Journal of Primeasia

1. Introduction

There is, perhaps, no loss more disorienting than the death of a child — and few forms of that loss are as physiologically unrelenting as the death of an infant in the earliest days of life. Parents describe the loss as reshaping the very architecture of who they believed themselves to be, a wound that does not fully close so much as it is carried, differently, for decades (Hurt et al., 2023). Within the neonatal period — conventionally defined as the first 28 days after birth — the compression of birth and death into the same narrow window leaves many parents in a kind of suspended shock, unable, at least at first, to locate themselves within either role: mother of a living child, or mother who has lost one (Kartaginer et al., 2026).

For mothers specifically, this rupture arrives with an added, almost cruel, biological insistence. The infant may be gone, but the body does not seem to know this. Lactation begins, or continues, on its own physiological schedule, indifferent to the fact that there is no longer an infant to receive it (Oreg et al., 2026). It is worth pausing on how strange this is, clinically and existentially: a body preparing, daily, to nourish a child who will never again be held to it. Some scholars have described this as a "representational vacuum" — a mismatch between the body's continuing readiness and the psyche's slower attempt to catch up with an irreversible fact (Kartaginer et al., 2026). Others frame it more plainly as an embodied paradox: milk as evidence of a motherhood that is, in the same breath, denied its ordinary expression (Aderibigbe, 2026).

Historically — and this is perhaps where clinical practice has been least generous — the response to lactation after infant death has been narrowly pharmacological. Suppress the milk, the reasoning goes, and at least one axis of daily reminder and distress is removed (Oreg et al., 2026). This is not an unreasonable instinct. But it is also, arguably, an incomplete one. A growing body of qualitative work suggests that for at least some parents, abrupt suppression forecloses something that might otherwise have been useful: a chance, however painful, to go on mothering in the only remaining form still available to them (Værland et al., 2021). The theoretical language most often invoked here is continuing bonds, a framework advanced by Klass, Silverman, and Nickman (1996) that reframes healthy grief not as a gradual detachment from the deceased but as an ongoing, symbolically sustained relationship with them. Expressing milk, donating it, or simply continuing to pump without any clear practical purpose can, within this frame, function as a bond-sustaining act rather than a stalled or pathological refusal to "move on" (Værland et al., 2021).

At the same time, this embodied experience does not occur in a vacuum, clinical or otherwise. Much of the literature on neonatal and perinatal loss converges on a related, if distinct, observation: that hospital environments — the Neonatal Intensive Care Unit (NICU) in particular — often compound rather than soften parental distress. Parents describe being treated as visitors in their own child's care, sidelined by a culture of high acuity that necessarily prioritizes clinical survival over relational bonding (Porter, 2018; Adcock et al., 2021). Researchers have termed this surplus suffering: pain that is not intrinsic to the loss itself but added on top of it by systems that were never quite designed with bereaved parents' psychological needs in mind (Porter, 2018). For families already navigating structural marginalization alongside grief — Black mothers facing disproportionately high rates of infant mortality (Saufley, 2024), or Māori whānau moving through a healthcare system inattentive to cultural safety (Adcock et al., 2021) — this compounding of harms appears, unsurprisingly, still more pronounced.

It is against this backdrop that identity, rather than symptom or stage, becomes perhaps the more useful lens through which to read the literature. Bereaved mothers repeatedly describe a kind of liminality: neither the mother of a living child, nor, in their own eyes, fully a non-mother (Kartaginer et al., 2026). The question that recurs — "Whose mother am I?" — captures something that conventional, stage-based grief models do not quite hold. Identity reconstruction, across this body of work, looks less like recovery and more like renegotiation: a slow, non-linear movement from what has been described as a split identity, in which grief is held apart from daily functioning, toward something closer to integration (Kartaginer et al., 2026; De Vincenzo et al., 2024).

Despite the richness of this qualitative record — spanning phenomenological, hermeneutic, and reflexive thematic traditions across settings as varied as Ghana, Norway, New Zealand, and Israel — a gap remains that, to our reading, has not yet been adequately closed. The literatures on lactation as embodied experience, on NICU-related trauma, and on identity reconstruction after infant death have tended to develop somewhat separately, each rich in its own terms but rarely brought into sustained conversation with one another. Reviews of perinatal bereavement care already exist (Hurt et al., 2023; Redshaw et al., 2021), as do studies of ritualized memory-making (Værland et al., 2021) and of lactation-specific grief more narrowly defined (Aderibigbe, 2026; Dion, 2025). What appears to be missing is a synthesis that treats the physiological fact of milk not as an incidental detail of postpartum care but as a central, symbolically loaded site where biology, identity, and clinical practice meet — sometimes uneasily.

