Preserving breastfeeding in the age of COVID-19: A call to action
COVID-19 has so far shown significant impact on maternity clinical practice, lactation counselling and support services. More than half of the healthcare professionals in the maternity ward and NICU have reported important changes in clinical practice.
The healthcare system is under considerable pressure and supporting staff are being reduced, with midwives and breastfeeding specialists being most affected by these reductions.
As a result, new mothers lack essential support in the first critical days to help their infants to breastfeed or, if the infant cannot breastfeed, to initiate and build an adequate milk supply for the long term. In addition, COVID-19 has caused significant stress in breastfeeding mothers due to diverse factors.
A call to action: Steps healthcare professionals can take to protect and promote breastfeeding during COVID-19 times and beyond
Keeping mother and baby together
One important way in which healthcare professionals can support mothers is to ensure that skin-to-skin contact is established as early as possible. Ideally, the baby should go to the breast within the first hour after birth. This recommendation reflects the latest guidelines from the CDC1 and the American Academy of Pediatrics (AAP),2 which recommend that all mothers - even those with COVID-19 - should stay with their babies (ideally rooming-in), with appropriate precautions to minimize the risk of infection (face coverings, hand washing, etc).
Ensuring maximum support during the critical period after birth
The first hours and days after birth are critical for successful breastfeeding.3, 4 Providing mothers with appropriate support and counselling during this period is imperative to help them initiate and maintain an adequate milk supply.
Initiating milk supply with pumps where necessary
Many mothers stop breastfeeding because they feel that their milk supply is inadequate.5, 6 It is helpful to identify women who could benefit from early pump use, to initiate and build an adequate milk supply in a timely fashion
On discharge from hospital
Healthcare professionals should discuss with mothers the importance of regular, frequent breastfeeding at home during the first two weeks after delivery, so they understand the importance of building an adequate milk supply for the long term. If direct breastfeeding is not effective or not possible during those early days, it is necessary to use a hospital-grade double breast pump to ensure proper initiation, building and maintenance of adequate milk volumes.7
Transitioning from hospital to home-based care
This may include guidance and advice on continuing breastfeeding, ongoing counselling, and the provision of information about available resources. In the FMR Global Health research study of maternity ward and NICU staff described previously, both groups identified virtual follow-up and education about precautionary measures to reduce the risk of infection as key elements in supporting mothers with their breastfeeding at home.8 Such support may take various forms including:
- Virtual support for any problem, or for lactation counselling
- Advising on precautionary measures to minimise the risk of infection
- Recommending support networks of family or friends
- Encouraging mothers to breastfeed and/or pump at home.
In the FMR Global Health report on Preserving breastfeeding in the age of COVID-19: A call to action8 39% of maternity ward staff, and almost half (47%) of NICU staff reported changes in the support offered to mothers on discharge. In particular, both groups reported that personal breast pumps were being provided to a higher proportion of breastfeeding mothers and maternity ward staff were providing more hospital-grade rental pumps as a result of the pandemic. It would be beneficial to ensure that women who need to pump in the early days know how to obtain a hospital-grade breast pump once at home.7
Conclusion
It is clear that the COVID-19 pandemic has had a marked impact on maternity and breastfeeding practices. As the pandemic has progressed, our understanding of the lack of any risk of transmission of infection from mothers to their infants via breast milk has been confirmed.9 Evidence also showed the protective value of human milk against the virus, with neutralizing antibodies being detected in milk from previously infected women.10, 14 It is therefore largely recognized that breastfeeding should be encouraged and supported even in women infected with COVID-19. Healthcare professionals can provide invaluable guidance and support to help mothers breastfeed successfully, despite the challenges posed by the pandemic and infection control measures. During the mother’s hospital stay, mothers and babies should be kept together and supported to initiate lactation appropriately. Given the shortened length of maternal stay in COVID-19 times, it is imperative that community-based support and hospital-grade pump technology are prescribed as appropriate and become indications in clinical guidelines.
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- CDC. Coronavirus Disease 2019 (COVID-19): Breastfeeding and Caring for Newborns; 2021 [cited 2021 Jul 6]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html#mothers-suspected?
- Wykoff AS. Rooming-in, with precautions, now OK in revised AAP newborn guidance. AAP News. 2020; July 22:1–3.
- Nilsson IMS et al. Focused breastfeeding counselling improves short- and long-term success in an early-discharge setting: A cluster-randomized study. Matern Child Nutr. 2017; 13(4).
- Widström A-M et al. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019; 108(7):1192–1204.
- Brown CRL et al. Factors influencing the reasons why mothers stop breastfeeding. CJPH. 2014; 105(3):e179-85.
- Wagner EA et al. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013; 132(4):e865-75.
- Meier PP et al. Which breast pump for which mother: An evidence-based approach to individualizing breast pump technology. J Perinatol. 2016; 36(7):493–499.
- FMR Global Health. Understanding the impact of COVID-19 on hospital maternity and breastfeeding practices; 2020 .
- Cheema R et al. Protecting Breastfeeding during the COVID-19 Pandemic. Am J Perinatol. 2020; doi: 10.1055/s-0040-1714277.
- Pace RM et al. Characterization of SARS-CoV-2 RNA, antibodies, and neutralizing capacity in milk produced by women with COVID-19. mBio. 2021; 12(1).
- Dong Y et al. Antibodies in the breast milk of a maternal woman with COVID-19. Emerging Microbes & Infections. 2020; 26(6):1–12.
- Fox A et al. Robust and Specific Secretory IgA Against SARS-CoV-2 Detected in Human Milk. iScience. 2020; 23(11):101735.
- van Keulen BJ et al. Breastmilk; a source of SARS-CoV-2 specific IgA antibodies [published online ahead of print, 21 Aug 2020]. SSRN Electron J [Internet]; Available from: https://ssrn.com/abstract=3633123.
- Juncker HG et al. Antibodies Against SARS-CoV-2 in Human Milk: Milk Conversion Rates in the Netherlands. J Hum Lact. 2021:8903344211018185.
