Having lost my first child at 19 months, I can certainly identify with
     the excruciating grief felt by Tina's client in Ohio as she feels this
     new life developing. The next pregnancy after an infant death contains
     all the labile emotions of the first, magnified about a hundredfold,
     and the gutwrenching fear of loss persists until the next child is
     well beyond the age at which the first one died. So what helps?

     - Being in touch with other mothers who have lost babies and survived
     and gone on to have healthy babies who grow up. The hospital should
     have a support group including such parents; otherwise try the
     Compassionate Friends local chapter. (I am also happy to write mothers
     who have lost children but real live folks close at hand are better.)

     - Compassionate daily attention and reinforcement of the sort that I am
     sure Tina will give, and I hope family and friends can provide.

     - Understanding of the mood swings and ambivalence that are going to
     take place, a natural part of the healing of grief. In my opinion and
     experience, women who take drugs for grief suffer it longer. If there
     are adequate supports around the woman it may be possible for her to
     consider just facing the experience of guild and resolution without
     medications.

     - Labour will not be easy, being complicated by dread; a doula or
     loving companion is vital. But the euphoria of giving birth and early
     bonding can heal. Try to arrange that no one takes the baby away from
     her for any reason in the first 24 hours; this may take special
     negotiation with the hospital in advance.

     - Elimination of the word "failure" (Could we all stop using this
     pejorative?  Breastfeeding is a relationship, not an exam). It may be
     the health care system failed to meet this mother's need. Is it
     possible to give her this perception, that she did the very best she
     could given that the system was not as helpful as it could be? And
     that next time around, the early visits and ongoing help you promise
     her will make an enormous difrerence.

     - Helping the mother feel at ease with her own body in pregnancy. Does
     she like stroking, massage, warm baths, any kind of healing touch from
     any person?  Try to help her develop that ease of non-sexual touching
     from any acceptable sources. Help her know that regardless of how she
     feeds her baby, lots of skin to skin contact, carrying in a sling and
     sleeping with the baby will bring them into a sense of safety and
     closeness through touch.

     - Downplay "what kind of milk". The suggestions that others have made
     to suggest partial breastfeeding make sense. You could also offer to
     help her cup feed any supplemental formula, explaining that then the
     baby will go on being interested in the breast, and if she wants to
     give more breastmilk as time goes on, you can help her do that.

     Please let us know how this goes for you, Tina, and for the mother and
     baby.

     Helen Armstrong IBCLC

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