This review attempts that synthesis. Rather than beginning from diagnostic categories or suppression protocols, we start, deliberately, from the body — from the small, recurring "micro-moments" of embodied experience that surface, in one form or another, across a dozen qualitative studies — and ask what these moments can tell us about how parents come to make sense of, and rebuild identity around, a loss that their own bodies seem, for a time, unwilling to accept.

To make this synthesis tractable, we organized our inquiry around three linked questions: how bereaved mothers perceive and assign meaning to the physiological experience of lactation following infant death; how embodied care practices — milk expression, donation, or ritualized retention — participate in reconstructing maternal identity within this liminal space; and how healthcare communication and institutional protocol shape the difference between suppression as reflexive clinical routine and suppression as one option among several, offered through informed choice. These questions are, admittedly, more exploratory than confirmatory; this is not a review built to test a hypothesis so much as one built to notice a pattern that has, so far, gone under-examined. If nothing else, we hope it makes a modest case: that milk, in this particular context, is never merely biological.

2. Trauma, Grief, and Resilience in Perinatal Loss

2.1 The Foundational Bond and Its Rupture

The bond between parent and child is often treated as the most basic of human connections — a symbol of protection, care, and hope for what is to come (Hurt et al., 2023; De Vincenzo et al., 2024). When this bond is broken by the death of an infant, or placed under severe strain by a medical emergency, the resulting experience cannot be reduced to a single clinical event. Several scholars argue that it more closely resembles a disruption of the natural order itself, one that touches a parent's sense of self, their physical body, and their place within the surrounding social world all at once (Maurya et al., 2026; De Vincenzo et al., 2024). Within this body of research, trauma is rarely treated as one discrete occurrence. Instead, it is understood as something cumulative, built up over time through the interaction between a distressing event and the systems that surround it.

2.2 The NICU as a Site of Compounded Trauma

This layered quality of trauma is especially visible in the Neonatal Intensive Care Unit, which functions for many parents of premature or critically unwell infants as the central location where trauma unfolds. Researchers have gone so far as to call the NICU a hostile environment, one where the hoped-for experience of bringing home a healthy newborn — the so-called "birth imaginary" — is replaced instead by machinery, medical unpredictability, and forced separation from the child (Adcock et al., 2021; Porter, 2018). Parents frequently describe a distinct form of what might be called surplus suffering: distress that does not stem directly from their child's medical condition, but instead from institutional structures that treat parents as visitors rather than as central caregivers in their child's life (Porter, 2018). This suffering is intensified when hospital staff focus primarily on clinical tasks at the expense of the emotional connection between mother and infant, leaving some parents with a feeling of being unnecessary to their own child's care, or even experiencing a kind of "imposter syndrome" in the parental role (Adcock et al., 2021; Porter, 2018).

2.3 Unequal Burdens: Structural Inequity and Grief

Importantly, this trauma is not distributed equally across populations. Structural inequities deepen the experience considerably for certain groups. Black mothers, for example, experience markedly higher rates of infant mortality, and this disparity has been linked by researchers not simply to unequal access to healthcare, but to a longstanding history of medical racism paired with the systemic dismissal of Black maternal grief (Saufley, 2024). The cultural expectation embodied in the "Strong Black Woman" stereotype appears to operate as a kind of amplifier of trauma, pushing mothers to hide or downplay their own suffering in order to preserve the comfort of those around them — a pattern that has been described as producing collective disenfranchisement (Saufley, 2024). In this context, the trauma experienced is not solely the loss of the child. It also includes an ongoing, compounding denial of the mother's right to express and process that loss in the open.

