Cynthia and Jean have posted excellent, intelligent discussions of the issue
of grief (both in the mother and the perhaps unexplored or unexpressed grief
of many of the mother's counselors).  However, I am interested in one of
Cynthia's comment:  "Losses related to childbearing are poorly supported in
the US (and I suspect
in most Western or Westernized societies)."  I hate to keep harping on this
subject, but again, I think it continues to repeat a fiction we tell
ourselves that  in more "natural" less modern settings women's needs are
better attended to.  I suspect it is the opposite, and that in general there
is much more sensitivity now in more stable, affluant societies than in
bygone days for the griefs that women experience in reproduction.

My reading of the demographics of  pre-public health/pre-antibiotic/no
access to care areas (historically and today) suggests that the loss of
children was/is so expected that some cultures didn't even name babies until
they reached an age when it looked like their survival was perhaps more
certain.

Our memories are so short.  It is only 2 or 3 generations in our past that
maternal/child deaths were common in the West.  I can recall my own
grandmothers and their friends saying things like:  "I have 7 children; 4
living." or "I have 5 children; 2 are in heaven."  My mother in law (who
died last year at 86) lost her first daughter  who was barely 3 to pneumonia
in Appalachia in the late 1930's when medical care in that region was
spotty.  I asked her about that experience once, and she commented that
people so frequently lost babies that "you just didn't talk about it; you
just went on." She got very depressed afterwards from what I could gather.
People's expectation was that she would be stoical,  probably because people
just couldn't afford to break down over it.  That was bad for her; but a
necessity for a community living in marginal, Depression-era conditions.  I
would be very interested in hearing from people on this list who live in
other regions to comment upon the cultural support for women who have lost
children (not just lactation).

My own impression is that there is much more sensitivity now than there was
in the past, more permission to grieve, and more opportunity for women to be
heard when they grieve than in times past.  Would I like this counseling to
be more routine and more available?  Yes, of course.  I myself have
profitted enormously from grief counseling.  It's important to gently
explore previous grief (miscarriage or lost lactation) when a mom has a new
baby -- esp. if she seems anxious or depressed.  (I have a question on my
intake form about previous pregnancies and previous lactation difficulties).
I've observed that the birth often renews the pain of an old loss. Sometimes
all it takes is just listening while the mother cries for a moment and tells
the story.  Then it's as if, by being validated, those feelings become less
potent in terms of undermining her energy to face the present circumstances.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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