The current Coronavirus pandemic is ever-evolving and we are learning more every day about SARS-CoV-2/COVID-19 and pregnancy. Click here to see the most recent episodes, articles, and resources on this topic.
COVID-19 can bring new challenges to breastfeeding. Don’t panic, plan. Get the evidence and guidelines on how COVID-19 can affect breastfeeding, and what precautions you should be taking to protect yourself and your baby. The COVID-19 pandemic is an ever-evolving situation, and this episode is the most recent info and data available as of April 25, 2020.
Article and Resources
In this article, we are talking about COVID-19 and breastfeeding. It would be amazing if every new mother found breastfeeding came easily and naturally. For a lot of new mothers, this is not the case. Breastfeeding comes with challenges, and it takes a lot of work. COVID-19 brings new challenges to breastfeeding, especially if you are exposed to the virus.
COVID-19/SARS-CoV-2 and Breastmilk
To date, SARS-CoV-2 has not been detected in breastmilk, which is good news for mothers and babies. It is important to remember that we are working with limited data, and there are ongoing studies, like one at the University of California San Diego that is investigating whether the virus is transmitted through breastfeeding and if human milk can protect infants from COVID-19. The researchers hope that they can identify human milk bioactives that protect from the virus and leverage that knowledge to develop novel antiviral therapeutics. I wish we had all of the answers to those questions now, but it is good to know that we will know more in the future.
Benefits of Breastmilk
One of the most significant benefits of breastfeeding is the immune-boosting properties of breastmilk. Babies who get breast milk are better protected to fight off illnesses, and they have stronger immune systems. You are directly passing antibodies to your baby through your breastmilk. If you are unable to breastfeed your baby directly, the next best thing is pumping milk. After that, if you have access to donor milk, that could also be an option. While exclusive breastfeeding is ideal, it is not an all or nothing. If your baby drinks formula, you can still breastfeed and give them the benefits of breastmilk, even if they are not drinking breastmilk at every feeding.
La Leche League Guidelines
La Leche League is overwhelmingly in support of breastfeeding, even if you have COVID-19. The organization states when any member of the family is exposed to COVID-19, the infant is exposed. Hence, any interruption of breastfeeding may actually increase the infant’s risk of becoming ill and even of becoming severely ill. LLL goes on to state in an extreme circumstance if an interruption of breastfeeding is deemed medically necessary, hand expressing or pumping the milk is encouraged. In such cases, the expressed milk, which contains multiple immune factors, may be fed to the baby to help prevent the baby from getting the infection or to help reduce the severity and duration of infection if the baby does get sick.
World Health Organization Guidelines
The World Health Organization states that close contact and early exclusive breastfeeding helps a baby to thrive. A woman with COVID-19 should be supported to breastfeed safely, hold her newborn skin-to-skin, and share a room with her baby.
The American College of Obstetricians and Gynecologists last made revisions to their guidelines on April 4, 2020. The reason I look at the guidelines put out by ACOG is that these guidelines drive policies and procedures for OBGYNs and hospitals in the United States. If you know what information is guiding your care provider, it can help give you a better understanding of how to navigate these policies and procedures.
To start, ACOG acknowledges the evidence-based benefits of skin-to-skin contact. The benefits include bonding, increased likelihood of breastfeeding, stabilization of glucose levels, and maintaining infant body temperature. They state that the determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team. Considerations in this decision include:
- The clinical condition of the mother and the infant
- SARS-CoV-2 testing results of mother (confirmed vs. suspected) and infant (a positive infant test would negate the need to separate)
- Desire to feed at the breast
- Facility capacity to accommodate separation or colocation
- The ability to maintain separation upon discharge
- Other risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant
Weeks ago, it was extremely alarming that there was talk about separating mothers and babies after birth. Hospitals are working to do their best for everyone’s safety, including you and your baby. These decisions should be made, as ACOG states, on a case-by-case basis. If you do not want to be separated from your baby, regardless of the status of a SARS-CoV-2 test, you can advocate for that. Your partner, or any support person with you, can also advocate that your baby stays with you. If this is important to you, bring this up with your doctor or midwife now. Do not wait to have that conversation in labor or after birth. Start that conversation now. Get informed on their current policies and make your wishes clear. Do keep in mind that these guidelines and hospital policies are changing.
Breastfeeding Guidelines if You and Your Baby Remain Together
ACOG goes states if there is no separation, other measures to reduce the risk of transmission from mother to infant could include the following, again, utilizing shared decision-making:
- Using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the mother.