2.4 The Embodied Nature of Loss: Lactation and the Body's Memory

Perinatal trauma also carries a uniquely embodied dimension, and here the research turns specifically toward lactation. Unlike most other kinds of bereavement, the maternal body does not stop preparing for the child who has died — it continues on a biological trajectory as though the infant were still present. The onset of milk production following an infant's death has been described as creating a kind of representational vacuum, in which the physical sensation of milk let-down becomes an unwelcome, repeated reminder that the child is gone (Oreg et al., 2026; Kartaginer et al., 2026). Many mothers experience this less as a neutral biological process and more as a form of bodily failure, one that disrupts their sense of femininity and produces shame at their perceived inability to carry out what feels like the most elemental maternal responsibility — feeding their child (Aderibigbe, 2026; De Vincenzo et al., 2024). Notably, the literature also identifies a related, though distinct, form of "breastfeeding grief" experienced by mothers whose infants are alive but unable to be fed as intended — for instance, due to medical conditions such as Cow's Milk Protein Allergy. In these situations, too, disruption of the feeding relationship is experienced as a loss of maternal agency, indicating that the emotional significance attached to lactation stretches well beyond contexts of death and bereavement alone (Dion, 2025; Aderibigbe, 2026).

2.5 Identity in Liminal Space

Beneath — and running alongside — these embodied and structural forms of trauma lies a quieter, more existential struggle: the destabilization of identity itself. Across the literature, bereaved mothers are described as entering a state of liminality, a kind of threshold space in which they exist, in participants' own words, neither fully here nor fully there (Kartaginer et al., 2026; Porter, 2018). Within this space, mothers confront a question that sounds simple but carries enormous existential weight: whose mother am I, if the child I am raising is no longer physically present (Kartaginer et al., 2026)? Framed this way, resilience is not about "getting over" a loss. Rather, it involves a movement away from what has been termed a split identity, in which grief is kept hidden and compartmentalized, and toward a more unified identity, in which the deceased child becomes gradually woven into the continuing narrative of the parent's life (Kartaginer et al., 2026). This process is neither quick nor linear, and it is frequently obstructed by external pressure to move on rapidly — pressure that has the effect of disenfranchising what is, in reality, a long-term and ongoing grief process (Oreg et al., 2026; Kartaginer et al., 2026).

2.6 Ritual as the Mechanism of Resilience

If the reconstruction of identity represents one dimension of resilience, ritual appears to serve as its practical vehicle. Central to this literature is the framework of continuing bonds, which reorients grief theory away from the idea of detachment from the deceased and toward the active, ongoing maintenance of a relationship with the child who has died (Kartaginer et al., 2026; Maurya et al., 2026). In practice, this often manifests as deliberate memory-making. Given the relative absence of established cultural or religious rituals specifically for infant death, NICU nurses and parent support networks often step into the role of ritual inventors, helping to create scrapbooks and memory boxes containing items such as locks of hair, footprints, and photographs (Værland et al., 2021). These small, tangible acts appear to accomplish several things simultaneously: they grant the infant a form of ontological personhood, they affirm the parents' identity as a family despite the child's death, and they offer a structured outlet for emotions that might otherwise feel overwhelming and unmanageable (Værland et al., 2021; Maurya et al., 2026).

2.7 From Grief to Advocacy and Growth

For many parents, meaning-making eventually moves outward into forms of social action. Some Black mothers redirect their grief toward advocacy for reform in maternal healthcare, while others find comfort in donating breast milk, transforming a biologically rooted grief into something closer to an act of altruistic legacy carried out in their child's memory (Saufley, 2024; Oreg et al., 2026). This trajectory is sometimes framed using the concept of post-traumatic growth, describing a shift from reactive survival toward a more deliberate, agency-driven engagement with life going forward (Adcock et al., 2021; Dion, 2025).

2.8 The Role of Culturally Safe and Supportive Care

None of this unfolds in isolation from the quality of surrounding support. Culturally safe care — one attentive, for example, to Māori concepts such as whakapapa (genealogy) and wairuatanga (spirituality) — appears essential in helping families remain fully themselves while navigating crisis (Adcock et al., 2021). When healthcare staff actively engage in whakawhanaungatanga, the process of building relationship, it appears to help "quieten the storm," allowing whānau to feel a sense of belonging within what would otherwise be an unfamiliar hospital setting (Adcock et al., 2021). By contrast, resilience is undercut by unsupportive or silencing reactions from family, friends, or clinicians — often arising from their own discomfort — that minimize the loss, or that treat a later pregnancy as though it could replace the child who died (Kartaginer et al., 2026; Saufley, 2024). Spiritual care, when thoughtfully incorporated into medical settings, is also identified as a protective factor, helping some parents move toward a sense of inner peace (Htay et al., 2026).

