Abstract
The death of an infant is devastating and life changing, eliciting profound grief for parents. Many mothers of stillborn infants and infants who die in the first days, weeks and months of life are faced with the complex task of managing the initial onset of breastmilk production or continuation of established lactation. In this case-study, we conducted focus groups with health professionals and interviews with grieving fathers to explore fathers’ awareness of and involvement in their partners’ lactation after infant death. We found that after the loss of a child fathers are often characterised as ‘supporters’. What was seen as ‘support’, however, was more akin to ‘care’, being evidenced by emotional expression and emotional interdependence. This vital attention to, and emphasis on men’s caring, allows a greater appreciation of the emotions present in men’s grief, including how care for others, particularly partners, allow men to express themselves emotionally after loss.
Introduction
Since 2000, the number of stillbirths and neonatal deaths in Australia have remained unchanged at a rate of 10.1 per 1000 births (Australia Institute of Health and Welfare (AIHW 2021). Such deaths are devastating and life changing, eliciting profound grief for parents. In addition, many mothers of stillborn infants and those experiencing infant death in the first days, weeks or months of life are faced with the complex task of managing the initial onset of breastmilk production or the continuation of established lactation. Despite the deep emotional responses, meanings, and needs that can come with such lactation (Noble-Carr et al. 2022, 2023), mothers often face limited support (Basile and Thorsteinsson 2015; Noble-Carr et al. 2021; Redshaw et al. 2014). If provided, hospital based bereaved lactation care is often limited to the suppression of milk (Noble-Carr et al. 2021). Potential care options for mothers like purposefully keeping or using breastmilk, sustaining lactation, or donating breastmilk to a Human Milk Bank (HMB) are often ignored (Noble-Carr et al. 2021).
While research on mother’s grief and the complexities of lactation management is becoming more common, less attention is paid to perinatal grief among fathers (Murphy 2025). Their involvement in post-loss lactation and milk donation is almost entirely unexplored. When acknowledged, fathers’ grief is positioned as ‘instrumental’, assuming men direct energy into mastering their feelings by doing logistical tasks and providing support to others (Doka and Martin 2010; Murphy 2025). Health professionals also position fathers solely as supporters in lactation, particularly after infant death (Noble-Carr et al. 2022).
This paper is one of the first to investigate how fathers experience and play a role in bereaved lactation care. Examining the intersection between grief and lactation care after infant death, our case study involved interviews with bereaved fathers and focus groups with health professionals within one health care jurisdiction in Australia. We explored fathers’ awareness of and involvement in their partners’ lactation after infant death and how their practices of grief and care during this process interact with their sense of their fatherhood and masculinity.
We found that fathers and health care professionals often positioned fathers as instrumental grievers, with fathers seen primarily as supporters, with their emotions and needs being secondary concerns. We found that fathers’ ‘support’, however, was embedded in practices of care. Care is often confused with support. However, there are subtle differences between these acts (Elliot 2016; Hanlon 2012), with support being more transactional, while care practices are evidenced by emotional expression and emotional interdependence between partners. Fathers sought to ‘be with’ and ‘care for’ their partner, with these practices giving men and their partners a means to enact and express their grief. Men’s involvement in lactation after infant death and breastmilk donation brought partners closer together and allowed their care to be extended to other anonymous parents and infants, giving further meaning to their loss.
This vital attention to, and emphasis on men’s caring, rather than support, allows a greater appreciation of the emotions present in men’s grieving. We reorient what is meant by ‘support’, to show it includes aspects of both of Doka and Martin’s (2010) typologies of grieving, instrumental and intuitive responses to grief. Acknowledging and thinking about care instead of support expands our understanding of men’s responses to infant loss.
Background
Researchers and policy makers in both fields of infant bereavement and infant feeding have only recently expanded their gaze beyond the maternal-infant dyad to consider fathers’ perspectives and experiences (Aydin and Kabukcuoglu 2020; Hounsome and Dowling 2018; Morelius et al. 2021; Obst et al. 2021). With recent research confirming the significance of fathers’ supporting role in infant feeding, father-inclusive family-centred care practices are now widely encouraged within Neonatal Intensive Care Unit (NICU) and hospital settings (Hall et al. 2017; Holdren et al. 2019; Sigurdson et al. 2020). With greater understandings of fathers’ grief following infant loss, the importance of continuing to offer father-inclusive family-centred bereavement care after the death of an infant or child is also now well established (Flenady et al. 2020; Tatterton et al. 2023).
