USA
United States Centers for Disease Control and Prevention (CDC)
Coronavirus (COVID-19) from the United States Centers for Disease Control and Prevention (CDC)
Pregnancy & Breastfeeding: Information about Coronavirus Disease 2019 from the CDC. 3 April 2020. (accessed 6 April 2020)
We still do not know if a pregnant woman with COVID-19 can pass the virus that causes COVID-19 to her fetus or baby during pregnancy or delivery. No infants born to mothers with COVID-19 have tested positive for the COVID-19 virus. In these cases, which are a small number, the virus was not found in samples of amniotic fluid or breastmilk.”
“Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers. Because people may be able to spread COVID-19 without symptoms and because COVID-19 illness is spreading in communities across the country, a breastfeeding mother should take all possible precautions to avoid spreading the virus to her infant. This includes washing her hands before touching the infant and wearing a cloth face covering over her nose and mouth, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If the mother is symptomatic, consider having someone who is well feed the expressed breast milk to the infant.”
Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. from the CDC. (accessed 6 April 2020)
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It is unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued…
“The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team…
“If colocation (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother’s wishes or is unavoidable due to facility limitations, facilities should consider implementing measures to reduce exposure of the newborn to the virus that causes COVID-19.
- Consider using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the ill mother.
- If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a facemask and practice hand hygiene1 before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based precautions in a healthcare facility.
“During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene.1 After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver.
“If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding.”
COVID-19 and Children from the CDC.
American College of Obstetricians and Gynecologists (ACOG)
Novel Coronavirus 2019 (COVID-19): Practice Advisory from ACOG. March 13 2020. (accessed 1 April 2020)
Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care practitioners. Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while breastfeeding. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.”
Outpatient Assessment and Management for Pregnant Women With Suspected or Confirmed Novel Coronavirus (COVID-19) from ACOG. March 2020.
US Department of Defense
Matos, R., Chung, K., et al. DoD COVID-19 Practice Management Guide: Clinical Management of COVID-19. 2020 March 23. (See p. 23-26.)
American Academy of Pediatrics
Initial Guidance: Management of Infants Born to Mothers with COVID-19. 2020 April 2.
Canada
Public Health Agency of Canada
Pregnancy, childbirth and caring for newborns: advice for mothers (COVID-19). 2020 April 1. (accessed 6 April 2020)
There is currently no evidence of mother-to-child transmission through childbirth when the mother gets COVID-19 in the third trimester.
“If you or your child have suspected, probable or confirmed COVID-19, you can stay together in the same room if preferred, especially during the establishment of breastfeeding.
“Breastfeeding lowers your baby’s risk of infection and illness throughout infancy and childhood. The virus that causes COVID-19 has not been found in breast milk and it is unlikely that COVID-19 can be transmitted while breastfeeding.
“If you have suspected, probable or confirmed COVID-19, you must isolate yourself in your home as much as possible; this includes practicing physical distancing in your home, with the only exception being the baby. You should take all possible precautions to avoid spreading the virus to your baby, which includes:
- Wash your hands often, especially before and after touching your baby or your other children.
- Wear a face mask that covers your mouth and nose. Homemade fabric masks are not medical devices. There is no evidence they protect you from virus-sized particles.
- Ensure the environment around you is clean and disinfected with approved hard-surface disinfectants.
“If you are too ill to breastfeed, you are encouraged to:
- Feed the child with formula or expressed milk
- Ask an uninfected adult to feed the baby
- If using a breast pump, sterilize the equipment carefully before each use
- Don’t share bottles or breast pump
UK
Royal College of Obstetricians and Gynaecologists
Coronavirus Infection and Pregnancy: Q&A (accessed 6 April 2020)
Q. Will I be able to stay with my baby/give skin-to-skin if I have suspected or confirmed coronavirus?
“Yes, if that is your choice. Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth.“In some other countries, women with confirmed coronavirus have been advised to separate from their baby for 14 days. However, this may have potential negative effects on feeding and bonding…
“Q. Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?
“Yes. There is no evidence showing that the virus can be carried in breastmilk, the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.“The main risk of breastfeeding is close contact between you and your baby, as if you cough or sneeze, this could contain droplets which are infected with the virus, leading to infection of the baby after birth.
“When you or anyone else feeds your baby, the following precautions are recommended:
- Wash your hands before touching your baby, breast pump or bottles
- Try to avoid coughing or sneezing on your baby while feeding at the breast
- Consider wearing a face mask while breastfeeding, if available
- Follow recommendations for pump cleaning after each use
- Consider asking someone who is well to feed your expressed breast milk to your baby.
“If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.”
Coronavirus (COVID-19) infection and pregnancy – guidance for healthcare professionals: Version 6 – 3 April 2020
Italy
Italian Society of Neonatology
Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and Coronavirus Disease‐2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. 03 April 2020. doi: 10.1111/mcn.13010.
If a mother previously identified as COVID-19 positive or under investigation for COVID-19 is asymptomatic or paucisymptomatic at delivery, rooming-in is feasible and direct breastfeeding is advisable, under strict measures of infection control.
“On the contrary, when a mother with COVID-19 is too sick to care for the newborn, the neonate will be managed separately and fed fresh expressed breast milk, with no need to pasteurize it, as human milk is not believed to be a vehicle of COVID-19.”