2.9 The Lived Landscape of Parental Loss and Meaning-Making

Taken as a whole, this research frames the movement from trauma toward resilience not as a straight, linear recovery but as something closer to an emotional rollercoaster — one in which profound vulnerability and unexpected strength can coexist within the same day (Adcock et al., 2021). Trauma, in these accounts, is rooted in the rupture of the parent-child bond and in the additional suffering imposed by systems not designed with grief in mind (Porter, 2018). Resilience, meanwhile, tends to reside in smaller, more intimate units of experience — the "micro-moments" of connection that participants describe as small in appearance but immense in their significance to a parent's heart (Porter, 2018). Results and Discussion: The Lived Landscape of Parental Loss and Meaning-Making

3. Methodology

3.1 Design and Rationale

We approached this review, from the outset, as a qualitative systematic review. More specifically, we adopted a thematic synthesis design, following the procedures which allowed us to move from the free coding of primary findings toward descriptive and, eventually, analytical themes that cut across studies rather than merely summarizing them one by one. Reporting throughout followed the ENTREQ guidance for qualitative evidence syntheses, and the overall review process, including the search and screening stages described below, where necessary, to the realities of qualitative rather than quantitative evidence. We did not register a formal protocol in advance, which we acknowledge as a limitation; in hindsight, prospective registration through PROSPERO would have strengthened the transparency of our eligibility decisions, and we say so plainly rather than gloss over it.

3.2 Search Strategy and Information Sources

Search terms were built around three conceptual clusters, combined with Boolean operators: (a) population terms (“infant death,” “perinatal loss,” “neonatal death,” “stillbirth,” “bereaved parents”), (b) phenomenon terms (“lactation,” “breast milk,” “milk suppression,” “embodied grief,” “continuing bonds,” “maternal identity”), and (c) design terms (“qualitative,” “phenomenolog*,” “hermeneutic,” “thematic analysis,” “interview*”). These were searched, in varying combinations, across PubMed/MEDLINE, CINAHL Complete, PsycINFO, Scopus, and Google Scholar (the latter capped, as is fairly standard practice, at the first 200 relevance-ranked results, since returns beyond that point tend to drift). We also hand-searched the reference lists of included studies and of closely related reviews — a step that, somewhat to our surprise, surfaced two eligible studies that the database searches alone had missed. The initial search was run to capture literature published between January 2000 and December 2023, which is the period reflected in [Table 1]; a supplementary search was then re-run in early 2026 specifically to capture newly emerging qualitative work on lactation-specific grief, which is how several 2024–2026 sources entered the synthesis despite falling outside the original window. We should be honest that this staggered search strategy is not the tidiest approach methodologically, but it reflects how the review actually developed, and we have tried not to paper over that.

3.3 Eligibility Criteria

Eligibility was defined using a variant of the SPIDER framework (Sample, Phenomenon of Interest, Design, Evaluation, Research type;, which tends to fit qualitative reviews rather better than the more clinically oriented PICO. Included studies had to: (a) report primary qualitative or mixed-methods data — not commentary or opinion pieces — (b) focus on parents’ (primarily mothers’) lived experience of infant death, embodied lactation-related grief, or related identity reconstruction within the perinatal or neonatal period, (c) be published in a peer-reviewed journal or, where directly relevant, as an accessible doctoral or master’s thesis, and (d) be reported in English. We excluded studies concerned solely with quantitative measures of postpartum depression or with pharmacological suppression outcomes in isolation, unless qualitative participant narratives were also reported. Grey literature was included cautiously and only where it met the same standard of methodological transparency as published work — which, admittedly, meant excluding some otherwise interesting sources for want of sufficient methodological detail to appraise them fairly.

3.4 Study Selection and Screening

All records retrieved from the databases were exported into a reference manager and de-duplicated. Two reviewers then independently screened titles and abstracts against the eligibility criteria above, with disagreements resolved through discussion and, where needed, a third reviewer acting as arbiter — which happened rarely, but did happen, mostly around borderline mixed-methods studies. Full texts of the remaining records were then read in their entirety before a final inclusion decision was made. This two-stage process yielded the eighteen primary empirical studies that form the evidentiary backbone of this review, summarized by design, sample, and aim in [Table 1], alongside the foundational theoretical work of Klass, Silverman, and Nickman (1996) on continuing bonds, which was retained as conceptual scaffolding rather than as a primary data source. Screening decisions and reasons for full-text exclusion were logged in a shared spreadsheet, in keeping with standard reporting practice so that the process could, in principle, be reconstructed by another team working from the same search terms.

