A review of the disruption of breastfeeding supports in response to the COVID-19 pandemic in five Western countries and applications for clinical practice

Abstract

Background The COVID-19 pandemic has significantly altered how breastfeeding support is provided, resulting in mixed breastfeeding outcomes and experiences for mothers. The World Health Organization has consistently supported breastfeeding from the beginning of the pandemic. However, recommendations from obstetrical and gynaecological societies within individual countries have varied in their alignment with this guidance, resulting in inconsistent recommendations. It is unknown how breastfeeding guidelines, maternal breastfeeding experiences, and breastfeeding initiation and duration compared across five Western countries. The current study is comprised of two parts, each with a different objective. Part One objective: to review pandemic-related changes in professional society guidelines on breastfeeding support in Australia, New Zealand, Canada, the United Kingdom, and the United States; and Part Two objective: to conduct a narrative review to summarize the evidence of how the pandemic has changed breastfeeding initiation, duration, and mothers’ breastfeeding experiences during the pandemic in these five countries and provide recommendations for clinical lactation support. Methods We searched for indicators that are impactful on breastfeeding outcomes: skin-to-skin contact, rooming in, direct breastfeeding and breast washing, in the five countries mentioned above and compared these to the recommendations from the World Health Organization. Next, we conducted a narrative review of the literature from these five countries to explore how the pandemic altered breastfeeding outcomes and used this information to provide suggestions for clinical practice moving forward. Results Recommendations on the four practices above differed by country and were not always in alignment with the World Health Organization recommendations. Mother-infant separation after birth in the United States was associated with a lower prevalence of breastfeeding initiation and duration. While some mothers reported positive breastfeeding experiences during the pandemic, many mothers indicated negative experiences related to decreased social and professional support. Conclusions The pandemic can inform practice recommendations and can be viewed as an opportunity to permanently modify existing methods to support breastfeeding families. The use of virtual care increased during the pandemic and should continue with specific considerations for prioritizing in-person care. This will help to provide more timely and accessible support for breastfeeding mothers.

Impact of the COVID-19 Pandemic on Breastfeeding Support Services and Women’s Experiences of Breastfeeding: A Review

“…Some of the papers highlighted the impact of separation between mothers and infants and between mothers and birth companions on breastfeeding rates. 24 , 25 The papers by Gribble et al 26 and Brown and Shenker 8 highlighted the unnecessary and detrimental impact of separating mother-infant dyads after birth, and particularly for those with additional vulnerabilities due to being born premature and/or sick, with Gribble et al 26 arguing how this occurred “despite no evidence of risks”. In the paper by Brown and Shenker, approximately a quarter of mothers who had an infant in the neonatal unit were told that they could not visit their infant, and this lack of contact was significantly associated with breastfeeding cessation.…”

“…The lack of professional support during the pandemic was highlighted, often associated with limited in-person breastfeeding support in the hospital unit and within the community, 8 , 24 , 25 , 31 with some women reporting that they felt they were doing it “on their own”. 34 While women were generally able to access different types of support, eg, health professionals and lactation consultations, 32 the quality and quantity of support were restricted.…”

“…The professionals who provided the groups felt that they were less effective. 24 Furthermore, in the review by Turner et al, 25 it was highlighted how mothers expressed difficulties in receiving professional help with breastfeeding techniques online. Conversely, in the paper by Feinstein, 27 converting an in-person breastfeeding support event to a telehealth environment, with parents viewing online breastfeeding sessions, was positively received.…”

“…Furthermore, the study by Sakalidis et al 30 undertaken in Australia reported a reduction in the odds of exclusive breastfeeding as infant age increased, associated with low milk supply. Turner et al 25 explored how the pandemic restrictions and positive COVID-19 status of the mother impacted breastfeeding initiation, duration, and mothers’ self-reported breastfeeding experiences in Australia, New Zealand, Canada, the UK and the United States of America (US). This work found that seven US studies and one UK study linked the pandemic to changes in breastfeeding initiation and duration, and that in most studies including COVID-19-positive mothers, a reduction in breastfeeding initiation and duration was observed.…”

Exclusive breastfeeding and women's psychological well-being during the first wave of COVID-19 pandemic in Italy

“…In the first weeks of the emergency, there was no evidence about the possibility of vertical transmission of SARS-CoV-2 through breastfeeding or human milk and the literature on vertical transmission of other coronaviruses (MERS or SARS) was very poor ( 8 – 10 ). Several studies showed how this uncertainty affected breastfeeding rates ( 11 ). The authors of an Italian study enrolled 204 mothers during the first lockdown and compared them to a group of 306 mothers who took part in a previous study.…”