You, Your Baby, Breastfeeding, and COVID-19

by Jessica Martin-Weber

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Breastfeeding Coronavirus Hand Washing

 

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).

 

Breastfeeding when COVID-19 positive

 

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.

For an ever growing list of resources and information on breastfeeding and COVID-19 including studies, health organization recommendations, and more, please see this list. We will be adding resources as they become available so check back frequently.

 

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Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of wereallhumanhere.com, freelance writer, and co-founder of Milk: An Infant Feeding Conference. Jessica lives with her family in the Pacific Northwest and co-parents her 8 daughters with her husband of 23 years.

Breastfeeding and COVID-19 Research and Resources

Updated June 19, 2020
Compiled by The Leaky Boob, theleakyboob.com, Facebook.com/TheLeakyBoob

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The Leaky Boob is committed to providing free information, support, and community. You can be a part of making that possible by joining our circle of support. Any and all support amount makes a difference.

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This resource list is an evolving work in progress. If you are aware of some resources or materials that should be included, please comment with the link.

 

Health Organizations Recommended Practices and Protocols:

Considerations for Inpatient Obstetric Healthcare Settings

  • CDC (Centers for Disease Control and Prevention)

 

Evaluation and Management Considerations for Neonates At Risk for COVID-19 – Caring for Newborns

  • CDC (Centers for Disease Control and Prevention)

“…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.”

 

Breastfeeding advice during the COVID-19 outbreak

  • WHO (World Health Organization)

 

ABM STATEMENT ON CORONAVIRUS 2019 (COVID-19)

  • ABM (Academy of Breastfeeding Medicine)

 

Pregnancy, childbirth and caring for newborns: Advice for mothers during COVID-19

  • Public Health Agency of Canada

 

Clinical Management of COVID-19

  • WHO (World Health Organization)

 

Infant and Young Child Feeding in Emergencies, including COVID-19

  • United States Breastfeeding Committee 

 

 

Pregnancy, Birth, and Breastfeeding and COVID-19 Specific Resources:

 

SARS‐CoV‐2 and human milk: What is the evidence?

  • Wiley Online Library
    • Kimberly A. Lackey, Ryan M. Pace, Janet E. Williams, Lars Bode, Sharon M. Donovan, Kirsi M Järvinen, Antti E. Seppo, Daniel J. Raiten, Courtney L. Meehan, Mark A. McGuire, Michelle K. McGuire

 

New Studies Investigate How COVID-19 May Impact Breast Milk and Pregnancy 

  • University of California San Diego School of Medicine – Michelle Brubaker

 

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.

  • The Lancet
    • Huijun Chen, PhD – Juanjuan Guo, MS – Chen Wang, PhD – Fan Luo, PhD – Xuechen Yu, MD – Prof Wei Zhang, PhD – Prof Jiafu Li, MS – Prof Dongchi Zhao, PhD – Dan Xu, MS – Qing Gong, MS – Jing Liao, PhD – Prof Huixia Yang, MD – Prof Wei Hou, PhD – Prof Yuanzhen Zhang, BS 

 

Antibodies in Infants Born to Mothers With COVID-19 Pneumonia

  • Jama Network
    • Hui Zeng, MD – Chen Xu, BS – Junli Fan, MD – Yueting Tang, PhD – Qiaoling Deng, MD – Wei Zhang, MD, PhD – Xinghua Long, MD, PhD

 

Guidelines for Healthcare Facility Management of Perinatal Care of Persons with COVID-19 of Suspected COVID-19

  • Bryna Sampey

 

Skin-to-Skin Care and COVID-19: downloadable file

 

Breastfeeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the union of European Neonatal & Perinatal Societies

  • Wiley Online Library
    • Riccardo Davanzo – Guide Moro – Fabrizio Sandri – Massimo Agosti – Corrado Moretti – Fabio Mosca

 

COVID-19, Pregnancy and Breastfeeding: What We Know Is Reassuring

  • Helpful blog post with compilation of materials explained

 

Mother-Infant Contact and Breastfeeding Should Remain Top Priorities during COVID-19

  • John Hopkins Nursing, Dr. Cecília Tomori

Breastfeeding, Separation, and COVID-19 Specific Resources:

When Separation is not the Answer: Breastfeeding Mothers and Infants affected by COVID‐19

  • Wiley Online Library
    • Cecilia Tomori – Karleen Gribble – Aunchalee E.L. Palmquist – Mija-Tesse Ververs – Marelle S. Gross

 

COVID-19: Separating Infected Mothers from Newborns: Weighing the Risks and Benefits

  • Harvard Medical School – Melissa Bartick, MD, MS, FABM

 

Mother-Baby Separation for COVID-19 Not Evidence-Based, Experts Say

  • MedScape – Troy Brown, RN 

 

Should New Mothers With COVID-19 Be Separated From Their Newborns

  • The Hastings Center
    • Stowe Locke Teti – Christy Cummings – Louise P. King – Cynthia C. Coleman – Kayla Tabari – Christine Mitchell 

 

 

Maternal Mental Health, Separation, and COVID-19 Specific Resources:

COVID-19 and maternal mental health: Are we getting the balance right? 

  • MedRxiv (The Preprint Server for Health Sciences) – CHS (Cold Spring Harbor Laboratory – BMJ – Yale
    • Anastasia Toplidou – Gill Thomson – Soo Downe

 

Effects of COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study

  • Taylor & Francis Online
    • Ferit Durankuş – Erson Aksu

 

 

Breastfeeding and Separation Resources, General:

Rights of Children in Relation to Breastfeeding in Child Protection Cases: downloadable file

 

 

Helpful Breastfeeding Resources, General:

Exclusive breastfeeding for the first 3 months of life may reduce the risk of respiratory allergies and some asthma in children at the age of 6 years.

  • Wiley Online Library – Gayla Bigman

 

 

Working with Health Care Providers Resources:

Breastfeeding Empowering Language in Medical Settings

  • Mom2Mom Global- Amy Smolinski

 

The SHARE Approach—Essential Steps of Shared Decisionmaking: Quick Reference Guide

  • AHRQ(Agency for Healthcare Research and Quality

The SHARE Approach is a 1-day training program developed by the Agency for Healthcare Research and Quality (AHRQ) to help health care professionals work with patients to make the best possible health care decisions. It supports shared decisionmaking through the use of patient-centered outcomes research (PCOR).

 

 

Current and Ongoing Studies:

ISRHML Activities and Guidance related to COVID-19

  • ISRHML (The International Society for Research in Human Milk and Lactation)

 

 

Additional Resources:

Safe Handling of Containers of Expressed Human Milk in All Settings During the SARS-CoV-2(COVID-19) Pandemic

  • National Library of Medicine – National Center of Biotechnology Information
    • Kathleen A Marinelli – Robert M Lawrence

 

Publishers Provide Scholarly Content Free on Project MUSE During COVID-19 Crisis

  • Project Muse

 

Is there a resource or research you’d like to see included here? Please let us know.

 

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If this resource was helpful for you, consider helping The Leaky Boob by giving back. Help us keep our information, support, and resources free by becoming a patron and get access to exclusive content just for our supporters. Join here today.

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