3.5 Quality Appraisal

Each included study was appraised using the Critical Appraisal Skills Programme Qualitative Checklist, which prompts attention to matters such as the clarity of the research aims, the appropriateness of the qualitative methodology to those aims, the recruitment strategy, and the adequacy of the reported analysis. We did not use appraisal scores to exclude studies outright — a decision some readers may disagree with, but one that reflects a fairly well-established position in the qualitative synthesis literature that low methodological reporting does not always equate to low value of insight, particularly in under-researched areas such as this one. Instead, appraisal findings were used to weight the confidence we placed in individual themes during synthesis, and, where relevant, to flag limitations transparently rather than to silently discard the more thinly reported studies.

3.6 Data Extraction and Charting

Data extraction proceeded in two parallel tracks. First, descriptive study characteristics — country, aim, methodology, participant type, sample size, and data collection method — were charted into a structured matrix, reproduced in condensed form as [Table 1]. Second, and more substantively, verbatim participant quotations and authors’ own interpretive commentary were extracted line-by-line from the findings and discussion sections of each included study, then charted into four thematic matrices organized around methodology and scope, multidimensional stressors, coping and meaning-making mechanisms, and healthcare barriers and facilitators — shown, respectively, as [Table 1] through [Table 4]. This charting process was iterative rather than linear; matrices were revised repeatedly as later studies were coded and earlier codes were, in a few cases, collapsed or split to better reflect the data.

3.7 Data Synthesis

Synthesis followed the three stages described: line-by-line coding of the extracted findings, organization of these codes into descriptive themes that stayed close to the original studies’ own language, and, only then, the more interpretive step of generating analytical themes that went beyond what any single study had said on its own. It was through this final stage that the five cross-cutting themes reported in Section 4 emerged — the NICU as a site of “surplus suffering,” lactation as an embodied paradox, identity reconstruction within a liminal space, ritual as an architecture of continuing bonds, and healthcare communication as a systemic barrier or facilitator. Where studies described comparable phenomena using different vocabulary — for instance, “representational vacuum” (Kartaginer et al., 2026) alongside “embodied paradox” (Aderibigbe, 2026) — we treated these as conceptually overlapping rather than forcing artificial distinctions between them, a decision we flag here so that readers can judge it for themselves rather than take our synthesis at face value.

3.8 Reflexivity, Rigor, and Ethical Considerations

Because this is a synthesis of others’ qualitative data rather than a primary study, formal ethical approval was not required; nonetheless, we treated the underlying participant narratives with the same interpretive care we would want extended to our own data, particularly given the sensitivity of infant death as a subject. Reflexivity was maintained through regular team discussion of how our own disciplinary backgrounds and assumptions about grief might be shaping theme development — a process that, we should admit, occasionally slowed us down, but that we think improved the honesty of the final synthesis. Rigor was further supported by maintaining an audit trail of coding decisions and by having a second reviewer independently verify a sample of the thematic coding

Figure 1. Conceptual Map of Five Interconnected Themes in Parental Coping After Infant Death. Solid lines depict bidirectional relationships between each theme and the central process of parental coping; dashed lines depict interrelationships among the themes themselves, based on the thematic synthesis described in Section 3.7.

Figure 2. Proposed Trajectory of Maternal Identity Reconstruction Following Infant Death. The model depicts four sequential stages — rupture, split identity, liminal negotiation, and integrated identity — though movement between stages is non-linear and may recur, particularly under external pressure to “move on.”

against the original source studies, consistent with recommended practice for qualitative evidence synthesis. Taken together, we hope this makes the review’s process reasonably transparent — and, just as importantly, reasonably reproducible — for other researchers wishing to build on, or challenge, what we have found.

4.  Results

The synthesized findings from the qualitative evidence base — spanning, broadly, 2000 to 2023, with several more recent studies extending the picture into 2024–2026 — suggest, taken as a whole, that parental bereavement after infant death is not a static psychological state so much as a dynamic, embodied, and deeply relational journey. Drawing on the methodological breadth summarized in [Table 1], which encompasses perspectives from settings as varied as New Zealand, Norway, Ghana, and Israel, the findings below are organized around themes that reflect both the multidimensional stressors parents face and the sometimes quiet, sometimes deliberate ways they work to reconstruct a shattered sense of the world. The five interconnected themes described below, along with the relationships we observed between them, are summarized visually in [Figure 1].

