Most parents who give birth to a stillborn infant, or who give birth then endure the death of their young infant, will encounter the onset of lactation (McGuinness et al., 2014). For breastfeeding parents who experience the death of their older infant, many will have established lactation or frozen stores of expressed human milk ([EHM] McGuinness et al., 2014). Despite this, lactation and EHM are rarely discussed with bereaved parents in healthcare settings (Britz & Henry, 2013; Carroll, Lenne, McEgan et al., 2014; Redshaw et al., 2014). As a result, many bereaved parents who have recently given birth are unprepared when they begin to lactate, and few are aware of the range of suppression, expression, or donation options that may be available to them (Carroll & Lenne, 2019; McGuinness et al., 2014; Welborn, 2012b). The lack of anticipatory guidance regarding lactation after infant death can be a significant source of distress for parents, exacerbating the emotional pain of their child’s death (Carroll & Lenne, 2019; McGuinness et al., 2014; Welborn, 2012b). This lack may also inadvertently compound the invisibility and ambiguity of parenthood experienced by many bereaved parents (Cacciatore et al., 2008; Layne, 2003; Oreg, 2019). Furthermore, parents bereaved as a result of giving birth to a stillborn infant or enduring their infant’s death are likely to experience breast engorgement, pain, and milk leakage (McGuinness et al., 2014) and, in the absence of reliable information, they may follow lactation management methods that prove ineffective or lead to mastitis or abscess. To prevent adverse outcomes, bereaved parents require anticipatory guidance or lactation support from qualified health professionals. Discussing or making decisions about the suppression, expression, or donation of human milk with bereaved parents in the midst of grief can be a confronting and difficult task for both health professionals and families (PATH, 2019). In addition to the general taboo that surrounds infant death and lactation in our society, health professionals may have limited knowledge, or lack the confidence to initiate or manage these conversations (Carroll & Lenne, 2019; Layne, 2003; Oreg, Key Messages • There is a dearth of targeted online lactation health information provided to bereaved parents after stillbirth and infant death. • We collated and critically reviewed international evidencebased lactation and bereavement information to devise a comprehensive framework on the diverse options for lactation management after stillbirth and infant death. • We outline the development of the 25point evidencebased Lactation AID Framework intended for use by health organizations that provide written online lactation health information to bereaved parents. Clinical Practice

中文翻译：

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“婴儿死亡后哺乳（AID）框架”：关于死产和婴儿死亡后哺乳的在线健康信息提供指南


大多数生下死产婴儿的父母，或者生下婴儿后忍受婴儿死亡的父母，都会遇到哺乳期的情况（McGuinness et al., 2014）。对于经历过大婴儿死亡的母乳喂养父母来说，许多人会建立哺乳期或冷冻储存挤出的母乳（[EHM] McGuinness 等，2014）。尽管如此，在医疗机构中，很少与失去亲人的父母讨论哺乳和 EHM（Britz & Henry，2013；Carroll、Lenne、McEgan 等，2014；Redshaw 等，2014）。因此，许多刚生完孩子的失去亲人的父母在开始哺乳时毫无准备，很少有人知道他们可以采取的一系列抑制、表达或捐赠选择（Carroll & Lenne，2019；McGuinness 等）等，2014；韦尔伯恩，2012b）。婴儿死亡后缺乏有关哺乳的预期指导可能是父母痛苦的一个重要来源，加剧了孩子死亡带来的情感痛苦（Carroll & Lenne, 2019; McGuinness et al., 2014; Welborn, 2012b）。这种缺乏也可能无意中加剧了许多失去亲人的父母所经历的父母身份的隐形和模糊性（Cacciatore et al., 2008; Layne, 2003; Oreg, 2019）。此外，因生下死产婴儿或忍受婴儿死亡而失去亲人的父母可能会经历乳房肿胀、疼痛和漏奶（McGuinness 等，2014），并且在缺乏可靠信息的情况下，他们可能会经历乳房肿胀、疼痛和漏奶的情况。遵循被证明无效或导致乳腺炎或脓肿的哺乳管理方法。为了防止不良后果，失去亲人的父母需要合格的卫生专业人员的预期指导或哺乳支持。 对于卫生专业人员和家庭来说，在悲伤中与失去亲人的父母讨论或做出有关抑制、表达或捐赠母乳的决定可能是一项艰巨的任务（PATH，2019）。除了我们社会中围绕婴儿死亡和哺乳的普遍禁忌之外，卫生专业人员可能知识有限，或者缺乏启动或管理这些对话的信心（Carroll & Lenne，2019；Layne，2003；Oreg，关键信息•缺乏向死产和婴儿死亡后失去亲人的父母提供的有针对性的在线哺乳健康信息。 • 我们整理并严格审查了国际循证哺乳和丧亲信息，以设计一个关于死产和婴儿死亡后哺乳管理的多种选择的综合框架。我们概述了 25 点基于证据的哺乳辅助框架的开发，旨在供向失去亲人的父母提供书面在线哺乳健康信息的卫生组织使用。临床实践