Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic

Abstract

For new families giving birth in a hospital setting, the COVID-19 pandemic has presented numerous challenges to their birth, breastfeeding, and postpartum experiences. We present experiences of three first-time, healthy mothers and their babies, as they gave birth in the hospital and were breastfeeding during the start of the pandemic in Philadelphia, PA. Each case is framed in the mother's prenatal goals, infant feeding intentions, birth, breastfeeding, and postpartum experiences. Shared concerns and experiences among the three participants are described in five key areas: 1) Recommendations changing every day, 2) Guilt, concern, and stress, 3) In-person versus telehealth visits, 4) Missing time with family and friends, and 5) Silver linings. Through these mothers' experiences, nurses and other health care providers can learn from their perceptions and events and proactively work to ensure we provide sound anticipatory guidance, enhance our communication, and improve provision of evidence-based lactation care and support.

Responsive caregiving, opportunities for early learning, and children’s safety and security during COVID-19: A rapid review

“…In contrast, others reported feeling violated during this impersonal interaction, describing how they felt discomfort recording their infant trying to latch onto the breast [59]. During the pandemic, some breastfeeding women reported some positive benefits, including having more time to focus on breastfeeding and responsive feeding, with fewer visitors, more, privacy and more significant breastfeeding support from fathers [58].…”

Promoting and Protecting Human Milk and Breastfeeding in a COVID-19 World

“…The initial lack of knowledge and continuing misinformation around COVID-19 and human milk has impacted breastfeeding mothers around the world. First and foremost, the COVID-19 pandemic has been a cause of significant stress for breastfeeding mothers (31), with families having difficulty in accessing evidence-based lactation care and support (2). This is of importance as prenatal and postnatal anxiety have also been identified as having a negative impact on breastfeeding duration, despite breastfeeding reducing post-partum depression (5-7).…”

“…Globally, the birth and breastfeeding experiences of families have not been prioritized and care has changed in ways that may negatively impact birth outcomes and the establishment of breastfeeding. Some of these negative practices are: 1) women being forced to go through labor and birth without the presence of a partner or support person (34,35), 2) some NICUs not allowing any parental presence at the bedside while others are limiting either the amount of time that the parents can visit or allowing only one parent to be present at a time (36), 3) some hospitals continue to separate mothers who are COVID-19 positive or a Person Under Investigation (PUI) from their infants despite WHO recommendations to avoid this practice (37), 4) discouragement of skin to skin contact and direct breastfeeding (38), 5) early discharge following birth, as early 24 h post-birth for vaginal births and 48 h post-cesarean birth (39, 40), 6) a lack of access to in person pediatric follow-up and hands-on technical breastfeeding assistance (2). Indeed, during the initial phase of the pandemic in Italy, there was concern that breastfeeding had actually been implicated as a "culprit or scapegoat, " despite available evidence suggesting that 1) few pregnant women have been severely affected by COVID-19, 2) evidence for transplacental transmission of the virus very rarely shows a clinical impact, and 3) infected neonates are generally asymptomatic, or have few symptoms, with similar infection rates with vaginal delivery or Cesarean section (41,42).…”

“…Rapidly changing recommendations on perinatal care induce stress and anxiety in pregnant women and in those who have just delivered a child (2). Families received conflicting information about allowing partners to be with them for childbirth, about whether or not direct breastfeeding and skin to skin contact were allowable, and conflicting advice about follow-up care.…”

“…Interviews conducted with first time COVID-19 negative mothers in the United States also found that birth and breastfeeding experiences were disrupted. Mothers reported that recommendations were changing daily and that they experienced significant stress and anxiety giving birth during the pandemic (2).…”