4.1 The Clinical Site of Trauma: Enforced Separation and "Surplus Suffering"

A fairly consistent finding across the literature — one that surprised us less in its content than in its persistence across such different health systems — is that the NICU environment often functions as the primary site of initial trauma, rather than simply the backdrop against which trauma occurs. As detailed in [Table 2], parents repeatedly describe the unit as a hostile environment, one where medical technology and a culture of high acuity prioritize the infant's physical survival, understandably, but often at the expense of the parental bond (Porter, 2018; Adcock et al., 2021). This has been termed surplus suffering: unnecessary emotional pain generated not by the loss itself but by systemic factors, such as being treated as a visitor rather than a primary caregiver in one's own child's care (Porter, 2018).

Mothers in particular describe how the physical design of so-called "baby barns" — open-bay wards offering little privacy — diminishes what might otherwise have been early, formative bonding moments. For indigenous whānau in New Zealand, this trauma is compounded further by a lack of cultural safety, where a clinical disregard for relational security, or whakawhanaungatanga, produces a profound sense of alienation and disenfranchisement (Adcock et al., 2021). It is worth noting, too, how small the triggering details often are: staff learning a parent's name, or making space for a father to participate in care, are recurrently described as "little things" that nonetheless function, in practice, as rather big things when it comes to a parent's ability to claim their identity within the ward (Porter, 2018).

4.2 The Embodied Paradox: Lactation as a Site of Grief and Meaning

The physiological reality of lactation after infant death emerges, across nearly every qualitative account we reviewed, as a uniquely agonizing form of embodied trauma — one that does not map neatly onto existing models of grief. Sources consistently indicate that the maternal body continues preparing for a role it can no longer fulfil, producing what has been described as a representational vacuum (Kartaginer et al., 2026; Oreg et al., 2026). As noted in [Table 2], the visceral sensation of milk letting down functions as a daily, involuntary reminder of the infant's absence — not a symbolic reminder, but a literal, physical one, which may be part of why it proves so difficult to simply reason one's way past.

And yet the findings also point to a meaningful shift in how parents come to manage this biological reality over time. Where hospital protocol has historically defaulted to immediate pharmacological suppression, parents increasingly appear to value what researchers term an informed choice approach — one that does not assume suppression is automatically the more compassionate route (Oreg et al., 2026). As indicated in [Table 3], for some mothers, the act of expressing milk purely for relief, or of donating it, ritualistically, to a milk bank, becomes a genuine tool for meaning-making rather than a purely medical decision. In this sense, the act allows a mother to perform one final maternal duty, transforming what began as biological grief into something closer to an altruistic legacy on behalf of the child who died (Værland et al., 2021).

4.3 Identity in Limbo: The "Whose Mother Am I?" Question

The death of an infant appears, again and again in this literature, to trigger a genuine rupture of identity — one characterized by a liminality that participants themselves describe as being "betwixt and between" (Kartaginer et al., 2026). Mothers grapple, often for years, with the deceptively simple existential question, "Whose mother, am I?" — a struggle that social and medical responses tend, unintentionally, to worsen by silencing grief on the assumption that a life so short cannot warrant such prolonged mourning.

The synthesis suggests, further, that identity reconstruction is best understood as a non-linear process: a slow movement from what has been described as a split identity, in which grief is compartmentalized away from daily functioning, toward a more unified sense of self in which the loss is, gradually, integrated rather than resolved (Kartaginer et al., 2026). As shown in [Table 4], when healthcare providers fail to recognize a mother's continuing parental status, an identity gap opens up — one that appears, across several studies, to increase the risk of longer-term depression and anxiety. Conversely, when staff actively validate a mother's role, using the baby's name and recognizing the mother as part of a dyad rather than a bystander, they seem to offer something closer to a compass for navigating this otherwise disorienting liminal space (Porter, 2018). This trajectory, moving from rupture through liminal negotiation toward an integrated sense of self, is depicted in [Figure 2].

