Dear Kerri:

Loss is an integral part of life. Grief is the natural, normal and healthy
response to loss. Breastfeeding is the biologically normal means of
nurturing human babies and young children. Because of its survival value,
breastfeeding is necessarily robust. Because breastfeeding is necessarily
robust, fluctuations in supply due to loss and other psychosocial stressors
can be expected to be temporary.

"Rules" for helping a mother breastfeeding after a loss might include:

1. Feed the baby.
2. Protect the milk supply.
3. Help the mother grieve her loss.

I include "Help the mother grieve her loss" because I see a connection
between the release of emotion and the release of milk. Anytime a mother
experiences a drop in milk supply after a loss or other psycho-social
stressor, I encourage facilitating the opportunity for more release of
emotion.

What do mothers need to grieve a loss? A few things might be:

1. Time: By this, I do not mean just the passage of time. Time heals the
wounds of a loss as well as time heals a broken washing machine. I mean
that mothers need time in which to do the work of grieving.
2. Privacy: By this, I do not mean isolation. We are not meant to grieve
alone any more than we are meant to mother alone. I mean that a mother
needs a safe space in which to express what they *really* are feeling to
people who can bear to fully be with the mother in her grief. That means
they may need to somehow "get away" from the listening ears of a young
child, a spouse, a relative, etc. Note that the "getting away" can involve
a great deal of nearness. Someone can cuddle a baby or keep a young child
happily engaged in a project in just the next room while the mother talks
on the phone or in person with someone about her grief.
3. Practical help: Grief is physically and emotionally depleting. A
grieving mother needs help with the housework, time off from paid
employment, help with the children, etc. *Someone other than the mother*
can arrange a few weeks (or whatever amount of time is needed) of practical
help: relatives, friends from a La Leche League Group, members of her
religious community, neighbors can bring a meal each day, wash dishes, fold
laundry and pull weeds, play ball in the back yard with an older child,
etc., etc., etc. *The grieving mother should not be expected to arrange
this care.* The person who coordinates this practical help should make a
point of telling the helpers what the mother needs (after finding out from
the mother), as the mother may be unable to do so herself.
4. Rest: Grief is physically and emotionally depleting. Sleep is often
disturbed. On a good day, many mothers do not get enough rest. During grief
the exhaustion can be incredible. The chance to lay down or actually sleep
in the middle of the day may much needed. This need can be met by the
people who are providing the practical help.
5. Validation: Common platitudes expressed to the bereaved often have me
anings and results quite different from our well-meaning intentions. We try
to offer comfort by saying things like "At least she led a full life." Or
"At least she died quickly." Or "She wouldn't want you to feel sad." The
underlying meaning of such expressions are, however, "Don't feel bad." This
leaves us feeling as though there is something wrong with us for feeling
what we are feeling. We try to console with advice like "Time heals all
wounds." Or "You've got to keep busy." Time in and of itself does not heal
anything. It's what we *do* while time passes that matters. And mothers
have more than enough to keep them busy just with mothering. More busyness
will only delay their work of grieving. Our saying just about anything
other than "I'm so sorry for your loss" results in mothers spending their
energy stifling their grief instead of fully grieving. Our listening will
do far more than our talking.
6. Companionship: Crying silently in the middle of the night and writing in
a journal are helpful for many mothers, but they are worlds apart from
sobbing in someone's arms. Grieving mothers need the chance to share their
grief with others, to have social recognition of their loss, to know that
they are not alone.
7. Respect for the individuality of grief: No matter how similar the loss,
no one truly knows how anyone else feels because personal histories differ,
relationships differ, beliefs differ, responses differ, etc. "I know how
you feel" is neither comforting nor accurate. Models of the grieving
process (e.g., stages), are just one way of conceptualizing what people
commonly experience. *Much* variation is to be expected. Every loss is
unique.
8. Physical care: Grief is physically and emotionally depleting. Grieving
mothers need nourishing foods, physical exercise, and healing touches from
people they trust (e.g., an embrace, a massage, a hand on their hand).
9. Respect for grief: Many people, including mental health care
professionals, do not understand the normalcy and healthiness of grief. A
crying mother who is having difficulty sleeping after a loss is normal and
mentally healthy. A sad mother who does not feel energetic is normal and
mentally healthy. Yet because the symptoms of grief and clinical depression
can overlap, others may believe that pharmacological treatment of grief is
necessary. Because grief is not the same thing as clinical depression, the
attempt to eliminate symptoms via medication can actually delay grief to
the detriment of the mother's physical and emotional health. A mental
health care professional with specialized training and experience in grief
will be better able to make the distinction between grief and clinical
depression than a professional without such training. She will also be
better able to facilitate grief in the context of counseling than a
professional without such training.  Grieving mothers may need to be told
over and over again: "It's all right to cry." Or "Whatever you are feeling
is OK." Or "It's all right to need care." Or "It's all right to accept
care." Or "You have the right to grieve." Or whatever it is that the mother
seems not to believe is OK about grief. Many people have "never" heard
anyone say anything supportive of grief. That is a loss worthy of grieving
in and of itself. It may not be enough to say "How are you?" in societies
where grief is not well supported. We may need to say "How are you? And I
really want to know how you really are." Or to ask specific questions like
"What was the hardest part of the day today?" so mothers know that we do
not expect them to say they are "Fine" when they are not. Mothers are often
unable to express what they need when asked "what can I do to help?"
because they have been socially trained to believe that needing help is
unacceptable. An accurate answer may not come until the mother realizes
that her grief is respected and accepted--and deserving of her own respect
and acceptance.
10. Recognition that there may be more to a mother's grief than meets the
eye: New losses can trigger the grieving of old losses. She may not know
that this often happens and may feel there is something "wrong" with her
for feeling badly about something else, too. A mother may need the chance
to talk about other losses in addition to the current one. She may feel
overwhelmed by the complexity of her loss and her feelings and have
difficulty speaking about it because she doesn't even know where to begin.

I am so sorry for the mother's loss. I hope that her needs will be met and
she will be able to grieve well.

And if I am correct in hearing grief in your own writing, I hold the same
hopes for you.

Cynthia

Cynthia Good Mojab, MS Clinical Psychology
Ammawell
Email: [log in to unmask]
Web site: http://home.attbi.com/~ammawell

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