Breastfeeding With COVID-19: Is it OK?
As COVID-19 continues to change the landscape of healthcare, new mothers may be left wondering if it is safe to breastfeed. Can COVID-19 be transmitted via breast milk? What safety precautions should a mother take to protect her baby? What would happen if a newly delivered mother tested positive?
These are all important questions, and even though official advice may change as more is learnt about the virus, at present the answers seem reassuringly simple.
Assessing the Risk of Transmission
To date, the virus hasn’t been detected in amniotic fluid, cord blood or placental tissue. According to Martin (2020), there is no evidence of ‘vertical transmission’ from mother to fetus - but what evidence is there regarding the possibility of transmission through breast milk?
Even though there have been several reports of COVID-19 in newborn babies, it’s believed that transmission occurs in the same way as for everyone else, through respiratory droplets passed on by close contact (Martin 2020). At present, there is no evidence of vertical transmission, but this is only based on two small clinical studies (Baud et al. 2020).
Another small study based on just six Chinese cases of COVID-19 positive mothers found that their breast milk tested negative for COVID-19. However, given the small sample size, this evidence should be viewed with caution (RCOG 2020). Johnson (2020), who has also evaluated the limited studies on pregnant women with COVID-19 and other coronavirus infections such as Severe Acute Respiratory Syndrome (SARS-CoV), reports that so far at least, the virus has not been detected in breast milk.
This is good news for women who wish to breastfeed, and could potentially be even better if research is able to demonstrate that breast milk also has antiviral properties that could protect infants from COVID-19.
Clearly, this is one area where further research is urgently needed and scientists at the University of California San Diego School of Medicine are amongst the first to seek answers to these two critically important questions:
Understandably, the level of precautions needed varies depending on whether the mother has tested positive for COVID-19, or if she is awaiting test results. For others with no known or probable infection, it seems the benefits of breastfeeding outweigh any potential risks of transmission of COVID-19 through breastmilk
Care of Infants With COVID-19 Positive Mothers
Guidance issued by the International Lactation Consultant Association (2020) currently recommends that breastfeeding should continue regardless of whether the mother has COVID-19, as long as sensible safety precautions are maintained.
For mothers who test positive for COVID-19, concerns about transmission of the virus arise due to:
- The potential for breastmilk to carry the virus; and
- The increased risk of airborne droplet infection when the baby is held close to the mother’s body.
Separation of mother and baby at birth is not something that should be taken lightly and as long as both mother and baby are well enough to stay together, breastfeeding should still be encouraged (Johns Hopkins Medicine 2020).
As Taylor (2020) confirms, current guidance suggests that mothers who have tested positive should not be automatically separated from their babies, but should take enhanced precautions with general hygiene and if possible wear a face mask when feeding. General infection control precautions include:
- Keeping the baby’s cot six feet from the mother’s bed;
- Thorough hand washing before touching the baby; and
- Wearing a face mask when making direct contact with the baby and breastfeeding.
If temporary separation is required because the infant’s mother is too sick and needs medical care herself, then breastfeeding should still be encouraged using expressed breast milk to establish and maintain a milk supply.
As an additional precaution, a dedicated breast pump should be provided to avoid cross-infection. All parts of the pump that have come into contact with the breast milk should be thoroughly washed after each session of pumping, and the entire pump should be disinfected according to the manufacturer’s instructions before being passed on for further patient use (Johnson 2020).
In summary, mothers who want to breastfeed can help protect their baby from exposure to the virus by:
- Hand washing before touching the baby, breast pump or bottles;
- Avoiding coughing or sneezing on the baby while feeding at the breast;
- Wearing a face mask while breastfeeding, if available;
- Following recommendations for pump cleaning after each use; and
- Considering asking someone who is well to feed expressed milk to the baby.
As an extra precaution, because the vernix caseosa contains antimicrobial peptides, it’s recommended that it should be left in place until 24 hours after birth (WHO 2020).
