with empty arms and took up vigil on my couch in our dark basement, where I would stay in the days and weeks to come, weighed down by my grief.
A few days after I got home from the hospital my breasts started to feel full and swollen. Then they started leaking tiny drops of milk. Without a baby to breastfeed, they got engorged and became extremely painful.
I had no idea that without a baby to feed, my milk was going to come in, particularly with a baby born so prematurely. Either no one told me, or they did tell me but my traumatized, grief-stricken brain couldn’t retain the information. It felt like a slap in the face; some sort of sick joke. My baby was gone but my boobs didn’t get the memo – it felt like once again my body was failing me when I needed it most. And the physical pain on top of my emotional pain was too much to bear.
I consulted Dr. Google but found him to be very unhelpful in this particular circumstance. Most of the articles were for mothers whose babies were earthside. Most of the advice I found was to not take hot showers (one of the only “self care” items I could manage at the time) or wearing a tight sports bra (no thanks). I wound up gritting my teeth through the pain until my next appointment at the hospital, at which time they prescribed me a medication to suppress my milk.
Nothing takes the pain of losing a baby away, but there are ways to alleviate the physical pain that can come with your milk coming in. I’ve partnered up with an incredible feeding consultant, Azura Goodman, to develop a comprehensive guide on what to do if your breastmilk comes in but there is no baby to feed.
WHAT TO EXPECT AND HOW TO PREPARE
Most parents begin to make colostrum (“early milk”) at around 16 weeks’ gestation. After the placenta leaves the body, the body is cued to begin the process of transitioning from colostrum to milk. Many bereaved parents are triggered and rendered uncomfortable by their milk coming in. Some folks refer to milk coming in where there is no infant to drink it as “white tears.”
It is common to want to learn how to suppress milk supply ASAP to support the grieving process. Others may choose to maintain their milk supply and donate it to a milk bank. There is no “right” thing to do here besides doing what makes most sense for you and best suits your grieving process.
Build up your circle of care
Therapy: A lot of intense emotions often accompany infant loss in general, and your milk coming in can be particularly challenging. A therapist can help you navigate the emotional aspects of your milk coming in such as guilt, anger, and resentment. Processing your physical changes, coping with loss and eventually nurturing seeds of hope for the future will be important work that is best not done alone. You deserve support.
Other Loss Moms / Bereavement Groups: Navigating life after the death of your baby can be extremely lonely. No two journeys are the same but connecting with people who have gone through similar experiences can be an incredible source of support. You can always reach out to me firstname.lastname@example.org or on Instagram @becoln_. There are also many amazing organizations that facilitate support groups and can connect you to other supports, such as the Pregnancy and Infant Loss Network (PAIL) the Pregnancy and Infant Loss Support Centre (PILSC).
Lactation Consultant: hiring a lactation consultant may be helpful if trying tactics to increase comfort and suppress milk are not working or if you’d like the support of a professional during this trying time. There may be a lactation consultant available to you at no cost at the hospital that managed your care. Another no-cost option would be reaching out to your public health department and asking to be connected to lactation supports.
Naturopath: There are natural remedies that may help suppress your milk supply (in concert with other measures). If you have the resources or insurance, you could work with a naturopath or herbalist to help guide you in identifying herbs to help supress your milk supply. They may even be able to develop a personalized tincture or poultice to suppress your breast milk. Prior to working with an herbalist or naturopath, ask them if they have experience managing lactation.
FOODS AND HERBS TO SUPPRESS MILK SUPPLY
Parsley: try tabbouleh, chimichurri, or pesto made with parsley instead of basil
Mint/Mint oil: add fresh mint to your smoothies, drink mint tea, or order it in some Thai salads
Sage: try it in a sage brown butter pasta suace, fresh sage tea, stuffing, salad dressing, or soup
Oregano: put it on chicken and roast potatoes or other main courses, or add it to sauces, salad dressings, or soups
Teas: Jasmine, chasteberry, and stinging nettle can all help suppress your milk supply
If interested in more guidance around herbal products, consult an herbalist experienced in lactation.
WHAT TO WATCH OUT FOR AND HOW TO MANAGE COMPLICATIONS
1-4 days after birth you may notice breast/chest swelling. This is called “engorgement” it is an inflammatory process related to your milk transitioning from colostrum to mature milk. Engorgement can occur anywhere from day 2-5.