Fathers’ grief, however, is still often positioned as secondary to mothers, with medical professionals, researchers and men, assuming fathers will experience less intense and enduring emotional responses after perinatal loss and are thus less requiring of support (Dyregrov and Matthiesen 1991; Murphy 2025). In turn, the extent of fathers’ grief and consequent needs are often left unacknowledged and unaddressed (Murphy 2025; Obst and Due 2019, 2021; Obst et al. 2020, 2021).
The diminishment of father’s roles is based within the structures of hegemonic masculinity (Connell 1995), which states that men must remain unemotional and inexpressive. The ‘cardinal’ rule of masculinity is ‘don’t cry’ (Kimmel 2008). Hegemonic masculinity lies “in the valuing and naturalising of what the ‘West’ has characterised as masculine (logic, reason, conflict, individualism)…and the disparaging of what has been, and continues to be, feminised (emotion, collectivity, cooperation, being other-oriented)” (Nicholas and Agius 2017, 37). In the context of childrearing, these norms mean that mothers are expected to play the role of emotionally available carer, while fathers are seen as a non-emotional provider of economic and logistical support (Lewington et al. 2021; Peukert 2018; Robb 2025).
A growing body of research challenges these notions, showing that emotional inexpressiveness is neither entirely valued nor the actual experience of men’s behaviour (MacArthur and Shields 2015; Wester et al. 2002). This is true during perinatal grief, with men’s experience and support needs following pregnancy loss differing in style – rather than intensity – to those of women (Murphy 2025; Obst and Due 2019, 2021; Robb 2025; Wagner et al. 2018). In the grief literature, two models - the “Patterns of Grieving” model as presented by Doka and Martin (2010) and the “Dual Process Model” as derived by Stroebe and Schut (1999) – exemplify these differences in style. We use these two grief theories or models as they have largely shaped contemporary understandings of men’s grieving and current healthcare practices around gender and parental grief after infant loss.
In the most influential “Patters of Grieving” model, Doka and Martin (2010) identified two ‘types’ of grievers – intuitive and instrumental. Doka and Martin (2010) explain that different grievers will usually choose different adaptive strategies to express grief and to adapt to the loss over time. Intuitive grievers are more likely to have an emotional experience of grief and express their grief through crying and wanting to share their inner experiences with others. These grievers experience losses deeply and will often find themselves without energy and motivation. Instrumental grievers convert most of their grieving into the cognitive domain rather than the affective. These grievers have a desire to master their feelings and will normally direct their energy into activities – such as organising funerals, supporting others and getting back to work. While Doka and Martin’s analysis is not inherently gendered, they state that intuitive grieving is primarily associated with women, and instrumental grieving, men. This work was deemed seminal at the time of publication, in that it was seen to validate men’s differing, but no less significant forms of grief, and provided accessible language and tools for grief counsellors to adopt with their male clients. Perinatal grief researchers have confirmed that fathers often adopt ‘instrumental roles’, feeling the need to present as stoic, and focus on keeping busy, moving forward, and supporting their partner after infant death, and have stated this understanding needs to help inform the support they receive (Aydin and Kabukcuoglu 2020; Cacciatore et al. 2013; Obst et al. 2021).
The Dual Process Model of Coping with Bereavement (DPM) (Stroebe and Schut 1999) approaches the issue of grief similarly, suggesting coping following bereavement often incorporates two distinct orientations. There is a loss orientation, which involves remembering the lost person and focusing on what is no more, and a restoration orientation, where the stressors associated with the change occurring from the loss are addressed, and new ways of doing things are adopted. Both orientations are essential for coping (Stroebe et al. 2001), with individuals oscillating continually between these two. The theory, however, posits that men are more inclined toward restoration-oriented activities and women towards a loss-oriented focus (Granek 2022; Stroebe et al. 2001).
Aligned with social constructionist orientations, both models complicate conceptions of the gendered nature of grief. Doka and Martin (2010) argue that gendered differences often apparent in grief responses are not deterministic, but instead are likely to be heavily influenced by contemporary patterns of male socialisation and social norms and expectations. Moreover, these two patterns of grief were conceptualised as end points on a continuum. Both theories suggest that all individuals experience different styles of and orientations to grieving, with most having some blended pattern.
