A second-time mother feels a familiar stab of panic, dread, and confusion. Her second child, just 4 months old, is refusing to latch to breastfeed.* The problem started when she returned to work a few weeks ago, and her son began regularly receiving bottles of her expressed milk during the day. Despite weeks of trying suggestions from books, online lactation resources, and pediatricians to coax her son back to breast, nothing seems to be working. Having been down this road before with her first child, she is dreading the idea of being tethered to her breast pump indefinitely and, with that, the constant worry about keeping up a sufficient milk supply. Worse than that, there is the profound sense of rejection, personal failure, and loss for the nursing relationship she had with her baby. The negative feelings are all-consuming—affecting her ability to concentrate at work and self-worth.
While this story is a personal one, it is hardly unique. It speaks to a phenomenon only recently named and described in the literature, though experienced by many parents for far longer—breastfeeding grief. So, what is breastfeeding grief and why is it important?
Grief itself is defined as “deep sadness, caused especially by someone's death,” “a deep and poignant distress by, or as if by, bereavement.”1 Research on the lived experience of some parents who face threatened or derailed breastfeeding plans seems to fit this definition. Particularly in the context of a strong prenatal commitment to breastfeed, parents who encounter lactation complications necessitating reduction or cessation of direct at-the-breast/chest feeds and/or provision of their own milk to their infant may encounter overwhelming and persistent negative emotions. These include mental and emotional anguish, shock, a sense of loss and failure, remorse, shame, anger, and sadness.2,3
Brown4 notes that breastfeeding grief bears hallmarks of psychological trauma and complicated grief in some cases. These include symptoms such as prolonged and intrusive thoughts about the experience, avoidance (including other breastfeeding people or conversations about infant feeding), and heightened reactivity and arousal interfering with daily activities, such as sleep and concentration. A trauma response to a breastfeeding crisis may partly arise from the inability to escape the exposure: parents struggling to breastfeed still need to feed their infants.4 Some may continue breastfeeding, or attempt to do so, with assistive devices like supplemental nursing systems or nipple shields. Some may implement complicated and time-intensive feeding regimens such as “triple feeding” (direct breastfeeding, pumping/milk expression, and formula supplementation). In addition to emotional anguish, parents with unresolved breastfeeding pain experience negative physical stimuli multiple times per day.
Outsiders, as well as affected parents themselves, may be flummoxed by the intensity of feelings experienced with breastfeeding grief. Yet these reactions are proportional when considering the meaning parents attach to breastfeeding. In fact, rather than distress caused by perceived loss of health benefits associated with breastfeeding, belief that formula is harmful or nutritionally inferior, or external pressures to breastfeed, the grief response with breastfeeding problems seems to be more existential. For many pregnant and postpartum people, breastfeeding is central to their developing maternal identity and relationship with their child. Loss of breastfeeding can disrupt one's sense of self-understanding and -worth as a mother and person.3 Several fascinating theories attempt to further explain the intensity of breastfeeding grief, including that the maternal brain is instinctually primed through genetic memory/imprinting to mourn the presumed death of one's infant or to “sound the alarm” to ensure the infant's survival if breastfeeding is not going well or ceases after birth.5
Breastfeeding problems or loss of direct breastfeeding may also translate to less physical contact with the infant and associated physiologic variations that have evolved to ensure dyadic emotional connection and parental well-being (eg, loss of frequent oxytocin surges with let-down).5 Brown2,4 notes a recursive relationship between breastfeeding grief and postpartum depression—such that breastfeeding problems and grief may contribute to or exacerbate postpartum depression, and postpartum depression may negatively impact breastfeeding behavior or perceptions. Other consequences of breastfeeding grief include inadequate infant intake if the parent is avoiding or delaying breastfeeds without supplementary feeds. Relationships with family members and healthcare providers may suffer if these individuals were perceived as unsupportive. The parent may also harbor resentment for themselves and even their infant.4,5
Jacobson5 and Brown4 offer some suggestions on recovering and healing from breastfeeding grief. These include accessing resources and using techniques to process grief, alleviate other uncomfortable or negative feelings, recognize what aspects of breastfeeding may be salvageable, and build infant connection and maternal/parental identity outside of breastfeeding. For example, parents might consider talking to lactation professionals who can help them understand why they experienced problems, if these problems are resolvable, and whether they are likely to recur. Connecting to a support group or peers in similar situations, as well as partners or family members who are skilled and caring listeners, may also be helpful. Parents can consider a variety of methods to process their grief and reframe their experience, including journaling, other creative expressions, and mindfulness-based meditation exercises like guided visualizations and body scans/progressive relaxation. Jacobson5 emphasizes the importance of finding new ways to connect physically and emotionally with one's infant. These might include extended skin-to-skin contact, infant massage, safe co-sleeping, and baby wearing. Parents may also find it comforting to read or hear other parents' experiences with breastfeeding grief, including that negative emotions are likely to fade over time as the infant moves on to other stages of development where breastfeeding is less front and center.
