This Moment

by Jessica Martin-Weber

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Friends, your baby has the right to breastfeed if that is what you were planning to do, want to do, and are able to do.

Not even COVID-19 should stop that from happening.

Even if you test positive for coronavirus.

Even if a health care provider insists that you should be separated from your baby for your baby’s health.

Overwhelmingly, evidence supports that if you are well enough to hold your baby, you are well enough to breastfeed even when you test positive for COVID-19.

(If you are not well enough to hold your baby, you still deserve to be supported in breastfeeding- see here as to how that can be possible).

** See this collection of resources of research on breastfeeding and COVID-19, what you need to know, what health care providers need to know, how you can advocate for you and your baby and more. We will be adding to it as materials become available.**

We’ve heard from a number of families who are being told they have to separate from their baby at the time of birth if they test positive. Even if they are not symptomatic. Even if they are able to mask and care for their baby following the recommendations of the World Health Organization, the CDC (in the USA), and other major health organizations.

After giving birth is an incredibly vulnerable time and it can be difficult to advocate for yourself and your baby in the immediate hours and days following your baby’s birth. Having a plan and communicating that with your health care team and support person can go a long way in making that easier. Being aware of current recommendations and evidence-based practices as well as being informed on your birth facility’s protocols will allow you to better advocate for you and your baby.

The following is for those in the USA who are COVID-19 positive and physically able to provide care and breastfeed their baby.

Communicate your wishes to breastfeed even if you are CV19+ with your health care provider BEFORE giving birth if possible and request that it be included in your chart even if you do not test positive. It may be helpful to reference the WHO and CDC recommendations (included in the document linked here) and request that they be included in your chart as well. For example ask that something like this be charted:

“Patient has communicated that breastfeeding is a priority according to the recommendations of the CDC and WHO and requests lactation support regardless of patient’s COVID-19 status at time of birth.”

Current recommendations from the World Health Organization encourage breastfeeding and skin-to-skin when the lactating parent is COVID-19 as the best available protection for the infant with the parent wearing a mask and practicing good hand hygiene (and doing so for the chest area as well).

Current recommendations from the CDC are vague at best, conflicting and confusing at worst. Hospitals are given quite a bit of autonomy in determining their protocols and there’s a wide range of interpretations of the CDC recommendations. Key in their recommendations (updated as of May 20, 2020) is this: “…the risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team, and decisions about temporary separation should be made in accordance with the mother’s wishes.”

So what do you do if you give birth, are COVID-19 positive, and are told that separation from your infant is mandatory?

First, remember that nobody can take your baby from you without your permission without reasonable cause. You have the right to refuse to comply with protocols and practices with which you do not agree or understand. You have the right and responsibility to understand what is being recommended for the health of your child and the evidence for those recommendations. You have the right and responsibility to ask questions until you are satisfied and have the understanding you need. You have the right and responsibility to make fully informed consent in the health care decisions of you and your child. You have the right to make decisions about your child’s health care without bullying, coercion, or threats.

If you are told that your health care facility’s protocols require separation and no direct breastfeeding (pumping only), ask to speak to your child’s doctor directly, tell them you want to work together with them for the health and well-being of your new baby, that you want to understand exactly what is being recommended and why, and inquire why the WHO recommendations are not being followed.

Listen respectfully as they explain.

Then communicate clearly that you wish to follow current evidence-based recommendations to breastfeed directly and will practice good hand and chest hygiene and wear a mask but that it is your intent to breastfeed your baby according to the WHO recommendations on breastfeeding and COVID-19 positive status.

If you are told that the institution does not follow the WHO recommendations, you may want to point out that the CDC clearly states “…decisions about temporary separation should be made in accordance with the mother’s wishes.”

If you are again told separation is mandatory, you may find it helpful to say that you appreciate their concern for you and your child’s well-being but that you do not consent to separation based on current evidence-based recommendations to breastfeed.

If you are told that they will call CPS, you may want to state: “I would like it charted that you, Doctor/Nurse _____________ have said that CPS would be called on me if I followed the recommendations from the WHO and CDC regarding separation of the breastfeeding pair in the case of CV19+ status and that this institution would not support me in following current evidence-based recommendations regarding breastfeeding during the coronavirus pandemic.” Asking for this to be in our chart is protective for both you and the health care team. Documentation is very important. Maintaining your own documentation is also important should things escalate. Hopefully that won’t be the case but it is wise to be prepared.

If things continue to escalate, it may be time to reach out to seek legal counsel.

As much as this is a vulnerable time and there’s a lot happening in the body postpartum, as much as possible, remaining calm and non-combative is helpful. Keep in mind that information is changing rapidly and protocols are often decided by hospital administration rather than the actual care providers. The majority of healthcare professionals are just trying to help others as best they know how and may have been given no say in the hospital policies. Attacking them rarely is beneficial and could cost you an influential ally.

You and your baby should be together and evidence supports that. Should you find yourself dealing with a situation of mandatory separation at birth due to COVID-19 status, please know that all evidence supports that you and your baby should be together, have skin-to-skin, and breastfeed. You are the best person to advocate for your baby and your baby needs to be with you.