Dear Christy:

Thank you so much for your sensitivity and your post. Here are a few of my thoughts on your questions:

1. You asked: "In the case of a mother who desires to breastfeed but has given birth to a baby with a poor prognosis, how soon, if at all, do you recommend that she begin expressing breastmilk for her baby?" Many, many, many babies who were not expected to survive a health crisis have gone on to do so. Mothers desiring to breastfeed a nursling who cannot yet breastfeed for any reason deserve information and support to protect their milk supply *immediately.* If the situation should improve, the mother's milk, presence, and touch may still mean the difference between life and death for the baby, and will mean the greatest chance of normal development if the crisis passes. Furthermore, any mother who desires to breastfeed a newborn, whether that breastfeeding experience will turn out to be a full feeding, one brief nuzzling, or one moment of her nursling's cheek on her breast, deserves to have the opportunity to have this experience mothering her child. It may be her most treasured memory and greatest comfort if her baby should die.

2. You asked: "Recently there was a mother facing this situation on our unit. The nurse caring for her confronted me and told me that it was cruel to bring in a pump and teach her how to express milk because it would give her false hope and intensify her grief if her baby dies. Are any of you aware of any research out there to support this viewpoint? Does expressing breastmilk for a baby really make it more painful if the baby dies?" This nurse should be required to find references to support her claims. By the logic presented, given the vulnerability inherent in life and the possibility any of us could die from some cause at any moment and the certainly that we will all die from a cause eventually, we had all best not enter into any relationship, provide any care or nurture to one another, or connect emotionally or physically in any way. Grief is grief. We will either grieve the loss of someone we loved while taking comfort in the care and love that we showed them during the time we had the privilege to know them or we will grieve the loss of love and care ungiven and a life lived in isolated loneliness. Loving and caring for a child, no matter how long that child lives, is normal, healthy and deserving of the greatest support that anyone can provide in any setting. A mother deserves to have memories of her baby, no matter how long that child lives. She deserves to have memories of expressing her love (and milk) for that baby, of being the mother of that baby, no matter how long that child lives.

3. You stated: "My opinion is that the mother should be given the option to express her milk for her baby, and that her choice should be respected either way. I personally have not been in the situation of potentially having a baby die, but I wonder if avoiding the topic of pumping will really protect her from painful feelings and false hope. I think it would be an extremely painful situation no matter what happens." Grief is painful no matter what. Hospitalization is frightening. Death watches are agonizing. Hope and terror, dreams and despair mixing and sweeping over a mother in an exhausting yet *completely normal and healthy* manner are part of the human experience of such life events. No one can protect a mother from the emotional experience of such a life event. No one has the right to. Mothers have the right to fully feel and experience every emotion that comes with such life events. They deserve support and companionship as they experience them--from people who are not afraid of grief. Hope is healthy. Painful feelings are healthy. Grief is healthy. They are all a part of the *completely normal and healthy* human experience of such life events.

4. You asked: "So what do you say? Am I totally off my rocker? Are you aware of any research in this area? Do you think it is better for her to wait a day before pumping just to see how her baby is doing before deciding whether to start expressing milk?" No. I absolutely do not believe that it is better to wait. Ask the nurse to find research that supports her opinion. Every mother deserves support to breastfeed and protect her milk supply if that is her desire. It sounds like your department (and the families you serve) would benefit greatly from a combination of breastfeeding education and grief counseling training. It does not seem to me that the psychological needs of mothers and infants in such situations are well understood or supported by all members of the staff on your unit.

You might find my article, "Congenital disorders: Implications for breastfeeding," and my LC Unit, "Congenital Disorders in the Nursling," of interest. You can find more information about both of them on the publications page of my website (http://home.attbi.com/~ammawell). My article can be read on-line.

Thank you again for your sensitivity.

Best wishes and many thoughts of support for the mother, her baby, and their family,

Cynthia

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

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