Nevertheless, aligning with the assumptions of hegemonic masculinity, the binaries offered by both models have readily been adopted by grief scholars, health professionals, and counsellors, as they offer accessible explanations of gendered differences in grieving and provide professionals with more diverse and expansive range of tools to respond to the unique needs presented by different styles of grief. In turn, both models have perhaps, unintentionally, reinforced gendered notions of grief.
Doka and Martin, for example, stressed their patterns of grieving should not be understood as a dichotomy based on gender lines, but rather as a continuum that is influenced but not determined by gender, with most grievers (regardless of gender) being blended grievers. Other scholars agree, stating the “theory has evolved to transcend gender” (Niemeier 2011, 278). Despite this, the perception of men as ‘instrumental grievers’ often shapes the role assigned to them. Notions such as “instrumental grief”, in turn, appear to have become synonymous with “masculine grief’ and is often readily applied to measure, explore and account for men’s grieving.
In the context of grief following infant death, both academic literature and clinical practice, men are generally positioned as supporters of bereaved women, rather than as bereaved themselves (Murphy 2025). Professionals who seek to provide support to those bereaved by infant death, for example, often typically feel that “men’s grief was more towards the instrumental side of the continuum (i.e., cognitive, problem-solving grief management)” with a focus on supporting their partner (Obst and Due 2021, 777). This orientation is magnified by a clinical context focused on patient centred care (Kokorelias et al. 2019) and woman-centered care (Obst and Due 2021) which focus on the birthing parent.
These theoretical understandings underpin and continue to ensure that the notion of men as supporters during grief is at the forefront of our thinking, research and responses to men’s grieving. The popularity of these theories and the eagerness and ease in which they have been adopted by grief researchers and those who seek to support the bereaved therefore, begs the question as to whether such constructions of a specifically masculine form of grief actually serve to reinforce dominant ideas of masculinity (Robb 2025).
Methodology
Our study explored the views and practices of fathers whose partners donated breastmilk to a Human Milk Bank after their infant’s death. The study was nested within an Australian Research Council funded qualitative research project that aimed to better understand Australian mother’s experiences of lactation after infant death and the lactation care they receive and require (for details see Noble-Carr et al. 2021, 2022, 2023). Separate funding for a nested study allowed researchers to undertake semi-structured in-depth interviews with partners of bereaved mothers participating in our study. All partners opting into the study were male and identified as fathers. Purposive sampling ensured five out of a total of seven bereaved father participants recruited around Australia had supported their partner to donate breastmilk to a HMB following infant death. This was possible, as one of the study hospital sites at the time of the study, hosted a HMB offering the option of bereaved milk donation for eligible donors; an option unavailable in several other jurisdictions (Carroll 2014).
The funding bodies were not involved in the collection, analysis, or reporting of the research. Ethics approval for the study was provided by the Human Research Ethics Committee (HREC) and/or Research Governance Office of participating hospitals and by the researchers’ University HREC.
Study Design
The empirical material in this study is structured through a case study design, which involves in-depth data collection from multiple sources of information and / or types of data to achieve a thick description of a particular bounded system or “case” (Creswell 2013, 97). We draw on what is known as an instrumental case study design, which examines a particular phenomenon of interest (fathers’ grief and loss and their involvement in bereaved lactation support) at a particular time and place (a HMB offering bereaved donation options in one state of Australia) (Creswell 2013).
Our case study focuses on data which conveys the unique experience of bereaved fathers’ involvement in breastmilk donation through a HMB and provides a novel opportunity to access, examine and critique understandings of men’s practices of grief and care. By focusing on one health jurisdiction and setting in Australia that has enabled bereaved parents to donate breastmilk following loss, we were able to examine how State-level health service policy and provision may impact and shape men’s grief and care practices following infant loss.
Data Sources
The sources of information included in this study are: interviews with fathers; demographic details; and focus groups with hospital-based health professionals.
Source 1: Interviews with Bereaved Fathers
We conducted interviews with five fathers who had experienced infant death and consequently supported their partner to donate breastmilk to a HMB. These interviews were underpinned by a qualitative approach in which we sought to understand, from the perspective of bereaved fathers, their experiences, feelings, and practices surrounding their bereaved partners’ lactation after infant death (Noble-Carr et al. 2022).