Nurses and other healthcare providers play a critical role in preventing, identifying, and reducing negative sequelae associated with breastfeeding grief. In prenatal settings, it is important to prepare pregnant people and their support person(s) for challenges and realities that are frequently encountered during breastfeeding. These discussions might take precedence over discussion of infant health benefits associated with breastfeeding among “already won hearts and minds.”3 Provision of anticipatory guidance on when and how to access outpatient lactation support and mental/emotional health services is also important. For parents struggling with breastfeeding, providers need to clearly communicate the circumstances that would necessitate formula supplementation and provide directions for formula selection, preparation, and use if it is needed.
For parents currently experiencing breastfeeding problems and grief, providers can validate their experiences and exercise reflexive listening. The tendency to revert to common societal tropes when providing emotional support (eg, “fed is best”) can minimize parents' feelings and, in some cases, alienate parents who attach significant meaning to breastfeeding.2,4 It is important that providers understand that grief reactions in infant feeding can occur in a variety of situations—not just with complete breastfeeding cessation. Parents who experience lactation problems leading to use of assistive feeding devices or exclusive pumping,6 for example, may experience grief. Researchers have also documented the potential for grief-like experiences among those experiencing breastfeeding aversion or dysmorphic milk ejection reflex (D-MER).7,8
Nurses and providers in birthing facilities can help parents connect and bond with their infants in ways that will endure, even if breastfeeding does not. For example, nurses play an important role in facilitating early and frequent skin-to-skin care. Providers can share their observations of the parent's growing confidence and competence in caregiving and the infant's reciprocal response (eg, calming effect of parental touch or voice on the infant).
On a systemic level, better structural supports for birthing and lactating families are sorely needed to prevent circumstances that may lead to or exacerbate breastfeeding grief. Measures such as federal extended, paid parental leave and increasing availability and access to qualified lactation support could help parents better meet their breastfeeding goals. Extending Medicaid coverage for birthing people to at least 1 year after birth can help address current access barriers to postpartum mental healthcare.9 Additional scrutiny is also warranted in choosing the language and focus of public health campaigns around breastfeeding.4 Finally, research is needed to improve our understanding of the prevalence and trajectory of breastfeeding grief, its sequelae including overlap with other postpartum mental/emotional health conditions, and treatment/management considerations.
—Jill R. Demirci, PhD, RN, IBCLC
University of Pittsburgh School of Nursing
1. Merriam-Webster. Grief. https://www.merriam-webster.com/dictionary/grief
. Updated January 20, 2022. Accessed January 27, 2022.
2. Brown A. What do women lose if they are prevented from meeting their breastfeeding goals? Clin Lact. 2018;9(4):200–207.
3. Robinson C. Misshapen motherhood: placing breastfeeding distress. Emot Space Soc. 2018;26:41–48.
4. Brown A. Why Breastfeeding Grief and Trauma Matter. London, England: Pinter & Martin Ltd; 2019.
5. Jacobson H. Healing Breastfeeding Grief. Ashland, OR: Rosalind Press; 2016.
6. Whipps MDM, Yoshikawa H, Demirci JR, Hill J. “Painful, yet beautiful, moments”: pathways through infant feeding and dynamic conceptions of breastfeeding success. Qual Health Res. 2022;32(1):31–47.
7. Morns MA, Steel AE, McIntyre E, Burns E. “It makes my skin crawl”: women's experience of breastfeeding aversion response (bar) [published online ahead of print January 7, 2022]. Women Birth. doi:10.1016/j.wombi.2022.01.001.
8. Uvnas-Moberg K, Kendall-Tackett K. The mystery of D-MER: what can hormonal research tell us about dysphoric milk-ejection reflex? Clin Lact. 2018;9(1):23–29.
9. The American College of Obstetricians and Gynecologists. Policy priorities: extend postpartum Medicaid coverage. https://www.acog.org/advocacy/policy-priorities/extend-postpartum-medicaid-coverage
. Published 2022. Accessed January 27, 2022.
10. Bartick M, Stehel EK, Calhoun SL, et al. Academy of Breastfeeding Medicine position statement and guideline: infant feeding and lactation-related language and gender. Breastfeed Med. 2021;16(8):587–590.