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Care Around Stillbirth and Neonatal Death (CASaND) Clinical Practice Guideline

Postnatal care and physical recovery

Best practice care for parents and family/whānau includes immediate and ongoing physical, social, emotional and practical support that recognises the birth and death of a baby.1 The woman should be informed of the physical effects and changes that will occur following the birth of the baby. This includes the body’s preparation for lactation, physical recovery process such as after-birth pains and discomfort, bleeding, and bowel movements and potential complications. Recovery from a caesarean birth should also be discussed with the woman (for example wound care) and appropriate support provided.

It is common for a woman who has experienced loss to have also experienced a complicated pregnancy and be more likely to experience postnatal complications, which can compound the grief response. It is important that women are provided with support and information to help prepare them for what to expect, particularly in the six weeks following birth, including when to seek medical advice and professional support.9,47,63 Physical changes and medical treatment for postnatal complications should be addressed by healthcare professionals as early as possible and before parents leave the hospital.64  

Lactation after loss

Discussion and management of lactation in the context of perinatal loss is an important aspect of best practice care. Information and support around lactation management is often reported by parents as inadequate.63 Many women will experience breast changes including discomfort, engorgement, and milk leakage,65 which, if not managed effectively, can lead to infection and mastitis. Without anticipatory guidance, the experience of lactation can be a significant source of distress for a woman.

Just as grief is an individual process, every woman’s experience of lactation will be different. Not all women will choose the same option.69

Women should be provided with sensitive and timely anticipatory guidance on lactation and their full range of options for management. It should not be assumed that mothers will want to suppress breastmilk immediately. As well as immediate suppression of lactation using medication, options include gradual suppression through expressing; the use of breastmilk to craft a memento such as jewellery; and ongoing lactation and donation of breastmilk to a milk bank or through a community-based sharing network (where available; this may be dependent on screening eligibility requirements).66-68 Women who choose to express their breastmilk should be assisted with information about hiring or buying a breast pump.

It is important to acknowledge lactation, physical changes, and parent’s emotional responses and meaning that may be attached to this experience.65 It is also be important for bereavement lactation management to be inclusive of family members, incremental and responsive to changing needs and circumstances, and for information to be provided in a range of formats.69

More information is available via The Australian Breastfeeding Association. Women can access free telephone counselling support within Australia from the National Breastfeeding Helpline.

“I wasn’t expecting to feel so emotional about all the changes in my body after the birth. Having an appointment with my GP helped to reassure me.”

Parent quote from the Guiding Conversations booklet.

Ensure medical follow-up (with general practitioner [GP] or obstetrician) and community-based supports are activated through appropriate handover and referrals. GPs play a vital role in supporting the physical, social, and emotional health of parents and families, including into subsequent pregnancies. It is also important to share information with parents about how to engage other healthcare professionals for physical health, such as women’s health physiotherapists, exercise physiologists, and dietitians and nutritionists. Other activities, including yoga70 and engaging with nature,37 may also have benefits for women following perinatal loss.

Consensus-based recommendation 3.21

Discuss expectations for postnatal care including lactation, vaginal bleeding, wound care, contraception, and physical activity. Provide all women with information about postnatal physical changes, postpartum care and potential complications that could occur, including when to seek medical advice and support.

Consensus-based recommendation 3.22

Provide information on the full scope of lactation management options to women and ask open ended and nondirective questions to understand and explore perspectives, while also considering cultural and individual variations.

Memory making and spending time with baby
Leaving hospital and ongoing support
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Western Pacific Regional Office of the International Stillbirth Alliance
Coordinating Centre, Stillbirth and Neonatal Death Alliance, Perinatal Society of Australia and New Zealand

Level 3, Aubigny Place
Mater Research Institute
Raymond Terrace,
South Brisbane QLD 4101
The University of Queensland Faculty of Medicine

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