Supporting the Need For Emotional Attachment
As every mother and midwife knows, supporting early emotional attachment after birth is of supreme importance. This is why for the sake of emotional wellbeing, babies should be kept close by so that their mothers can respond to their need for love, comfort and care, even if the mother tests positive for COVID-19.Remote Breastfeeding Support
Supporting breastfeeding mothers has always been an integral part of the midwife’s role, but doing so whilst maintaining social distance poses new problems. One solution is to draw on the rapidly expanding use of technology for remote consultations.
Not only do telephone and video calls fulfil the requirements of social distancing, but they also offer the potential for midwives who are self-isolating to continue contributing to the workforce without the risk of cross-infection. Training in the use of video calling is both simple and cost-effective, and for mothers with access to a webcam or smartphone, it can offer a safe and practical option for ongoing support.
Whilst no one can yet say definitively that there’s no risk of passing on COVID-19 via breastmilk, for the time being at least, the evidence appears to be reassuringly clear. The benefits of breastfeeding outweigh any potential risks of transmission of the virus, and mothers should be given every encouragement to breastfeed if they wish to.
- Australian Breastfeeding Association, COVID-19 Information, https://www.breastfeeding.asn.au/bfinfo/covid-19
- Unicef, Infant & Young Child Feeding in the Context of COVID-19, https://www.ibfan.org/wp-content/uploads/2020/03/IYCF-Programming-in-the-context-of-COVID-19-Brief-2_v1-30-March-2020_-for-distribution-1.pdf
- Queensland Government Department of Health, COVID-19 and Breastfeeding, https://www.health.qld.gov.au/__data/assets/pdf_file/0041/949676/c-covid-bf.pdf
- Supporting the Breastfeeding Mother, https://www.ausmed.com.au/cpd/articles/supporting-the-breastfeeding-mother
- Baud, D, Giannoni, E, Pomar, L, Qi, X, Nielsen-Saines, K, Musso, D & Favre, G 2020, COVID-19 in pregnant women – Authors' reply, The Lancet Infectious Diseases, viewed 6 April 2020, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30192-4/fulltext
- Brubaker, M 2020, New Studies Investigate How COVID-19 May Impact Breast Milk And Pregnancy, UC Health - UC San Diego, viewed 6 April 2020, https://health.ucsd.edu/news/releases/Pages/2020-03-26-new-studies-investigate-how-covid-19-may-impact-b reast-milk-and-pregnancy.aspx
- International Lactation Consultant Association 2020, Resources for Lactation Supporters Providing Infant and Young Child Feeding Advice During COVID-19, International Lactation Consultant Association, viewed 6 April 2020, https://ilca.org/wp-content/uploads/2020/03/Resources-for-Lactation-Supporters-Covid-19.pdf
- Johns Hopkins Medicine 2020, Breastfeeding With Coronavirus, Johns Hopkins Medicine, viewed 6 April 2020, https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/breastfeeding-with-coronavirus
- Johnson, B 2020, ABM Statement Coronavirus, Academy of Breastfeeding Medicine, viewed 31 March 2020https://www.bfmed.org/abm-statement-coronavirus
- Martin, N 2020, What Coronavirus Means For Pregnancy, And Other Things New And Expecting Mothers Should Know — Propublica, viewed 31 March 2020, ProPublica, https://www.propublica.org/article/coronavirus-and-pregnancy-expecting-mothers-q-an d-a
- RCOG 2020, Coronavirus (COVID-19) Infection In Pregnancy: Information for healthcare professionals, London: Royal College of Obstetricians and Gynaecologists, viewed 6 April 2020, https://www.rcm.org.uk/media/3799/coronavirus-covid-19-infection-in-pregnancy-v3-20-03-18.pdf
- Taylor, T 2020, 'What Are The COVID-19 Risks For Teens, Kids And Pregnant Mums?'', ABC News, 24 March, viewed 31 March 2020, https://www.abc.net.au/news/health/2020-03-24/coronavirus-covid-babies-pregnancy-children-kids/12080892
- World Health Organization, Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected, World Health Organization, Viewed 14 March 2020, https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-nov el-coronavirus-(ncov)-infection-is-suspected
Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at www.MindBodyInk.com. See Educator Profile