Potential participants were identified via interviews with bereaved mothers as part of the larger study. Consistent with best practice in bereavement research (Sque et al. 2014; Stroebe et al. 2003) fathers who opted into the study had access to a specialist infant bereavement counsellor before or after their interview, and were offered a range of choices, including whether they were interviewed by a male or female researcher, and whether they engaged in an interview or provided a written response. All participants chose to be interviewed, either by phone, zoom video or in-person, with interviews lasting approximately 1 hour. Interviews were conducted between November 2019 and April 2020, facilitated by one of two researchers (SC, DNC). Interviewers asked fathers about: (i) their partner’s pregnancy; (ii) anything they would like to share about life and death of their baby; (iii) observations of their partner’s lactation experiences; (iv) support provided to their partner to suppress, express or donate breastmilk after their infant’s death and how this fitted in with grieving the loss of their baby; (v) the lactation options (including breastmilk donation) they think may support bereaved mothers; and (vi) how lactation care and support can be improved. Interviews were recorded and transcribed by a professional qualitative research transcriptionist.
Source 2: Demographic Data
Participant Characteristics, Type and Timing of Infant Death Experienced & Donation Experience
Source 3: Focus Groups and Interviews with Health Professionals
We conducted focus groups and interviews with 45 health professionals from one major tertiary hospital with maternity, neonatology and human milk banking services. Focus groups enable health professionals to share, question and debate perspectives and practice experiences (Jayasekara 2012; Pope et al. 2002). We identified eligible health disciplines as those being most likely to be called on to offer lactation care following stillbirth and infant death. In total eight focus groups were conducted with health professionals from eight different health disciplines. The number and type of health professionals included in each of our discipline specific focus groups included: 8 obstetricians, 17 neonatologists, 3 midwives, 6 neonatal nurses, 3 lactation consultants, 4 social workers, 2 HMB staff, and 2 specialist perinatal bereavement nurses. Each focus group was conducted in 2019, facilitated by one of two researchers (DNC, KC). Focus groups all discussed generalist bereavement care, lactation care currently provided, their understanding of preferred or optimal lactation care, and the challenges and barriers to enhancing lactation care. All participants were offered the support of a specialist infant bereavement counsellor before and after the interviews. Focus Groups were recorded and transcribed by a professional qualitative research transcriptionist. Further details are available elsewhere (Noble-Carr et al. 2021).
Data Analysis
We conducted a thematic analysis for both the bereaved father and health professional data sets. This involved a line-by-line analysis of the transcripts, assisted by NVIVO software, to identify key themes and patterns (Braun and Clarke 2013; Jackson and Bazeley 2019). Themes were inductively and deductively derived, with some key questions initially informing the analysis of each data set. A final summary report of key themes was developed by lead researchers (SC, DNC, KC) which was shared, commented on, and further refined by discussions within the research team.
Findings and Discussion
Men’s Grief was Often Invisible, Despite Them Experiencing Deep Emotions after the Loss of an Infant
We found that men were, at least initially, either left out of conversations in health settings about infant death and lactation, or, when mentioned, were cast in almost entirely ‘instrumental’ and supporter terms.
There was very little discussion of fathers in any of the health professional focus groups, and sometimes none without explicit questioning from the researchers. The involvement of fathers in bereaved lactation care did not seem routine, and was often only done incidentally, if at all. As one obstetrician stated: “I usually do it [lactation conversations] as a one on one with the patient, and the partner may be in the room.”
The midwife group stated that lactation remains commonly viewed as being “secret women’s business” and as such is often not comprehensively discussed with mothers, let alone, men.
In saying this, when the context of healthcare discussions were broadened beyond lactation care to generalist bereavement care, fathers were more often welcomed and acknowledged for the positive supporter role they were seen to provide for bereaved mothers. As one social worker said: “If there’s a dad, typically I find they want to do something, they want to feel busy and instrumental, so often they will start making arrangements with funeral directors.”
This was also noted in the context of bereaved lactation care by HMB Staff who recounted that although they may not be involved in initial care conversations with mothers, fathers were significantly involved in the practical aspects of organising and facilitating donation. “We don’t get to usually meet the partners unless they’re dropping off [the milk]” “They [the partners] will often be the person that drops it off, or they will come with their partner, and they are amazing as well.” “[Sometimes] they’ve [the partner] done the emails, they’ve done the drop off. We’ve never met Mum.”
