Review shows differences in breastfeeding guidance as pandemic unfolded

During outbreaks of contagious illnesses, the fear that infected mothers will transmit the disease to their newborns often becomes a concern. Initially, public health experts advised that COVID-19-infected mothers be separated from their nursing infants.

breastfeeding guidance changed as pandemic unfoldedResearch to date shows that mothers with COVID-19 do not pass it to their infants through breastmilk. An Alive & Thrive review of guidance documents around the world showed that the initial guidance spread widely.

A&T reviewed 33 guidance documents issued around the world between March 1 and April 30, 2020. The analysis revealed considerable diversity in recommendations related to postpartum maternal and newborn care and was presented during “COVID-19 – Ensuring Safe Breastfeeding and Newborn Care: Lessons from Countries,” a global webinar hosted in early July by the Nurturing Care Coordinating Group: UNICEF, WHO, the World Bank Group, the Partnership for Maternal, Newborn and Child Health, and the Early Childhood Development Action Network.

This unpublished research showed that:

  • Fewer than one in three guidance documents recommended skin-to-skin contact for babies of mothers with suspected or confirmed COVID-19
  • Many guidance documents recommended isolating mothers with confirmed or suspected COVID-19 from their newborns
  • Most guidance documents recommended the provision of expressed breastmilk when mothers’ own milk was unavailable, while few mentioned donor human milk
  • Few guidance documents addressed the need for psychological support for separated mothers and infants

The differences seen in the review of guidance documents can be traced to the differences in guidance issued by various authorities as the pandemic unfolded.

In February, the China Consensus, US Centers for Disease Control and the American College of Obstetricians and Gynecologists separately recommended separation of mothers and infants and prohibition of or impediments to breastfeeding. By March, however, the Royal College of Midwives and the World Health Organization separately recommended mothers and infants be kept together with breastfeeding explicitly supported.

The guidance urging separating mothers and infants echoed the response to the HIV/AIDS epidemic in the 1980’s, a coincidence that did not go unnoticed.

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