- Mothers who choose to feed at the breast should put on a face mask and practice hand hygiene before each feeding.
- If the mother is not breastfeeding and no other healthy adult is present in the room to care for the newborn, a mother with known or suspected COVID-19 should put on a face mask and practice hand hygiene before each feeding or other close contact with her newborn.
- The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based Precautions in a healthcare facility.
Keep in mind these guidelines are if you have confirmed or suspected COVID-19. For mothers who are not infected, there should be no changes to being with your baby after birth. Remember, any decision to temporarily separate you from your baby should be a shared decision between you and your care provider. This decision is not something that should be determined without consulting you or without your consent.
The importance of discussing the guidelines on whether mothers and babies remain together has a significant impact on breastfeeding. Typically, you are skin-to-skin with your baby as soon as they are born, and uninterrupted for the first hour. In those early days and weeks, you should be skin-to-skin with your baby as much as possible.
Breastfeeding Guidelines if You and Your Baby are Separated
According to ACOG, if there is a temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. If possible, you should have a dedicated breast pump. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed, and the entire pump should be appropriately disinfected per the manufacturer’s instructions. Expressed breast milk should be fed to the newborn by a healthy caregiver. If a mother with known or suspected COVID-19 and her infant does room-in, and the mother wishes to feed at the breast, she should put on a face mask and practice hand hygiene before each feeding.
The Demand and Supply System of Milk Production
A key thing to keep in mind is that breastfeeding and pumping work on a demand and supply system. The more milk that is removed from your breast, the more you will produce. Staying on top of breastfeeding or pumping in the first few weeks is crucial to establishing your milk supply. If you skip a feeding or a pump session, you are effectively telling your breasts to produce less milk. When you are skin-to-skin with your newborn breastfeeding is much easier, than if you have to set an alarm to pump. If you are pumping milk for your baby you should be pumping as often as your baby would be feeding.
Pumping vs. Breastfeeding
Pumping is the next best thing to breastfeeding, but these two are not identical. A breast pump is less efficient at removing milk from your baby. If you can get access to a hospital-grade pump, those tend to be better than a pump for home use. Even if you do not plan to use a breast pump or think you will need one, get one. These are covered by your health insurance and should be free. There are some companies, like Aeroflow, that help coordinate this process. You can always also reach out to your insurance company to get more information on what is covered and how to order your pump before your baby is born.
Access to Lactation Consultants
A lactation consultant can be a lifesaver for your breastfeeding relationship. Lactation consultants may be limited in being able to see you in person, but there is a lot they can do in a virtual meeting. If you are having any issues with breastfeeding or pumping, you want to get in touch with a lactation consultant right away. Their help can keep a small problem from becoming a big problem. If you are meeting with a lactation consultant virtually, it can be helpful to have someone else hold your phone or help position a laptop or camera so the consultant can see your baby latch from a good angle.
Getting Educated and Preparing for Breastfeeding
I am a big advocate of getting educated about breastfeeding before your baby arrives. It is a common misconception that breastfeeding comes naturally to everyone. I sincerely hope that is the case for you. That was not my experience, and many mothers struggle with breastfeeding. The more educated you are before you start, the better prepared you will be to overcome challenges.
I am optimistic that we will all get through the problems we are facing right now. Don’t panic, plan. Even if you have no symptoms of COVID-19, you may be tested upon admission to a hospital in labor. Many people who have COVID-19 are asymptomatic. The best thing you can do to prepare is to get educated and stay as healthy as possible. While the vast majority of people who contract COVID-19 are recovering, if you can avoid it, you want to. Guidelines we discussed in this article apply to anyone who is positive for COVID-19 or who is a patient under investigation. You are considered a PUI if you have been in contact with anyone who is positive for COVID-19 or who has any symptoms, or if you have any symptoms.
Additional Breastfeeding Resources
Talk to Your Doctor or Midwife
This topic is one you should be discussing with your doctor or midwife for their thoughts and recommendations. They are your trusted partner during your pregnancy and birth and can help you navigate this. Hopefully, they are communicating any changes in their practice, policies, or recommendations with you as this situation evolves.
How Can I Help?
Please email me and let me know what resources I can help you find and how I can help you navigate this challenging time.
- American College of Obstetricians and Gynecologists
- Royal College of Obstetricians and Gynaecologists
- World Health organization
- Centers for Disease Control & Prevention
- Dr. Peter Attia is an excellent resource for additional information and podcasts on the SARS-CoV-2 virus and COVID-19
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