To Feed or Not to Feed? Challenges of COVID-19 and Human Milk guidelines.

In August we celebrated National Breastfeeding Month as well as World Breastfeeding Week, after a very traumatic year for breastfeeding moms and caregivers. Each year, the message is to unite the medical and scientific community, as well as public health officials on the evidence-based medicine of breastfeeding/chestfeeding and remind the community of their benefits for mothers and babies.In the past few years, the World Health Organization(WHO) as well as the Center for Disease Prevention (CDC) have released a guidelines on promoting and supporting breastfeeding in facilities providing maternity and newborn services. The message at the beginning of the year, however, became very unclear when many moms and babies were separated at the start of the pandemic.

As a Doctor-in-Training Board member of the Academy of Breastfeeding Medicine, I saw the guidelines and best practices shift from one day to the next, as providers and families feared exposure to COVID-19 for their newborns and infants. A lot of pressure was placed on major medical organizations to release guidance on pressing questions about COVID in the care of infants and families. In march, the CDC advised that facilities should “consider temporarily separating mothers and newborns after having a discussion with these mothers, as well as their healthcare teams on the risks and benefits of breastfeeding.” At the same time, the Academy of Breastfeeding medicine put out a statement which said that “the choice to breastfeed is the mother’s and family’s.”

The Academy of Pediatrics first released guidance document on the “Management of Infants Born to Mothers with COVID-19” which was met with a lot of backlash from several physician scientists and community providers, such as Pediatricians, Front-line healthcare workers, and Lactation consultants. This was due to the fact that these guidelines were based on very little evidence that the SARS- CoV-2 virus could be transmitted via breastmilk and the risk of exposure outweighed the numerous benefits to immunity and health that came with human breast milk.

Due to this uncertainty which affected a lot of babies born around the summer this year, as well as those who were already breastfeeding, many physician scientists started on efforts to research COVID-19 and Breastmilk. One of these researchers is Dr. Melissa Bartick (an internist and assistant professor of medicine at Harvard Medical School) who has made the effort to translate her study recruitment materials in various languages, in order to reach a variety of different families around the world who have been affected by the virus. Dr. Casey Rosen-Carole (a Pediatrician and Breastfeeding Medicine expert) is also working as co-investigator in a study at the University of Rochester which aims to “Study Evidence of Transmission and Antibodies in Breast Milk of COVID-19 Positive Mothers.”

Luckily, various organizations around the world, as well as U.S based groups and organizations such as the Academy of Pediatrics (AAP), Academy of Breastfeeding Medicine (ABM), and the World Health Organization (WHO) are now on the same page moving forward. In August, the DC Breastfeeding Coalition, under the direction of Dr. Sahira Long (a board certified pediatrician and lactation consultant ) hosted an event which brought together representatives from these 3 organizations with one common message. This was, essentially, that Breastfeeding continues to be an important goal for babies and children as the world navigates through the COVID-19 pandemic and that mother and infant separation is detrimental.  

Today, we are dealing with other pressing issues in the Infant Feeding world, such as “Telelactation” visits, and getting the message out to mothers that it is recommended by professionals to breastfeed your baby, as long as you take the necessary precautions such as wearing a mask, and washing hands as well as pump parts. But most importantly, we want mothers to feel comfortable during this whole experience.

For more information on the current breastfeeding guidance from major organizations as well as how to contribute to some of the current COVID-19 and breastfeeding studies please visit the websites below.

Image may contain: 1 person, closeup, text that says 'Make a difference! you or your baby had Covid-19, we want to hear about your experiences. Take our survey! COVID Mothers Study HARVARD MEDICAL SCHOOL'

References

COVID-19 Mothers Study: https://hms.az1.qualtrics.com/jfe/form/SV_eXN0LFMwOW0R2u1

COVID-19 and Breastmilk study University of Rochester:

https://www.urmc.rochester.edu/childrens-hospital/news/breast-milk-covid-19.aspx#:~:text=A%20collaborative%20project%20between%20researchers,immunological%20properties%20against%20the%20disease.

Academy of Breastfeeding Medicine: https://www.bfmed.org/abm-statement-coronavirus

Academy of Pediatrics: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/

CDC: https://www.cdc.gov/breastfeeding/recommendations/index.htm

American College of Obstetrics and Gynecologists: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019

Unicef: https://www.unicef.org.uk/babyfriendly/infant-feeding-during-the-covid-19-outbreak/

International Society for Research in Human Milk and Lactation: https://www.isrhml.com/i4a/pages/index.cfm?pageid=3368

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