When fathers were discussed by health professionals, therefore, they were normally cast as supporters, with their needs largely overlooked. Fathers did this as well, de-centering their grief, often due to the common belief that the loss of their infant impacted their partner more deeply than it did for themselves. When asked about the days and months following infant death, Ryan said: “Just being there for her. In situations like that, there’s not a lot you can do, but to be there for your wife in the same situation, but it’s probably even harder for her, because she’s the mum, obviously. She carried her for nine months.”
All fathers expressed a need to remain ‘stoic’ in the face of their grief so that they could support their partner, care for their children, return to work, and attend to logistics. Matt said logistics was the main things he did after losing his child: “So yeah, we went home, and I don’t even…seriously, the first couple of days after [infant] died, I can’t even remember. I just remember, I don’t know, trying to organise a funeral, and not knowing what I want, and having to make choices about (inaudible), and all this stuff. Yeah. And just, like, not being able to think clearly at all.”
As previous perinatal grief researchers have identified (Obst and Due 2019, 2021; Obst et al. 2020, 2021), it seemed that fathers were naturally aligned to taking on an ‘instrumental’ support role. Despite this, fathers explained that they experienced profound grief and distress. During interviews men frequently cried, required time to stop to compose themselves, and discussed the long, emotional difficulties they faced after infant death. Men also spoke about the deep impact the loss of a child had on their mental health. Andrew, for example, said: “Obviously, it was very sad when [infant] was [still]born. (crying) Only a little thing. Reasonably well-formed...you know”.
Andrew continues, by talking about his emotions during the time of loss and how he and his partner grieved together, saying: Oh, we just hugged her [deceased infant] a lot. (crying) And just felt her and looked at her. Just really enjoyed having her there…I think we were just amazed that she can be so perfect, perfect-looking and nothing wrong with her, but just passed away.
Ryan, who was emotional throughout his interview stated: All I can remember is, like, we had five weeks with her. A lot of just (crying) sitting on the couch. Um, a lot of love! Sorry.
Matt also spoke about how the experience of infant loss was overwhelming: “The weirdest feeling. Through my career, I’m paid to make decisions and to be analytical and to make, like, decisions under pressure, and I just didn’t have the capacity to think. That was a weird thing.”
Matt’s quote highlights the assumed pressure for fathers to be able to think clearly and act rationally following infant death. This, however, doesn’t always align with their own feelings. Doka and Martin (2010) explain that rigid self or societally imposed expectations can lead some people to adopt an unhealthy ‘dissonant grieving pattern’ – when a griever takes on a grieving pattern counter to their own natural style or sense of identity. Doka and Martin (2010, 241) explain that one of the most common examples of this is “male intuitive grievers [who] are often at odds with societal norms for gender-stereotyped behaviours…for these grievers, their need to express their feelings and share them with others is overshadowed by a rigid definition of manliness.”
Caring Masculinity after Infant Death
Fathers’ taking on the supporter role following infant death could be readily interpreted as them adopting an ‘instrumental’ role. Instead, we found this to be more complex. This ‘support’ involved enacting significant care responsibilities for their partners and others. The small amount of research engaged with masculine experience in the wake of infant death shows that men often try to fulfil multiple caring roles in the immediate aftermath (Murphy 2025). These include caring for partners and children, attending to the running of the household and returning to work, while simultaneously experiencing their own grief (Aydin and Kabukcuoglu 2020; Cole et al. 2019; Murphy 2025; Obst et al. 2020).
Rather than this care being an expected and pragmatic response, we found that the emotional investment made by fathers provided them with an avenue for expressing and processing some of their grief. This was specifically true when their partners were involved in extended lactation, during which men’s intensive caring for their partner gave them a deep sense of purpose and meaning following the loss of their child.
Care operates differently from support as it is based in partnership and a form of interdependence. Chris, for example, described his relationship with is partner as being based on shared time together making joint decisions. When asked about how he supported or cared for his partner, he replied: “Well, for me, I’ve been there every step of the way. All the difficult conversations that we’ve had. All the tests, all…every day, every day I’ve been there. We often say that not many people have a relationship like we do, and it’s something very special. And yeah, I don’t know what the situation would be like for other couples, but for us, we do everything together. We've been through these losses together, and I was with her…as much as I could be. Took so much time off work because I needed to be there for her. I knew, you know, she needed me, and I had to be there. She couldn’t have done it on her own, and she couldn’t have endured those difficult conversations with medical professionals, and making decisions on her own.”
