Webinar – COVID-19: Infant Feeding During the Postpartum Period

No CEUs are provided for this webinar.

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

In response to these unprecedented times and the concerning medical practices we have seen adopted in China and New York, we invited Dr. Aunchalee Palmquist to discuss the current WHO and CDC guidelines and recommendations.

Dr. Palmquist, a medical anthropologist and IBCLC, provided a wealth of information and resources. The fast-moving presentation lasted a little over an hour with an additional 30 minutes of Q&A with participants. The California Breastfeeding Coalition is grateful to Dr. Palmquist, our moderator, Dr. Ifeyinwa Asiodu and the more than 700 individuals that registered for this webinar.

Click here to access the full session recording.

Click here to access the webinar slides.We highly recommend that you listen to the webinar to give context to the slides.

A summary of key points from the webinar with timestamps.

9:50 – What is known about maternal-child transmission (MTCT) of COVID-19

13:50 – Summary of relevant letters from the Journal of the American Medical Association (JAMA)

20:39 – Why is human milk critical for infants during the COVID-19 pandemic?

  • Colostrum is baby’s first vaccine; personalized medicine
  • Continuously nursing baby or providing expressed human milk offers ongoing immunological support (influenza, RSV, pneumonia, diarrhea)
  • Reduces reliance on formula feeding after discharge (food security impacts)
  • Reduces burden on stressed health systems
    • In emergencies (natural disasters, pandemics, etc.), public health systems and medical systems burdened by limitations of space, personal protective equipment (PPE) and rapid growth in caseloads decrease access to care. Whatever can be done to reduce the need for non-crisis care supports system response to crisis care.

24:11 – WHO guidance is clear (applies to all countries, though not every country has the same level of access to quality care)

  • PUI (person under investigation of infection) or COVID-19+ patients should be supported to nurse if they are well enough to do so:
    • Practice respiratory hygiene
    • Practice hand hygiene
    • Avoid touching eyes, nose and mouth (own and baby’s)
    • Routinely disinfect surfaces they may have touched
    • Close early contact still recommended
      • Skin-to-skin should be supported along with hygiene practices among all caregivers/helpers
  • PUI or COVID-19+ patients too sick to care for their baby but wishing for baby to receive own milk or donor milk:
    • Assistance with latching baby and support while baby nurses
    • Support to express milk (pump or hand expression)
    • Support with relactation
  • PUI or COVID-19+ and nursing or expressing milk for baby at home:
    • Guidance for if they are well or have mild symptoms
    • Guidance for it they are sick and moderate to serious symptoms
    • Another healthy caregiver can support lactation by helping with latching baby, milk expression and feeding expressed milk. Use infection prevention control (IPC) best practices.
    • Essential care includes mental health and psychosocial support and lactation counseling and infant feeding.

34:25 – U.S. CDC Guidance (aligns with WHO)

37:29 — Academy of Breastfeeding Medicine (ABM) Statement Summary

  • In hospital, the choice to breastfeed belongs to the mother and family. If mother is well, has only been exposed or is a PUI with mild symptoms, breastfeeding is a reasonable choice. If birthing parent has COVID-19, it is still reasonable to choose to breastfeed and provide expressed milk to the infant.
  • Several choices exist in the hospital concerning housing for a breastfeeding mother and her infant, including rooming-in and temporary separation.

43:05 – Confusion around WHO and CDC guidance because medical facilities and staff around the world are implementing policies that diverge from the WHO guidelines (e.g. mandatory C-sections, scrubbing mothers before baby is allowed latch)

44:20 – Risks of Routine Mandatory Postnatal Separation

47:06 – Communities as Primary Care Settings

48:25 – Clinical-Community Connections

  • Relactation education and information for all mothers/birthing individuals
  • Telehealth and virtual lactation support
  • Facilitating donations to milk banks, education about donor human milk
  • Linking families to community resources
  • Food insecurity awareness (formula access assessment prior to discharge, ensure families have what they need after discharge)
  • Mental health and psychosocial resources

52:20 – COVID-19 will only worsen inequities in perinatal, intrapartum, and postpartum care in communities facing everyday structural inequities in care.

53:00 – Some Immediate Actions

  • Educate all pregnant and postpartum patients about the importance of immediate skin-to-skin, latching baby to nurse/milk expression and the guidance to support this, respiratory hygiene, and hand hygiene
  • Empower all patients to advocate for a support person during intrapartum and postpartum care, rooming-in, providing human milk for their baby
  • Advocate for facilities to use WHO guidance whenever possible. Adapt key messages from WHO guidance for patient-facing resources, community resources, resources for infant caregivers
  • Scale up training in providing virtual and mobile support
  • Rapidly scale up training in critical lactation counseling and support skills
  • Support parents/caregivers of formula-dependent infants (ensuring families have adequate supply while protecting them from exposure to predatory marketing practices)

57:47 – Policy and Advocacy Actions

  • Advocate that all public health/emergency response systems that are mobilized consider infant and young child feeding, and prioritize continuity of care from clinic to community
  • Lactation support persons and doulas are essential to positive pregnancy, birth and infant feeding outcomes
  • Advocate for the adoption of WHO guidance for intrapartum and immediate postpartum care of PUI-COVID+ birthing parent and infant
  • Identify and strengthen opportunities to coordinate response in ways that center perinatal, postpartum, and infant health, particularly in marginalized and vulnerable communities and populations

58:32 – Community Mobilizing

  • Share key messages with parents and caregivers about infant feeding and care for COVID-19
  • Adapt perinatal, postpartum, family care services to strengthen community safety net
  • Survey what families in your community need
  • Share needs with other community organizations
  • Coordinate support resources, consider innovations in care delivery

59:00 – Are there nationwide formula shortages?

01:01:09 – Where to Find Resources

  • UNICEF UK Baby Friendly initiative on relactation
  • Patients still have human rights protections

01:06:18 – References

01:07:00 – Q&A Begins

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