Webinar – Going Home During a Pandemic: Challenges for Breastfeeding Families


No CEUs are provided for this webinar after May 13, 2021.

Note: This webinar was conducted at the start of the pandemic and recommendations presented may have changed.

Click here to view the webinar recording.

Click here to view the ppt slides.

Email californiabreastfeeding@gmail.com if you would like to receive continuing education after viewing the webinar.

  • Inland Empire Breastfeeding Coalition is approved by the California Board of Registered Nursing, Provider #CEP 16234, for (1) contact hour for the webinar. This certificate must be retained by the licensee for a period of four years.
  • Inland Empire Breastfeeding Coalition is an approved Long-Term provider by the International Board of Lactation Consultant Examiners (IBLCE) #CLT112-06. This webinar provides (1.5 L) CERPS.
  • This program is approved for CPEU Level II by the ADA. Provider number CA004 for a number of a maximum 1.5 contact hours.

Anne Aglash, MD, IBCLC, FABM bio

Karen Bodnar, MD, IBCLC bio

Objectives: By the end of the webinar, attendees will be able to:  

  • Identify national and international testing guidelines for COVID-19 in obstetric and newborn patients and risks and benefits of universal testing
  • Discuss the risks and benefits of direct breastfeeding with COVID-19 vs trying to establish breastfeeding while maintaining infant/mother separation
  • Recognize the current trend toward earlier discharge, the increased risks for babies and strategies to mitigate these risks
  • Explain how to care for infant isolation when to end isolation, and how to help those who choose separation back to get to the breast
  • Identify barriers for moms with COVID obtaining lactation support and ways to overcome these barriers during birth hospitalization, at home after discharge and if infant if is readmitted
  • Summarize the exceptional barriers that all families currently face in obtaining in-person lactation support and identify ways to overcome this challenge

A summary of key points from the webinar with timestamps.

0:00- Introduction by Robbie Gonzalez-Dow (Host)

02:55- Introduction by Dr. Susan Crowe

05:45- Dr. Eglash presentation

07:20- COVID-19 Spread and Contagion.

  • COVID-19 is spread through respiratory droplets, NOT amniotic fluid, and NOT breastmilk.

08:15- Hospital admission during labor.

  • The majority of COVID-19 positive women are asymptomatic.
  • Routine testing is important to prevent spread in the hospital.
  • Risk of false-positive testing or false-negative testing (~15%-25%).
  • Support partners should be screened and wear cloth masks

14:25- Newborns/Children and COVID-19

  • Children rates of COVID-19 are less than
  • Different guidelines between CDC and AAP for newborns with COVID + moms
  • Many barriers for testing based on resource availability

18:05- COVID-19 + Mother

  • A mother without symptoms can stop isolating when she is at least 10 days from their first positive test as long as she hasn’t started symptoms
  • Mother with symptoms can stop isolating when 3+ days have passed since recovery AND at least 10 days have passed since symptoms first appeared
  • Test-based strategy: has two negative tests >24 hours.

20:05- Dr. Bodnar presentation

20:24- Optimize shorter time families are in the hospital

  • Clip tongue-tie
  • Avoid nipple shield
  • Teach hand expression,
  • Avoid formula supplements
  • Plan for mothers with delayed milk production
  • Update referral lists

25:53- Changes to Postpartum Care

  • Bathing baby of COVID-19+ mother right away is not encouraged
  • Infants not feeding well at discharge due to less in-person education

30:30- The 37 1/7 Week Infant

  • May leave at 24 hours, but a higher risk for poor feeding, jaundice, hypothermia, and dehydration
  • Follow up is very important

32:20- Buying time for breastfeeding

  • Feed the baby (something)
  • Remove milk (frequently & effectively)
  • Rest

34:20- Feeding Guidelines

  • WHO- risk for infants is low, skin to skin should still be encouraged, breast milk. should still be encouraged, separated families should have psychosocial support
  • CDC- shared decision making for breastfeeding, face mask, and clean hands when breastfeeding, clean hands and materials for expressed milk, if possible have a healthy person feed the infant the expressed milk
  • AAP- Direct breastfeeding discouraged if the mother is COVID-19 positive, encourage pumping and bottle feeding if rooming with a baby or doing skin-to-skin follow precautions.

45:05- Breastfeeding with COVID-19

  • Need more information, more studies to be done
  • Answers on how best to feed a baby are individual to each family’s circumstances
  • HMBANA has safe guidelines on how to safely express, transfer, and then feed or label and store for COVID-19 positive mothers

54:15- Supporting COVID+ Mothers at Home

  • Food, fluids, errands while avoiding close contact
  • Wear gloves when touching contaminated products
  • Caregiver should self-isolate for 14 days after the last day of the symptoms mother of the mother.

56:45- Discharge Advice to COVID+ Mothers

  • CDC- Take precautions to prevent spread (wash hands, face mask, etc); baby being cared for by COVID+ mother should be considered positive as well
  • WHO- Breastfeed directly, ideally while wearing a medical mask and following precautions.
  • AAP- Mothers should stay 6 feet away from the baby or wear a mask and practice good hygiene; recommend caregiver be under age 60; direct breastfeeding is discouraged
  • Reality check- it’s not easy to isolate when parents get home.

01:02:35- Healthcare Support the the COVID+Mom at Discharge

  • Mental health support- postpartum depression worse with COVID isolation; also check for generalized anxiety disorder
  • Telemedicine mother follows up for questions, education, and lactation
  • Postpartum symptoms are similar to COVID+ symptoms.

01:11:30- Outpatient followup of COVID+ Babies

  • Avoid waiting rooms, see newborns first thing in the am
  • In person follow up within 24-48 hours
  • Weight gain is the BEST way to assess feeding
  • Some babies admitted with COVID-19: poor feeding, mild upper respiratory infection, or fever, rapid recovery
  • Solutions: send home with infant scales, drop-in/mobile weight checks, use of Telemedicine, zoom support groups.

01:19:05- Lower SE and racial/ethnic minorities higher morbidity and mortality from COVID-19.

  • Lower access to private LCs, home scales, and pumps.

01:20:00- Transition Babies to Breastfeeding- Watch for baby cues

01:20:45- Studies of Breastfeeding COVID

01:22:10- Conclusions

01:24:05- Q&A

  • Breast hygiene- do what is safest, but also doable for mother; need more research
  • Home visits- COVID+ wear full PPE, otherwise medical mask and face shield
  • Breastfeeding is so important because you can give babies your antibodies.
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