The care Chris provides therefore goes beyond ‘instrumental’ support, because it is not about being an individual engaging in an active doing to or even doing for but rather being with their partner.
Chris’s approach is an example of a ‘caring masculinity’. While reproductive labour and practices of ‘care’ have historically been associated with the ‘feminine’ domain, men and particularly fathers often enact forms of masculinity that contest this assumption (Marsiglio and Roy 2012, 161; Scheilbling 2020). Caring masculinities reject domination, and instead integrate “values of care, such as positive emotion, interdependence, and relationality, into masculine identities” (Elliot 2016, 241). Caring masculinities incorporate “positive, relational, interdependent emotions” and reject domination and separateness (Elliot 2016, 253). This form of masculinity departs from hegemonic concepts, which are framed around independence, separation from others, and a drive for power, agency, and action (Tarrant 2018). Caring masculinities are therefore theorised as a way in which men can engage in gender equality, particularly in the household, “because doing care work requires men to resist hegemonic masculinity and to adopt values and characteristics of care that are antithetical to hegemonic masculinity” (Elliot 2016, 245).
As Chris explains, these practices of care were conducted with a deep interdependence with their partner. Interdependence is central to caring masculinities. As feminist scholar of care ethics Held (2006, 12, original emphasis) argues, “[t]hose who conscientiously care for others are not seeking primarily to further their own individual interests; their interests are intertwined with the persons they care for.” This is supported by social care scholar Hanlon (2012, 29) who argues that “as social and emotional animals we necessarily subsist within webs of emotionally reciprocal relations.” Interdependence suggests that social relations are reciprocal and emotional, with caring masculinities emphasising these elements in their practices (Elliot 2016). These practices are richly described by Chris above, who talks about being with his partner ‘every step of the way’.
Caring Masculinity during Lactation
The joint decisions fathers made with their partners about lactation following infant death appeared to provide a unique opportunity to enact the type of interdependent care described above. This was particularly true regarding decisions to donate breastmilk to a HMB, and the practice of sustaining lactation for the purpose of donation.
Despite limited recognition and attention from health professionals in our study, research increasingly shows that fathers seek to, and do play, a substantial role in lactation and feeding practices in the context of healthy and preterm or sick infants (Alves et al. 2016; Denoual et al. 2016; Morelius et al. 2021; Noble-Carr et al. 2022; Sweet 2008; Sweet and Darbyshire 2009). Lactation after infant death, however, is a topic that men in our study had not previously been aware of. Fathers themselves were mostly unaware of lactation in the early stages after the loss of an infant, with participants being surprised about the phenomenon, and the sheer amount of milk that continued to flow despite the loss of their infant. Men also reported they did not initially know how to care for their partner.
With little guidance being offered to them by health professionals, due to their commitment to be with and care for their partners, some of the study fathers became increasingly aware of and more intimately involved in lactation, by observing their partners’ expression or leakage of milk that occurred after their infants died. By seeking to be with, and care for his partner, Chris became deeply attuned to his partner’s lactation: “She would have to wear breast pads all the time. Whenever she was in the shower, the milk would run.”
Three of our case study fathers had partners who deliberately sustained their lactation for the purpose of donation, and it was in these cases where, over time, fathers’ care work centering on lactation became intimately and significantly intertwined with their own grief. The care required to support bereaved mothers to sustain lactation for the purpose of donation was significant and largely fell solely on the shoulders of fathers, at a time when they were also grieving. Andrew’s partner sustained her lactation over several months after the loss of their infant, starting to donate breastmilk while they were hospitalised and continuing when they arrived back home. Andrew helped with the logistics of donation, as well as picking up other domestic duties to allow his partner to focus on regular breastmilk expression: “The breast pump and all that needed washing. We had to buy a couple of breast pumps…and stuff like that, so money was, you know, had to provide that, because [partner] doesn’t work. Yeah. Just washing up, you know, bringing the pump to her sometimes, or if she’s pumping, make dinner and just support her in that, whatever needed to be done. Probably more the washing up sort of side of it, or bringing things to her when she needed it. Otherwise she was pretty right once she got hooked up to it. Sometimes she had two bottles and needed three, so you had to run and grab another one, or something like that.”
