1. © 2016 Mayo Foundation for Medical Education and Research Katherine Carroll, PhD 1 ; Elizabeth LaFleur, RN, IBCLC, RLC 2 ; Anna Grace Stout 3 1 Division of Health Sciences Research, 2 Department of Nursing, 3 University of Mississippi, 1,2 Mayo Clinic, Rochester, MN Matter out of Place 6 : This anthropological theory teaches us that stigma doesn’t exist on its own, but that it is actually created through a social system. As part of the social system health professionals can help combat the stigma of lactation and donation after loss. Selective Forgetting 7 : This feminist theory teaches us that the generosity of some is recognized, while the generosity of others is ‘selectively forgotten’. Health professionals have the power to recognize bereaved mothers’ ability to both grieve and give breast milk. Stigma of Lactation and Donation After Infant Death Providing health professionals with resources for providing anticipatory guidance to bereaved mothers is important, but it is not enough. The socio-cultural factors that shape health professionals’ interactions with bereaved mothers about lactation management are crucially important to address in training and when establishing lactation and donation policies in hospitals and milk banks. Conclusions 1.Welborn, J. M. (2012). The experience of expressing and donating breast milk following a perinatal loss. Journal of human lactation 28(4), 506-510. 2.Cole, M. (2012). Lactation after Perinatal, Neonatal, or Infant Loss. Clinical Lactation, 3(3), 94-100. 3.Welborn J. M. (2012) Lactation Support for the Bereaved Mother: A Toolkit. Information for Health Care Providers. Human Milk Banking Association of North America (HMBANA), USA. 4.Carroll, K. et al. (2014). Breast milk donation after neonatal death in Australia: a report. International Breastfeeding Journal, 9(1) 5.Britz, S. P., & Henry, L. (2013). Supporting the Lactation Needs of Mothers Facing Perinatal and Neonatal Loss. JOGNN, 42, S105-S106. 6.Douglas, M. (1966) Purity and Danger. Routledge, New York. 7.Diprose, R. (2002) Corporeal Generosity. SUNY Press. New York. References Background: Thanks to a growing awareness in the community, in hospitals, and among Human Milk Banking Association of North America (HMBANA) milk banks, milk donation after infant death is becoming an increasingly well-known option for bereaved mothers. Despite the presence of scientific literature 1, clinical protocols 2, and the development of toolkits that may be used by health professionals to guide their interactions with bereaved mothers 3, research suggests that many health professionals are uncomfortable with, or ill-equipped to provide lactation and donation guidance to bereaved mothers 4,5, Objective: Identify, analyze and share the socio- cultural factors that were found to both enhance and impinge upon staff discussions with bereaved mothers about lactation management and milk donation. Methodology and Methods: The research used a feminist research praxis to examine how lactation and nursing staff are currently experiencing their work with bereaved mothers on the topic of breast care, lactation management and milk donation. In 2015, four qualitative focus groups were conducted with 27 nursing staff and lactation consultants recruited from 9 Mayo Clinic units: neonatal intensive care, intermediate special care nursery, pediatric intensive care, pediatrics, family birth center (labor and delivery and postpartum), and cardiovascular surgery intensive care. The focus groups were recorded, transcribed, and then analyzed thematically by KC and AGS. Results: Most nurses and lactation consultants view offering bereaved mothers options for lactation management and donation as an important part of their job. Yet, there are significant socio-cultural barriers to doing so. Barriers include: the discomfort and stigma of infant death coupled with lactogenesis or continuing lactation for the purposes of donation; breastfeeding as an intimate topic of conversation requiring specialist knowledge; time restrictions on the unit after infant death resulting in reduced opportunity to speak with the mother before the family leaves the hospital; and the lack of a milk depot in the region. Conclusions: Socio-cultural factors shape health professionals’ interactions with bereaved mothers about lactation management and donation. Addressing these factors is crucial to optimize lactation care for bereaved mothers and their families. Abstract 1. How do staff currently (a) engage with mothers and (b) experience engaging with mothers about their lactation, breast care and milk donation after infant death? 2. What is needed by staff to enhance discussions with bereaved mothers about their lactation, breast care and milk donation after infant death? 3. What are the important cultural differences or unique aspects of practice that exist between different units that may need to be attended to in order to improve staff conversations with mothers about their lactation, breast care and milk donation after infant death? Research Questions Most nurses and lactation consultants view offering bereaved mothers options for lactation management and donation as an important part of their job. The following are socio-cultural barriers to providing anticipatory guidance to bereaved mothers on lactation and donation: Discomfort and stigma associated with infant death and continuing lactation for donation (Fig. 1) Clinical protocols that stipulate time restrictions for removing the infant’s body for autopsy or to the morgue, resulting in a reduced opportunity to speak with the mother before the family leaves the hospital (Fig. 2) Lactation and donation requiring specialist staff knowledge. The lack of a milk depot in the region Results Identify, analyze and share the socio-cultural factors that were found to both enhance and impinge upon staff discussions with bereaved mothers about lactation management and milk donation. Study Aim Methodology: The research used a feminist research praxis to examine how lactation and nursing staff are currently experiencing their work with bereaved mothers on the topic of breast care, lactation management and milk donation. Feminist research approach does research that has direct impact on, and makes a positive difference to women’s lives. This research sought to (i) make the work of a highly feminized occupational group (nurses and lactation consultants) easier (ii) promote the lactation and milk donation options for bereaved mothers (iii) train new researchers and clinicians in focus group methods and qualitative analysis. Methods: In 2015, four qualitative focus groups were conducted with 27 nursing staff and lactation consultants recruited from 9 Mayo Clinic units: neonatal intensive care, intermediate special care nursery, pediatric intensive care, pediatrics, family birth center (labor and delivery and postpartum), and cardiovascular surgery intensive care. The focus groups were recorded, transcribed, and then analyzed thematically by KC and AGS. IRB Approval: Mayo Clinic IRB Approval # 15-002650 Funding: COMPASS Program, Mayo Clinic. Methodology & Methods Fig. 1: Identifying Stigma ‘And people would be like, “oh, you know Amy’s baby died in March, and it’s October and she’s still providing milk to this milk bank; you know she needs to get on with her life”. I can see that playing out.’ (Focus Group Participant) Fig 2: Cultural Differences Between Units After Infant Death Axis label here Lactation Management and Milk Donation After Infant Death: Nurses’ Perspectives and Practices from the Bedside