The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study

Abstract

Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

Overview of Breastfeeding Under COVID-19 Pandemic

“…The risk of vertical transmission of SARS-CoV-2 through the breastmilk is low ( 33 , 35 , 105 ). Therefore, recommendations for pregnant COVID-19 patients have been rapidly shifting with various waves of the pandemic, but in general, World Health Organization ( 90 ), United Nations International Children’s Emergency Fund ( 106 ), and most countries ( 107 , 108 ) support mothers with COVID-19 to contact and breastfeed their newborns and infants following the necessary hygiene rules, including disinfection with alcohol, wearing face masks, and obtaining written informed consent from parents ( 109 ).…”

Protecting Breastfeeding during the COVID-19 Pandemic: A Scoping Review of Perinatal Care Recommendations in the Context of Maternal and Child Well-Being

“…During the COVID-19 pandemic, many hospitals have suspended human milk banking services due to the reduced number of personnel, resulting from imposed quarantine or isolation [ 67 ]. In Brazil [ 91 ], most of the medical centers did not accept milk donation due to fear of SARS-CoV-2 infection (23 out of 24, 95.8% of reviewed hospitals). Therefore, as it was reported by the Collaborative Network of Milk Banks and Associations, the significant decrease in human milk donation rates was globally observed in the time of the COVID-19 pandemic.…”

“…In 19% (7 papers) it was directly indicated that, regarding SSC, pre-pandemic recommendations should not be changed and routine care should be provided [18,42,47,69,82,86,87]. Recommendations against SSC were found in 27% of the papers addressing this issue (15 papers) [25,26,[28][29][30]37,48,53,61,62,64,68,89,90], including 1 paper in which different kinds of Brazilian recommendations, mostly prohibiting SSC, were recalled and discussed due to being controversial and potentially negatively impacting breastfeeding success, but the authors did not formulate their own recommendations [91]. Half of the recommendations (7 studies) among those against SSC were published in the second and third quarters of 2020 [25,26,37,61,62,64,68].…”

COVID-19 Pandemic-Related Restrictions: Factors That May Affect Perinatal Maternal Mental Health and Implications for Infant Development

“…These restrictions have a negative effect on mother's mood, self-esteem, self-confidence and confidence in their abilities related to their infant's care. Standard precautions (such as hand hygiene, use of medical mask, routine disinfection) applied by mothers with suspected, or confirmed COVID-19, who must take care of their infants by themselves, may impose psychological demands on new mothers and may complicate the early mother-infant relationship ( 51 – 56 ).…”

“…However, the absence of recommendations on breastfeeding support and lack of support has led to reduced compliance to the recommendations of main scientific institutions suggesting breastfeeding initiation. This may has affected adversely both maternal mental health and the rate of breastfeeding ( 50 , 51 , 109 ). However, mothers experience breastfeeding heterogeneously since 41.8% felt that breastfeeding was protected due to the lockdown but 27% of mothers reported a negative impact of lockdown upon their breastfeeding experience.…”