You should have a baby to hold that needs you. Who needs your love, your safety, your comfort, and who needs to be fed. Your heart and your body wanted and prepared for that, maybe even without your knowledge. Now you have a heart and body ready but are without your child. That is devastating on every level.
When does your milk come in?
It is possible to have your milk come in earlier than 16-18 weeks gestation (as many professional literature lists) and there is more updated information that a loss at 12 weeks may result in having your milk be present enough to be noticeable. That may be true even earlier than 12 weeks gestation. You may notice milk leaking from your nipples, uncomfortably full breasts, or even milk let-downs after a birth at 12 weeks gestation, and it may be in an unexpected time frame.
Milk generally transitions from a relatively small amount of colostrum to a noticeable supply an average of 3-5 days after birthing your first term gestation aged baby that you are breastfeeding. If you have previously birthed a baby and your milk came in, it can happen up to 24-48 hours before that.
The earlier the gestational age of birth, the longer the transition takes. Your body prepares to help the smaller stomach of your child by taking longer. That means that if the birth of your baby was less than term or less than preterm, your milk transitioning may not occur until an average of 2-10 days after birth.
What should you do about your milk?
This can be a very complicated choice that may be delayed in presenting or may not be needed at all. In a time when your heart, soul, and body are already struggling to survive with a grief that isn't even always validated by those around us, and is heart-rending in a way impossible to explain, now there's another reminder. You must make a decision, one that others may not understand or agree with. That is okay. It's okay to make a decision yourself or with your partner. It's also okay to change that decision. And neither decision is bad, for any reason.
You may choose to suppress lactation, to dry up that milk. Your baby isn't with you, you need healing in your entire body from birth, and you are grieving. There is nothing wrong with choosing to discontinue a process that is only biologically needed to nourish your baby once they are outside your body as you did when they were growing inside you. If that is your choice, I want you to do it with knowledge. The most important thing is that to dry up your milk, you need to do so healthfully. If your breasts become uncomfortably full, as little milk should be removed as possible in order to become no longer uncomfortable. If milk is removed to the point of not very full or to empty or to very comfortable, your body may think that is an indication to continue to produce milk for longer. The less milk you remove, while ensuring that your breasts are not uncomfortably full, the sooner your supply will be suppressed. It will likely still be present anywhere from days to weeks. If you are struggling with the process, I encourage you to reach out to a lactation consultant for expert information, help developing a plan, and someone to be available if questions or concerns arise. Regardless of how long it takes to suppress your milk, your body's caloric needs are higher while you lactate. Be sure to remember to feed yourself as best as you are able.
Importantly: if you notice breast redness, pain, or hard lumps you do need to quickly contact a healthcare provider. An IBCLC, your primary care provider, or your OB-GYN can help in resolving what has become a medical complication of a milk supply. Mastitis and clogged ducts can happen to anyone who is lactating. These medical complications require treatment, though not always medicine.
The other option is to keep and encourage your milk supply. Reasons to do this include wanting to donate breastmilk, making breastmilk to feed an older child, to save for a keepsake, or to see for yourself that your body can. This is best done by mimicking what your baby would be doing - regular, frequent, and effective milk removal as well as breast stimulation. In the first days and weeks it is recommended to rent a hospital-grade pump since it is designed to have very long-term consistent pumping power, mimic a newborn learning to breastfeed, and elevate your hormone levels to help your milk come in fully. Most especially in the early days, a pump may only be stimulating hormones and not removing milk. To help with milk removal, you can utilize hand expression. After you have established a supply, you may be able to change pumps, and you may be able to pump less frequently. Because this is likely to be an emotionally charged time, I would encourage reaching out for guidance from a lactation consultant. The 1st two weeks after birth are very instrumental in the ease, or difficulty, of establishing a milk supply. Your baby's gestational age at delivery will also factor into this. Your goal may not be a full supply; it may be a certain number of milliliters (or ounces) or a length of time. A lactation consultant will have training, guidelines, and the emotional support to give you in learning how to establish and/or maintain a supply without a baby. Again, please note, as long as you are lactating, your body has increased nutritional needs. Be sure that you are caring for yourself properly.
My Story
Educating on loss in regards to lactation awareness is very personal for me. I had my firstborn, who was a toddler at the time, when I miscarried two days before 12 weeks gestation with my second baby. I was quite surprised, as well as distraught, when I woke up part way through the night four days after my second baby's birth with puddles of milk around each breast. It felt like a fresh loss all over again, and I was horrified that the grief I thought I had begun to process was truly still too raw for me to have processed at all.
I was trying to hold myself together while feeling the most intense sensations of emptiness, and I had tried to accept that I could and should and would “move on” past my grief. I felt I was a failure as a mother - to my toddler who should have their sibling but didn't and now had an emotionally wrecked mom who was not as involved as before. Also to my baby that I didn't get to feel kick inside my body, celebrate their birth with my extended family, hold and lock gazes with, hear their noises, see their expressions and wonder at the world, kiss while they giggled, or feed from my body that helped them form and come into this world.
I did not want that milk. I utilized every natural and inexpensive trick I could find to suppress my supply. I don't regret it for one moment. I was not in a place to be able to handle anything emotionally and mentally in addition to surviving and caring for my toddler. I want to share that grace - to decide what is needed and wanted now and not regret surviving this experience in the way you want or need to survive.
Your decision may be different than mine was. As long as it is yours, and not to the detriment of your health, I want to share the grace of giving. You may choose that doing something is what you need and want to do. You can pump and hand express and give of your body's incredible ability to nourish and provide during this grief. I think there are few things that are more healing to the soul than helping someone else. But healing does not come if trying to give is bringing harm to yourself.
Learning to live with the grief of having a child that others tend to forget is hard. In solidarity I want you to give yourself the grace to decide what to do if your milk comes in without leaving room for regret. If you don't have support, reach out for help. A counselor, a lactation professional, or your doctor is a great place to start.
This grief is valid. So are your choices.
Forever also aching to hold my child,
Kayla Swilling, BS RN IBCLC CLS
Owner and founder Drink Deeply Lactation LLC