4.4 The Architecture of Resilience: Rituals and Continuing Bonds

Resilience, within this body of work, is depicted not as "letting go" — a phrase several participants explicitly reject — but as the active, ongoing maintenance of continuing bonds (Klass et al., 1996; Værland et al., 2021). One of the more striking findings, reflected in [Table 3], concerns the therapeutic function of ritualized memory-making, often initiated not by parents themselves but by nurses and parent support groups acting, in effect, as ritual inventors. These individuals create scrapbooks and memory boxes containing locks of hair, footprints, and photographs, and these small collections appear to serve at least three distinct functions: granting the infant a kind of ontological personhood, by collecting tactile evidence that the child existed and mattered; validating the parents' own status as a family, through physical "proof" of a life however brief; and controlling chaos, by providing a structured, contained outlet for otherwise unmanageable emotion during an existential crisis (Værland et al., 2021).

A further, somewhat unexpected adaptive strategy identified across the sources is what one set of authors term "puddle jumping" — the ability to move, sometimes within a single afternoon, between deep sadness and moments of genuine joy or ordinary functional engagement. This capacity for emotional regulation appears essential to parents' ongoing functioning, particularly for those who have surviving children still requiring their care (Porter, 2018).

4.5 Systemic Barriers and the Path Forward

Finally, the results underscore the considerable role played by healthcare communication and institutional protocol in shaping long-term outcomes. As shown in [Table 4], recurring barriers to parental well-being include contradictory clinical information, resource scarcity in rural settings, and, perhaps most fixable of all, a simple lack of staff training on how to approach lactation care after loss (Hurt et al., 2023; Ani-Amponsah, 2016).

Staff who practice what the literature calls sensitive and responsive care — being heard, being genuinely involved in decisions, and being given adequate, unhurried time for final proximity with their infant — appear, across multiple studies, to meaningfully mitigate the trauma associated with loss (Redshaw et al., 2021). The phrase "this is time we'll never get back" recurs often enough in participants' own words that it seems worth taking at face value: time, more than any single intervention, is what bereaved parents describe as their most precious and least renewable resource (Redshaw et al., 2021). Hospital protocols, accordingly, may do well to prioritize maximum contact time and the creation of genuinely dyadic spaces, where parents can simply be with their children without the constant pressure of the medical gaze.

This is, admittedly, a simplification of a considerably messier and more individual set of experiences — parental coping after infant death appears to function as a negotiated process in which the physical (milk), the psychological (identity), and the social (ritual) intersect, each shaping and constraining the others. By shifting away from a narrowly medicalized model of suppression and toward a more humanized model of meaning-making, healthcare systems may be able to move from being, however unintentionally, sites of additional trauma toward becoming genuine partners in the tender, ongoing reconstruction of a bereaved parent's life.

5. Conclusion

This review suggests, cautiously but consistently, that

Table 1: Study Characteristics and Methodological Overview of Included Qualitative Research (2000–2023). Each row summarizes one included study by author(s) and year, country, primary research aim, qualitative methodology, participant type and sample size, and data collection method.

Table 2: Multidimensional Stressors Experienced by Parents Following Perinatal and Neonatal Loss (2000–2023). Each row identifies a distinct stressor category and cross-references its physical, emotional, social, and systemic impacts, its effect on parental identity, and associated mitigation strategies, with supporting references.

Table 3. Coping and Meaning-Making Mechanisms Reported by Bereaved Parents After Infant Death (2000–2023). Each row describes a specific coping mechanism, its theoretical grounding, the concrete activity involved, the facilitating role of staff or systems, relevant cultural considerations, its intended outcome, and potential barriers, with supporting references.

Table 4. Healthcare System Barriers and Facilitators Affecting Parental Well-Being After Infant Death (2000–2023). Each row addresses one dimension of care, contrasting an identified barrier with a corresponding facilitator, and detailing staff training needs, communication style, the role of spiritual care, and policy implications, with supporting references.

lactation after infant death is not a peripheral clinical detail but a central, embodied site where grief, identity, and care intersect. Across culturally diverse qualitative studies, bereaved mothers describe milk as both wound and evidence — a painful reminder of absence, and, at times, a final act of mothering. Healthcare systems built around reflexive suppression may inadvertently foreclose this meaning-making process. A more humanized, informed-choice approach — paired with cultural safety, ritualized memory-making, and sensitive communication — appears better positioned to support identity reconstruction after loss. Future work should test these qualitative patterns against structured outcome measures and examine implementation of informed-choice lactation protocols across diverse healthcare settings.

References