You may not feel like eating when you are grieving or, you may want to eat more than usual. However you are feeling, try to choose healthy food to support your emotional and physical health.

How you can help yourself

• Ask for help with grocery shopping and meal planning; dropping off a meal or healthy snack can be a simple way for friends and family to show they care
• Visit Eating Well to learn more

Grief causes stress. Exercise can help you relax and reduce stress. Listen to your body and give yourself a chance to regain your energy. When you are ready, exercise may help with the emotions you are feeling.

How you can help yourself

• Choose a form of exercise that you enjoy such as walking or yoga
• Do more intense exercise when you are ready

Physiotherapists are a useful resource postpartum. Call our Physiotherapy department at 604-875-2126 to learn more about healing after pregnancy and/or delivery.‎

Some people do not want to be sexual when they feel sad; others find comfort in physical closeness. Both feelings are common. Physically, it is safe to have intercourse or other kinds of sex once your stitches or tears have healed and vaginal bleeding has lessened.

If you are not emotionally ready to be sexual, talk to your partner. Your partner may or may not feel the same way but it is important for both of you to share your feelings. Cuddling, hand-holding and back rubs are other ways to feel close.

How you can help yourself

• Use lubricant during sex to reduce vaginal dryness
• Express milk from your breasts before sex if you want to lower the chance of your breasts leaking during sex
• Explore other ways to be intimate with your partner if you do not want to be sexual

Call your healthcare provider if you:

• Have severe, ongoing pain during sex more than six weeks after delivery
• Are worried about being sexual again, or if you don't feel interested in sex

The decision to become pregnant again is personal. You can become pregnant soon after your delivery even if you are expressing milk or before your period starts again. You may wish to be pregnant again or you may want to take time before becoming pregnant again. These feelings are normal. Talk to your health care provider about pregnancy planning and birth control options.

It is common to feel anxious when you are pregnant after a loss, but counselling or additional support may help you manage your anxiety. Another child will not replace the one you lost. If you decide to have another baby, think of them as their own person. Every one of your children will have a unique and special place in your heart.

Caring for yourself gives you the strength to care for your family. You need rest, good nutrition, exercise, and support to recover from giving birth

Call your care provider if:

• Your bleeding soaks more than one maxi pad in an hour
• You have a fever higher than 38 degrees Celsius or 100.4 degrees Fahrenheit
• You feel dizzy or faint, and resting does not help
• You have pain that does not get better with pain medicine
• The skin between your vagina and anus becomes more swollen, or sore
• Your stitches open up
• You have trouble peeing or pooing

If you have flu-like symptoms or reddened painful breasts, contact your health care provider as you may have a breast infection.

Normal sleep patterns can be affected when you are grieving a loss. You may:

• Find it difficult to fall asleep
• Feel that constant thoughts of your baby or specific issues related to your loss prevent you from falling asleep
• Find yourself waking up frequently during the night
• Sleep fitfully or have disturbing dreams
• Wake up not feeling refreshed
• Feel you are sleeping too much

Sleep is an important part of the recovery process but it is common for people who are grieving to experience difficulty sleeping or notice changes in their sleep patterns. For most people, this is temporary and the issue resolves itself over time.

How you can help yourself

Engage in activities that help relax you:

• Drinking chamomile tea
• Drinking warm milk and honey
• Writing in a journal
• Reading or meditating
• Eliminating screen time for at least 30-60 minutes before bed
• Avoiding caffeine, sugar and carbohydrates for several hours before bed
• Practising gratitude

Whether your problem is falling asleep or staying asleep, try not to force sleep by staying in bed, but rather get up and do something relaxing. This could mean listening to music, reading, doing a puzzle or practising yoga. Try to avoid electronic devices as these may be more stimulating than relaxing.

Sleeplessness can be caused by grief, but it can also be a symptom of depression.

Call your health care provider if:

• Your sleep problems persist
• Your sleep interferes with your ability to function
• Difficulty sleeping is accompanied by other signs of depression

Allow yourself to express your emotions in as many ways as possible. Talk to friends, family members, or elders you trust. Let them know how you feel and what you need. Be honest with them if you are not ready to talk about your feelings.

Sometimes choosing a spokesperson to share news and information on your behalf can help, particularly with coworkers and your wider circle of friends. If you are not ready to talk about your feelings, let your family and friends know. When talking is hard, you may find writing or other forms of expression‎ such as singing, dancing, deep breathing and making art helpful.

