Perceptions and attitudes of midwives toward breast milk expression following perinatal loss.

backgroundPerinatal loss involves profound psychological distress alongside ongoing physiological processes such as lactation. In many clinical settings, lactation management after perinatal loss is addressed primarily through pharmacological suppression, while alternative options, including gradual suppression, milk expression, or donation, receive limited clinical attention. Midwives play a central role in bereavement care and are often the primary professionals supporting women immediately after loss. However, their perspectives on lactation management following perinatal loss remain underexplored, particularly in Israel, where formal clinical guidance addressing lactation beyond suppression is limited and culturally sensitive considerations may further shape practice.

methodsThis qualitative study explored Israeli midwives’ perceptions and experiences regarding lactation management after perinatal loss within a healthcare context characterized by cultural, religious, and institutional diversity. Semi-structured interviews were conducted with 22 midwives employed in two Israeli medical centers, one tertiary and one secondary hospital. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive reflexive thematic analysis, allowing an in-depth examination of how midwives interpret and navigate lactation-related care following loss.

resultsThree overarching themes were identified: (1) professional discomfort associated with insufficient training and the absence of clear clinical guidelines; (2) cultural and religious considerations shaping attitudes toward lactation, milk expression, and donation; and (3) systemic and ethical concerns, including workload constraints, emotional burden, and apprehension about potential psychological harm to bereaved mothers. Across themes, participants described pharmacological lactation suppression as the predominant and institutionally supported practice. Clinically, this reliance served to manage uncertainty and emotional risk, while simultaneously constraining opportunities for individualized, informed discussions about alternative lactation options.

conclusionsMidwives’ approaches to lactation management following perinatal loss are shaped by intersecting professional, cultural, and systemic factors embedded within institutional care settings. These findings underscore the need for integrating lactation-related content into midwifery education, developing clear and culturally responsive clinical guidelines, and supporting informed, individualized decision-making in bereavement care. Recognizing lactation as an integral component of post-loss care may contribute to more consistent, compassionate, and clinically responsive support for bereaved mothers.