Fathers often became deeply involved in the process of sustaining expression and breastmilk donation and their support extended beyond practical tasks and duties. Sebastien, whose partner sustained lactation for several months after their twin infants passed away, describes the intimate emotional care this also required: “My support for her is always to see how she feels, talk to her, talk to each other, make decisions together, and be with her all the time.”
Lactation after infant death was therefore something that brought some partners closer together, as couples continued to care and support each other with this emotionally challenging practice. Chris’ attunement and proximity to his partner continued throughout the months of sustained expression and even beyond: “And what made things more difficult was that after she decided ‘OK, that’s enough, that’s enough, I don’t want to do this anymore,’ it’s not just like a, you know, that’s it…The milk continues coming. She just expressed less and less and less amounts, but even after she stopped expressing completely, her milk would still come for months.”
Bereaved fathers, therefore, developed a form of caring masculinity following the loss of their infant that was facilitated by their involvement in their partners’ lactation practices.
Participating in Bereaved Donation Assists Men’s Grieving and Meaning Making
Fathers who were closely involved in their partners lactation and subsequent milk donation after infant death explained the care they provided their partner gave them a purpose, and a way to deal with their own grief. Initially, when asked what role milk donation played in their grief, fathers often directed their attention to their partner. Sebastien, for example, indicated he believed donation was beneficial to his partner: “It was certainly part of her healing process, thinking she [partner] can do something for someone else. Just keep connected, I suppose, in her mind, with [infant] and [infant]. Thinking that, well, she could have been giving the milk to our babies, but may as well give it to another baby.”
Although this can be seen as men downplaying their own importance, it is a recognition that the strength of their emotional connection with their partners meant that if their partners benefited then they too also benefited. Sebastien explained this, stating that breastmilk donation was a joint act that impacted on and had significance to the grief of each partner: “It’s an internal healing. We took some steps, for instance, going together to bring the milk, knowing that we would be helping others, that was a healing process. It was an opportunity to live life after someone’s death, so basically an opportunity to keep someone alive through someone’s death. It was an opportunity to donate the milk to help other people keeping them alive, and basically keeping a memorial to [infant] at the same time.”
In talking about ‘going together’ to the milk bank, Sebastien exemplifies a practice of ‘interdependent care’, one in which partners managed difficult processes together. Chris also explained how this sense of connectedness gave him meaning: “As a purpose for her, there was a purpose for me as well, and yeah, I did find a lot of significance from doing that, and it was a shared duty, I guess, that we took on together to do this. We did it together.”
Thus, breastmilk donation not only facilitated joint healing for bereaved fathers and mothers but was also an act of care that assisted another family. Providing critical care for babies and helping other families through donation was significant to fathers in their grieving. All fathers benefited from this, whether it was through their partner’s donation of frozen stores of milk or through the practice of sustained expression. Again, this was a simultaneous and joint act of doing and caring that provided much solace to fathers’ grieving: “It was good, the fact that both of us felt like we were giving something back to other babies” (Andrew) “We were donating it other babies, it made you feel really good. At least you can help someone” (Ryan)
The option to donate breastmilk following loss is not widely available in Australia (Noble-Carr et al. 2021). However, the unique care setting included in our case study that facilitated the practice became significant to families; allowing them to process their grief in different ways, and providing them with much needed recognition and support of their unique grief. HMB Staff recognised this in our focus groups: “One of the women that we had, she donated once following a loss, and the second time, the baby was born not very well and was in NICU, and the first person [the partner] came to tell that she’d had this baby was [ the HMB staff member], and I think it’s because we were safe, and so he wasn’t dropping off milk, but he didn’t tell any family, nothing. He came straight to us, and I think it was – we don’t support partners as a whole in anything in maternity. We give lip service to it, but he obviously felt safe to come. This is a safe environment. And he sat here and sobbed and sobbed and sobbed and sobbed, but he didn’t think he could do that in front of his partner, because he felt he had to support her.”
Bereaved milk donation, therefore, created - even if unintentionally - an opportunity for ‘family-centred’ care as is advocated by the literature around bereavement. In our study fathers found a safe space through relationships built up during extended lactation, where they could grieve openly and in ways often not understood or sanctioned by their broader community.