Everyone experiences grief differently. Respect your partner's way of grieving and their timetable. If your partner is not showing grief in the same way you are or does not wish to share their feelings. It does not mean they are not grieving deeply. Try to give them time to grieve at their own pace.‎

Sometimes it is easier to talk to someone you do not know than it is to share with a friend or family member who may also be grieving, or who may have their own ideas about how you should grieve. Participating in an in-person or online pregnancy and infant loss support group can also be helpful. Many people form deep bonds with others who have shared a similar experience and understand how it feels to lose a baby.

Some people find that donating their baby's milk to a milk bank helps their grieving process. Donated milk may be life saving for other fragile and ill infants.

“These are my white tears. Every drop I pumped in the hope that Jamie would be able to come home one day and I could feed her a long time. Since she is at rest in eternity, these tears can go on to bless other babies who need a fighting chance with the gentlest food source they can have. There is so much love put into this. This is in honour of her”. SD

How to start

After you give birth, begin expressing milk by hand about every 2-3 hours during the day and at least once at night. Use a pump once your milk production moves beyond a few drops. Collect each milk expression in a separate container – either hospital containers or milk storage bags. If you need milk bags contact BC Women’s Provincial Milk Bank. Ask your nurse to show you how to use a breast pump.

If your milk supply is already established when your baby dies, continue pumping 6-8 times each 24 hours to maintain milk production. Expressing milk increases oxytocin levels in the early weeks which can help with mood and decrease your risk for depression.

Screening for milk donation

All donors, including bereaved donors, are screened to ensure suitability for donation. You will be asked verbal and written questions and have some blood tests. You will also be asked to complete the Donor Expression of Interest form.

Keep in mind that most medications given at the time of birth do not prevent you from donating milk but check with the Milk Bank before using herbal remedies, over-the-counter medications or dietary supplements to find out if they are ok to use while donating milk. Once screening is completed, any amount of milk you wish to donate is accepted with gratitude.

Delivering your milk to the Milk Bank

Once your screening is complete, the Milk Bank will call you to discuss where the closest depot is. If your milk is in storage at a BC hospital NICU, it can be sent directly to the Milk Bank by that hospital.

How to stop donating

How long you continue to express and donate milk is up to you. Some prefer to donate only once, others donate for a period of time. Once you decide to stop donating, you need to slowly reduce your milk production by decreasing the number of times you pump each day. To do this naturally, follow the instructions in the "Drying up your milk" section below.

You may wish to dry up your milk supply. The most comfortable and low risk method is to allow your milk to dry up over a period of time.

Natural methods of drying up milk

If your baby is stillborn:

• Wear a sports bra (stretchy material) to provide support. Binding your breasts is not recommended and is very uncomfortable as your breasts will get very full and often hard. Binding can also lead to a breast infection
• Let the milk leak into your bra – use breast pads to absorb the leaking milk. Change the pads once they become wet
• If breasts are very full, express only enough milk to be comfortable
• Use warm or cold compresses for comfort; cold reduces swelling of overly-full breasts
• Take pain medication such as ibuprofen
• Check your breasts for signs of infection (redness, tender areas) and call your health care provider if you develop flu like symptoms
• Drink when you are thirsty; restricting fluids does not decrease milk production

If your baby dies after you have established a milk supply, you need to gradually reduce the number of times you express or pump over a period of a week or so. Leaving milk in the breasts causes milk production to slow and eventually stop. Start by:

1. Dropping one pumping session in the middle of the day
2. Reduce the number of pumping sessions until you are only pumping once in the morning and once at night
3. The evening pumping session is usually the last one you will stop

If you have a lot of milk you may find that gradually shortening a pumping session will ensure you do not become uncomfortable or develop sore breasts. Pay attention to how full your breasts are and pace your pumping so you are not uncomfortable.

Stopping milk expression abruptly is very uncomfortable and can lead to blocked ducts. If you have flu-like symptoms or reddened painful breasts, you may have a breast infection (mastitis); contact your health care provider to confirm and get help.

Medication to stop milk production

Using medication, especially in the first few days after birth, means you will not have to deal with ongoing milk production. Prescription medication used to dry up breast milk works by interfering with the production of prolactin, the hormone that causes milk production. Cabergoline, is currently prescribed. Possible side effects from Cabergoline include nausea, vomiting, headache, dizziness and nosebleeds. Some people experience ‘rebound lactation’ or return of milk production after the initial drying up period. Talk to your health provider for guidance about using medication to stop milk production.

Herbal remedies

Ingestion of herbs such as jasmine flowers, sage, peppermint, lemon balm and oregano has been promoted to stop milk production. Unfortunately, reliable studies have not yet been done to determine whether they work, or in what dosage. There are also concerns about additional ingredients in certain supplements that may be harmful.

Talk with your health care provider about traditional remedies for stopping milk production and work together to make a plan that is best for you.