Engorgement looks/feels like:
The pain/symptoms are typically bilateral but sometimes it’s just one side
Breast/chest warm to the touch
Skin feels stretched, shiny, sometimes itchy
Breasts are very tender
Breasts might throb
How to manage engorgement:
Use gentle breast massage to soften your breasts and relieve some discomfort. Massage the area with olive oil, coconut oil, or any massage oil.
When feeling uncomfortably full try pumping or hand expressing your breasts/chest for a few minutes, or however long it takes for the feeling of extreme fullness to subside. Please be careful to not fully drain the breasts—try to stop right when the fullness recedes (unless you plan on pumping and donating your milk). After about 7-10 days your milk supply will be based largely on supply and demand. The less you remove from the breast the less you will make, generally. If you fully drain the breasts with frequency, you may cue your body to produce more milk. By only removing a small amount when the discomfort is too much to manage, we ensure that the body begins to wind down production. (Check out this video and fast forward to 1:40: https://vimeo.com/65196007)
Use ice wrapped in 1-2 towels or icepacks, cool gel packs, cool grain bags, etc. on the breasts on and off throughout the day.
Traditionally people use cold cabbage leaves (torn from one another and placed in the freezer with a paper towel between them so they don’t freeze together). The cold compress of the cabbage feels quite nice, and some find the cabbage itself helps with engorgement.
If you don’t have an allergy and no medical contraindication, over-the-counter anti-inflammatories can help manage both the inflammation and the pain of engorgement, when taken as advised by that specific med or your MD/NP/Midwife.
A “plug” is an obstruction in one of the milk ducts, often by milk that has lingered around for a bit too long or when there is compression from an internal or external source. If you encounter a plug, work to dislodge it ASAP as to prevent nasty sequelae like mastitis (breast inflammation often caused by infection), continued pain, abscess, etc. Some bodies, more than others, are prone to plugs.
A plug looks/feels like:
These symptoms are typically unilateral (on one side only)
A lump that typically presents with tenderness. Some parents won’t feel a palpable lump, but most do.
Localized pain, sometimes with localized engorgement, warmth and sometimes redness.
How to manage plugged ducts:
Use a warm, moist compress in the affected area and do breast massage above the plug and between the plug and the nipple. You can massage the plug itself but please be careful with these inflamed tissues and massage gently. Follow with hand expression and a pumping session to relieve fullness. To suppress milk supply we often reduce milk expression frequency. This is one time to stray from that guidance! You want to pump that plug out, so that it doesn’t plug an area of the breast which could render it susceptible to infection or continued pain and discomfort.
Prioritize nutrient dense foods, rest, and hydration.
You can also try:
o Massaging above the plug
o Using a vibrator or toothbrush on the plug prior to express some milk
o Use compressions above the plug while you pump
o If you have benefits or resources for additional treatment, there is therapeutic ultrasound that works to dislodge plugs
Mastitis looks/feels like:
These symptoms are typically unilateral
Feeling generally unwell, or "fluey"
Wedge shaped, dense area of tissue
Pain at the breast
Red streaking pattern on the skin
Area is hot to the touch
If you think you may have mastitis, see a doctor, midwife (if still under their care) or nurse practitioner for evaluation. You may need antibiotics if your symptoms persist. When managing plugged ducts or mastitis try to eat high quality foods to bolster your immune system and prioritize rest.
WHAT NOT TO DO
Bind your breasts/chest: this can render you more at risk for a plugged duct due to overly compressed tissues which could compress a duct
Take prescription drugs without medical guidance that you believe will “dry up” milk supply
Overstimulate the breasts/chest by milk removal unless a milk supply is desired for donation
Use too much heat to sooth the engorgement. As the engorgement is an inflammatory process we typically want to cool it down. The application of warmth is helpful in dislodging a plug, but otherwise avoid using too much heat.
Some people find that donating their milk to other babies and families that need it to be a healing experience. If you think this is something you can do, there are milk banks that accept donated milk which they provide to families in neonatal intensive care units.
The process of being accepted to donate your milk is lengthy and involved, including blood tests and questionnaires, so please make sure you’re in the right emotional state to do this. I’d recommend working with a therapist through this process, and if at any point it no longer feels right, take steps to ween yourself off the pump safely. If you’re able to donate your breastmilk it is a beautiful gift you can give a sick baby, but make sure you’re it’s the right choice for you.
Azura Goodman is a Registered Nurse and International Board Certified Lactation Consultant who operates Azura Infant Feeding Support in southern Ontario. You can find out more about Azura and book a virtual or in-person session at www.azurainfantfeeding.com. Check Azura out on Instagram @azurainfantfeeding.