Limitations and Potentials for Future Research
While our focus groups and interviews have provided valuable insight into the experiences of men during lactation after infant death, the small number of participants, as well as the geographical limitations, means that we cannot draw generalisable conclusions from our data. This does not limit the value of this data, but instead positions it as a starting point. This research provides opportunities for further research at a larger scale to pay careful attention to the language used to frame men’s experiences and grief and to further examine their experiences of grief, support and care post infant loss, and particularly during post-loss lactation.
Conclusion
Our research found that fathers bereaved by stillbirth, neonatal and older infant death dealt with their grief primarily through directing energy toward the care of others, particularly their partners. In examining the reported practices surrounding lactation after infant death, some fathers in our study directed their attention to assisting, supporting, and caring for their partner, particularly during long periods of bereaved breastmilk donation. Fathers and health practitioners noted these caring practices shaped men’s expression and experience of grief.
It would be possible to view this caring role as a confirmation of the ‘styles of grieving’ binary commonly applied to explain grief experiences. However, we gently reshape this dominant mode of understanding. While they spoke in instrumental terms about their grief, and often acted as instrumental grievers, the ‘support role’ fathers provide in the context of infant bereavement and/or lactation may be better conceptualised and acknowledged as care. This term enables us to better acknowledge their attunement to the needs of their partner, their emotional and physical proximity to their partners, and the shared decision making about practices related to lactation and milk donation. The binary of instrumental vs. intuitive grievers adopted from the grief literature often assumes a separation between practices of support and the expression of emotions. Instrumental care is seen as a way to suppress emotions. We found the opposite. Men used emotional connectedness and interdependent care to jointly grieve with their partner, with lactation, expressing breast milk, and donating milk forming an important space in which couples could bond during their grief.
As Karla Elliot (2016, 253) says “…caring masculinities revolve around an incorporation of positive, relational, interdependent emotions and a rejection of domination and its associated traits.” Our analysis showed that men had an all-encompassing, holistic view of care for the family, which was inflected through relations of care for their partners and dependent children (living and deceased). Men emphasised care, both emotional and practical, for their partner, children and other family members. They did so while maintaining employment, organising milk donation and attending to funeral and health care logistics.
Traditionally, masculinity has been seen as the public facing, rational self, with men figured as the atomised individual, unruffled, and unaffected by the circumstance or others (Robb 2025). Our analysis challenges this binary. In their interviews, study participants displayed a complex version of masculinity and manhood, maintaining societal expectations that they would be stoic and strong in the face of infant death, while at the same time prioritising care for others behind the scenes. This care was an integral part of their grieving process, forming the means through which men could find meaning after their infant’s death. Rather than a direct challenge to their masculinity, bereaved fathers saw these caring behaviours as a normal and expected part of the fathering role. Typical of twenty-first Century models of Western masculinity (Robb 2025), this is an example of the masculine, stoic self that is concurrently tied to the family, requiring multiple caring roles of the father that, in turn, creates relational ties to others.
These practices of care are, variously, facilitated, supported, and diminished by healthcare institutions. Our health practitioner focus groups and interviews revealed that unlike mothers, fathers were rarely evoked in their thinking. This is despite an official policy and practice turn to ‘family-centred care’. When fathers were considered, it was primarily through the lens of being instrumental grievers and logistical supporters. Because the ‘styles of grieving’ conceptual model has become so popular, it is often simplistically understood and applied in a gendered binary that does not do justice to the complexity of the father’s grief and the care role they often play. Even if unintentional, binary models of grief have created simple structures that health professionals, and others, use to pigeonhole grievers. In practice, binary gendered models of grief simply map themselves onto gender, so that whatever the experience of mothers or fathers, their distress is read reductively according to normative gender codes. This continues even when health practitioners seek to implement a ‘family centred’ model of care.
The fathers in our study remained steadfastly willing and able to be involved in care practices that involve lactation and healthy infants, in the NICU/palliative care environment or after infant death. They sought out the information they required to care for their partner as best as they could. Fathers however noted that they received little information and most often no support regarding lactation after infant death from health professionals. In retrospect, fathers noted that this was frustrating as they had hoped to support their partner’s needs following their infant’s death, including lactation.
As health practitioners come to terms with adopting a more family centered approach to care, understanding the complexity of fathers’ experiences is increasingly important. Our research supports others who argue that more work needs to be done to bring fathers into the fold after infant loss, rather than continuing to assume they experience grief and adopt practices of support in a stereotypical, limited way.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Australian Research Council and Newborn Intensive Care Foundation.
