Updating Clinical Practices to Promote and Protect Human Milk and Breastfeeding in a COVID-19 Era

Abstract

The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices implemented early in the pandemic being mostly anti-breastfeeding, e.g., separation of mothers from their infants, and not evidence based. As the pandemic has progressed, evidence has emerged reconfirming the value of human milk and the importance of protecting and supporting breastfeeding, especially the initiation of lactation. However, it is clear that COVID-19 has changed the clinical care paradigm around breastfeeding and lactation support and, as such, it is imperative that practices adapt and evolve to maintain the emphasis on lactation support. We participated in a round table conference aiming to rescue and develop protocols and practices that support breastfeeding during the COVID-19 pandemic. One key area to target will be to maximize the use of the antenatal period. The early identification of lactation risk factors together with the development of person-centered methods to deliver breastfeeding information and education to parents-to-be will be critical. In addition, the establishment of a hospital culture that values breastfeeding and prioritizes the use of human milk will be integral for the motivation of health care professionals. That culture will also support active management of the initiation of lactation and the development of a 'back-up plan' toolkit to support the mother experiencing lactation difficulties. Post-discharge support will also be crucial with the development of both in-person and virtual lactation support programs, in particular for the immediate post-discharge period to benefit mothers who experience an early discharge process. These measures will allow for a new, adapted framework of practice that acknowledges the current COVID-19 paradigm and maintains the emphasis on the need to protect and support breastfeeding and the use of human milk.

Mother-to-child transmission of SARS-CoV-2 infection in high-income countries: a systematic review and meta-analysis of prospective observational studies

“…Differences in available studies could be due to the difficulty of discriminating whether a more severe clinical course is the result of an induced delivery or caesarean section imposed by the severe clinical condition of the mother, associated to neonatal complications connected to preterm delivery, mode of delivery and critical maternal conditions at the time of delivery, rather than to a real direct effect of the virus on the infants' organism 39 , 45 . In fact, our data support that the balance between the potential risk of postnatal transmission of the virus by the mother is decisively outweighed by the well-known benefits of skin-to-skin contact, rooming-in practice and above all, breastfeeding 6 . In fact, since the first wave of the pandemic, several international institutions, including the WHO, have issued guidelines that did not recommend the precautionary separation of the infected mother from her child 46 , 47 .…”

“…As a result, increased reliance on breast milk substitutes occurred 4 , 5 . However, many authors have demonstrated the safety of breastfeeding even during maternal COVID-19 infection, and nowadays, these concerns and the choice of formulated milk seem unjustified 6 . Furthermore, breastfeeding provides the optimum nutrition for the neonate and protects the infant against infection, even in the case of SARS-CoV-2 6 , 7 .…”

“…However, many authors have demonstrated the safety of breastfeeding even during maternal COVID-19 infection, and nowadays, these concerns and the choice of formulated milk seem unjustified 6 . Furthermore, breastfeeding provides the optimum nutrition for the neonate and protects the infant against infection, even in the case of SARS-CoV-2 6 , 7 . Indeed, it has now been demonstrated that breast milk does not contain complete viral particles with the ability to replicate but instead contains antibodies with a neutralizing capacity in the case of a mother infected with the virus 8 , 9 .…”

Impact of COVID-19 on Breastfeeding among SARS-CoV-2 Infected Pregnant Women: A Single Centre Survey Study

“…Despite these reassuring data, guidelines and local practices that emerged during the pandemic were largely contrary to the promotion and protection of breastfeeding, including the restriction of parental presence at the bedside, complete separation of mothers who were either confirmed or suspected as COVID-19 positive from their infants, discouragement or abandonment of skin-to-skin contact and direct breastfeeding, early discharge following birth, and a lack of access to in-person pediatric follow-up and breastfeeding assistance [21]. Therefore, especially in the first phase of the pandemic, separation of the newborns from their mothers was applied in many settings, even though such a practice has been considered a violation of human rights [22].…”

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

“…Apart from mortality and morbidity, the pandemic has also impacted all areas of health service delivery including breastfeeding. 4 At the start of the pandemic, the medical and scientific community lacked information regarding the route of transmission of the virus, thus many preventative measures were launched to protect mothers and babies. When it became evident that it is a respiratory virus, the next question was whether mothers could infect their infants during breastfeeding.…”