Dealing with a stillbirth or neonatal death is a difficult and saddening experience. At the same time, your body may undergo common changes that women experience after birth, such as sore breasts, breast milk production and vaginal bleeding. Some of these changes may be a painful reminder of your loss, so it is important to know that support is available to you.

Breast soreness and milk production

From week 16 of your pregnancy your breasts will have been getting ready to produce milk so they may be large and feel hard and sore. Some women's breasts are engorged and leak milk 1 to 4 days after the birth. Engorgement means there is more milk being produced than is being discharged. This can be uncomfortable, painful and, for many women, very distressing.

Some women who are producing milk may choose to donate their milk to women who have a sick or premature baby.

Others may prefer to let their milk production cease. By ensuring that you only express a small amount of milk if you feel uncomfortable, your milk supply will gradually decrease until it stops. This can take a few days or weeks depending on how advanced your pregnancy was, how much milk you're expressing, or if you become pregnant again.

In the meantime, to help relieve the discomfort of engorged breasts:

• support your breasts with a firm bra and handle them gently
• use breast pads inside your bra and change these when they become wet
• put cold or gel packs on your breasts
• put cold, clean cabbage leaves inside your bra, changing them every 2 hours
• lie on your side or back and support your breasts with pillows
• ask your doctor about using a mild pain reliever
• express a small amount of milk (it's best not to express very much or this will stimulate more milk production)

Reducing the amount of fluids you drink won't reduce milk production, so it's best to just drink whenever you're thirsty.

See your doctor immediately if you have the signs of mastitis:

• one breast becomes painful or warm or has a red patch on it
• you feel flu-like symptoms, such as a fever, aches or chills

Bleeding

It is normal to have vaginal bleeding (or lochia) after the birth.

In the first 24 hours, the bleeding is usually bright red and heavy — you can soak one sanitary pad an hour. Over the next few days, the bleeding will gradually get less and change in colour to pink or brown, then a creamy colour.

You should seek help from your doctor or midwife if it is more 24 hours after the birth and:

• You are still soaking more than 1 pad every 1 to 2 hours.
• The amount of bleeding suddenly increases or you pass large clots.
• The blood suddenly changes to a bright red colour.
• You feel dizzy, weak, sweaty or have trouble breathing.
• You have a high temperature.
• You are worried that your bleeding is not normal.

Return of your period and contraception

When your breastmilk production is decreasing or stopped, your period may return more quickly. Therefore it's best to consider contraception early before you plan to have intercourse again. Your doctor or midwife will be able to advise you about this.

Future pregnancy

Some parents want to try for a baby again soon after a stillbirth or neonatal death. However, it may be helpful to give yourself time for your body and emotions to recover first. Some women who get pregnant before processing their grief can find it more difficult to cope emotionally with another pregnancy or to bond with a new baby while still dealing with their earlier loss.

It could also be helpful to have medical or genetic tests before becoming pregnant again, to see if you or your partner has any underlying medical condition that could cause another complicated pregnancy. Your GP will be able to refer you to the most appropriate service. Depending on the results of those tests, you or your partner might be recommended to have treatment or a procedure before trying to get pregnant again.

Where to find help

Your doctor, midwife, maternal child health nurse or social worker will be able to guide you through the process after the birth, including having a check-up 6 weeks afterwards. They will also be able to advise you about who can help you if your grief becomes overwhelming.

Sands Australia provides information and support for parents who have experienced stillbirth or newborn death. You can speak to someone 24 hours a day on their helpline, 1300 072 637.

Red Nose Grief and Loss has information and resources. You can call their helpline 24 hours a day on 1300 308 307.

Lifeline supports anyone having a personal crisis — call 13 11 14 or chat online.

You can also call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse.