Breastfeeding Recommendations in the Time of COVID-19 – What Nurses Need to Know
Once considered the happiest time of motherhood, new mothers are now facing anxiety and uncertainty about bringing a new life into this world. Pregnant women are receiving less in-office care and more virtual visits. They are unable to have a baby shower with friends and family or introduce their newborn to anyone due to shelter-in-place guidelines.
Expectant mothers who go into labor are swabbed for COVID-19 upon arrival at the hospital. They are required to labor in a mask in many institutions despite their results, while surrounded by providers wearing personal protection equipment. Some hospitals allow one support person, while others are requiring mothers to labor alone.
Contracting COVID-19 means the possibility of separation from their newborn baby, as well as the chance of becoming ill for an extended period of time and missing out on important bonding experiences with their newborn. During this difficult time, expecting mothers need support more than ever. The question arises for nurses: should we separate infected mothers from their Infants? This article will breakdown the recent recommendations for COVID-19.
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What Happens After Delivery?
According to the Center for Disease Control (CDC), infants born to mothers with known COVID-19 at the time of delivery should be treated as infants suspected with COVID-19. Infants should be isolated from healthy infants and cared for accordingly.
Many hospitals in the US are routinely separating mothers infected with COVID-19 from their newborns due to conflicting recommendations. While current guidelines allow and support breastfeeding and cohorting mothers, this is not conveyed in the media and can cause anxiety in new mothers.
According to the CDC's Inpatient Obstetric Guideline, the determination of separation of a positive or suspected positive mother and her infant should be made on a case-by-case basis through shared decision-making between the clinical team and the mother. Considerations rely primarily on the clinical condition of the mother. If the mother is too ill to care for the infant, it is safest to separate the infant from the mother.
Additional considerations include the confirmed positive measured against the suspected results of the mom and baby. If a newborn tests positive, there is no reason to separate as long as the mother is clinically stable. Decision-making may also include the facility's ability to accommodate separation between the mother and infant and maintain separation of mother and baby upon discharge.
Benefits Versus Risks of Breastfeeding With COVID-19
According to the American College of Obstetrics and Gynecology, traces of the virus have not been found in breast milk thus far. However, since this is a novel virus, there is not enough evidence yet on whether a mother carrying the illness can pass the virus through her breast milk. Breast milk gives babies protection against many illnesses and is vital to helping their immune system.
If a mother has symptoms or tests positive for COVID-19, the ACOG recommends the following steps towards decreasing the spread of the virus; the mother should always wash her hands before touching the baby and the mother should wear a face mask while breastfeeding if possible. If the mother chooses to pump, she should wash her hands prior to touching any pump parts or bottles and be sure to sanitize all parts properly after use.
If a mother is exclusively pumping, have a person who is healthy feed the infant with her expressed breast milk. In extreme cases, if a mother is too ill to care for the infant and separation has occurred, women with a strong desire to breastfeed but are too weak or not clinically stable to pump on their own, can be expressed by a healthcare provider with an electric breast pump if deemed safe for the mother and provider.
Separating an infant from their mother compromises the important hours immediately following birth and allowing for skin to skin contact, which is vital in establishing a successful breastfeeding relationship.
There is conflicting data around infants becoming seriously ill from COVID-19, but the risk of the mother spreading the virus to the infant should always be considered and attempted to be prevented as much as possible by following strict respiratory hygiene.
The CDC does not routinely recommend separating infants from infected mothers, and there is currently insufficient data to support doing so. Mothers and health providers must weigh the risk of the rare possibility of the infant contracting a severe COVID infection, versus the risk of not establishing breastfeeding in the immediate newborn period and potentially experiencing breastfeeding failure. Breastfeeding has been shown to provide significant protection from infections, and mothers pass antibodies through their milk from pathogens that they have been exposed to.
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Ultimately, the decision is up to the mother. Health care providers should educate new mothers on the potential risks for exposure, as well as the risks and benefits of separation versus cohorting together. During this stressful time, it's important for mothers to be educated and empowered to make decisions that are safe and healthy for their newborn.
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