The case against separating breastfeeding mothers and infants during the pandemic

In a Q&A, Diane Spatz of Penn Nursing and CHOP discusses why it’s safe and beneficial to keep them together, even when the mother tests positive for COVID-19.

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Diane Spatz is a professor of perinatal nursing and the Helen M. Shearer Professor of Nutrition at the School of Nursing. She is also a nurse scientist for the lactation program at the Children’s Hospital of Philadelphia.

In just three months, the coronavirus pandemic has thrown many facets of life into upheaval. Yet during that time, babies continue to be born. 

Because much is still unknown about COVID-19, families may worry that the virus will harm their child, says Diane Spatz of Penn’s School of Nursing and the Children’s Hospital of Philadelphia. That’s why to Spatz, based on what we know about the science of human milk, it’s more important than ever to promote breastfeeding. 

“It’s a lifesaving medical intervention,” she says. “When babies are being directly breastfed, they are constantly interacting with their mother. The microbiota stay intact. The mother provides her child antibodies. The milk itself is also filled with all types of components that protect the infant from infectious diseases, such as the coronavirus.” 

For those reasons and many others, nearly every large health care entity, from the World Health Organization (WHO) to the Centers for Disease Control and Prevention, has come out in support of continued breastfeeding, when possible. They also recommend against separating mom and child, even when the mother tests positive for COVID-19. 

In late May, Spatz gave a talk on breastfeeding in the time of COVID. In a follow-up conversation, Penn Today asked her about the breastfeeding guidance, why some hospitals aren’t following it, and how to keep all parties involved safe. 

Can you provide some context for how many women breastfeed?

Globally, we know that about 41% of infants receive exclusive human milk for the first six months. In the U.S., despite having higher initiation rates than ever, the drop-off rates are quite significant, with fewer than 25% of infants receiving exclusive human milk for the first six months. Considering that human milk is the gold standard for infant nutrition, 75% of our children are at risk for suboptimal health and developmental outcomes.  

Are there geographic, socioeconomic, or racial disparities within those statistics?

Tremendous disparities. We know there aren’t equal breastfeeding outcomes based on race, poverty, or income level. It’s one of my real worries about this current situation. Because we already have these disparities in breastfeeding rates for low-income women and women of color, the coronavirus pandemic could make those disparities even starker. We clearly have our work cut out for us to ensure that all families can make informed breastfeeding decisions.

You’ve described several anecdotes of hospitals separating COVID-positive mothers from their children, despite guidance from so many groups not to. Why are institutions taking this approach? 

People are doing their own thing but not based on evidence. That’s both in the U.S. and other parts of the world. They have chosen not to follow the WHO guidelines, or anyone’s guidelines for that matter. The problem is that none of us can control an individual birth hospital. Hospitals and administrators are going to make the decisions they’re going to make, even if they’re not what’s best for mom and baby. That’s why it’s important to educate families about the importance of having their voices heard and about the science of breastfeeding. They can and should be talking to their health care providers about shared decision-making. 

What about mothers scared to breastfeed for fear of passing the virus to their infants?

One of the main things to remember is that this is a respiratory virus. People contract the disease through respiratory droplets. Someone has it, they cough, the droplets are spread. That’s why we have social distancing and staying six feet apart. 

Live or ‘active virus’ has not been detected in human milk. A May article reported two cases with the potential for virus in the milk. However, the type of testing the researchers did doesn’t detect live virus. It could have been viral fragments, and even if they were there that doesn’t mean they have the ability to do anything. There’s no evidence to support the fact that something in the milk could harm the baby. We do know that COVID-positive mothers produce an antibody response; their babies receive the immunities via milk. The WHO emphasizes breastfeeding based on what we know about the substantial and far-reaching benefits of breastfeeding for mother, child, and society.

How do breastfeeding mothers keep themselves and their newborns safe?

Hand washing is very important. Make sure the mom is washing her hands before and after pumping and/or breastfeeding. Appropriate pump hygiene is also important. The family should wash all parts of the pump kit that touch the mother’s breast or the milk with hot water and dish soap after every use, rinse well, and completely air dry. Once a day, the kit should be sanitized or sterilized in the dishwasher using a microsteam cleaning bag or boiling water for 15 minutes. In the hospital, ask for a dedicated hospital-grade pump. The pump must be wiped down with a hospital-approved cleanser in between patient use.

A breastfeeding mother should also practice respiratory hygiene. She should be wearing a mask, washing her hands before and after touching the baby. She does not have to wash or clean her breast unless she coughed on it and exposed the breast to droplets. She should keep her chest covered, wear a mask, and follow appropriate hand hygiene before and after holding the baby. 

Are there any instances when you would recommend splitting up mother and child? 

The only time you should see them separated is if the mom is really too sick to directly breastfeed. A former student of mine told me this story about a COVID-positive postpartum mom who was sick. The mom wanted to breastfeed, so the nurses pumped the mom to make sure they had milk for the baby. Even in cases like that, someone could express milk for the mom, though it would require a lot of work. You would need the commitment of nursing staff or, at home, another family member. 

Where does formula fit into this discussion? 

During this pandemic, there have been formula shortages and price gouging. If families don’t have the resources or the ability to purchase formula, we should ensure that prior to delivery they are making an informed choice about human milk and breastfeeding. COVID-19 is an emergency; breastfeeding mothers don’t have to worry about having access to resources or availability to purchase formula. 

Anything else? 

I just want to reiterate this point. If you look at the multiple benefits of breastfeeding compared to the potential small risk of COVID for these infants, it’s clear that the benefits outweigh the risks. Human milk is not just food. It’s there for the baby’s brain and eyes, to develop the baby’s lungs and GI system. It’s there to protect the baby from infection. If families never learn that science, they could just be scared because it’s a scary time in the world. 

Diane Spatz is a professor of perinatal nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing. She is also a nurse scientist for the lactation program at the Children’s Hospital of Philadelphia